RESUMO
AIM: To analyze the prevalence of nonspecific UTI in patients with tuberculosis and to evaluate the efficiency of therapy and prevention measures. MATERIAL AND METHODS: A total of 936 patients with tuberculosis of various localizations aged from 18 to 96 years were examined. There were 447 men (47.8%) and 489 women (52.2%). A diagnosis of nonspecific UTI was done using following criteria: the presence of characteristic symptoms, leukocyturia and bacteriuria detected by microscopic examination of the urine sediment, positive urine culture for nonspecific species, negative urine tests for Mycobacterium tuberculosis. RESULTS: The prevalence of nonspecific UTI among 936 patients with tuberculosis was 18.6% (n=174). Non-specific species were determined in all forms of tuberculosis, but most often in urogenital tuberculosis (74.1%). Proposed therapeutic and prophylactic tactics included antibacterial therapy, herbal drug Kanefron N and sanitary measures. The efficiency of treatment was 94.6%. It should be noted that patients received anti-tuberculosis therapy, and there were no adverse reactions associated with a combination of drugs. CONCLUSION: When choosing treatment tactics, it is necessary to take into account the presence of structural and functional changes in the urinary tract, which reduce treatment efficiency.
Assuntos
Infecções Urinárias , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Uzbequistão/epidemiologia , Idoso , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia , Infecções Urinárias/tratamento farmacológico , Adolescente , Prevalência , Idoso de 80 Anos ou mais , Tuberculose/epidemiologia , Tuberculose/tratamento farmacológico , Tuberculose Urogenital/epidemiologia , Tuberculose Urogenital/tratamento farmacológico , Adulto JovemRESUMO
A multiplex-nested PCR (M-nested PCR) targeting mpt64 (Rv1980c) + IS6110 was designed to detect Mycobacterium tuberculosis (Mtb) DNA within urine (n = 35), endometrial biopsies (n = 22) and menstrual blood (n = 3) of male/female UGTB patients, and results were compared with M-PCR using the same targets. Detection limit of the purified Mtb DNA was found to be 1 fg by M-nested PCR, which was 106 -fold lower than M-PCR. Moreover, sensitivities of 100% and 81·8% were obtained in confirmed (n = 5) and clinically suspected UGTB (n = 55) cases, respectively, by M-nested PCR, with a specificity of 97·1% (n = 70). Sensitivities attained by M-nested PCR were significantly higher (p < 0·05) than M-PCR in both clinically suspected and total UGTB (n = 60) cases. To confirm the true PCR-negative results, an internal amplification control, that is, human ß-globin gene (hbb) was incorporated in the M-nested PCR/M-PCR assays, wherein all the clinical specimens (positive/negative for mpt64/IS6110) were found to be positive for hbb. Some UGTB specimens (n = 35) were also subjected to GeneXpert® MTB/RIF assay that revealed a significantly lower (p < 0·001) sensitivity (17·1 vs 88·6%) than M-nested PCR, although high specificity (100%) was attained with GeneXpert. After validating the results in a higher number of UGTB specimens, our M-nested PCR may be translated into an attractive diagnostic kit.
Assuntos
Mycobacterium tuberculosis , Tuberculose Urogenital , Feminino , Humanos , Masculino , Técnicas de Diagnóstico Molecular/métodos , Reação em Cadeia da Polimerase Multiplex/métodos , Mycobacterium tuberculosis/genética , Sensibilidade e Especificidade , Globinas beta/genéticaRESUMO
BACKGROUND: Tuberculosis is a serious medical and social problem that does not lose its importance, despite all the advances in pharmacology and surgery. Diagnosis of urogenital tuberculosis (UGTB), as a rule, is delayed due to low index of suspicion to tuberculosis and the absence of pathognomonic symptoms. AIM: Determining the change in the ratio of clinical forms of renal tuberculosis from 1999 to 2020. MATERIALS AND METHODS: A retrospective cohort comparative non-interventional study on the spectrum of the incidence of extrapulmonary tuberculosis (EPTB) was carried out. Among all 13852 extrapulmonary tuberculosis patients which were diagnosed from 1999 to 2020, patients with renal tuberculosis were selected, and the spectrum of their clinical forms in three periods was analyzed: 1st period 1999-2004 (1155 patients), second period 2005-2014 (2657 patients), and the third period 2015-2020 (671 patients). The clinical features of nephrotuberculosis in 88 patients was also estimated. RESULTS: Over the 20 years of the analyzed period, the number of patients with UGTB decreased by 80.6%; for the year of the COVID-19 pandemic, this figure fell by another third. In the first period, destructive complicated forms of nephrotuberculosis prevailed (922 patients - 79.8%), while the so-called "minor forms" were diagnosed in 233 patients (20.2%). In the second period, the situation was statistically significantly more favorable: the proportion of destructive and complicated forms of renal tuberculosis decreased to 43.8% (1124 patients), "small forms" were diagnosed in 1443 patients (56.2%). In the third period, destructive and complicated forms of nephrotuberculosis were diagnosed in 531 patients (77.6%), and the proportion of "small forms" in comparison with the previous period decreased by half, to 22.4%. Analysis of the clinical features of renal tuberculosis, depending on the prevalence of the destruction, showed that an asymptomatic course is possible, and pain, dysuria, intoxication and renal colic are present with different frequencies, and the clinical picture of tuberculosis of the renal parenchyma differs significantly from the clinical picture of tuberculous papillitis, cavernous nephrotuberculosis and symptoms of renal tuberculosis as whole. CONCLUSION: Currently, there is no screening on urogenital tuberculosis at all. Patients are diagnosed by referral, with a long history, after receiving multiple courses of antibacterial treatment; mainly through the pathomorphological examination of the operating material. Thus, a sharp decrease in the proportion of UGTB patients does not mean the disappearance of tuberculosis of this localization, but only states the tragic defects in timely diagnosis and low index of suspicion of medical doctors in relation to UGTB.
Assuntos
COVID-19 , Tuberculose Renal , Tuberculose Urogenital , Tuberculose , Humanos , Tuberculose Renal/diagnóstico , Tuberculose Renal/epidemiologia , Estudos Retrospectivos , Pandemias , COVID-19/diagnóstico , COVID-19/epidemiologia , Tuberculose Urogenital/diagnóstico , Tuberculose Urogenital/epidemiologia , Tuberculose/epidemiologiaRESUMO
INTRODUCTION: Tuberculosis of the genitourinary system is still of importance. The observed decrease in the incidence of urogenital tuberculosis is largely due to the inaccuracies of registering this disease. MATERIALS AND METHODS: A retrospective cohort comparative non-interventional study of the structure of urogenital tuberculosis in the Siberian and Far Eastern federal districts was carried out. We analyzed statistical reports from 2003 to 2015, which included data for a total of 456 patients, as well as extended questionnaires compiled specifically for this study. In addition, outpatient records of 95 patients with urogenital tuberculosis who were registered at the Novosibirsk Regional Tuberculosis Dispensary by 01/01/2022 were evaluated. RESULTS: An analysis of the structure of urogenital tuberculosis from 2003 to 2015 showed that urinary system was affected in the most of cases (n=314, 68.8%). Tuberculosis of male and female genital organs took the second place (n=101, 22.2%) patients. Generalized urogenital tuberculosis was diagnosed in 41 (9%) patients. From 2003 to 2008, the proportion of renal tuberculosis increased by 12.6%, but then a significant decrease in its proportion was found (82.2% in 2008 vs. 48.6% in 2015 [2 =12.71; =0.0004]). On the contrary, in 2003 the proportion of genital tuberculosis was 18% (n=18) compared to 29.1% (n=3) in 2015 (2 =3.46; p=0.06). In 2015, generalized forms of urogenital tuberculosis were diagnosed in 23 (22.3%) patients, which is approximately 2.5 times more than in 2003 (n=9; 9%) and 2008 (n=7; 6.6%) (2> 6.46; p<0.01). The proportion of prostate tuberculosis ranged from 0 in 2003 and 7.1% in 2008 to 54.2% in 2013. In 2003, tuberculosis of the scrotum was diagnosed in 100% of men with genital tuberculosis, while in 2013 and 2015 its proportion was 25%. In total, scrotal tuberculosis during whole follow-up was diagnosed in 26 patients, which accounted for 41.9% of all male genital tuberculosis. The combination of tuberculosis of the scrotum and prostate also varied significantly from 17.3 to 35.7%. Generalized urogenital tuberculosis was diagnosed with a minimum proportion (1.4%) in 2008, then there was an upward trend with a maximum rate in 2015 (22.3%, 2 =29.38; <0.0001). Among 95 patients with tuberculosis of the urinary and male reproductive system, who were followed by the phthisiourologist of Novosibirsk Regional Tuberculosis Dispensary, 34 (35.8%) had a diagnosis of kidney tuberculosis, 42 (44.2%) had isolated tuberculosis of the male genital organs, and the remaining 19 (20.0%) men had generalized urogenital tuberculosis. In total, HIV infection was detected in 23 (24.2%) patients with urogenital tuberculosis, and among patients with kidney tuberculosis, it was diagnosed in 7 (20.6%) cases compared to 9 (21.4%) cases in those with male sexual tuberculosis. In patients with generalized urogenital tuberculosis, HIV infection was detected almost 2 times more often, namely in 7 (36.8%) cases. CONCLUSION: Patients with urogenital tuberculosis are under follow-up of urologists for a long time with erroneous diagnoses, and only when the disease becomes irreversible and requires surgical intervention, the pathomorphological study of the surgical material will allow to make a proper diagnosis.
Assuntos
Infecções por HIV , Tuberculose dos Genitais Masculinos , Tuberculose Renal , Tuberculose Urogenital , Tuberculose , Humanos , Masculino , Feminino , Estudos Retrospectivos , Tuberculose Urogenital/diagnóstico , Tuberculose Urogenital/epidemiologia , Genitália Masculina , Tuberculose dos Genitais Masculinos/diagnósticoRESUMO
OBJECTIVES: To describe characteristics, details of diagnosis and outcomes of urogenital tuberculosis (UGTB) in a low-prevalence country. METHODS: We conducted a retrospective observational study of 37 consecutive patients diagnosed with UGTB between 1st January 2014 and 31st October 2019 in an East London hospital. RESULTS: 68% (25/37) of patients were male and the median age was 42 years (IQR 34-55). 89% (33/37) of patients were born outside the United Kingdom with 65% (24/37) born in the South Asian region. Renal (32.4%), epididymal (24.3%) and endometrial TB (21.6%) were the most prevalent forms of UGTB. Only 13.5% of UGTB patients had concurrent pulmonary TB. The median length of time from symptom onset to treatment was 163 days, while endometrial TB had an average delay to diagnosis of 564 days. Approximately half of patients with UGTB were culture positive (51.4%). However, 70% of early morning urines (EMUs) sent in urinary TB were culture positive. 11 patients (30.6%) underwent two or more invasive procedures, such as biopsy to obtain specimen samples. The mean treatment length for all UGTB cases was 7.3 months (SD 3.1). Notably, 25% of patients with endometrial TB required surgery despite antituberculous treatment. CONCLUSIONS: UGTB is challenging to diagnose as early disease is often asymptomatic. Clinicians faced with non-specific symptoms, or features suggestive of urogenital malignancy amongst patients from TB-endemic areas, should maintain a high suspicion of UGTB.
Assuntos
Diagnóstico por Imagem/métodos , Tuberculose Urogenital/diagnóstico , Adulto , Biópsia , Feminino , Humanos , Londres , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Tuberculose Urogenital/diagnóstico por imagem , Tuberculose Urogenital/patologia , Sistema Urinário/diagnóstico por imagem , Sistema Urinário/microbiologia , Sistema Urinário/patologiaRESUMO
BACKGROUND: Although genitourinary Tuberculosis (GUTB) is the second commonest source of extrapulmonary TB in most countries, the reported rate of GUTB in Sri Lanka remains low. The characteristics of GUTB in Sri Lanka have not been studied and documented so far. We aimed to study the clinical and imaging characteristics, treatment modalities and outcome of GUTB in Sri Lanka. METHODS: Data collected from patients treated by a single urological surgeon in two institutes consecutively over a period of 21 years were analysed. All patients with a microbiological and/or histopathological diagnosis of GUTB were included. Median duration of follow-up was 24 months (range: 6-96). RESULTS: There were 82 patients and 45 (54.9%) were men. The median age was 51 (range: 26-75) years. Most patients (39%, n = 32) had vague non-specific symptoms at presentation. Common specific symptoms at presentation were haematuria (15.8%, n = 13) and scrotal manifestations (15.8%, n = 13). Mantoux test was done in 70 patients and was > 10 mm in 62 (88.5%). Erythrocyte sedimentation rate was available in 69 patients and was > 30 mm in 54 (78.3%) patients. Chest x-ray and x-ray kidney-ureter-bladder (KUB) abnormalities were detected in 9 (11%) and 6 (7.3%) respectively. CT-urography was performed in 72 patients and abnormalities were detected in 57 (79%) patients. Forty-two patients underwent cystoscopy and 73.8% (n = 31) had abnormal findings. Microbiological diagnosis was feasible in 43 (52.4%) and rest were diagnosed histopathologically. Commonest organs involved were kidney (64.6%, n = 53), ureter (51.2%, n = 42), bladder (43.9%, n = 36) and testis/epididymis (15.8%, n = 13). One patient had TB of the prostate. All were treated primarily with anti-TB drugs however, 50 (61%) required ancillary therapeutic interventions. The majority of interventions were reconstructive surgeries (n = 20, 24.4%) followed by excisional surgeries (n = 19, 23.2%) and drainage procedures (n = 11, 13.4%). Seven patients developed serious adverse reactions to anti-TB drugs. Five patients developed a thimble bladder with disabling storage symptoms. Eight patients had deranged renal functions at diagnosis and three patients developed progressive deterioration of renal function and two patients died of end stage renal disease. CONCLUSIONS: The combination of urine for acid-fast bacilli, Mantoux test, CT-Urography, cystoscopy and histopathology is necessary to diagnose GUTB in resource-poor settings. Most ureteric strictures, non-functioning kidneys and epididymal masses need surgical treatment. Long-term follow up is essential to detect progressive deterioration of renal function.
Assuntos
Tuberculose Urogenital , Tuberculose , Humanos , Masculino , Pessoa de Meia-Idade , Sri Lanka/epidemiologia , Teste Tuberculínico , Tuberculose Urogenital/diagnóstico , Tuberculose Urogenital/tratamento farmacológico , Tuberculose Urogenital/epidemiologia , Bexiga UrináriaRESUMO
The genitourinary region is one of the most common sites of extrapulmonary tuberculosis (TB) involvement. The imaging features of genitourinary TB are protean and can mimic other entities, including malignancy, and pose a diagnostic dilemma. Hematogenous seeding and lymphatic spread of mycobacteria from pulmonary, tonsillar, and nodal TB are implicated in the pathogenesis of genitourinary TB. In addition, contiguous extension from the urinary tract and sexual transmission are described as sources of genital TB. Genitourinary TB can be indolent and results in nonspecific signs and symptoms; thus, imaging has a vital role in the working diagnosis for these cases. Classic uroradiologic signs of genitourinary TB are primarily described from the era of intravenous urography and conventional radiography. Now, CT, CT urography, MRI, and US are used in the diagnosis and management. Familiarity with the imaging features of genitourinary TB may help guide the diagnosis and, in turn, lead to timely management. US has a vital role in the evaluation of scrotal and female genital TB. MRI offers superior soft-tissue contrast resolution and excellent depiction of anatomic detail. The various imaging manifestations of genitourinary TB are highlighted. ©RSNA, 2021.
Assuntos
Tuberculose Urogenital , Tuberculose , Feminino , Humanos , Imageamento por Ressonância Magnética , Radiografia , Tuberculose/diagnóstico por imagem , Tuberculose Urogenital/diagnóstico por imagem , UrografiaRESUMO
BACKGROUND: Genitourinary tuberculosis (GUTB) is known to cause high rates of structural organ damage, however, literature on its biochemical manifestations is limited. Additionally, local studies in the Philippine setting, where cases are rampant, are few and dated. This study aimed to determine the serologic and urinary profile of patients with GUTB admitted at a tertiary hospital within January 2009 to March 2020 and their association with short-term outcomes. METHODS: This retrospective study included 112 patients with laboratory-confirmed GUTB (i.e., positivity in acid-fast smear, polymerase chain reaction, culture, or histology). Demographic data, clinical characteristics, laboratory and radiologic findings, histopathology reports, treatment, and short-term outcomes were recorded. RESULTS: Bladder (54.5%) and kidney (36.4%) were the most affected organs. The male:female ratio was 1:1.15, and the mean age was 35.79 ± 18.29 years. Weakness (14.29%) was the most common chief complaint. A majority presented with anemia (83.04%), while several had leukocytosis (41.96%) and thrombocytosis (26.79%). Hypoalbuminemia (58.10%), impairment of renal function (36.94%), and electrolyte abnormalities such as hyponatremia (50.93%), hypercalcemia (20.19%), and hypokalemia (21.82%) were common. Proteinuria (67.96%) and pyuria (67.96%) were the most frequent abnormal findings, followed by hematuria (51.46%), acidic urine (45.63%) and low specific gravity (31.07%). Age, leukocytosis, and the need for pressors were all significantly associated with mortality (p values of <0.001, 0.010, and <0.001, respectively). CONCLUSIONS: The young age at presentation with severe clinical and laboratory manifestations may reflect local epidemiology as TB continues to be widespread in the country. Apart from the more commonly cited abnormalities in literature, multiple electrolyte imbalances and urinary concentration defects were also observed in many cases, possibly indicating tubulointerstitial involvement-a complication increasingly mentioned in case reports. As several patient characteristics were found to be associated with the high mortality rates observed in the study, further research is recommended to explore predictive modeling.
Assuntos
Tuberculose Urogenital/sangue , Tuberculose Urogenital/urina , Adolescente , Adulto , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Anemia/etiologia , Criança , Pré-Escolar , Feminino , Humanos , Hipoalbuminemia/etiologia , Hipopotassemia/etiologia , Lactente , Recém-Nascido , Leucocitose/etiologia , Masculino , Pessoa de Meia-Idade , Filipinas , Estudos Retrospectivos , Centros de Atenção Terciária , Trombocitose/etiologia , Resultado do Tratamento , Tuberculose Urogenital/complicações , Tuberculose Urogenital/terapia , Adulto JovemRESUMO
BACKGROUND: genitourinary tuberculosis (GUTB) refers to a Mycobacterium tuberculosis infection of the urinary tract with clinical manifestation masquerading as various urological diagnostic entities. With an incidence rate of 192-232 per 100,000 individuals, current diagnoses have fallen short in comparison to the total incidence. Combined with an atypical and non-specific manifestation, a high false negative rate of acid-fast bacilli (AFB) staining, and long AFB culture duration has made diagnosis difficult. We aim to gather current available evidence regarding the diagnostic performance of polymerase chain reaction (PCR) in the diagnosis of GUTB. METHODS: a literature search was conducted in four different, well-known databases using a predetermined PICO, keywords, and Boolean operators. All included articles will be subjected to rigorous appraisal according the University of Oxford's Centre for Evidence-Based Medicine (CEBM) Diagnostic Variability Criteria. Review and meta-analysis will be subjected to the QFAITH appraisal checklist to assess its quality. RESULTS: out of a total of 243 initial search results, 11 relevant studies were determined after title and abstract screening. Additionally, nine articles were excluded based on the predetermined criteria. Two fully appraised articles were included in the study: one systematic review article, revealing a heterogenous (I2 = unstated; p = unstated) result of sensitivity mean above 85% and specificity above 75%; and one cross-sectional diagnostic study that reported the use of two different PCR primers: IS6110-PCR and 16SrRNA-PCR primer with a sensitivity of 95.99% and 87.05% and specificity of 98.11% and 98.9%, respectively. CONCLUSION: current limited evidence showed that PCR could not be solely used for the diagnosis of GUTB, but its use is recommended to guide patient treatment and monitoring.
Assuntos
Reação em Cadeia da Polimerase , Tuberculose Urogenital/diagnóstico , Urina/microbiologia , Adulto , Prática Clínica Baseada em Evidências , Feminino , Humanos , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/isolamento & purificação , Sensibilidade e EspecificidadeRESUMO
Despite the modest positive trends in the epidemic situation for tuberculosis, the incidence of extrapulmonary tuberculosis is not consistent. The relevance of urogenital tuberculosis remains high, as well as its social significance. Tuberculosis of the kidneys and urinary tract is often diagnosed late, when drug therapy is not enough and surgical treatment is required. A total of 78 national and foreign publications dedicated to surgical treatment of patients with urogenital tuberculosis were analyzed. Various surgical techniques for renal and bladder tuberculosis are described with a comparison of their advantages and disadvantages. Tuberculosis of the urinary system, like any infectious disease, can and must be cured with drug therapy. Unfortunately, there are complicating subjective (low alertness of doctors regarding tuberculosis, low adherence to national and international guidelines) and objective (absence of pathognomonic symptoms of urogenital tuberculosis, which results in late diagnosis, increased drug resistance of the pathogen, high comorbidity) factors. The advancements in surgical techniques and modern drugs for neoadjuvant therapy give patients the opportunity to receive minimally invasive treatment that saves not only life, but also provides them acceptable quality of life.
Assuntos
Tuberculose Urogenital , Tuberculose , Sistema Urinário , Humanos , Qualidade de Vida , Tuberculose Urogenital/tratamento farmacológico , Tuberculose Urogenital/epidemiologia , Tuberculose Urogenital/cirurgia , Bexiga UrináriaRESUMO
Late diagnosis of renal tuberculosis leads to complications that cannot be eliminated by treatment. A clinical observation of renal tuberculosis, complicated by total ureteral obliteration, in a comorbid patient is presented. He underwent planned bowel substitution of the right ureter. In the postoperative period, pyelonephritis developed, which was resolved by drug therapy. In this case, there is the correct tactics of outpatient urologists. When hydronephrosis was diagnosed, a nephrostomy tube was put, which allowed to preserve the kidney, Then the patient was immediately referred to a phthisiatrician to exclude urogenital tuberculosis. In the local TB dispensary, the patient did not have the opportunity to receive necessary treatment, and he was transferred to the TB Research Institute of Ministry of Health of Russia, where a reconstructive laparoscopic procedure was performed.
Assuntos
Hidronefrose , Tuberculose Renal , Tuberculose Urogenital , Ureter , Humanos , Hidronefrose/cirurgia , Masculino , Federação Russa , Tuberculose Renal/complicações , Tuberculose Renal/tratamento farmacológico , Tuberculose Renal/cirurgia , Tuberculose Urogenital/complicações , Tuberculose Urogenital/diagnóstico , Tuberculose Urogenital/cirurgiaRESUMO
BACKGROUND: Urinary tuberculosis (TB) is a challenging disease to cope with, as there has been no noticeable difference in basic diagnostic and therapeutic options in clinical practice over time. PURPOSE: The aim of the current review was the critical assessment and evaluation of TB, which remains a major global health problem. METHODS: The available literature regarding TB in the PubMed database was extensively searched. RESULTS: New interdisciplinary team approaches such as next-generation sequencing are promising for the diagnosis and treatment of the disease. The epidemiology of the disease is changing with globalization and increasing migration events; however, the knowledge here is limited. Despite ongoing destruction, kidney functions need to be preserved as much as possible, and relatively rapid development of minimally invasive techniques relieved the surgeons in this regard. Experience is increasing in minimally invasive techniques that provide better comfort for patients compared to extensive radical surgeries. CONCLUSIONS: Knowing the pathogenesis of urinary TB is essential for understanding the range of clinical manifestations. The onset of the disease is usually insidious. Despite modern TB drugs, reconstructive surgery, and minimally invasive procedures, progression cannot be prevented in some patients, and patient selection is essential, but we still do not have sufficient information and objective parameters to predict progression.
Assuntos
Tuberculose Urogenital , Infecções Urinárias , Humanos , Tuberculose Urogenital/diagnóstico , Tuberculose Urogenital/epidemiologia , Tuberculose Urogenital/terapia , Infecções Urinárias/diagnóstico , Infecções Urinárias/epidemiologia , Infecções Urinárias/terapiaRESUMO
PURPOSE: For better understanding of urogenital tuberculosis (UGTB), its clinical spectrum and characteristic features need to be evaluated. MATERIALS AND METHODS: One hundred and forty-two cases of UGTB patients were analyzed retrospectively. We considered age, gender, symptoms, and diagnostic procedures. RESULTS: The total of 142 patients were divided into group A (consisted of 93 patients with only urinary TB), group B (consisted of 13 male patients with generalized UGTB, including urinary TB and male genital TB (MGTB). Group C consisted of 36 patients with MGTB. Sixty patients in groups A and B 56.6% had kidney TB third-to-fourth stages, which are incurable for anti-TB therapy and require surgery. The urinary tract was involved in 48 patients (45.3%): 25 (23.6%) had ureteral TB and 23 (21.7%) had also bladder TB. The most common symptom for kidney TB was flank pain (69.8%) followed by dysuria (47.2%). Perineal pain and dysuria were most common symptoms for prostate TB and were found in 87.5% (14 patients) and 56.3% (9 patients), respectively. Of total, in only 58 UGTB patients (40.8%), the culture for Mycobacterium tuberculosis (Mtb) was positive. CONCLUSION: Of 142 patients with UGTB, 106 (74.7%) had kidney TB and 13 (9.2%) of them had kidney TB in combination with MGTB. Only MGTB (prostate, scrotal, or generalized) was diagnosed in 49 (34.5%) patients. The most common symptoms were flank pain and dysuria. Identification of Mtb in UGTB is difficult. Therefore, the most advanced microbiological technology should be used to establish the correct diagnosis.
Assuntos
Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Urogenital/diagnóstico , Sistema Urinário/microbiologia , Adulto , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/métodos , Estudos Retrospectivos , Federação Russa/epidemiologia , Tuberculose Urogenital/epidemiologia , Tuberculose Urogenital/microbiologia , Adulto JovemRESUMO
INTRODUCTION: Tuberculosis is an infectious disease, which can result in self-cure, chronic process or relapse course. AIM: To analyze the incidence of recurrence of urogenital tuberculosis and to identify the features of patients with recurrent disease. MATERIALS AND METHODS: Specially developed questionnaires on the structure of the incidence of extrapulmonary tuberculosis in the Siberian Federal District and the Far Eastern Federal District were analyzed. We also studied 140 outpatient medical records of patients with tuberculosis of the urinary tract and male reproductive system, who was followed at the Novosibirsk Regional TB Outpatient Department. The medical records of patients with recurrent disease were analyzed in detail. RESULTS: In 2019, 563 patients with isolated extrapulmonary tuberculosis in the Siberian Federal District and the Far Eastern Federal District were identified, and 14.4% of them had urogenital tuberculosis. In 99 (17.6%) patients, the present state was a relapse, while urogenital tuberculosis occupied 8.1%, and all patients were HIV-negative. In the Novosibirsk Region, 127 out of 140 patients were diagnosed with urogenital tuberculosis for the first time, and in 13 (9.3%) had recurrent disease. Among patients with relapse, male predominated (61.5%). The primary focus of tuberculosis was located in the genitourinary system in 53.9% of patients, which supports the theory of reactivation of dormant foci. In addition, 38.5% of patients with primary episode of tuberculosis were smear-positive. The average relapse time after successful cure of tuberculosis was 9.1 years. Among patients with recurrent urogenital tuberculosis, mycobacteriuria was recorded in 23.1% of cases, and in one case drug resistance of the pathogen to streptomycin and isoniazid was seen. In general, the kidneys were the most susceptible to relapses and were involved in 69.2% of cases. CONCLUSIONS: Nearly 8.1-9.3% of patients with genitourinary tuberculosis had previously tuberculosis and were successfully cured. When urogenital tuberculosis recurs, the kidneys are affected in 69.2% of cases. The overwhelming majority (61.5%) of patients with recurrent genitourinary tuberculosis are men, therefore gender can be considered a predictor of recurrence. HIV infection was found in isolated cases in patients with both newly diagnosed and recurrent urogenital tuberculosis.
Assuntos
Infecções por HIV , Tuberculose Urogenital , Tuberculose , Antituberculosos/uso terapêutico , Infecções por HIV/tratamento farmacológico , Humanos , Incidência , Masculino , Recidiva , Tuberculose Urogenital/tratamento farmacológico , Tuberculose Urogenital/epidemiologiaRESUMO
INTRODUCTION: Methods for evaluating the efficiency of treatment which were developed for pulmonary tuberculosis (absence of bacterial transmission and closure of cavities) are not suitable for urogenital tuberculosis. AIM: To evaluate the use of scoring system for assessing the efficiency of treatment of urogenital tuberculosis. MATERIALS AND METHODS: A pilot simple open-label prospective noncomparative cohort study was carried out, which included 15 patients with urogenital tuberculosis. All patients completed the urogenital tuberculosis score upon admission and after 1 month, along with standard clinical, laboratory and X-ray examinations. We developed this score to objectify evaluate the efficiency of antituberculosis therapy and it includes clinical and laboratory manifestations of urogenital tuberculosis. RESULTS: Eleven (73.3%) patients responded well to standard therapy, and 4 (26.7%) required therapy correction. Considering that the correction of therapy was carried out in a timely manner, the final result of the treatment was satisfactory. The efficiency of the proposed score has been demonstrated by clinical results. CONCLUSION: Using the urogenital tuberculosis score for assessing the results of treatment of urogenital tuberculosis allows timely correction of therapy according to objective criteria.
Assuntos
Tuberculose Pulmonar , Tuberculose Urogenital/tratamento farmacológico , Antituberculosos/uso terapêutico , Estudos de Coortes , Humanos , Estudos ProspectivosRESUMO
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.
Assuntos
Imageamento por Ressonância Magnética/métodos , Tuberculose/diagnóstico por imagem , Abscesso/diagnóstico por imagem , Abscesso/fisiopatologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Doenças Musculares/diagnóstico por imagem , Doenças Musculares/fisiopatologia , Risco , Tuberculoma/diagnóstico por imagem , Tuberculose/fisiopatologia , Tuberculose do Sistema Nervoso Central/diagnóstico por imagem , Tuberculose do Sistema Nervoso Central/fisiopatologia , Tuberculose dos Linfonodos/diagnóstico por imagem , Tuberculose dos Linfonodos/fisiopatologia , Tuberculose Meníngea/diagnóstico por imagem , Tuberculose Meníngea/fisiopatologia , Tuberculose Osteoarticular/diagnóstico por imagem , Tuberculose Osteoarticular/fisiopatologia , Tuberculose Urogenital/diagnóstico por imagem , Tuberculose Urogenital/fisiopatologiaRESUMO
OBJECTIVE: To assess renal unit survival and factors affecting renal salvageability in a cohort of patients receiving modern medical and surgical therapy for urinary tuberculosis. METHODS: This was a retrospective single-center study including all patients diagnosed and treated as urinary tuberculosis between 2005 and 2015 at Christian Medical College, Vellore, Tamil Nadu, India. The primary outcome was time to renal unit non-salvageability (estimated glomerular filtration rate of <15 mL/min). RESULTS: A total of 128 patients were included in the study. The mean age was 37.7 ± 11.3 years, 33% had microbiological and 73% had histopathological confirmation in addition to radiological diagnosis. The estimated median survival of the involved renal units (n = 187) on Kaplan-Meier estimate was 75 months (95% CI 39-99). On multivariate analysis, renal units with initial split function >15 mL/min had fivefold the survival estimate as compared with those ≤15 mL/min (P < 0.001); the presence of one, two and three infundibular strictures had a 2.2-, 2.9- and fivefold higher hazard of renal unit loss respectively, and lower ureteric strictures had fivefold longer estimated survival (P = 0.015) after treatment. Renal units in the reconstruction group had 5.44-fold (95% CI 2.71-10.88, P < 0.001) longer survival than the permanent diversion group, with a mean change in split function of +0.76 (±16.11) mL/min, versus -5.61 (±10.87) mL/min respectively. CONCLUSIONS: Loss of renal units is a function of time despite modern treatment. Baseline renal unit function, site of ureteric involvement and extent of infundibular involvement on imaging are helpful in predicting the duration of renal salvageability. When feasible, reconstruction is better at renal function preservation.
Assuntos
Rim/cirurgia , Tuberculose Urogenital/terapia , Adulto , Antituberculosos/uso terapêutico , Feminino , Taxa de Filtração Glomerular , Humanos , Índia , Estimativa de Kaplan-Meier , Rim/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Mycobacterium tuberculosis/efeitos dos fármacos , Nefrectomia , Valor Preditivo dos Testes , Radiografia , Estudos Retrospectivos , Terapia de Salvação , Tuberculose Urogenital/diagnóstico por imagem , UltrassonografiaRESUMO
AIM: To analyze the clinical spectrum of urogenital tuberculosis (TB) in children from 1993-1997 to 2013-2017, who were treated at the FSCU "Kiritsy". MATERIALS AND METHODS: Clinical forms of urogenital tuberculosis were diagnosed in 195 children (stage 1) and 158 children (stage 2). Conventional methods of TB diagnosis, including clinical, laboratory, imaging studies, tuberculin skin test and urine culture for BCG were used. In all cases, standard treatment for TB in combination with physiotherapy were performed. RESULTS: When comparing the clinical spectrum of urogenital tuberculosis in children in 1993-1997 yy. (stage 1) and 2013 and 2017 yy. (stage 2), who were treated at the children's tuberculosis clinic "Kiritsy", the authors concluded that during the last 5 years the number of children with urogenital tuberculosis had decreased by 1.5 times (195 children in 1 stage, 158 in 2 stage) and proportion of children with a destructive form of urogenital tuberculosis decreased by 4 times (15 children in stage 1, 4 in stage 2). The contemporary diagnostic methods (urine culture, Diaskintest, ultrasound, instrumental methods) contributed to improved diagnosis of urogenital tuberculosis. Novel powerful antituberculous antibiotics allowed to significantly improve treatment outcomes. RESULTS: 1) The incidence of urogenital tuberculosis in children over the past 5 years has decreased by 1.5 times compared with 90th years of the the last century. 2) At the current stage, the use of urine culture, Diaskintest, ultrasound, x-ray and instrumental methods contributes to the diagnosis of urogenital tuberculosis in children. 3) Multidisciplinary team consisted of pediatricians, pediatric urologists, phthisiopediatric as well as sanitary and educational work in the foci of infection allow to identify the urogenital tuberculosis in children.
Assuntos
Tuberculose Urogenital , Criança , Humanos , Incidência , Radiografia , Teste Tuberculínico , Tuberculose Urogenital/diagnósticoRESUMO
INTRODUCTION: Currently, the limits of therapeutic efficiency in urogenital tuberculosis have been achieved. The etiological therapy should be supplement by pathogenetic drugs. AIM: to determine the efficiency of deoxyribonucleate sodium in the complex treatment of patients with urogenital tuberculosis. MATERIAL AND METHODS: Single-center open-label randomized comparative prospective study was carried out. A total of 62 patients with active urogenital tuberculosis were included. All patients received therapy in accordance with National clinical guidelines for urogenital tuberculosis. In the main group, patients additionally received pathogenetic therapy in form of deoxyribonucleate sodium via intramuscular injection of 75 mg every 48 hours. Whole one-month course consisted of 15 injections. Pathogenetic therapy was started immediately after the choosing of anti- tuberculosis drugs and confirmation of good tolerability. The efficiency of treatment was evaluated after one and three months. The assessed criteria included the intensity of pain and severity of dysuria, signs of inflammation, bacterial isolation and changes in the quality of life. CONCLUSION: The addition of deoxyribonucleate sodium in the form of intramuscular injections of 75 mg every 48 hours for 1 months resulted in a significant increase in the efficiency of treatment. Quality of life in patients receiving deoxyribonucleate sodium improved twice (from 11.1 to 21.5 points), while in the control group this value was twice as low (from 10.8 to 15.9 points).
Assuntos
Tuberculose Urogenital , DNA/uso terapêutico , Humanos , Estudos Prospectivos , Qualidade de Vida , Tuberculose Urogenital/terapiaRESUMO
Genitourinary system tuberculosis (GUTB) is a chronic granulomatous infection in which tuberculous bacilli affect one or more organs in the genitourinary system. In this report, an unusual presentation of miliary tuberculosis was presented as GUTB. A 15-year-old girl presented with complaints of severe abdominal pain and dysuria. Abdominal examination showed tenderness and defense. Pyuria and microscopic hematuria were observed. Acute abdominal causes could not be excluded through abdominal ultrasound. On abdominal computed tomography, a necrotic lesion was detected in the right kidney. Acid-fast bacilli were detected in the urine. Quartet anti-tuberculosis therapy was started. After treatment, static renal scintigraphy with 99mTc-dimer captosuccinic acid and single-photon emission CT imaging showed parenchymal injury. In any suspected patient, voiding symptoms, abdominal or flank pain, sterile pyuria, and hematuria should be kept in mind as the presenting manifestations of GUTB in the differential diagnosis.