Tuberculosis
Keith Struthers in Clinical Microbiology, 2017
With the Mantoux test, PPD is injected into the dermis of the anterior forearm (Figure 9.12a). The degree of hypersensitivity is determined by examining the injection site 48–72 hours later (Figure 9.12b). As previous BCG vaccination can give a positive result, the response to PPD is most useful in patients who have not been vaccinated. A reaction of >15 mm identifies individuals who are certainly infected and who need further investigation, and this would include a chest X-ray. Those individuals who have no reaction to PPD have not come into contact with the organism, or they could be in the early stages of primary exposure, before DTH develops. In the setting of exposure to a case of TB, it is these latter individuals who could be offered prophylaxis with INH for 6 months.
Medicine
Seema Khan in Get Through, 2020
For each patient below, choose the SINGLE most likely diagnosis from the list of options. Each option may be used once, more than once or not at all. A 50-year-old man presents with distal sensory neuropathy affecting the lower limbs in a ‘stocking’ distribution and is noted to have Charcot’s joints. The ankle reflex is absent.A 55-year-old man who drinks heavily presents with numbness and paraesthesiae in his feet. He complains of ‘walking on cotton wool’.A 40-year-old man, who is being treated with chemotherapy for lymphoma, presents with peripheral paraesthesiae, loss of deep tendon reflexes and abdominal bloating.A 45-year-old woman presents with peripheral neuropathy. There is bilateral hilar gland enlargement on the chest radiograph. The Mantoux test is negative. She also suffers from polyarthralgia and has tender, red, raised lesions on her shin.A 25-year-old man presents with paraesthesiae followed by a flaccid paralysis of his limbs and face. He has a history of a recent upper respiratory tract infection.
Control of Tuberculosis in Low-Incidence Countries
Peter D O Davies, Stephen B Gordon, Geraint Davies in Clinical Tuberculosis, 2014
The two main methods for testing for latent infection include TST and IGRA. TST has been the main diagnostic tool for latent TB infection over the past century. The Mantoux test is used most commonly in low-incidence countries. In the past, other alternatives such as the Tine, Pirquet and Heaf tests have been used. France and the United States use five tuberculin units (TU) purified protein derivative S (PPD-S), while most European countries use the WHO recommended five TU PPD RT-23. This difference in tests complicates international comparison studies due to the differing performance characteristics of the tests. The main limitations of the Mantoux test relate to its cross-reactivity with BCG and non-tuberculous mycobacteria. The sensitivity of TST is also limited by HIV infection and has reduced utility in very young children. Due to its low specificity, the use of TST to detect latent TB infection should be limited to individuals at high risk of infection and those who would benefit from treatment [66].
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).
Culture and Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) Proven Mycobacterium Tuberculosis Endophthalmitis: A Case Series
Published in Ocular Immunology and Inflammation, 2018
Ekta Rishi, Pukhraj Rishi, K. Lily Therese, Gayathri Ramasubban, Jyotirmay Biswas, Tarun Sharma, Pramod Bhende, Pradeep Susvar, Mamta Agarwal, Amala Elizabeth George, Kushal Delhiwala, Vishal Rajan Sharma
Ocular TB with myriad presentations precludes diagnosis based on the clinical signs and symptoms alone. There has been a report of tuberculosis-induced endophthalmitis being misdiagnosed as non-infectious uveitis and treated accordingly.12 Four patients in our case series were young and immunocompetent and 3 out of 4 had negative tuberculin sensitivity test; all of these patients were being treated with systemic steroids and other systemic drugs (antivirals and immunosuppressives) (Table 1). There have been recorded instances in the literature where certain patients had a ‘negative’ Mantoux test in spite of concurrent pulmonary and ocular tuberculosis.13 In one of the published adult series of miliary tuberculosis, the tuberculin test was positive only in 32% of cases, while in another series it was negative in 54% of cases.14,15 Quantiferon TB gold test and Mantoux are nonspecific for ocular TB as these tests are more significant in latent TB and may be negative in active infection or in patients with immunosuppression.16,17
Acute Retinal Necrosis as a presenting ophthalmic manifestation in COVID 19 recovered patients
Published in Ocular Immunology and Inflammation, 2021
Aniruddh Soni, Raja Narayanan, Mudit Tyagi, Akash Belenje, Soumyava Basu
A 5-year-old male child presented with sudden decrease in vision in both eyes associated with redness since 1 week. The parents denied a history of trauma or any other history of similar ocular complaints in past. The child gave history of fever 1 month earlier. His RT-PCR was positive for COVID-19 one month prior to the onset of his ocular symptoms and he had received oral antibiotics and antihistamines. The vision in his right eye was a Snellens equivalent of 20/50 and in the left eye was counting fingers at Face at the time of presentation. Ocular examination revealed vitritis in his right eye along with areas of retinitis in periphery and whitish pre-retinal exudates and hemorrhages. The left eye had a dense vitritis along with pre-retinal exudates and peripheral retinitis lesions (Figure 1). Based on the clinical picture, an initial diagnosis of ARN was made. However, a differential diagnosis of endogenous endophthalmitis was also considered and therefore a subsequent vitreous biopsy was done. Meanwhile, the patient was also investigated for other uveitides and laboratory investigations along with chest X-ray to exclude sarcoidosis and tuberculosis were done. Mantoux test for tuberculosis was indeterminate and serology for HIV and syphilis was negative. The vitreous sample taken from the left eye tested positive for HSV 1 by RT-PCR.
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