Tuberculous encephalopathy (TBE) is an important diagnosis in countries with a high prevalence of tuberculosis. TBE is a life-threatening condition but rarely reported in the modern literature. We reported a case of a man with extensive parenchymal lesions involving the brainstem and right cerebellar hemisphere that resolved after treatment. The clinical, laboratory and pathological features of this case are highlighted and the pathogenesis is discussed.
Aged ; Antitubercular Agents ; therapeutic use ; Brain Diseases ; diagnosis ; drug therapy ; microbiology ; Humans ; Hydrocephalus ; diagnosis ; drug therapy ; microbiology ; Male ; Tuberculosis, Central Nervous System ; diagnosis ; drug therapy ; microbiology

We report a rare case of oculomotor nerve palsy and choroidal tuberculous granuloma associated with tuberculous meningoencephalitis. A 15-year-old male visited our hospital for an acute drop of the left eyelid and diplopia. He has been on anti-tuberculous drugs (isoniazid, rifampin) for 1 year for his tuberculous encephalitis. A neurological examination revealed a conscious clear patient with isolated left oculomotor nerve palsy, which manifested as ptosis, and a fundus examination revealed choroidal tuberculoma. Other anti-tuberculous drugs (pyrazinamide, ethambutol) and a steroid (dexamethasone) were added. After 3 months on this medication, ptosis of the left upper eyelid improved and the choroidal tuberculoma decreasedin size, but a right homonymous visual field defect remained. When a patient with tuberculous meningitis presents with abrupt onset oculomotor nerve palsy, rapid re-diagnosis should be undertaken and proper treatment initiated, because the prognosis is critically dependent on the timing of adequate treatment.
Adolescent ; Antitubercular Agents/therapeutic use ; Blepharoptosis/diagnosis/drug therapy/microbiology ; Choroid Diseases/diagnosis/drug therapy/*microbiology ; Dexamethasone/therapeutic use ; Drug Therapy, Combination ; Ethambutol/therapeutic use ; Glucocorticoids/therapeutic use ; Humans ; Magnetic Resonance Imaging ; Male ; Meningoencephalitis/diagnosis/drug therapy/*microbiology ; Mycobacterium tuberculosis/*isolation & purification ; Oculomotor Nerve Diseases/diagnosis/drug therapy/*microbiology ; Perimetry ; Pyrazinamide/therapeutic use ; Radiography, Thoracic ; Tuberculoma/diagnosis/drug therapy/*microbiology ; Tuberculosis, Meningeal/diagnosis/drug therapy/*microbiology ; Tuberculosis, Ocular/diagnosis/drug therapy/microbiology ; Visual Fields

Urachal cysts are uncommon. Rarely, these cysts can become infected. Tuberculosis of the urachal cyst is exceedingly rare, with only one case reported previously in the English language literature. Here we report the case of a 23-year-old male who presented with an infra-umbilical mass that turned out to be tuberculosis of the urachal cyst.
Antitubercular Agents/therapeutic use ; Drug Therapy, Combination ; Humans ; Male ; Tomography, X-Ray Computed ; Treatment Outcome ; Tuberculosis/diagnosis/*microbiology/therapy ; Urachal Cyst/diagnosis/*microbiology/therapy ; Young Adult

A worsening scenario of drug-resistant tuberculosis has increased the need for new treatment strategies to tackle this worldwide emergency. There is a pressing need to simplify and shorten the current 6-month treatment regimen for drug-susceptible tuberculosis. Rifamycins and fluoroquinolones, as well as several new drugs, are potential candidates under evaluation. At the same time, treatment outcomes of patients with drug-resistant tuberculosis should be improved through optimizing the use of fluoroquinolones, repurposed agents and newly developed drugs. In this context, the safety and tolerance of new therapeutic approaches must be addressed.
Animals ; Antitubercular Agents/adverse effects/*therapeutic use ; *Drug Discovery ; *Drug Repositioning ; Drug Resistance, Bacterial ; Drug Therapy, Combination ; Extensively Drug-Resistant Tuberculosis/drug therapy/microbiology ; Humans ; Lung/*drug effects/microbiology ; Mycobacterium tuberculosis/*drug effects/pathogenicity ; Treatment Outcome ; Tuberculosis, Multidrug-Resistant/diagnosis/*drug therapy/microbiology ; Tuberculosis, Pulmonary/diagnosis/*drug therapy/microbiology

Adrenal Cortex Hormones ; therapeutic use ; Antitubercular Agents ; therapeutic use ; Diagnosis, Differential ; Humans ; Sarcoidosis ; drug therapy ; epidemiology ; microbiology ; pathology ; Tuberculosis ; drug therapy ; epidemiology ; microbiology ; pathology

BACKGROUNDT-SPOT.TB is a novel test for tuberculosis infection with higher sensitivity and specificity than the traditional tuberculin skin test (TST). However, there are no longitudinal data in the literature evaluating T-SPOT.TB for Mycobacterium tuberculosis in patients with acquired immune deficiency syndrome (AIDS) on highly active antiretroviral therapy (HAART). The objective of this study was to assess the value of T-SPOT.TB longitudinally in AIDS patients on HAART without prophylaxis for tuberculosis.

METHODSA prospective observational study was conducted in 50 AIDS patients on HAART. None of the subjects had evidence of active tuberculosis. T-SPOT.TB, a T-cell-based interferon gamma released assay, was performed at the onset of the study and repeated 24 months thereafter. Subjects were evaluated every 6 months during the 36-month follow-up.

RESULTSTwenty-one (42%) AIDS patients on HAART tested positive by T-SPOT.TB (95%CI 28.3% - 55.7%). The pooled spot-forming cells of early secretory antigenic target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10) peptides were 68/million peripheral blood mononuclear cell (PBMC) (interquartile range 44 - 220). The average number of CD4 cells in subjects was (305 +/- 152) cells/microl, and there was no significant difference in T-SPOT.TB response rates between subjects with CD4 cell counts < 200 cells/microl (7/15 (46.7%), 95%CI 21.5% - 71.9%) and those with CD4 cell counts >/= 200 cells/microl (14/35 (40.0%), 95%CI 23.8% - 56.2%, P = 0.662). In the 32 subjects who completed the 24-month follow-up, 10 underwent T-SPOT.TB reversion, one had T-SPOT.TB conversion, six remained positive and 15 remained negative. None of them advanced to active tuberculosis during the 36-month follow-up.

CONCLUSIONThe inactive status of tuberculosis infection may be maintained for a long period in AIDS patients on HAART.

Acquired Immunodeficiency Syndrome ; drug therapy ; immunology ; microbiology ; Adult ; Antiretroviral Therapy, Highly Active ; Female ; Humans ; Interferon-gamma ; secretion ; Male ; Middle Aged ; Mycobacterium tuberculosis ; pathogenicity ; Prospective Studies ; Tuberculosis ; diagnosis ; immunology

An unusual case of spontaneous cerebrospinal fluid (CSF) rhinorrhea with a pneumocephalus is described in a middle-aged woman who presented with a watery nasal discharge for 1 week and headache, vomiting, and fever for 1 day. The neurological examination revealed meningeal signs and bilateral papilledema. The CSF picture suggested pyogenic meningitis, and computed tomography of the brain revealed pneumocephalus. Diagnostic nasal endoscopy showed outpouching of the dura from the left olfactory cleft with a CSF leak and granular nasal mucosa. The defect was repaired surgically, and a biopsy of that area revealed granulomatous changes suggestive of tuberculosis. The patient recovered completely with standard four-drug antitubercular therapy. To our knowledge spontaneous CSF rhinorrhea with pneumocephalus occurring secondary to nasal tuberculosis has not been previously reported.
Antitubercular Agents/therapeutic use ; Biopsy ; Cerebrospinal Fluid Rhinorrhea/diagnosis/*etiology/therapy ; Endoscopy ; Female ; Humans ; Middle Aged ; Nose Diseases/*complications/diagnosis/microbiology/therapy ; Otorhinolaryngologic Surgical Procedures ; Pneumocephalus/diagnosis/*etiology/therapy ; Tomography, X-Ray Computed ; Treatment Outcome ; Tuberculosis/*complications/diagnosis/microbiology/therapy

BACKGROUND/AIMS: We evaluated the trend in the rates of drug-resistant tuberculosis (TB) over time, as well as the difference in the drug-resistance pattern between pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) at a private referral center in South Korea. METHODS: All patients with culture-confirmed TB from 2006 to 2013 were included. RESULTS: In total, 1,745 patients were included: 1,431 (82.0%) were new cases, and 314 (18.0%) were cases treated previously; 1,610 (92.3%) were diagnosed with PTB, and 135 (7.7%) were diagnosed with EPTB. Multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB were detected in 5.8% and 2.0% of new cases and in 20.1% and 8.6% of previously treated cases, respectively. The MDR TB rate during the study period decreased remarkably, whereas the MDR and XDR TB rates decreased significantly in previously treated cases. No difference in the drug-resistance rate was detected between PTB and EPTB. CONCLUSIONS: The TB drug-resistance rate, particularly that of MDR TB, remained high at a private referral hospital, and the drug-resistance rate did not decrease significantly from 2006 to 2013. This finding underscores the need for a national survey regarding the prevalence of drug-resistant TB to obtain the most accurate and current drug-resistance status in South Korea, including the private sector.
Adult ; Aged ; Antitubercular Agents/*therapeutic use ; *Drug Resistance, Multiple, Bacterial ; Extensively Drug-Resistant Tuberculosis/drug therapy/microbiology ; Female ; Hospitals, Private ; Humans ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Mycobacterium tuberculosis/*drug effects/isolation & purification ; Prevalence ; Republic of Korea/epidemiology ; Retrospective Studies ; *Tertiary Care Centers ; Time Factors ; Treatment Outcome ; Tuberculosis, Multidrug-Resistant/diagnosis/*drug therapy/epidemiology/*microbiology ; Tuberculosis, Pulmonary/diagnosis/*drug therapy/epidemiology/*microbiology

Histoplasmosis is a very rare disease in Korea. Clinical manifestations are very similar to those of tuberculosis. This is the first case report of combined disseminated histoplasmosis and tuberculosis in a patient with HIV infection in Korea. A 42-year-old Korean with Acquired Immunodeficiency Syndrome (AIDS) was diagnosed with tuberculosis. He had lived in Guatemala for the past five years. Upon diagnosis of disseminated tuberculosis with HIV infection, he was treated with anti-tuberculosis medications and anti-retroviral agents. Fever, weakness, hepatosplenomegaly and pancytopenia were persistent despite treatment. The patient's history of living in Guatemala caused us to seek opportunistic infectious organisms other than tuberculosis. Bone marrow aspiration and biopsy were performed and the result revealed numerous intracellular organisms consistent with Histoplasma capsulatum; therefore, the diagnosis of disseminated histoplasmosis was made.
AIDS-Related Opportunistic Infections/microbiology ; Acquired Immunodeficiency Syndrome/complications/pathology ; Adult ; Bone Marrow/microbiology/pathology ; HIV Infections/*complications/drug therapy ; Histoplasma/isolation & purification ; Histoplasmosis/complications/*diagnosis/microbiology ; Humans ; Male ; Thorax/microbiology/pathology/radionuclide imaging ; Tuberculosis/complications/*diagnosis

The significance of metastastic disease in the cervical lymph nodes has long been appreciated. The rich lymphatics of the upper aerodigestive tract explained the high incidence of cervical metastasis, occasional bilaterally spread. Even with appropriate treatment, cervical recurrences do occur. Nonetheless, with the resurgence of tuberculosis, the differential of tuberculous cervical lymphadenitis should be excluded. Appropriate modalities should be employed in making the appropriate diagnosis possible.
Aged ; Antitubercular Agents ; therapeutic use ; Female ; Humans ; Lymph Nodes ; microbiology ; pathology ; Tuberculosis, Lymph Node ; diagnosis ; drug therapy