HIV/AIDS, Tuberculosis, and Malaria in Pregnancy.

J Pregnancy. 2012;2012:140826

Authors: Ezechi O, Odberg Petterson K, Byamugisha J

PMID: 22593828 [PubMed - in process]

[[Tuberculosis of the midfoot, an unusual location: report of a case]].

Pan Afr Med J. 2012;11:53

Authors: Hachimi H, Tahiri L, Kadi N, Ibrahimi A, Elmrini A, Harzy T

Abstract
La tuberculose ostéoarticulaire représente 2 à 5% de l'ensemble des tuberculoses, la localisation au médio-pieds est rare. Nous en rapportons le cas d'une patiente âgée de 18 ans, qui présente depuis 2 ans des douleurs du médio-pied droit inflammatoires avec tuméfactio, La radiographie a montré des géodes et des érosions des os naviculaire et cunéiformes. L'IRM a orienté vers le dignostic de tuberculose confirm par biospie et étude anathomopathologique. C'est pourquoi devant tout tableau clinique traînant ou devant toute lésion osseuse suspecte ou de présentation atypique le diagnostic de tuberculose doit être évoqué afin d'éviter un retard diagnostique.

PMID: 22593789 [PubMed - in process]

Tubercular endometritis detected through Pap smear campaign in Enugu, Nigeria.

Pan Afr Med J. 2012;11:47

Authors: Onuigbo W, Esimai B, Nwaekpe C, Chijioke G

Abstract
In a series of 3,267 cervical smears examined in Enugu, Nigeria, from 1993 through 2010, there was a single positive case of tuberculosis (TB). It was found in a 55-year-old, Para 7, postmenopausal woman. Treatment for tuberculosis was instituted successfully.

PMID: 22593783 [PubMed - in process]

The role of eis mutations in the development of kanamycin resistance in Mycobacterium tuberculosis isolates from the Moscow region.

J Antimicrob Chemother. 2012 May 16;

Authors: Gikalo MB, Nosova EY, Krylova LY, Moroz AM

Abstract
OBJECTIVES: Kanamycin is an important second-line drug used to treat multidrug-resistant (MDR) tuberculosis (TB). Molecular analysis of the rrs gene seems to be not enough to identify every case of kanamycin resistance. In the present study we evaluated the incidence of eis mutations in kanamycin-resistant Mycobacterium tuberculosis isolates. METHODS: We analysed 70 MDR M. tuberculosis clinical isolates. All isolates were screened for rrs and eis mutations using single-strand conformation polymorphism and sequencing. Phenotypic drug susceptibility testing was performed using Bactec MGIT 960 and the absolute concentration method on Lowenstein-Jensen medium. RESULTS: eis mutations were found in 10 isolates. The most prevalent mutations were the A1401G substitution in the rrs gene and the C14T substitution in the eis promoter region. CONCLUSIONS: Our study shows that the eis promoter region is a useful molecular marker of kanamycin resistance in the Moscow region. Complex analysis of rrs and eis mutations will significantly reduce the time to diagnose kanamycin resistance in TB patients, compared with phenotypic drug resistance testing.

PMID: 22593564 [PubMed - as supplied by publisher]

Adequacy of the emergency point-of-care ultrasound core curriculum for the local burden of disease in South Africa.

Emerg Med J. 2012 May 16;

Authors: van Hoving DJ, Lamprecht HH, Stander M, Vallabh K, Fredericks D, Louw P, Müller M, Malan JJ

Abstract
ObjectiveThis prospective cross-sectional study assesses the adequacy of the current South African emergency point-of-care ultrasound (EPCUS) core curriculum against the local burden of disease.MethodPatients presenting to five Emergency Centres during July 2011 were eligible for inclusion. Patients under the age of 12, after-hour presentations, missing folders and folders with incomplete notes were excluded. Emergency physicians with EPCUS exposure were responsible for data collection. They were all blinded to the study's aim. Summary statistics describe the proportion of clinical cases and procedures for which EPCUS was used. One investigator assessed the adequacy of the curriculum by matching the clinical indications of each module with the presenting complaint and final diagnosis of each patient. The ultrasound modules were ranked according to the frequency of their clinical indications. κ-Statistics are reported on 10% randomly selected cases to quantify interobserver agreement.ResultsThe study included 2971 patients. Ultrasound assisted with diagnosis in 384 (12.92%) patients and in 34 (1.14%) procedures. A total of 1933 EPCUS procedures were indicated in 1844 (66.07%) patients. The five most frequently indicated modules were pulmonary, musculoskeletal, cardiac, focused assessment with sonography of HIV/tuberculosis co-infection and renal. The interobserver agreement (κ) was 0.602 (95% CI 0.559 to 0.645).ConclusionsThis study was an attempt to ensure an evidence-based approach to assess the adequacy of the EPCUS core curriculum in South Africa. The results illustrate that our local burden of disease may require a change of the current core curriculum.

PMID: 22593261 [PubMed - as supplied by publisher]

Trends and Barriers to HIV Testing Among Tuberculosis Patients in Prey Kabas Operational District, Takeo Province, Cambodia.

Asia Pac J Public Health. 2012 May 16;

Authors: Samrith W, Rahman M, Harun-Or-Rashid M, Sakamoto J

Abstract
Data for this study were obtained from 2375 tuberculosis (TB) patients registered during 2007-2009 and 43 health providers to examine the trend of TB patient referral for HIV (human immunodeficiency virus) testing and to investigate provider-associated barriers to the referral in Prey Kabas operational district, Takeo province, Cambodia. Referral rate for HIV testing was 4.4% (30/684) in 2007, 15.4% (116/751) in 2008, and 30.1% (283/940) in 2009, with a significant upward trend over the period of time (P = .009). The main barriers perceived by health providers were poor knowledge about TB/HIV, lack of communication skills, absence of any target plan for TB patient referral for HIV testing, and fear associated with informing positive test results to the TB patients and the associated stigma. Strategies to raise awareness about HIV/AIDS/TB among TB patients and their providers may improve the current state of low referral and its barriers in Cambodia.

PMID: 22593219 [PubMed - as supplied by publisher]

Linking Surveillance with Action against Drug-resistant Tuberculosis.

Am J Respir Crit Care Med. 2012 May 16;

Authors: Cohen T, Manjourides J, Hedt-Gauthier B

Abstract
The speed at which most countries with high burdens of multidrug resistant tuberculosis (MDRTB) have scaled-up their capacity to diagnose and treat individuals with these forms of TB has failed to keep pace with the problem. Limited availability of drug susceptibility testing, high costs and inefficiencies in the supply of second-line drugs, and inadequate capacity for the management of MDRTB patients have contributed to the wide gap between the estimated need for and the delivery of MDRTB treatment. The most recent global estimates indicate that only about one in twenty individuals with incident MDRTB will be properly diagnosed; fewer still receive quality assured treatment. As policy makers confront the threat of growing levels of drug resistant tuberculosis, there is a clear role for improved surveillance methods that can facilitate more effective public health responses. In countries that can not yet test all incident cases for drug resistance, analysis of programmatic data and employment of periodic, efficient surveys can provide information to help prioritize the use of limited resources to geographic areas or population subgroups of greatest concern. We describe methods for the analysis of routinely collected data and alternative surveys that can help tighten the link between surveillance activities and interventions.

PMID: 22592806 [PubMed - as supplied by publisher]

Patient education and counselling for promoting adherence to treatment for tuberculosis.

Cochrane Database Syst Rev. 2012;5:CD006591

Authors: M'imunya JM, Kredo T, Volmink J

Abstract
BACKGROUND: Non-adherence to tuberculosis treatment can lead to prolonged periods of infectiousness, relapse, emergence of drug-resistance, and increased morbidity and mortality. In this review, we assess whether patient education or counselling, or both, promotes adherence to tuberculosis treatment.
OBJECTIVES: To evaluate the effects of patient education or counselling, or both, on treatment completion and cure in people requiring treatment for active or latent tuberculosis.
SEARCH METHODS: Without language restriction, we searched for eligible studies in the Cochrane Infectious Diseases Group Specialized Register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and LILACS; checked reference lists of relevant articles; and contacted relevant researchers and organizations up to 24 November 2011.
SELECTION CRITERIA: Randomized controlled trials examining the effects of education or counselling, or both, on treatment completion and cure in people with clinical tuberculosis; and treatment completion and clinical tuberculosis in people with latent disease.
DATA COLLECTION AND ANALYSIS: We independently screened identified studies for eligibility, assessed methodological quality, and extracted data; with differences resolved by consensus. We expressed study results as risk ratios (RRs) with 95% confidence intervals (CI).
MAIN RESULTS: We found three trials, with a total of 1437 participants, which examined the effects of different educational and counselling interventions on adherence to treatment for latent tuberculosis.All three trials reported the proportion of people who successfully completed treatment for latent tuberculosis. Overall, education or counselling interventions may increase successful treatment completion but the magnitude of benefit is likely to vary depending on the nature of the intervention, and the setting (data not pooled, 923 participants, three trials, low quality evidence).In a four-arm trial in children from Spain, counselling by nurses via telephone increased the proportion of children completing treatment from 65% to 94% (RR 1.44, 95% CI 1.21 to 1.72; 157 participants, one trial), and counselling by nurses through home visits increased completion to 95% (RR 1.46, 95% CI 1.23 to 1.74; 156 participants, one trial). Both of these interventions were superior to counselling by physicians at the tuberculosis clinic (RR 1.20, 95% CI 0.98 to 1.47; 159 participants, one trial).In the USA, a programme of peer counselling for adolescents failed to show an effect on treatment completion rates at six months (RR 1.01, 95% CI 0.90 to 1.13; 394 participants, one trial). In this trial treatment completion was around 75% even in the control group.In the third study, in prisoners from the USA, treatment completion was very low in the control group (12%), and although counselling significantly improved this, completion in the intervention group remained low at 24% (RR 1.94, 95% CI 1.03 to 3.68; 211 participants, one trial).None of these trials aimed to assess the effect of these interventions on the subsequent development of active tuberculosis, and we found no trials that assessed the effects of patient education or counselling on adherence to treatment for active tuberculosis.
AUTHORS' CONCLUSIONS: Educational or counselling interventions may improve completion of treatment for latent tuberculosis. As would be expected, the magnitude of the benefit is likely to depend on the nature of the intervention, and the reasons for low completion rates in the specific setting.

PMID: 22592714 [PubMed - in process]

Time to Initiate Antiretroviral Therapy between 4 Weeks and 12 Weeks of Tuberculosis Treatment in HIV-infected Patients: Results from the TIME Study.

J Acquir Immune Defic Syndr. 2012 May 15;

Authors: Manosuthi W, Mankatitham W, Lueangniyomkul A, Thongyen S, Likanonsakul S, Suwanvattana P, Thawornwan U, Suntisuklappon B, Nilkamhang S, Sungkanuparph S,

Abstract
BACKGROUND:: Optimal timing for initiation of antiretroviral therapy (ART) among HIV-infected patients with tuberculosis (TB) is not well established. METHODS:: HIV/TB co-infected patients were randomized to initiate tenofovir/lamivudine/efavirenz at 4 weeks (4-week group) or 12 weeks (12-week group) of TB treatment. The primary outcome was 1-year all-cause mortality. RESULTS:: Of 156 patients, 79 were in 4-week group and 77 in 12-week group. Overall median (IQR) CD4 was 43 (47-106) cells/mm and median (IQR) HIV-1 RNA was 5.8 (5.4-6.3) log copies/mL. Eleven (7%) mortalities occurred in a total follow-up period of 137 patient-years. Seven percent (6/79, 8.76 per 100 patient-years) mortalities were in 4-week group and 6% (5/77, 7.25 per 100 person-years) mortalities were in 12-week group (RR=0.845, 95%CI=0.247-2.893). Twenty-eight (35%) patients in 4-week group and 25 (32%) patients in 12-week group were hospitalized (RR=1.142, 95%CI=0.588-2.217). Grade 2-4 adverse events were 39% (31/79) in 4-week group and 34% (26/77) in 12-week group (RR=1.267, 95%CI=0.659-2.435). In multivariate analysis, 'low albumin' (RR=2.695, 95%CI=1.353-5.475) and 'low baseline CD4 count' (RR=4.878, 95%CI=1.019-23.256) were the independent predictors of mortality. IRIS was more frequent in 4-week group with an incidence of 8.86 vs. 5.02 per 100 person-months in 12-week group over the first 6 months of ART (P=0.069). CONCLUSIONS:: In middle-income countries where ART is initiated at CD4 count of <350 cells/mm, immediate initiation of ART in HIV-infected patients with active TB was not associated with survival advantage when compared to initiation of ART at 12 weeks.

PMID: 22592586 [PubMed - as supplied by publisher]

Pulmonary infections imitating lung cancer: clinical presentation and therapeutical approach.

Ir J Med Sci. 2012 May 17;

Authors: Schweigert M, Dubecz A, Beron M, Ofner D, Stein HJ

Abstract
BACKGROUND: Pulmonary infections occasionally present with infectious pseudotumour of the lung not easily distinguishable from true pulmonary neoplasm. In such cases, radiographic findings and clinical manifestation are highly suggestive of lung cancer. These inflammatory lung lesions cause significant diagnostic problems and appropriate therapy is often considerably delayed. We therefore report on our experience with infectious pseudotumour of the lung caused by bacterial, mycobacterial and fungal pulmonary infections. METHODS: In a retrospective case series, patients with lung infections simulating pulmonary carcinoma were identified. Clinical presentation, radiological features, surgical procedures and outcome were analysed. RESULTS: There were seven male and six female patients with a mean age of 53 years. Presumed pulmonary carcinoma and hemoptysis were main reasons for hospital admission. Procedures performed were video-assisted thoracoscopic wedge resection (6), lobectomy (5), video-assisted thoracoscopic lobectomy and open wedge resection each in one case. Pathologic examination of the obtained specimens revealed tuberculoma (5), aspergilloma (3), pulmonary actinomycosis related pseudotumour (3) and coccidioidoma (2). Following definite diagnosis, patients with tuberculosis and fungal infections received antituberculotic and antifungal medications, respectively. Patients suffering from pulmonary actinomycosis received penicillin. There was no in-hospital mortality. One re-thoracotomy was mandatory because of pleural empyema. CONCLUSIONS: Pulmonary infections simulating lung cancer require surgical removal both for establishing definite diagnosis and to manage complications like haemoptysis and ongoing contamination of the airways by infectious agents. Whenever feasible, limited thoracoscopic resections are preferable. Following definite diagnosis antimicrobial drug therapy for a sufficient length of time is mandatory.

PMID: 22592566 [PubMed - as supplied by publisher]

Reply to 'TLR-2 ligand lipomannan from Mycobacterium tuberculosis does not stimulate inflammatory cytokines in dendritic cells'.

AIDS. 2012 Jun 1;26(9):1184-5

Authors: Tan DB, Price P

PMID: 22592073 [PubMed - in process]

Toll-like receptor-2 ligand lipomannan from Mycobacterium tuberculosis does not stimulate inflammatory cytokines in dendritic cells.

AIDS. 2012 Jun 1;26(9):1182-1184

Authors: Hegde P, Kaveri SV, Bayry J

PMID: 22592072 [PubMed - as supplied by publisher]

Role in metal homeostasis of CtpD, a Co(2+) transporting P(1B4) -ATPase of Mycobacterium smegmatis.

Mol Microbiol. 2012 May 17;

Authors: Raimunda D, Long JE, Sassetti CM, Argüello JM

Abstract
Genetic studies in the tuberculosis mouse model have suggested that mycobacterial metal efflux systems, such as the P(1B4) -ATPase CtpD, are important for pathogenesis. The specificity for substrate metals largely determines the function of these ATPases; however, various substrates have been reported for bacterial and plant P(1B4) -ATPases leaving their function uncertain. Here we describe the functional role of the CtpD protein of Mycobacterium smegmatis. An M. smegmatis mutant strain lacking the ctpD gene was hypersensitive to Co(2+) and Ni(2+) and accumulated these metals in the cytoplasm. ctpD transcription was induced by both Co(2+) and superoxide stress. Biochemical characterization of heterologously expressed, affinity-purified CtpD showed that this ATPase is activated by Co(2+) , Ni(2+) and to a lesser extend Zn(2+) (20% of maximum activity). The protein was also able to bind one Co(2+) , Ni(2+) or Zn(2+) to its transmembrane transport site. These observations indicate that CtpD is important for Co(2+) and Ni(2+) homeostasis in M. smegmatis, and that M. tuberculosis CtpD orthologue could be involved in metal detoxification and resisting cellular oxidative stress by modulating the intracellular concentration of these metals.

PMID: 22591178 [PubMed - as supplied by publisher]

Pelvic urothelial carcinoma with nested pattern of growth and an uncommon clinical presentation: a case report.

Anal Quant Cytol Histol. 2011 Dec;33(6):340-4

Authors: Tripodi S, Rocca BJ, Ambrosio MR, Gentile F, Cintorino M

Abstract
BACKGROUND: Nested variant of urothelial carcinoma (NVUC) is a rare and often unrecognized urothelial neoplasia. Diagnosis is based on morphology only, and no immunohistochemical or cytogenetic differences from usual high-grade urothelial carcinomas have been reported.
CASE: We describe the case of a 49-year-old woman affected by hepatitis C virus presented with fever, discomfort, urgency, and hypertension. Computed tomography showed a sclerosing inflammatory process involving the connective and adipose tissue of the renal sinus. In the absence of renal or pelvic masses an underlying malignancy was excluded and renal abscess or tuberculosis was suspected. Accordingly, nephrectomy and proximal ureterectomy was performed. Grossly, calices, renal pelvis, and pyeloureteral junction appeared modestly dilated with whitish, thickened, and uneven mucosa. Microscopically, the subepithelial connective tissue, the fibromuscular layer, and the renal sinus fat were diffusely infiltrated by small nests of medium to large urothelial cells (p63 positive) with abundant eosinophylic cytoplasm and slightly atypical nuclei.
CONCLUSION: On the basis of morphologic and immunohistochemical features, a diagnosis of NVUC was made. After surgery, the patient recovered from hypertension. Pelvic and upper urothelial tract NVUCs are uncommon, and to the best of our knowledge, this is the second case of NVUC with renal involvement.

PMID: 22590812 [PubMed - in process]

[I didn't have any motivation, desire, impulse and condom -- Géza Csáth's activity as a balneologist].

Lege Artis Med. 2012 Jan;22(1):62-5

Authors: Kiss L

PMID: 22530275 [PubMed - indexed for MEDLINE]

Drug resistance mutations and heteroresistance detected using the GenoType MTBDRplus assay and their implication for treatment outcomes in patients from Mumbai, India.

BMC Infect Dis. 2012;12:9

Authors: Tolani MP, D'souza DT, Mistry NF

Abstract
BACKGROUND: Only 5% of the estimated global multidrug resistant TB (MDRTB) load is currently detected. Endemic Mumbai with increasing MDR would benefit from the introduction of molecular methods to detect resistance.
METHODS: The GenoType MTBDRplus assay was used to determine mutations associated with isoniazid and rifampicin resistance and their correlation with treatment outcomes. It was performed on a convenience sample comprising 88 onset and 67 fifth month isolates for which phenotypic drug susceptibility testing (DST) was determined by the Buddemeyer technique for an earlier study. Simultaneous presence of wild type and mutant bands was referred to as "mixed patterns" (heteroresistance).
RESULTS: Phenotypically 41 isolates were sensitive; 11 isoniazid, 2 rifampicin, 2 pyrazinamide and 5 ethambutol monoresistant; 16 polyresistant and 78 MDR. The agreement between both methods was excellent (kappa = 0.72-0.92). Of 22 rifampicin resistant onset isolates, the predominant rpoB mutations were the singular lack of WT8 (n = 8) and mixed D516V patterns (n = 9). Of the 64 rifampicin resistant fifth month isolates, the most frequent mutations were in WT8 (n = 31) with a further 9 showing the S531L mutation. Mixed patterns were seen in 22 (34%) isolates, most frequently for the D516V mutation (n = 21). Of the 22 onset and 35 fifth month katG mutants, 13 and 12 respectively showed the S315T1 mutation with loss of the WT. Mixed patterns involving both S315T1 and S315T2 were seen in 9 and 23 isolates respectively. Seventeen of 23 and 23/35 inhA mutant onset and fifth month isolates showed mixed A16G profiles. Additionally, 10 fifth month isolates lacked WT2. Five onset and 6 fifth month isolates had both katG and inhA mutations. An association was noted between only katG but not only inhA resistance and poor outcome (p = 0.037); and additional resistance to ethambutol (p = 0.0033). More fifth month than onset isolates had mixed profiles for at least 1 gene (p = 0.000001).
CONCLUSIONS: The use of the assay to rapidly diagnose MDR could guide simultaneous first- and second-line DST, and reduce the delay in administering appropriate regimens. Furthermore, detection of heteroresistance could prevent inaccurate "cured" treatment outcomes documented through smear microscopy and permit more sensitive detection of neonascent resistance.

PMID: 22260344 [PubMed - indexed for MEDLINE]