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Laboratory Diagnostic Tests in the Evaluation of Fever
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
The Mantoux test should be carefully administered, with attention to use of proper antigens, injected intradermally. The extent of induration (not erythema) is determined 48 h after injection of 0.1 ml of purified protein derivative (5 tuberculin units). Reactivity of ≥10 mm is positive; 5 to 9 mm is “doubtful.” The tine test is useful for large scale testing, but is imprecise, expensive, and subject to false-positive reactions. All positive tine tests should be verified by Mantoux testing.
Changing “Unchangeable” Bodily Processes by (Hypnotic) Suggestions: A New Look at Hypnosis, Cognitions, Imagining, and the Mind-Body Problem
Published in Anees A. Sheikh, Imagination and Healing, 2019
The subject works at a hospital as a nurses’ aide. A few days prior to receiving a routine Mantoux test (a skin prick test utilizing old tuberculin for determining the possible presence of tuberculosis), she was told by a co-worker, “It’s really awful. They stick you with a needle a bunch of times, it really hurts terribly. …” Our subject said that, while her co-worker was describing the skin prick test, she clearly could feel the pain of the (imagined) needle puncturing her arm in a specific spot. She further related that she was later surprised to discover a skin reaction, a wheal, on the exact spot on her arm where she had imagined the skin pricks. The next day, she showed me the wheal, and it remained on her arm for almost a week.
Malaria, tuberculosis and other infectious diseases
Published in Théodore H MacDonald, Noël A Kinsella, John A Gibson, The Global Human Right to Health, 2018
European civilisation lived with tuberculosis for centuries, and indeed in many instances Europeans spread the disease to areas of the less developed world that had never had it before. In Victorian times it was commonplace, especially among the poor, in large cities such as London, Paris and New York. Often referred to as ‘consumption’, it was long after the discovery of the bacterium responsible (Mycobacterium tuberculosis) that medical scientists in the developed world finally worked out how to treat it and prevent it. Starting in the 1930s and 1940s, most of the developed-world nations undertook the use of mass X-ray campaigns in schools, etc., and the use of BCG vaccination and the Mantoux test were hugely effective in dramatically reducing the incidence of TB in the developed world. The BCG vaccine is a preparation of attenuated Mycobacterium bacilli that, once injected into a healthy person, causes immunity to further infection. The letters BCG stand for ‘bacillus of Chalmette and Guérin’, referring to the two discoverers of the vaccine. The Mantoux test is a skin test which shows whether the person is already naturally immune or whether they need the BCG vaccination for protection.
Adjunctive Intravitreal Anti-vascular Endothelial Growth Factor and Moxifloxacin Therapy in Management of Intraocular Tubercular Granulomas
Published in Ocular Immunology and Inflammation, 2023
Manisha Agarwal, Chanda Gupta, K Varsha Mohan, Pramod K Upadhyay, Aditi Dhawan, Vivek Jha
A total of 10 eyes of 10 patients were included in the study. Eight patients were females and 2 patients were males. The mean age of presentation was 25.9 ± 12.27 years (5–51 years). There was a past history of pulmonary tuberculosis in 6 out of 10 patients. Left eye was affected in 7 out of 10 patients. Anterior uveitis (SUN classification)14 was present in 6 patients. Varying grades of vitritis was found in all the patients. Eight patients presented with a choroidal granuloma and two patients with optic nerve head (ONH) granuloma. Multiple patches of choroiditis extending till the equator were noted along with ONH granuloma in one patient. Exudative RD with SRF was found in 8 patients. Eight patients reported a positive Mantoux test. CECT chest was suggestive of active pulmonary TB in seven patients. PCR detected Mtb genome in four aqueous samples and one vitreous sample. Four drug ATT was started in five patients and in the other five patients the ongoing ATT was continued, for a minimum duration of 9 months (9–12 months) (Table 2).
Role of Endoscopic Ultrasound in the Management of Tubercular Uveitis
Published in Ocular Immunology and Inflammation, 2018
Deepa Sharma, Manisha Agarwal, Vikas Singla, Vivek Jha, Ankita Shrivastav
This is a prospective interventional case series of 30 consecutive patients suspected of having tubercular uveitis conducted at a tertiary eye care hospital in North India from November 2013 to June 2016. The study complies with the declaration of Helsinki and was approved by the institutional review board. Data recorded included age, gender, history, and ocular complaints. Details of ophthalmic evaluation included best corrected visual acuity (BCVA), slit lamp examination, and detailed fundus evaluation. The patients underwent detailed systemic examination. All the patients underwent routine investigations, including Mantoux test, erythrocyte sedimentation rate (ESR) and contrast-enhanced computed tomography (CECT)-chest. Mantoux test was performed with intradermal injection of five tubercular units of purified protein derivative (PPD) in all patients and the result was interpreted as per the national TB guidelines in India.7 A positive test was taken as induration >10 mm and strongly positive if induration was >20 mm in immunocompetent individuals.
Clinical Profile of Patients with Tubercular Subretinal Abscess in a Tertiary Eye Care Center in Southern India
Published in Ocular Immunology and Inflammation, 2018
Parthopratim Dutta Majumder, Jyotirmay Biswas, Nishat Bansal, Avirupa Ghose, Hitesh Sharma
A total of 12 eyes of 12 patients were included in the study. Seven patients were male (58.33%), five patients were female (41.67%). The mean age of presentation was 29.75 ± 16.72 years (range: 14–62 years). All the patients had uniocular involvement. A history of pulmonary tuberculosis was found in five patients. Anterior chamber reaction was present in nine eyes (75%) and one eye had scleritis at presentation. Varying degrees of vitreous inflammation was observed in all the eyes. One eye had subretinal exudates (8.33%). Retinal vasculitis was present in one eye (8.33%) and exudative retinal detachment (RD) in four eyes (33.33%). Choroiditis patches were observed in two eyes (16.67%). Choroidal granuloma was noted in seven eyes along with the subretinal abscess (58.33%). A Mantoux test was positive in seven patients (58.33%). Interestingly, the QuantiFERON TB gold test was positive in only one patient. The chest X-ray was suggestive of pulmonary tuberculosis in eight patients (66.67%). Serum ACE was elevated in two patients (16.67%), though this can be a nonspecific response to systemic infection. PCR from aqueous aspirate was carried out in 11 eyes, of which six eyes were positive for the Mycobacterium tuberculosis genome (54.54%). Vitreous biopsy was positive in 4 of 7 patients (57.14%) (see Table 1).