Among critically ill patients,severe pulmonary and extrapulmonary tuberculosis has high morbidity and mortality.Yet,it is a diagnostic challenge given its nonspecific clinical symptoms and signs in early stages of the...Among critically ill patients,severe pulmonary and extrapulmonary tuberculosis has high morbidity and mortality.Yet,it is a diagnostic challenge given its nonspecific clinical symptoms and signs in early stages of the disease.In addition,management of severe pulmonary and extrapulmonary tuberculosis is complicated given the high risk of drug-drug interactions,drug-disease interactions,and adverse drug reactions.To help clinicians acquire an up-to-date approach to severe tuberculosis,this paper will provide a narrative review of contemporary diagnosis and management of severe pulmonary and extrapulmonary tuberculosis in critically ill patients.展开更多
BACKGROUND Tuberculosis(TB)remains a global health concern despite decreasing incidence.Delayed TB diagnosis can exacerbate patient outcomes and lead to broader public health issues such as mass infections.Differentia...BACKGROUND Tuberculosis(TB)remains a global health concern despite decreasing incidence.Delayed TB diagnosis can exacerbate patient outcomes and lead to broader public health issues such as mass infections.Differentiation between TB and bacterial pneumonia is often complicated by variable clinical and radiological manifestations of TB,leading to diagnostic delays.CASE SUMMARY An 89-year-old,Japanese male patient with a history of diabetes mellitus,hypertension,and hypothyroidism presented with right-sided chest pain.Based on the elevated inflammatory response,right pleural effusion,and infiltrating shadow in the lung field,the diagnosis of right pleurisy was made and the antibiotic,ampicillin/sulbactam,was administered.The patient’s condition,inflammatory reaction,and right pleural effusion temporarily improved.However,persistent low-grade fever and malaise prompted further evaluation,revealing repeated right pleural effusion and inflammatory response.A right thoracentesis was performed;the patient was diagnosed with tuberculous pleurisy as a result of exudative effusion with lymphocyte predominance,elevated adenosine deaminase levels,and positive Mycobacterium TB polymerase chain reaction test.Anti-TB treatment,including isoniazid,rifampicin,and ethambutol was initiated,leading to significant clinical improvement.The patient successfully completed a 12-month course of TB therapy without recurrence or deterioration.CONCLUSION There are cases of TB wherein temporary improvement apparently could be shown through treatment with antimicrobial agents other than anti-TB drugs,necessitating careful evaluation in atypical cases of bacterial pneumonia.展开更多
Mycobacterium tuberculosis(Mtb)employs multiple mechanisms,such as phagocytosis and autophagy,to evade innate immune clearance and establish infection.In the present study,we identified the ESX-1 secretion-associated ...Mycobacterium tuberculosis(Mtb)employs multiple mechanisms,such as phagocytosis and autophagy,to evade innate immune clearance and establish infection.In the present study,we identified the ESX-1 secretion-associated protein EspL,which promotes Mtb survival by inhibiting phagosome maturation and autophagy initiation.EspL knockout decreased Mtb intracellular survival,while EspL overexpression increased bacterial survival by interfering with phagocytosis and autophagy.EspL interacts with ULK1 and promotes its phosphorylation at Ser^(757),leading to the inhibition of autophagy initiation.Additionally,overexpression of EspL reduced antigen presentation and T-cell responses both in vitro and in vivo.Our findings revealed that EspL interferes with autophagy and antigen presenta-tion by suppressing ULK1 activation.These insights provide a novel understanding of Mtb pathogenicity.展开更多
BACKGROUND Pancreatic tuberculosis(PTB)is a rare disease,even in immunocompetent hosts.Abdominal tuberculosis involving the pancreatic head and peripancreatic areas may simulate pancreatic head carcinoma.CASE SUMMARY ...BACKGROUND Pancreatic tuberculosis(PTB)is a rare disease,even in immunocompetent hosts.Abdominal tuberculosis involving the pancreatic head and peripancreatic areas may simulate pancreatic head carcinoma.CASE SUMMARY We present the case of a 32-year-old man who was admitted to our hospital for intermittent epigastric pain and weight loss.A computed tomography scan and magnetic resonance imaging revealed a mass in the head of the pancreas.The lesion was initially diagnosed as pancreatic head carcinoma on abdominal imaging.Laparotomy confirmed the diagnosis of PTB and the patient received antituberculosis therapy.CONCLUSION The present case is reported to emphasize the importance of including PTB in the differential diagnosis of pancreatic lesions.展开更多
Peritoneal tuberculosis is the most common digestive location of tuberculosis. Its diagnosis is often based on a combination of clinical and biological arguments, and confirmed by bacteriology which is rarely availabl...Peritoneal tuberculosis is the most common digestive location of tuberculosis. Its diagnosis is often based on a combination of clinical and biological arguments, and confirmed by bacteriology which is rarely available. In Congo there is little published data on this entity. Objectives: To describe the epidemiological, diagnostic, and progression characteristics of peritoneal tuberculosis at the university hospital center in Brazzaville. Patients and Methods: This study is a descriptive and retrospective analysis conducted from January 1, 2015, to December 31, 2021, in the Gastroenterology and Internal Medicine department of the CHU of Brazzaville. It included all patients hospitalized during this period with a confirmed diagnosis of peritoneal tuberculosis, encompassing 54 records that met the inclusion criteria. Results: Out of the study period, 54 records that fulfilled the inclusion criteria were analyzed. The annual incidence of peritoneal tuberculosis was 7.7 patients, with a prevalence of 1.4%, showing a male predominance of 61% and an average age of 39.93 ± 14.62 years. The primary symptoms were abdominal bloating and abdominal pain, present in 100% and 74% of cases, respectively. The clinical presentation was primarily characterized by febrile ascites observed in all patients. HIV co-infection was noted in 29.6% of cases. Anemia was present in 79.6% of patients, and an elevated sedimentation rate was observed in 74% of cases. The tuberculin skin test returned positive in 50% of cases. The ascitic fluid was exudative, rich in proteins and white blood cells (exceeding 1000/mm3, predominantly lymphocytes) in the majority of cases (100%, 83.3%, 83.3%, respectively). The diagnosis was deemed highly probable based on the clinical and paraclinical signs and the favorable response to treatment in 79.6% of cases. There were instances of pleural involvement (33.3%) and lymph node involvement (pulmonary 22.2% and lymph node 16.6%). Treatment outcomes were favorable in 37% of cases, with a mortality rate of 9%. Conclusion: Peritoneal tuberculosis is prevalent in Brazzaville, predominantly affecting young males. The diagnosis relies chiefly on a combination of clinical, paraclinical, and progression indicators.展开更多
BACKGROUND Mycobacterium tuberculosis(TB)is the causative agent of TB,a chronic granulo-matous illness.This disease is prevalent in low-income countries,posing a significant global health challenge.Gastrointestinal TB...BACKGROUND Mycobacterium tuberculosis(TB)is the causative agent of TB,a chronic granulo-matous illness.This disease is prevalent in low-income countries,posing a significant global health challenge.Gastrointestinal TB is one of the three forms.The disease can mimic other intra-abdominal conditions,leading to delayed diagnosis owing to the absence of specific symptoms.While gastric outlet obs-truction(GOO)remains a frequent complication,its incidence has declined with the advent of proton pump inhibitors and Helicobacter pylori eradication therapy.Gastroduodenal TB can cause upper gastrointestinal hemorrhage,obstruction,and malignancy-like tumors.CASE SUMMARY A 23-year-old male presented with recurrent epigastric pain,distension,nausea,vomiting,and weight loss,prompting a referral to a gastroenterologist clinic.Endoscopic examination revealed distorted gastric mucosa and signs of chronic inflammation.However,treatment was interrupted,possibly owing to vomiting or comorbidities such as human immunodeficiency virus infection or diabetes.Subsequent surgical intervention revealed a dilated stomach and diffuse thickening of the duodenal wall.Resection revealed gastric wall effacement with TB.CONCLUSION Primary gastric TB is rare,frequently leading to GOO.Given its rarity,suspicions should be promptly raised when encountering relevant symptoms,often requiring surgical intervention for diagnosis and treatment.展开更多
BACKGROUND Tuberculosis is a chronic infectious disease and an important public health pro-blem.Despite progress in controlling tuberculosis,the incidence of tuberculosis in China is still very high,with 895000 new ca...BACKGROUND Tuberculosis is a chronic infectious disease and an important public health pro-blem.Despite progress in controlling tuberculosis,the incidence of tuberculosis in China is still very high,with 895000 new cases annually.This case report des-cribes the investigation of a case of severe disseminated tuberculosis in a young adult with normal immune function,conducted to ascertain why a Mycobacterium tuberculosis(M.tuberculosis)strain caused such severe disease.CASE SUMMARY A previously healthy 28-year-old woman presented to our hospital with a 1-mo-nth history of fever and fatigue.She was diagnosed with severe disseminated pulmonary tuberculosis,spinal tuberculosis with paravertebral abscesses,and tuberculous meningitis.M.tuberculosis was isolated from bronchoal-veolar lavage fluid.She was treated with standard antituberculous therapy and underwent debridement,bone graft,and internal fixation surgery for spinal tuberculosis.She responded to therapy and regained her ability to walk following the surgery.We analysed the whole-genome sequence of the strain and designated it BLM-A21.Additional M.tuberculosis genomes were selected from the Virulence Factor Database(http://www.mgc.ac.cn/cgi-bin/VFs/genus.cgi?Genus=Mycobacterium)for comparison.An evolutionary tree of the BLM-A21 strain was built using PhyML maximum likelihood software.Further gene analysis revealed that,except for the pks1 gene,BLM-A21 had similar virulence genes to the CDC 1551 and H37Rv strains,which have lower dissemination.CONCLUSION We speculate that the pks1 virulence gene in BLM-A21 may be the key virulence gene responsible for the wide-spread dissemination of M.tuberculosis infection in this previously healthy adult with normal immune function.展开更多
In this editorial,we comment on an article published in a recent issue of the World Journal of Clinical Cases.There is a pressing need for reliable tools for diagnosing tuberculosis(TB)of the gastrointestinal tract.De...In this editorial,we comment on an article published in a recent issue of the World Journal of Clinical Cases.There is a pressing need for reliable tools for diagnosing tuberculosis(TB)of the gastrointestinal tract.Despite advancements in the diagnosis and treatment,TB remains a global health challenge.Ali et al demon-strated that TB may mimic gastrointestinal conditions,such as gastric outlet obstruction,causing a delay in the diagnosis.Furthermore,the latter complication is frequently observed during infections,including Helicobacter pylori,and rarely is related to TB,as in the presented case.In line with this,we think that laboratory tests based on interferon-gamma release assays can be a helpful tool for diagnosing latent TB paced in the gastrointestinal tract.Innovative strategies and approaches for diagnosing latent/active extra pulmonary TB are crucial for establishing the diagnosis early and enhancing treatment strategies to mitigate the global burden of TB.展开更多
Gastroduodenal tuberculosis(GD-TB)is exceptionally rare.The clinical manifestations of gastrointestinal TB are diverse and non-specific,which makes diagnosis difficult,leading to delayed diagnosis and high mortality.A...Gastroduodenal tuberculosis(GD-TB)is exceptionally rare.The clinical manifestations of gastrointestinal TB are diverse and non-specific,which makes diagnosis difficult,leading to delayed diagnosis and high mortality.As a peer-reviewer of World Journal of Clinical Cases,I would like to share my opinion on the article published by this journal.The patient had no family history of TB or contact with people with TB.Primary GD-TB presenting as gastric outlet obstruction and normal findings of thoracic computed tomography increased the difficulty of diagnosis and treatment in this patient.The diagnosis and treatment scheme of this typical case have reference value for the clinical treatment of GD-TB.展开更多
BACKGROUND Orificial tuberculosis is a rare type of tuberculosis,which is easy to be misdiagnosed,and can cause great damage to the perianal skin and mucosa.Early diagnosis can avoid further erosion of the perianal mu...BACKGROUND Orificial tuberculosis is a rare type of tuberculosis,which is easy to be misdiagnosed,and can cause great damage to the perianal skin and mucosa.Early diagnosis can avoid further erosion of the perianal muscle tissue by tuberculosis bacteria.CASE SUMMARY Here,we report a case of disseminated tuberculosis in a 62-year-old male patient with a perianal tuberculous ulcer and active pulmonary tuberculosis,intestinal tuberculosis and orificial tuberculosis.This is an extremely rare case of cutaneous tuberculosis of the anus,which was misdiagnosed for nearly a year.The patient received conventional treatment in other medical institutions,but specific treatment was delayed.Ultimately,proper diagnosis and treatment with standard anti-tuberculosis drugs for one year led to complete cure.CONCLUSION For skin ulcers that do not heal with repeated conventional treatments,consider ulcers caused by rare bacteria,such as Mycobacterium tuberculosis.展开更多
Objective We aimed to understand the willingness and barriers to the acceptance of tuberculosis(TB)preventive treatment(TPT)among people with latent TB infection(LTBI)in China.Methods A multicenter cross-sectional stu...Objective We aimed to understand the willingness and barriers to the acceptance of tuberculosis(TB)preventive treatment(TPT)among people with latent TB infection(LTBI)in China.Methods A multicenter cross-sectional study was conducted from May 18,2023 to December 31,2023 across 10 counties in China.According to a national technical guide,we included healthcare workers,students,teachers,and others occupations aged 15-65 years as our research participants.Results Overall,17.0%(183/1,077)of participants accepted TPT.There were statistically significant differences in the acceptance rate of TPT among different sexes,ages,educational levels,and occupations(P<0.05).The main barriers to TPT acceptance were misconceptions that it had uncertain effects on prevention(57.8%,517/894),and concerns about side effects(32.7%,292/894).Conclusion An enhanced and comprehensive understanding of LTBI and TPT among people with LTBI is vital to further expand TPT in China.Moreover,targeted policies need to be developed to address barriers faced by different groups of people.展开更多
BACKGROUND Organizing pneumonia secondary to pulmonary tuberculosis is rare.Moreover,the temporal boundary between pulmonary tuberculosis and secondary organizing pneumonia has not been defined.We report a case of sec...BACKGROUND Organizing pneumonia secondary to pulmonary tuberculosis is rare.Moreover,the temporal boundary between pulmonary tuberculosis and secondary organizing pneumonia has not been defined.We report a case of secondary organizing pneumonia associated with pulmonary tuberculosis occurring after nine months of antituberculosis treatment.CASE SUMMARY A 54 years old man,previously diagnosed with pulmonary tuberculosis and tuberculous pleurisy,underwent nine months of antituberculosis treatment.Follow-up lung computed tomography revealed multiple new subpleural groundglass opacities in both lungs,and a lung biopsy confirmed organizing pneumonia.Treatment continued with anti-tuberculosis agents and hormone therapy,and subsequent dynamic pulmonary computed tomography exams demonstrated improvement in lesion absorption.No disease recurrence was observed after corticosteroid therapy discontinuation.CONCLUSION When treating patients with active pulmonary tuberculosis,if an increase in lesions is observed during anti-tuberculosis treatment,it is necessary to consider the possibility of tuberculosis-related secondary organizing pneumonia,timely lung biopsy is essential for early intervention.展开更多
Background:Tuberculosis(TB),caused by Mycobacterium tuberculosis,remains the second leading cause of death from a single infectious disease globally and poses a significant economic and clinical burden in the world in...Background:Tuberculosis(TB),caused by Mycobacterium tuberculosis,remains the second leading cause of death from a single infectious disease globally and poses a significant economic and clinical burden in the world in 2022.Of particular concern is the emergence of drug-resistant TB,accounting for 15%-20%of TB deaths.It is imperative to delve into the global trends of incidence and death rate for multidrug-resistant tuberculosis(MDRTB)and extensively drug-resistant tuberculosis(XDR-TB),drawing upon the comprehensive Global Burden of Disease(GBD)2021 drug-resistant tuberculosis dataset.Methods:From the GBD 2021,data on incidence,prevalence,disability-adjusted life years(DALYs),and death of MDR-TB and XDR-TB from 1990 to 2021 were collected.We calculated the estimated annual percentage changes in age standardized incidence rate(ASIR)and age-standardized death rate(ASDR),segmented by age,sex,and socio-demographic index(SDI).The impacts of various risk factors on MDR-TB and XDR-TB were also analyzed.Results:In 2021,there were an estimated 443,680(95%uncertainty interval[UI]:259,196-766,545)incident cases of MDR-TB,and an estimated 106,818(95%UI:41,612-211,854)death cases of MDR-TB,while there were an estimated 24,036(95%UI:17,144-34,587)incident cases of XDR-TB and 7,946(95%UI:3,326-14,859)death cases of XDR-TB.The incidence and death cases of MDR-TB were lowest in high SDI regions,whereas the incidence rates of XDR-TB in high-middle SDI regions were higher than those in middle SDI and high SDI regions.Conclusion:This study reported the disease burden of drug-resistant TB from 1990 to 2021.Until 2021,drugresistant TB is still a serious problem in low SDI countries,especially for high-risk age populations with highrisk factors.Controlling drug-resistant TB requires effective control strategies and healthcare systems.展开更多
Latent tuberculosis infection(LTBI)has become a major source of active tuberculosis(ATB).Although the tuberculin skin test and interferon-gamma release assay can be used to diagnose LTBI,these methods can only differe...Latent tuberculosis infection(LTBI)has become a major source of active tuberculosis(ATB).Although the tuberculin skin test and interferon-gamma release assay can be used to diagnose LTBI,these methods can only differentiate infected individuals from healthy ones but cannot discriminate between LTBI and ATB.Thus,the diagnosis of LTBI faces many challenges,such as the lack of effective biomarkers from Mycobacterium tuberculosis(MTB)for distinguishing LTBI,the low diagnostic efficacy of biomarkers derived from the human host,and the absence of a gold standard to differentiate between LTBI and ATB.Sputum culture,as the gold standard for diagnosing tuberculosis,is time-consuming and cannot distinguish between ATB and LTBI.In this article,we review the pathogenesis of MTB and the immune mechanisms of the host in LTBI,including the innate and adaptive immune responses,multiple immune evasion mechanisms of MTB,and epigenetic regulation.Based on this knowledge,we summarize the current status and challenges in diagnosing LTBI and present the application of machine learning(ML)in LTBI diagnosis,as well as the advantages and limitations of ML in this context.Finally,we discuss the future development directions of ML applied to LTBI diagnosis.展开更多
Objective:To investigate and compare the demographic characteristics,clinical findings,and laboratory results of pulmonary tuberculosis(PTB)and extrapulmonary tuberculosis(EPTB)patients,among Turkish citizens,and fore...Objective:To investigate and compare the demographic characteristics,clinical findings,and laboratory results of pulmonary tuberculosis(PTB)and extrapulmonary tuberculosis(EPTB)patients,among Turkish citizens,and foreign nationals.Methods:This study included patients aged 18 and over,both Turkish citizens and foreign nationals,diagnosed with PTB or EPTB between 2016 and 2022.All patients were divided into PTB and EPTB group,and demographic characteristics,clinical findings,and laboratory results were compared.Patients with both PTB and EPTB were not included in the comparison.Multivariate logistic regression analysis was conducted to identify potential risk factors for PTB.Results:Among the 261 TB cases included,46 patients(17.6%)had PTB,and 188(72%)had EPTB.The percentage of female patients was significantly higher(P=0.003)in EPTB compared to PTB group.While the prevalence of diabetes mellitus(P=0.002),hypertension(P=0.017),coronary obstructive pulmonary disease(P=0.001),congestive heart failure(P=0.005),coronary artery disease(P=0.001)and immunosuppressive medication use(P=0.017)were significantly higher in PTB patients than in EPTB patients.Multivariate logistical analysis reveals that male(OR 2.6,95%CI 1.3-5.5,P=0.009),diabetes mellitus(OR 2.7,95%CI 1.2-6.1,P=0.015),and asthma(OR 6.3,95%CI 1.2-33.9,P=0.032)were associated with an increased risk of PTB.Social security coverage(P<0.001)and regular employment status(P<0.001)were found to be lower and the presence of multidrug resistance(P=0.002),isoniazid resistance(P=0.012),and rifampin resistance(P=0.012)were found to be significantly higher in foreign-national TB patients comparing with Turkiye citizens.Conclusions:Patients with PTB need to be evaluated for comorbidities and PTB should be investigated in men,in patients with diabetes mellitus or asthma if there are clinical findings suspicious for TB.TB screening for foreign nationals upon entry into the country is essential for TB control and elimination.展开更多
In this editorial,we comment on the article by Ali et al published in the recent issue of the World Journal of Clinical Cases.This case report shed light on a particularly rare manifestation of this disease-primary ga...In this editorial,we comment on the article by Ali et al published in the recent issue of the World Journal of Clinical Cases.This case report shed light on a particularly rare manifestation of this disease-primary gastrointestinal tuberculosis(GTB)presenting as gastric outlet obstruction.GTB presents diagnostic challenges due to its nonspecific symptoms and lack of highly accurate diagnostic algorithms.This editorial synthesizes epidemiological data,risk factors,pathogenesis,clinical presentations,diagnostic methods,and therapies to raise awareness about GTB.GTB constitutes 1%-3%of all tuberculosis cases globally,with 6%-38%of patients also having pulmonary tuberculosis.Pathogenesis involves various modes of Mycobacterium tuberculosis complex entry into the gastrointestinal system,with the terminal ileum and ileocecal valve commonly affected.Clinical presentation varies,often resembling other intra-abdominal pathologies,necessitating a high index of suspicion.Diagnostic tools include a combination of biochemical,microbiological,radiological,and endoscopic assessments.Antitubercular medication remains the cornerstone of treatment,supplemented by surgical intervention in severe cases.Multidisciplinary management involving gastroenterologists,surgeons,pulmonologists,and infectious disease specialists is crucial for optimal outcomes.Despite advancements,timely diagnosis and management challenges persist,underscoring the need for continued research and collaboration in addressing primary GTB.展开更多
This editorial article takes an opportunity to apprehend the diagnostic challenges of primary gastrointestinal tuberculosis(an uncommon extrapulmonary tuberculosis condition)utilizing the recently published case repor...This editorial article takes an opportunity to apprehend the diagnostic challenges of primary gastrointestinal tuberculosis(an uncommon extrapulmonary tuberculosis condition)utilizing the recently published case report of a young male with prolonged gastrointestinal symptoms and weight loss who received intermittent anti-tubercular treatment and underwent operative interventions to relieve gastric outlet obstruction.The diagnosis chiefly relied on high-end examinations,like computed tomography scans and histopathological evaluation of postoperatively resected bowel tissue,which wasn't preceded by an all-inclusive stepwise primary pulmonary tuberculosis exclusion approach that usually begins with a detailed tuberculosis-pertinent history acquisition.Given the geographic locations where the patient had been(and/or treated),pivotal consideration of tuberculosis-associated endemicities in those regions,like human immunodeficiency virus(HIV)infection,might have improved the case description.The obtainment of HIV-relevant histories,like intravenous drug use and sexual practice,are good places to start.The sputum bacteriology also seems imperative to rule out atypical Mycobacterium species infection because of its clinico-radiohistopathological resemblance with pulmonary Mycobacterium tuberculosis.Altogether,this editorial aims to underscore that primary extrapulmonary tuberculosis diagnosis should comprise an elaborative,comprehensive,systematic,and stepwise primary pulmonary Mycobacterium tuberculosis exclusion workup.展开更多
BACKGROUND Tuberculosis(TB)is a chronic respiratory infectious disease that considerably jeopardizes human health,and there is no effective vaccine suitable for its prevention in the entire population.AIM To investiga...BACKGROUND Tuberculosis(TB)is a chronic respiratory infectious disease that considerably jeopardizes human health,and there is no effective vaccine suitable for its prevention in the entire population.AIM To investigate the promotion of medication adherence and disease cognition in patients with drug-resistant(DR-)TB using detailed nursing management.METHODS In total,114 patients with DR-TB who were diagnosed and treated at our hospital between January 2019 and January 2023 were included in this study.Patients in the control group(n=57)were managed with conventional nursing care,while those in the observation group(n=57)were managed with detailed nursing care.Medication adherence,disease awareness scores,medication safety,and nursing satisfaction were compared between the two groups after the intervention.RESULTS The post-intervention medication compliance rate was 91.23%in the observation group and 75.44%in the control group,with the former being 15.79%higher than the latter(P<0.05).There was no statistically significant difference in the disease awareness scores between the two groups before the intervention;the disease awareness scores of the observation group were significantly higher than those of the control group after the intervention(P<0.05).The incidence of gastrointestinal reactions,joint swelling and pain,hearing loss,electrolyte disorders,and liver and kidney function abnormalities were lower in the observation group than those in the control group.The total nursing satisfaction of the observation group was higher than that of the control group(P<0.05).CONCLUSION Implementation of detailed nursing management for patients with DR-TB can effectively improve medication adherence,enhance awareness of the disease,ensure safety of medication,and improve satisfaction with nursing care.展开更多
Tuberculosis(TB)remains a huge global healthcare challenge even in the 21^(st) century though the prevalence has dropped in developed countries in recent decades.Diabetes mellitus(DM)is an important risk factor for th...Tuberculosis(TB)remains a huge global healthcare challenge even in the 21^(st) century though the prevalence has dropped in developed countries in recent decades.Diabetes mellitus(DM)is an important risk factor for the development and perpetuation of TB owing to the immune dysfunction in patients with DM.The coexistence of both diseases in the same individual also aggravates disease severity,complications,and chance of treatment failure because of gross immune alterations posed by DM as well as TB.Various complex cellular and humoral immunological factors are involved in the dangerous interaction between TB and DM,some of which remain unknown even today.It is highly important to identify the risk factors for TB in patients with DM,and vice versa,to ensure early diagnosis and management to prevent complications from this ominous coexistence.In their research study published in the recent issue of the World Journal of Diabetes,Shi et al elaborate on the factors associated with the development of TB in a large cohort of DM patients from China.More such research output from different regions of the world is expected to improve our knowledge to fight the health devastation posed by TB in patients with diabetes.展开更多
Primate sanctuaries across Africa play a pivotal role in the rescue and rehabilitation of confiscated and rescued wild primates, many of whom have had extensive contact with humans prior to their arrival and throughou...Primate sanctuaries across Africa play a pivotal role in the rescue and rehabilitation of confiscated and rescued wild primates, many of whom have had extensive contact with humans prior to their arrival and throughout the rehabilitation process, heightening the risk of disease transmission. While tuberculosis is not naturally occurring in free-living chimpanzees, it has been extensively observed in captive primates that have been in close proximity to humans or other captive primates infected with Mycobacterium tuberculosis. This case report delves into an outbreak of extra-pulmonary tuberculosis among juvenile chimpanzees within a sanctuary, detailing the associated diagnostic challenges and treatment approaches. The five cases had close contact with a caregiver infected with tuberculosis, subsequently transmitting the infection to other in-contact chimpanzees. Prolonged treatment, employing the human protocol of quadri-therapy (rifampicin, isoniazid, pyrazinamide, and ethambutol), followed by bi-therapy (rifampicin and isoniazid), resulted in complete resolution for all five cases. These cases underscore the critical importance of maintaining high levels of biosecurity, implementing effective quarantine measures, and adhering to strict hygiene practices when working with non-human primates.展开更多
文摘Among critically ill patients,severe pulmonary and extrapulmonary tuberculosis has high morbidity and mortality.Yet,it is a diagnostic challenge given its nonspecific clinical symptoms and signs in early stages of the disease.In addition,management of severe pulmonary and extrapulmonary tuberculosis is complicated given the high risk of drug-drug interactions,drug-disease interactions,and adverse drug reactions.To help clinicians acquire an up-to-date approach to severe tuberculosis,this paper will provide a narrative review of contemporary diagnosis and management of severe pulmonary and extrapulmonary tuberculosis in critically ill patients.
文摘BACKGROUND Tuberculosis(TB)remains a global health concern despite decreasing incidence.Delayed TB diagnosis can exacerbate patient outcomes and lead to broader public health issues such as mass infections.Differentiation between TB and bacterial pneumonia is often complicated by variable clinical and radiological manifestations of TB,leading to diagnostic delays.CASE SUMMARY An 89-year-old,Japanese male patient with a history of diabetes mellitus,hypertension,and hypothyroidism presented with right-sided chest pain.Based on the elevated inflammatory response,right pleural effusion,and infiltrating shadow in the lung field,the diagnosis of right pleurisy was made and the antibiotic,ampicillin/sulbactam,was administered.The patient’s condition,inflammatory reaction,and right pleural effusion temporarily improved.However,persistent low-grade fever and malaise prompted further evaluation,revealing repeated right pleural effusion and inflammatory response.A right thoracentesis was performed;the patient was diagnosed with tuberculous pleurisy as a result of exudative effusion with lymphocyte predominance,elevated adenosine deaminase levels,and positive Mycobacterium TB polymerase chain reaction test.Anti-TB treatment,including isoniazid,rifampicin,and ethambutol was initiated,leading to significant clinical improvement.The patient successfully completed a 12-month course of TB therapy without recurrence or deterioration.CONCLUSION There are cases of TB wherein temporary improvement apparently could be shown through treatment with antimicrobial agents other than anti-TB drugs,necessitating careful evaluation in atypical cases of bacterial pneumonia.
基金supported by the National Natural Science Foundation of China under grant number U21A20259the National Key Research and Development Program of China under grant number 2021YFD1800401.
文摘Mycobacterium tuberculosis(Mtb)employs multiple mechanisms,such as phagocytosis and autophagy,to evade innate immune clearance and establish infection.In the present study,we identified the ESX-1 secretion-associated protein EspL,which promotes Mtb survival by inhibiting phagosome maturation and autophagy initiation.EspL knockout decreased Mtb intracellular survival,while EspL overexpression increased bacterial survival by interfering with phagocytosis and autophagy.EspL interacts with ULK1 and promotes its phosphorylation at Ser^(757),leading to the inhibition of autophagy initiation.Additionally,overexpression of EspL reduced antigen presentation and T-cell responses both in vitro and in vivo.Our findings revealed that EspL interferes with autophagy and antigen presenta-tion by suppressing ULK1 activation.These insights provide a novel understanding of Mtb pathogenicity.
文摘BACKGROUND Pancreatic tuberculosis(PTB)is a rare disease,even in immunocompetent hosts.Abdominal tuberculosis involving the pancreatic head and peripancreatic areas may simulate pancreatic head carcinoma.CASE SUMMARY We present the case of a 32-year-old man who was admitted to our hospital for intermittent epigastric pain and weight loss.A computed tomography scan and magnetic resonance imaging revealed a mass in the head of the pancreas.The lesion was initially diagnosed as pancreatic head carcinoma on abdominal imaging.Laparotomy confirmed the diagnosis of PTB and the patient received antituberculosis therapy.CONCLUSION The present case is reported to emphasize the importance of including PTB in the differential diagnosis of pancreatic lesions.
文摘Peritoneal tuberculosis is the most common digestive location of tuberculosis. Its diagnosis is often based on a combination of clinical and biological arguments, and confirmed by bacteriology which is rarely available. In Congo there is little published data on this entity. Objectives: To describe the epidemiological, diagnostic, and progression characteristics of peritoneal tuberculosis at the university hospital center in Brazzaville. Patients and Methods: This study is a descriptive and retrospective analysis conducted from January 1, 2015, to December 31, 2021, in the Gastroenterology and Internal Medicine department of the CHU of Brazzaville. It included all patients hospitalized during this period with a confirmed diagnosis of peritoneal tuberculosis, encompassing 54 records that met the inclusion criteria. Results: Out of the study period, 54 records that fulfilled the inclusion criteria were analyzed. The annual incidence of peritoneal tuberculosis was 7.7 patients, with a prevalence of 1.4%, showing a male predominance of 61% and an average age of 39.93 ± 14.62 years. The primary symptoms were abdominal bloating and abdominal pain, present in 100% and 74% of cases, respectively. The clinical presentation was primarily characterized by febrile ascites observed in all patients. HIV co-infection was noted in 29.6% of cases. Anemia was present in 79.6% of patients, and an elevated sedimentation rate was observed in 74% of cases. The tuberculin skin test returned positive in 50% of cases. The ascitic fluid was exudative, rich in proteins and white blood cells (exceeding 1000/mm3, predominantly lymphocytes) in the majority of cases (100%, 83.3%, 83.3%, respectively). The diagnosis was deemed highly probable based on the clinical and paraclinical signs and the favorable response to treatment in 79.6% of cases. There were instances of pleural involvement (33.3%) and lymph node involvement (pulmonary 22.2% and lymph node 16.6%). Treatment outcomes were favorable in 37% of cases, with a mortality rate of 9%. Conclusion: Peritoneal tuberculosis is prevalent in Brazzaville, predominantly affecting young males. The diagnosis relies chiefly on a combination of clinical, paraclinical, and progression indicators.
文摘BACKGROUND Mycobacterium tuberculosis(TB)is the causative agent of TB,a chronic granulo-matous illness.This disease is prevalent in low-income countries,posing a significant global health challenge.Gastrointestinal TB is one of the three forms.The disease can mimic other intra-abdominal conditions,leading to delayed diagnosis owing to the absence of specific symptoms.While gastric outlet obs-truction(GOO)remains a frequent complication,its incidence has declined with the advent of proton pump inhibitors and Helicobacter pylori eradication therapy.Gastroduodenal TB can cause upper gastrointestinal hemorrhage,obstruction,and malignancy-like tumors.CASE SUMMARY A 23-year-old male presented with recurrent epigastric pain,distension,nausea,vomiting,and weight loss,prompting a referral to a gastroenterologist clinic.Endoscopic examination revealed distorted gastric mucosa and signs of chronic inflammation.However,treatment was interrupted,possibly owing to vomiting or comorbidities such as human immunodeficiency virus infection or diabetes.Subsequent surgical intervention revealed a dilated stomach and diffuse thickening of the duodenal wall.Resection revealed gastric wall effacement with TB.CONCLUSION Primary gastric TB is rare,frequently leading to GOO.Given its rarity,suspicions should be promptly raised when encountering relevant symptoms,often requiring surgical intervention for diagnosis and treatment.
基金Supported by the Research on Intelligent Recommendation Decision Model of Geriatrics Based on Big Data,No.2021CX01010136.
文摘BACKGROUND Tuberculosis is a chronic infectious disease and an important public health pro-blem.Despite progress in controlling tuberculosis,the incidence of tuberculosis in China is still very high,with 895000 new cases annually.This case report des-cribes the investigation of a case of severe disseminated tuberculosis in a young adult with normal immune function,conducted to ascertain why a Mycobacterium tuberculosis(M.tuberculosis)strain caused such severe disease.CASE SUMMARY A previously healthy 28-year-old woman presented to our hospital with a 1-mo-nth history of fever and fatigue.She was diagnosed with severe disseminated pulmonary tuberculosis,spinal tuberculosis with paravertebral abscesses,and tuberculous meningitis.M.tuberculosis was isolated from bronchoal-veolar lavage fluid.She was treated with standard antituberculous therapy and underwent debridement,bone graft,and internal fixation surgery for spinal tuberculosis.She responded to therapy and regained her ability to walk following the surgery.We analysed the whole-genome sequence of the strain and designated it BLM-A21.Additional M.tuberculosis genomes were selected from the Virulence Factor Database(http://www.mgc.ac.cn/cgi-bin/VFs/genus.cgi?Genus=Mycobacterium)for comparison.An evolutionary tree of the BLM-A21 strain was built using PhyML maximum likelihood software.Further gene analysis revealed that,except for the pks1 gene,BLM-A21 had similar virulence genes to the CDC 1551 and H37Rv strains,which have lower dissemination.CONCLUSION We speculate that the pks1 virulence gene in BLM-A21 may be the key virulence gene responsible for the wide-spread dissemination of M.tuberculosis infection in this previously healthy adult with normal immune function.
基金The European Union-Next Generation EU,through the National Recovery and Resilience Plan of the Republic of Bulgaria,Project,No.BG-RRP-2.004-0008.
文摘In this editorial,we comment on an article published in a recent issue of the World Journal of Clinical Cases.There is a pressing need for reliable tools for diagnosing tuberculosis(TB)of the gastrointestinal tract.Despite advancements in the diagnosis and treatment,TB remains a global health challenge.Ali et al demon-strated that TB may mimic gastrointestinal conditions,such as gastric outlet obstruction,causing a delay in the diagnosis.Furthermore,the latter complication is frequently observed during infections,including Helicobacter pylori,and rarely is related to TB,as in the presented case.In line with this,we think that laboratory tests based on interferon-gamma release assays can be a helpful tool for diagnosing latent TB paced in the gastrointestinal tract.Innovative strategies and approaches for diagnosing latent/active extra pulmonary TB are crucial for establishing the diagnosis early and enhancing treatment strategies to mitigate the global burden of TB.
基金Supported by Shenyang Science and Technology Plan Project,No.23-408-3-01The Natural Science Foundation of Liaoning Province,No.2022-MS-435.
文摘Gastroduodenal tuberculosis(GD-TB)is exceptionally rare.The clinical manifestations of gastrointestinal TB are diverse and non-specific,which makes diagnosis difficult,leading to delayed diagnosis and high mortality.As a peer-reviewer of World Journal of Clinical Cases,I would like to share my opinion on the article published by this journal.The patient had no family history of TB or contact with people with TB.Primary GD-TB presenting as gastric outlet obstruction and normal findings of thoracic computed tomography increased the difficulty of diagnosis and treatment in this patient.The diagnosis and treatment scheme of this typical case have reference value for the clinical treatment of GD-TB.
文摘BACKGROUND Orificial tuberculosis is a rare type of tuberculosis,which is easy to be misdiagnosed,and can cause great damage to the perianal skin and mucosa.Early diagnosis can avoid further erosion of the perianal muscle tissue by tuberculosis bacteria.CASE SUMMARY Here,we report a case of disseminated tuberculosis in a 62-year-old male patient with a perianal tuberculous ulcer and active pulmonary tuberculosis,intestinal tuberculosis and orificial tuberculosis.This is an extremely rare case of cutaneous tuberculosis of the anus,which was misdiagnosed for nearly a year.The patient received conventional treatment in other medical institutions,but specific treatment was delayed.Ultimately,proper diagnosis and treatment with standard anti-tuberculosis drugs for one year led to complete cure.CONCLUSION For skin ulcers that do not heal with repeated conventional treatments,consider ulcers caused by rare bacteria,such as Mycobacterium tuberculosis.
基金Public-Benefit Project on Tuberculosis Patient Care Action[09107].
文摘Objective We aimed to understand the willingness and barriers to the acceptance of tuberculosis(TB)preventive treatment(TPT)among people with latent TB infection(LTBI)in China.Methods A multicenter cross-sectional study was conducted from May 18,2023 to December 31,2023 across 10 counties in China.According to a national technical guide,we included healthcare workers,students,teachers,and others occupations aged 15-65 years as our research participants.Results Overall,17.0%(183/1,077)of participants accepted TPT.There were statistically significant differences in the acceptance rate of TPT among different sexes,ages,educational levels,and occupations(P<0.05).The main barriers to TPT acceptance were misconceptions that it had uncertain effects on prevention(57.8%,517/894),and concerns about side effects(32.7%,292/894).Conclusion An enhanced and comprehensive understanding of LTBI and TPT among people with LTBI is vital to further expand TPT in China.Moreover,targeted policies need to be developed to address barriers faced by different groups of people.
基金Supported by The Science and Technology Innovation Program of Changde City.
文摘BACKGROUND Organizing pneumonia secondary to pulmonary tuberculosis is rare.Moreover,the temporal boundary between pulmonary tuberculosis and secondary organizing pneumonia has not been defined.We report a case of secondary organizing pneumonia associated with pulmonary tuberculosis occurring after nine months of antituberculosis treatment.CASE SUMMARY A 54 years old man,previously diagnosed with pulmonary tuberculosis and tuberculous pleurisy,underwent nine months of antituberculosis treatment.Follow-up lung computed tomography revealed multiple new subpleural groundglass opacities in both lungs,and a lung biopsy confirmed organizing pneumonia.Treatment continued with anti-tuberculosis agents and hormone therapy,and subsequent dynamic pulmonary computed tomography exams demonstrated improvement in lesion absorption.No disease recurrence was observed after corticosteroid therapy discontinuation.CONCLUSION When treating patients with active pulmonary tuberculosis,if an increase in lesions is observed during anti-tuberculosis treatment,it is necessary to consider the possibility of tuberculosis-related secondary organizing pneumonia,timely lung biopsy is essential for early intervention.
基金supported by International Joint Laboratory on Tropical Diseases Control in Greater Mekong Subregion(grant number 21410750200)from Shanghai Municipality Government.
文摘Background:Tuberculosis(TB),caused by Mycobacterium tuberculosis,remains the second leading cause of death from a single infectious disease globally and poses a significant economic and clinical burden in the world in 2022.Of particular concern is the emergence of drug-resistant TB,accounting for 15%-20%of TB deaths.It is imperative to delve into the global trends of incidence and death rate for multidrug-resistant tuberculosis(MDRTB)and extensively drug-resistant tuberculosis(XDR-TB),drawing upon the comprehensive Global Burden of Disease(GBD)2021 drug-resistant tuberculosis dataset.Methods:From the GBD 2021,data on incidence,prevalence,disability-adjusted life years(DALYs),and death of MDR-TB and XDR-TB from 1990 to 2021 were collected.We calculated the estimated annual percentage changes in age standardized incidence rate(ASIR)and age-standardized death rate(ASDR),segmented by age,sex,and socio-demographic index(SDI).The impacts of various risk factors on MDR-TB and XDR-TB were also analyzed.Results:In 2021,there were an estimated 443,680(95%uncertainty interval[UI]:259,196-766,545)incident cases of MDR-TB,and an estimated 106,818(95%UI:41,612-211,854)death cases of MDR-TB,while there were an estimated 24,036(95%UI:17,144-34,587)incident cases of XDR-TB and 7,946(95%UI:3,326-14,859)death cases of XDR-TB.The incidence and death cases of MDR-TB were lowest in high SDI regions,whereas the incidence rates of XDR-TB in high-middle SDI regions were higher than those in middle SDI and high SDI regions.Conclusion:This study reported the disease burden of drug-resistant TB from 1990 to 2021.Until 2021,drugresistant TB is still a serious problem in low SDI countries,especially for high-risk age populations with highrisk factors.Controlling drug-resistant TB requires effective control strategies and healthcare systems.
文摘Latent tuberculosis infection(LTBI)has become a major source of active tuberculosis(ATB).Although the tuberculin skin test and interferon-gamma release assay can be used to diagnose LTBI,these methods can only differentiate infected individuals from healthy ones but cannot discriminate between LTBI and ATB.Thus,the diagnosis of LTBI faces many challenges,such as the lack of effective biomarkers from Mycobacterium tuberculosis(MTB)for distinguishing LTBI,the low diagnostic efficacy of biomarkers derived from the human host,and the absence of a gold standard to differentiate between LTBI and ATB.Sputum culture,as the gold standard for diagnosing tuberculosis,is time-consuming and cannot distinguish between ATB and LTBI.In this article,we review the pathogenesis of MTB and the immune mechanisms of the host in LTBI,including the innate and adaptive immune responses,multiple immune evasion mechanisms of MTB,and epigenetic regulation.Based on this knowledge,we summarize the current status and challenges in diagnosing LTBI and present the application of machine learning(ML)in LTBI diagnosis,as well as the advantages and limitations of ML in this context.Finally,we discuss the future development directions of ML applied to LTBI diagnosis.
文摘Objective:To investigate and compare the demographic characteristics,clinical findings,and laboratory results of pulmonary tuberculosis(PTB)and extrapulmonary tuberculosis(EPTB)patients,among Turkish citizens,and foreign nationals.Methods:This study included patients aged 18 and over,both Turkish citizens and foreign nationals,diagnosed with PTB or EPTB between 2016 and 2022.All patients were divided into PTB and EPTB group,and demographic characteristics,clinical findings,and laboratory results were compared.Patients with both PTB and EPTB were not included in the comparison.Multivariate logistic regression analysis was conducted to identify potential risk factors for PTB.Results:Among the 261 TB cases included,46 patients(17.6%)had PTB,and 188(72%)had EPTB.The percentage of female patients was significantly higher(P=0.003)in EPTB compared to PTB group.While the prevalence of diabetes mellitus(P=0.002),hypertension(P=0.017),coronary obstructive pulmonary disease(P=0.001),congestive heart failure(P=0.005),coronary artery disease(P=0.001)and immunosuppressive medication use(P=0.017)were significantly higher in PTB patients than in EPTB patients.Multivariate logistical analysis reveals that male(OR 2.6,95%CI 1.3-5.5,P=0.009),diabetes mellitus(OR 2.7,95%CI 1.2-6.1,P=0.015),and asthma(OR 6.3,95%CI 1.2-33.9,P=0.032)were associated with an increased risk of PTB.Social security coverage(P<0.001)and regular employment status(P<0.001)were found to be lower and the presence of multidrug resistance(P=0.002),isoniazid resistance(P=0.012),and rifampin resistance(P=0.012)were found to be significantly higher in foreign-national TB patients comparing with Turkiye citizens.Conclusions:Patients with PTB need to be evaluated for comorbidities and PTB should be investigated in men,in patients with diabetes mellitus or asthma if there are clinical findings suspicious for TB.TB screening for foreign nationals upon entry into the country is essential for TB control and elimination.
文摘In this editorial,we comment on the article by Ali et al published in the recent issue of the World Journal of Clinical Cases.This case report shed light on a particularly rare manifestation of this disease-primary gastrointestinal tuberculosis(GTB)presenting as gastric outlet obstruction.GTB presents diagnostic challenges due to its nonspecific symptoms and lack of highly accurate diagnostic algorithms.This editorial synthesizes epidemiological data,risk factors,pathogenesis,clinical presentations,diagnostic methods,and therapies to raise awareness about GTB.GTB constitutes 1%-3%of all tuberculosis cases globally,with 6%-38%of patients also having pulmonary tuberculosis.Pathogenesis involves various modes of Mycobacterium tuberculosis complex entry into the gastrointestinal system,with the terminal ileum and ileocecal valve commonly affected.Clinical presentation varies,often resembling other intra-abdominal pathologies,necessitating a high index of suspicion.Diagnostic tools include a combination of biochemical,microbiological,radiological,and endoscopic assessments.Antitubercular medication remains the cornerstone of treatment,supplemented by surgical intervention in severe cases.Multidisciplinary management involving gastroenterologists,surgeons,pulmonologists,and infectious disease specialists is crucial for optimal outcomes.Despite advancements,timely diagnosis and management challenges persist,underscoring the need for continued research and collaboration in addressing primary GTB.
文摘This editorial article takes an opportunity to apprehend the diagnostic challenges of primary gastrointestinal tuberculosis(an uncommon extrapulmonary tuberculosis condition)utilizing the recently published case report of a young male with prolonged gastrointestinal symptoms and weight loss who received intermittent anti-tubercular treatment and underwent operative interventions to relieve gastric outlet obstruction.The diagnosis chiefly relied on high-end examinations,like computed tomography scans and histopathological evaluation of postoperatively resected bowel tissue,which wasn't preceded by an all-inclusive stepwise primary pulmonary tuberculosis exclusion approach that usually begins with a detailed tuberculosis-pertinent history acquisition.Given the geographic locations where the patient had been(and/or treated),pivotal consideration of tuberculosis-associated endemicities in those regions,like human immunodeficiency virus(HIV)infection,might have improved the case description.The obtainment of HIV-relevant histories,like intravenous drug use and sexual practice,are good places to start.The sputum bacteriology also seems imperative to rule out atypical Mycobacterium species infection because of its clinico-radiohistopathological resemblance with pulmonary Mycobacterium tuberculosis.Altogether,this editorial aims to underscore that primary extrapulmonary tuberculosis diagnosis should comprise an elaborative,comprehensive,systematic,and stepwise primary pulmonary Mycobacterium tuberculosis exclusion workup.
文摘BACKGROUND Tuberculosis(TB)is a chronic respiratory infectious disease that considerably jeopardizes human health,and there is no effective vaccine suitable for its prevention in the entire population.AIM To investigate the promotion of medication adherence and disease cognition in patients with drug-resistant(DR-)TB using detailed nursing management.METHODS In total,114 patients with DR-TB who were diagnosed and treated at our hospital between January 2019 and January 2023 were included in this study.Patients in the control group(n=57)were managed with conventional nursing care,while those in the observation group(n=57)were managed with detailed nursing care.Medication adherence,disease awareness scores,medication safety,and nursing satisfaction were compared between the two groups after the intervention.RESULTS The post-intervention medication compliance rate was 91.23%in the observation group and 75.44%in the control group,with the former being 15.79%higher than the latter(P<0.05).There was no statistically significant difference in the disease awareness scores between the two groups before the intervention;the disease awareness scores of the observation group were significantly higher than those of the control group after the intervention(P<0.05).The incidence of gastrointestinal reactions,joint swelling and pain,hearing loss,electrolyte disorders,and liver and kidney function abnormalities were lower in the observation group than those in the control group.The total nursing satisfaction of the observation group was higher than that of the control group(P<0.05).CONCLUSION Implementation of detailed nursing management for patients with DR-TB can effectively improve medication adherence,enhance awareness of the disease,ensure safety of medication,and improve satisfaction with nursing care.
文摘Tuberculosis(TB)remains a huge global healthcare challenge even in the 21^(st) century though the prevalence has dropped in developed countries in recent decades.Diabetes mellitus(DM)is an important risk factor for the development and perpetuation of TB owing to the immune dysfunction in patients with DM.The coexistence of both diseases in the same individual also aggravates disease severity,complications,and chance of treatment failure because of gross immune alterations posed by DM as well as TB.Various complex cellular and humoral immunological factors are involved in the dangerous interaction between TB and DM,some of which remain unknown even today.It is highly important to identify the risk factors for TB in patients with DM,and vice versa,to ensure early diagnosis and management to prevent complications from this ominous coexistence.In their research study published in the recent issue of the World Journal of Diabetes,Shi et al elaborate on the factors associated with the development of TB in a large cohort of DM patients from China.More such research output from different regions of the world is expected to improve our knowledge to fight the health devastation posed by TB in patients with diabetes.
文摘Primate sanctuaries across Africa play a pivotal role in the rescue and rehabilitation of confiscated and rescued wild primates, many of whom have had extensive contact with humans prior to their arrival and throughout the rehabilitation process, heightening the risk of disease transmission. While tuberculosis is not naturally occurring in free-living chimpanzees, it has been extensively observed in captive primates that have been in close proximity to humans or other captive primates infected with Mycobacterium tuberculosis. This case report delves into an outbreak of extra-pulmonary tuberculosis among juvenile chimpanzees within a sanctuary, detailing the associated diagnostic challenges and treatment approaches. The five cases had close contact with a caregiver infected with tuberculosis, subsequently transmitting the infection to other in-contact chimpanzees. Prolonged treatment, employing the human protocol of quadri-therapy (rifampicin, isoniazid, pyrazinamide, and ethambutol), followed by bi-therapy (rifampicin and isoniazid), resulted in complete resolution for all five cases. These cases underscore the critical importance of maintaining high levels of biosecurity, implementing effective quarantine measures, and adhering to strict hygiene practices when working with non-human primates.
