Digital Commons Network^™

Clinical Care Of Incarcerated People With Hiv, Viral Hepatitis, Or Tuberculosis, Josiah D. Rich, Curt G. Beckwith, Alexandria Macmadu, Brandon D L Marshall, Lauren Brinkley-Rubinstein, Joseph J. Amon, M-J Milloy, Maximilian R F King, Jorge Sanchez, Lukoye Atwoli

Internal Medicine, East Africa

The burden of HIV/AIDS and other transmissible diseases is higher in prison and jail settings than in the non-incarcerated communities that surround them. In this comprehensive review, we discuss available literature on the topic of clinical management of people infected with HIV, hepatitis B and C viruses, and tuberculosis in incarcerated settings in addition to co-occurrence of one or more of these infections. Methods such as screening practices and provision of treatment during detainment periods are reviewed to identify the effect of community-based treatment when returning inmates into the general population. Where data are available, we describe differences in the …

Cerebral Aspergillosis And Pulmonary Tuberculosis In A Child With Chronic Granulomatous Disease, Muhammad Waqas, Sidra Zafar, Tooba Rehman, Muhammed Riyaz, Muhammad Ehsan Bari, Romana Idress

Section of Neurosurgery

Background: Chronic granulomatous disease (CGD) is an immune disorder that affects phagocytes. It is characterized by recurrent or persistent bacterial and fungal infections. Reports of tuberculosis (TB) in patients with CGD are rare. In developing countries, where TB is endemic, possibility of other chronic infections is often overlooked by physicians.
Case description: We report the case of a 4-year-old boy who had recurrent respiratory infections and episodes of headache. He was put on antituberculosis (ATT) drugs without microbiological or pathological evidence 2 months prior to presentation. The child did not improve and was brought to our hospital where a computed …

Isolated Gastric Tuberculosis Mimicking, W. Memon, Saad Siddiqui

Department of Radiology

No abstract provided.

Isolated Gastric Tuberculosis Mimicking Malignancy, Wasim Memon, Saad Siddiqui

Department of Radiology

Isolated tuberculosis of upper gastrointestinal tract is a rare pathology, often mimicking malignancy in clinical presentation and radiological features. We present a case of middle aged gentleman with isolated tuberculosis of stomach, proven on histopathology and showing remarkable improvement on follow up.

Omental Infarction In A Child, Saad Siddiqui, Anwar Ahmed, Naila Nadeem

Department of Radiology

Omental infarction is a rare cause of acute abdomen in children. Typical findings on imaging establish the diagnosis. We present case of a 7 years old boy who presented with acute right iliac fossa pain with diagnosis of omental infarction on imaging and findings confirmed on laparotomy. Sound knowledge regarding this infrequent cause of acute abdomen in children is necessary for timely diagnosis.

Mycobacterium Tuberculosis Lineage 4 Comprises Globally Distributed And Geographically Restricted Sublineages, David Stucki, Daniela Brites, Leïla Jeljeli, Mireia Coscolla, Gunturu Revathi

Pathology, East Africa

Generalist and specialist species differ in the breadth of their ecological niches. Little is known about the niche width of obligate human pathogens. Here we analyzed a global collection of Mycobacterium tuberculosis lineage 4 clinical isolates, the most geographically widespread cause of human tuberculosis. We show that lineage 4 comprises globally distributed and geographically restricted sublineages, suggesting a distinction between generalists and specialists. Population genomic analyses showed that, whereas the majority of human T cell epitopes were conserved in all sublineages, the proportion of variable epitopes was higher in generalists. Our data further support a European origin for the most …

Fluoroquinolone-Resistant Tuberculosis: Implications In Settings With Weak Healthcare Systems, Kauser Jabeen, Sadia Shakoor, Rumina Hasan

Department of Pathology and Laboratory Medicine

Fluoroquinolones (FQ) play an essential role in the treatment and control of multidrug-resistant tuberculosis (MDR-TB). They are also being evaluated as part of newer regimens under development for drug-sensitive TB. As newer FQ-based regimens are explored, knowledge of FQ resistance data from high TB burden countries becomes essential. We examine available FQ resistance data from high TB burden countries and demonstrate the need for comprehensive surveys to evaluate FQ resistance in these countries. The factors driving FQ resistance in such conditions and the cost of such resistance to weak healthcare systems are discussed. The need for a comprehensive policy for …

Interplay Of Chemo Attractant Peptides (Cathelicidin And Chemerin) With Vitamin-D In Patients With Pulmonary Tuberculosis, Najeeha Talat Iqbal, Syeda Sadia Fatima, Rabia Hussain, Nisar Ahmed Rao, Narius Virji, Bushra Jamil, Muhammad Irfan

Department of Paediatrics and Child Health

Aim: Both Cathelicidin and Chemerin are chemoattractant proteins and possess antimicrobial activity.Sufficient level of Vitamin D is important for optimum response of Cathelicidin for its antimycobacterial activity. Studies on the role of these antimicrobial peptides and their relationship withVitamin D level are limited in tuberculosis. The aim of this study was to investigate an associationof Vitamin D with antimicrobial peptide (Cathelicidin) and an adipokine (Chemerin) in patients with pulmonary tuberculosis (TB). Methods: In a case control study we estimated level of Vitamin D, Chemerin, Cathelicidin and TNFα in pulmonary TB patients (n=22) and healthy endemic controls (n=17) using sandwich ELISA …

Drug Resistant Tuberculosis: Challenges Of Urbanization, Rumina Hasan

Department of Pathology and Laboratory Medicine

No abstract provided.

Community Based Interventions For The Prevention And Control Of Tuberculosis, Ahmed Arshad, Rehana A. Salam, Zohra S. Lassi, Jai K. Das, Imama Naqvi, Zulfiqar A. Bhutta

Department of Paediatrics and Child Health

In 2012, an estimated 8.6 million people developed tuberculosis (TB) and 1.3 million died from the disease. With its recent resurgence with the human immunodeficiency virus (HIV); TB prevention and management has become further challenging. We systematically evaluated the effectiveness of community based interventions (CBI) for the prevention and treatment of TB and a total of 41 studies were identified for inclusion. Findings suggest that CBI for TB prevention and case detection showed significant increase in TB detection rates (RR: 3.1, 95% CI: 2.92, 3.28) with non-significant impact on TB incidence. CBI for treating patients with active TB showed an …

Daily Contact With A Patient And Poor Housing Affordability As Determinants Of Pulmonary Tuberculosis In Urban Pakistan, Batool A. Haider, Saeed Akhtar, Juanita Hatcher

Community Health Sciences

Objective: This study aimed to evaluate the factors associated with pulmonary tuberculosis (TB) among individuals aged 15years or more in urban Karachi, Pakistan.DESIGN AND SETTING: A case-control design was implemented in three major tertiary-care hospitals to select cases (n=342) with active pulmonary TB (i.e. two sputum smears positive for Mycobacterium tuberculosis with clinical and radiographic evidence of current pulmonary TB and diagnosed between August 2002 and October 2003. Selected controls (n=342) were surgery patients from the same hospitals at time of recruitment of the cases, without clinical and radiographic evidence of pulmonary TB.Results: Multivariable logistic regression model showed that daily …

Histologic Findings In Biopsies/Resection Specimens From The Small Intestine With Special Emphasis On Celiac Disease: Experience From A Developing Country In South Asia, Huma Arshad, Zubair Ahmad

Department of Pathology and Laboratory Medicine

Biopsies from the small intestine especially the duodenum are now being performed much more frequently than in the past. The most frequent reason for performing duodenal biopsies is to evaluate for malabsorption. In the last few years, increased awareness has resulted in more biopsies sent for evaluation of malabsorption, especially celiac disease (CD). In the duodenum, features of malabsorption (increased intraepithelial lymphocytes, villous shortening, and atrophy) were the most common histologic finding seen in 63.4% of cases. Serum tTG levels were available for correlation in 52.8% of cases. In patients with confirmed CD, 53.4% were MARSH IIIb, and 29.5% were …

Line Probe Assay For Detection Of Rifampicin And Isoniazid Resistant Tuberculosis In Pakistan, Joveria Qais Farooqi, Erum Khan, Syed Muhammed Zaheer Alam, Asho Ali, Zahra Hasan, Rumina Hasan

Department of Pathology and Laboratory Medicine

Objective:
To assess the efficacy of a line-probe assay delta (LiPA) as rapid diagnostic test for early detection of drug-resistant tuberculosis compared to conventional susceptibility methods in Pakistan.
Methods:
Resistance to rifampicin (RIF) and isoniazid (INH) in 108 smear-positive pulmonary tuberculosis samples was detected using a line-probe assay [GenoType MTBDRplus (Hain Lifescience, GmbH, Nehren, Germany)] at the clinical microbiology laboratory of Aga Khan University Hospital in May, 2009. Results were compared with susceptibilities performed while using agar proportion.
Results:
In comparison to the agar proportion method, the detection rate and specificity of resistance using MTBDR plus was 92.5% and 98.2% …

Laryngeal Tuberculosis Presenting As Laryngeal Carcinoma, Anwar Suhail, Muhammad Sheharyar Ahmed, Zain-Ul-Abdeen Sobani, Shahzad Ghaffar

Section of Otolaryngology, Head & Neck Surgery

Tuberculosis (TB) accounts for the highest number of mortalities among infectious diseases worldwide. Laryngeal TB is an extremely rare presentation of TB. It has many similarities to laryngeal carcinoma, one of the three most common cancers among males in the city, with an age standardized rate of 8.6. The associated risk factors of laryngeal carcinoma i.e. smoking, paan, betel nut usage and alcohol use also tend to be concentrated in the same demographic background as that of TB, creating a diagnostic dilemma. We present a case of granulomatous laryngeal TB, in a 40 year old male, with characteristic presenting features …

Resistance Patterns Of Mycobacterium Tuberculosis Isolates From Pulmonary Tuberculosis Patients In Nairobi, Perpetual Wangui Ndung’U, Samuel Kariuki, Zipporah Ng’Ang’A, Gunturu Revathi

Pathology, East Africa

Introduction: In Kenya, which ranks thirteenth of 27 high tuberculosis burden countries, diagnosis is based on Ziehl-Neelsen staining alone and patients are treated without information on sensitivity patterns. This study aimed to determine resistance patterns of Mycobacterium tuberculosis isolated from pulmonary samples.

Methodology: Pulmonary tuberculosis patients in Nairobi were randomly sampled after informed consent and recruited into the study using a structured questionnaire. Specimens were cultured in liquid and solid media, and drug susceptibility tests were performed for first-line drugs including (isoniazid, rifampin, streptomycin, ethambutol and pyrazinamide).

Results: Eighty-six (30%) of 286 isolates were resistant to at least one of …

Presence Of Rd149 Deletions In M. Tuberculosis Central Asian Strain 1 Isolates Affect Growth And Tnfalpha Induction In Thp-1 Monocytes., Akber Kanji, Zahra Hasan, Mehnaz Tanveer, Raunaq Mahboob, Sana Jafri, Rumina Hasan

Department of Pathology and Laboratory Medicine

Central Asian Strain 1 (CAS1) is the prevalent Mycobacterium tuberculosis genogroup in South Asia. CAS1 strains carry deletions in RD149 and RD152 regions. Significance of these deletions is as yet unknown. We compared CAS1 strains with RD149 and concurrent RD149-RD152 deletions with CAS1 strains without deletions and with the laboratory reference strain, M. tuberculosis H37Rv for growth and for induction of TNFα, IL6, CCL2 and IL10 in THP-1 cells. Growth of CAS1 strains with deletions was slower in broth (RD149; p = 0.024 and RD149-RD152; p = 0.025) than that of strains without deletions. CAS1 strains with RD149 deletion strains …

Treatment Outcome Of Multi-Drug Resistant Tuberculosis Treated As Outpatient In A Tertiary Care Center, Zeeshan Waheed, Muhammad Irfan, Ahmed Suleman Haque, Muhammad Owais Khan, Atif Zubairi, Noor Ul Ain, Javaid A. Khan

Section of Pulmonary & Critical Care

INTRODUCTION: Community-based out-patient treatment for multidrug-resistant tuberculosis (MDR TB) is relatively new concept with reported successful outcomes.

OBJECTIVE: To assess the treatment outcomes of HIV negative multidrug-resistant tuberculosis (MDR TB) patients treated as outpatient at a tertiary care center in Karachi, Pakistan.

METHODS: A retrospective observational study of 53 consecutive, culture proven HIV negative MDR TB patients (resistant at least to both Isoniazid (H) and Rifampin(R) treated at Aga Khan University Hospital, Karachi between August 1999 and March 2007. Data were collected on predesigned performa regarding patient’s demography, clinical features, radiological findings, drug sensitivity, treatment and outcome.

RESULTS: A total …

Ccl2 Responses To Mycobacterium Tuberculosis Are Associated With Disease Severity In Tuberculosis, Zahra Hasan, Jacqueline M. Cliff, Hazel M. Dockrell, Bushra Jamil, Muhammad Irfan, Mussarat Ashraf, Rabia Hussain

Section of Pulmonary & Critical Care

Background

Leucocyte activating chemokines such as CCL2, CCL3, and CXCL8 together with proinflammatory IFNγ, TNFα and downmodulatory IL10 play a central role in the restriction of M. tuberculosis infections, but is unclear whether these markers are indicative of tuberculosis disease severity.

Methodology

We investigated live M. tuberculosis- and M. bovis BCG- induced peripheral blood mononuclear cell responses in patients with tuberculosis (TB) and healthy endemic controls (ECs, n = 36). TB patients comprised pulmonary (PTB, n = 34) and extrapulmonary groups, subdivided into those with less severe localized extrapulmonary TB (L-ETB, n = 16) or severe disseminated ETB (D-ETB, …

Esat6-Induced Ifngamma And Cxcl9 Can Differentiate Severity Of Tuberculosis., Zahra Hasan, Bushra Jamil, Mussarat Ashraf, Muniba Islam, Muhammad S Yusuf, Javaid A Khan, Rabia Hussain

Department of Pathology and Laboratory Medicine

Background: Protective responses against Mycobacterium tuberculosis are dependent on appropriate T cell and macrophage activation. Mycobacterial antigen six kDa early secreted antigenic target (ESAT6) and culture filtrate protein 10 (CFP10) can detect M. tuberculosis specific IFNgamma responses. However, most studies have been performed in non-endemic regions and to study pulmonary tuberculosis (PTB). We have studied ESAT6 and CFP10 induced cytokine and chemokines responses in PTB and extrapulmonary (EPul) TB.
Methodology: IFNgamma, IL10, CXCL9 and CCL2 responses were determined using an ex vivo whole blood assay system in PTB (n = 30) and EPulTB Patients with limited (LNTB, n = …

Cytokine Gene Polymorphisms Across Tuberculosis Clinical Spectrum In Pakistani Patients., Ambreen Ansari, Najeeha Talat, Bushra Jamil, Zahra Hasan, Tashmeem Razzaki, Ghaffar Dawood, Rabia Hussain

Department of Pathology and Laboratory Medicine

Background:Pakistan ranks 7(th) globally in terms of tuberculosis (TB) disease burden (incidence 181/100000 pop./yr, prevalence of 329/pop./yr). Reports from different populations show variable associations of TB susceptibility and severity with cytokine gene polymorphisms. Tuberculosis clinical severity is multi-factorial and cytokines play a pivotal role in the modulation of disease severity. We have recently reported that the ratio of two key cytokines (IFNgamma and IL10) show significant correlation with the severity spectrum of tuberculosis. The objective of the current study was to analyze the frequency of cytokine gene polymorphisms linked to high and low responder phenotypes (IFNgamma +874 T(hi)-->A(lo) …

Public Private Mix Model In Enhancing Tuberculosis Case Detection In District Thatta, Sindh, Pakistan, Jameel Ahmed, Mubashir Ahmed, A Laghari, Wasdev Lohana, Sajid Ali, Zafar Fatmi

Community Health Sciences

To enhance the TB case detection through Public Private Mix (PPM) model by involving private practitioners in collaboration with National TB Control Program, (NTP) in district Thatta. Private practitioners (PPs) of district Thatta involved in treatment of TB cases were requested to participate in the study. All consenting physicians were provided with training on Directly Observed Treatment Short course (DOTS) module. In addition to routine cases, TB cases diagnosed by private practitioners through sputum microscopy were also registered with the district TB control program and medicines were provided by NTP. After intervention of PPM-DOTS change in Case Detection Rate (CDR) …

A Case Of Histoplasmosis Mimicking Tuberculosis, Asim Qureshi

Department of Pathology and Laboratory Medicine

Drug resistance to Tuberculosis is an emerging problem but proper exhaustive workup needs to be done before confirming the diagnosis. The case of a 5 year old male child who presented with low grade fever and lymphadenopathy and was being treated with anti TB drugs with no satisfactory response is presented. A detail workup including a biopsy gave the diagnosis of histoplasmosis.

Knowledge, Attitude And Misconceptions Regarding Tuberculosis In Pakistani Patients, Javaid Ahmed Khan, Muhammad Irfan, Amna Zaki, Madiha Beg, Syed Fayyaz Hussain, Nadeem Rizvi

Section of Pulmonary & Critical Care

Objective:

To assess knowledge of patients with tuberculosis; about their disease and misconceptions regarding TB.

Methods:

A cross sectional study was conducted at Out-patient clinics of two teaching hospitals (private and public) in Karachi, Pakistan. A questionnaire was filled for the purpose.

Results:

A total of 170 patients were interviewed, 112 from private and 58 from a public sector hospital. Cough, fever, bloody sputum and chest pain were recognized as the common symptoms of TB. Eleven (7%) patients thought TB was not an infectious disease and 18 (10.6%) did not consider it a preventable disease. Contaminated food was considered the …

Broncho Alveolar Carcinoma (B.A.C.), Ahmed N. Abbasi, Muhammad Irfan, Syed Arsalan Raza

Section of Pulmonary & Critical Care

No abstract provided.

Elevated Ex Vivo Monocyte Chemotactic Protein-1 (Ccl2) In Pulmonary As Compared With Extra-Pulmonary Tuberculosis, Zahra Hasan, Irfan Zaidi, Bushra Jamil, M Aslam Khan, Akber Kanji, Rabia Hussain

Department of Pathology and Laboratory Medicine

Background: Tuberculosis causes 3 million deaths annually. The most common site of tuberculosis is pulmonary however; extra-pulmonary forms of the disease also remain prevalent. Restriction of Mycobacterium tuberculosis depends on effective recruitment and subsequent activation of T lymphocytes, mononuclear and polymorphonuclear cells to the site of infection. Tumor necrosis factor (TNF)-α is essential for granuloma formation and is a potent activator of monocyte chemotactic protein (MCP-1, CCL2). CCL2 is essential for recruitment of monocytes and T cells and has been shown to play a role in protection against tuberculosis. Interleukin -8 (CXCL8) is a potent activator of neutrophils. Increased …

Patterns Of Tuberculosis In The Central Nervous System, Soobia Raza, Aliyah Sadaf, Faisal Fecto, Rushna Pervez Ali, Muhammad Ehsan Bari, Ather Enam

Medical College Documents

Tuberculous involvement of central nervous system (CNS), although not very frequent, results in severe morbidity. Tuberculosis (TB) is endemic in developing countries but even in developed countries, after an initial decline up until 1980’s, incidence of TB is on the rise. The AIDS epidemic, emergence of multi-drug resistant strains and immigration of people from endemic areas are some of the factors significantly contributing to this increase. Consequently, the burden of central nervous system tuberculosis has increased significantly worldwide.

Socio-Economic And Diagnostic Aspects Of Tuberculosis In Pakistan, Saba Sohail

Department of Radiology

No abstract provided.

Bilateral Cervical Radiculopathy As A Presentation Of Spinal Tuberculosis: Report Of Two Cases, G R. Sharma, Rashid Jooma

Section of Neurosurgery

No abstract provided.

Localized Tuberculosis And Myelofibrosis With Myeloid Metaplasia : An Extremely Unusual Presentation, Suhail Muzaffar

Department of Pathology and Laboratory Medicine

Myelofibrosis with myeloid metaplasia (MMM) is usually considered primary agnogenic, however, it may be secondary to various diseases, The association of tuberculosis with MMIM is exceedingly rare, however, the pathogenetic relationship between the two is difficult to define. We present a case report showing simultaneous presentation of localized active tuberculosis and MMM The literature on the subject is also reviewed with special emphasis on pathogenic relation­ship between the two.

Endobronchial Tuberculosis Simulating Bronchial Asthma, J A. Khan, N Islam, J Akhter, S F. Hussain

Section of Pulmonary & Critical Care

No abstract provided.