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Bacterial, Mycobacterial, and Spirochetal (Nonvenereal) Infections
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Laboratory studies: A skin biopsy will reveal granulomas, consisting of giant cells with central caseating necrosis. These contain acid-fast bacilli that can be detected by tissue staining, culture, and polymerase chain reaction. Chest x-rays and sputum cultures are indicated to detect pulmonary tuberculosis. Interferon gamma release assays (Quantiferon) are serum blood tests that can measure a person’s immune reactivity to tuberculosis. A positive result need not necessarily indicate active infection but could also be due to latent tuberculosis.
Respiratory Infections
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
If available, order FBC, renal profile, liver profile, CRP or erythrocyte sedimentation rate (ESR), clotting. Mantoux/tuberculin skin tests (TSTs) and IFN gamma release assays (QuantiFERON®-TB Gold In-Tube test (QFT-GIT) have a role in identifying latent but not active TB. Any patient with suspected TB should have an HIV test, as well as hepatitis B virus (HBV) and hepatitis C virus (HCV). Check vitamin D levels, as deficiency can affect cell-mediated immunity. Chest x-ray may show hilar lymphadenopathy, pleural effusions, consolidation, cavitation and military findings. A normal chest x-ray does not preclude a diagnosis of TB with the right syndrome. If the patient is expectorating, three samples of sputum should be sent for smear (acid-fast bacilli [AFB] or Ziehl-Neelsen [ZN] stain) and mycobacterial culture and sensitivities (takes 4–6 weeks and requires a specialist laboratory); as such, if suspected, refer to a local TB centre where induced sputum or bronchoscopy and the ability to investigate sites of extrapulmonary TB may be available, for example, lymph node aspirates and cerebrospinal fluid (CSF). Newer diagnostics are being rolled out by the WHO; these include molecular tests (e.g. Cepheid Xpert MTB/RIF) that detect Mycobacterium tuberculosis (MTB) DNA and can indicate the presence of mutations that confer rifampicin resistance, which could indicate MDR or XDR TB.
Adalimumab
Published in John Y. M. Koo, Ethan C. Levin, Argentina Leon, Jashin J. Wu, Alice B. Gottlieb, Moderate to Severe Psoriasis, 2014
Maya G. Debbaneh, John Y. M. Koo
Patients must be evaluated for latent tuberculosis infection with a tuberculin skin test or quantiferon gold blood test prior to therapy and, if positive, a chest radiograph should be obtained to rule out active infection. Treatment of latent tuberculosis should be initiated under guidelines by the Centers for Disease Control before beginning adalimumab therapy. To date, there is no established guideline regarding how long a patient must be receiving antituberculosis prophylactic therapy prior to initiation of adalimumab. Patients with initial negative tuberculin skin tests should receive continued monitoring for tuberculosis throughout treatment; patients who develop persistent cough, weight loss, malaise, or low-grade fever should be evaluated for active tuberculosis. Adalimumab should be used with caution in patients who have resided in regions where tuberculosis is endemic. Recommendations for monitoring are discussed here.
Clinical presentation of peritoneal tuberculosis
Published in Baylor University Medical Center Proceedings, 2023
Nazli Begum Ozturk, Christos Tsagkaris, Naile Dolek, Raim Iliaz
Laboratory tests showed a mild anemia, with a hemoglobin of 13.0 g/dL (reference range, 13.1–17.2 g/dL), erythrocyte sedimentation rate of 34 mm/h (0–15 mm/h), and C-reactive protein of 34.46 mg/L (<5 mg/L). Abdominal ultrasound revealed the presence of free abdominal fluid and diffuse heterogeneous granular liver parenchyma, supporting the diagnosis of chronic liver disease. Liver tests were within normal limits, and tests for hepatitis A, B, and C and HIV were negative. A diagnostic paracentesis showed a serum ascites albumin gradient (SAAG) of 0.2 g/dL and ascitic fluid white blood cells of 1.70 × 103 cells/dL (91.8% lymphocytes). Ascitic fluid cytology was negative for malignant cells. An ascitic fluid acid-fast bacilli (AFB) test and mycobacterial culture were negative. The adenosine deaminase (ADA) level in ascitic fluid was elevated at 108.5 U/L (0–40 U/L). The Quantiferon test was positive.
Empyema necessitans as a rare manifestation of Aspergillus fumigatus infection
Published in Baylor University Medical Center Proceedings, 2022
Juthipong Benjanuwattra, Natnicha Leelaviwat, Cynthia Guerin, Parth U. Patel, Poemlarp Mekraksakit, Kenneth Nugent
Laboratory testing showed leukocytosis (14.36 × 103 cells/µL), thrombocytosis (705 × 103 cells/µL), and an elevated erythrocyte sedimentation rate (130 mm/h) and C-reactive protein (16.1 mg/dL). Computed tomography (CT) of the chest showed a right upper posterior pleural-based mass extending into the right paraspinal region and a small right pleural effusion (Figure 1). Ultrasound-guided biopsy of the pleural mass showed chronic granulomatous inflammation with abscess formation. Fine-needle aspiration of the paraspinal mass revealed extensive infiltration of lymphoid and plasma cells. Pancytokeratin staining was negative. The initial workup for fungal infection, including Histoplasma capsulatum, Cryptococcus spp., Coccidioides spp., and serum β-D-glucan, was negative. The fungus and mycobacterial stains from biopsied tissue were negative. The tuberculin skin test and QuantiFERON test were also negative. An empiric quadruple regimen of antituberculosis agents was initiated; however, he was later rehospitalized with persistent fever and intractable back pain. Repeat CT showed an enlarging paraspinal mass with osseous erosion at T4–T5. He underwent video-assisted thoracoscopic surgery, including drainage, decortication, pleural and rib debridement, biopsy, and intercostal tube placement. The pathology report showed a granulomatous abscess with positive PAS/Light Green Stain for fungus. The final culture grew A. fumigatus complex. He was given intravenous and then oral voriconazole, which was later switched to isavuconazole due to hepatotoxicity.
Pattern of Recurrent Inflammation following Anti-tubercular Therapy for Ocular Tuberculosis
Published in Ocular Immunology and Inflammation, 2022
Prabhjot Kaur Multani, Rohit Modi, Soumyava Basu
Tuberculosis (TB) has been widely recognized as an etiology for intraocular inflammation, in endemic as well as non-endemic countries.1–3 Ocular TB (OTB) manifests in various forms affecting different anatomical compartments of the eye. These include anterior and intermediate uveitis, various forms of posterior uveitis, panuveitis, and optic neuritis.4 The current guidelines for the diagnosis of tubercular etiology in these clinical presentations typically require demonstration of ancillary evidence of systemic TB infection, such as tuberculin skin test (TST), Quantiferon TB-Gold test (QFT), or chest radiography; and the exclusion of non-TB entities. Direct evidence of Mycobacterium tuberculosis (Mtb) such as culture, microscopy, or amplification of Mtb DNA by polymerase chain reaction is rarely found in ocular fluid samples.