Tuberculosis (TB) and non-tuberculous mycobacteria (NTM) are socioeconomically important infectious diseases. Diagnosis is supported by radiological examinations following the evaluation of clinical symptoms. Definitive diagnosis is made microbiologically or histopathologically. TB and NTM infections progress with different radiological findings such as cavitary and nodular infiltrations. In our study, it was aimed to investigate which criteria are stronger radiological determinants of which disease in microbiologically positive TB and NTM cases. In our study, 417 cases that were positive for TB and NTM infections in the five-year microbiology laboratory were evaluated. The symptoms, sociodemographic, laboratory and radiological findings of the cases were obtained retrospectively from epicrisis information. Patients with NTM growth were examined according to ATS/IDSA NTM Infection diagnostic criteria. There was a male sex predominance in both groups, and mean age was similar between the groups. The TB group was observed to present with more systemic symptoms, while the NTM group presented with more pulmonary symptoms. In radiological evaluation, the most common findings in both groups were nodules, consolidation, cavitation, and lymphadenopathy. The appearance of a tree in bud was also a common radiological finding in the TB group. When the two groups were compared, the presence of emphysema and atelectasis was significantly higher in the NTM group. In the diagnosis of TB and NTM infections, after taking a detailed anamnesis, care should be taken especially in terms of NTM infections in patients with radiological parenchymal damage.
This study aimed to compare diagnostic delay (Patient delay and health system delay) and treatment problems of tuberculosis among refugees during the coronavirus disease-2019 pandemic and determine access to healthcare and affecting factors. This cross-sectional study involved 62 patients who presented to the tuberculosis clinic and were diagnosed between 2019 and 2021. Among the participants, 45.2% were refugees. While 64.3% of the refugees reported that they experienced fear and unwillingness to present to a health institution due to pandemic conditions, this frequency was 52.9% among Turkish citizens. Mean patient delay was 37.29 days among the refugees and 26.74 days among the Turkish citizens. A significant difference was found between patient delay and health system delay times in the groups according to citizenship. Patient delay was statistically significant in the refugee group according to educational status. A negative correlation was found between the mean knowledge total score and diagnostic delay. Four Turkish participants and six refugees died. This study was the first to demonstrate the diagnostic experienced by refugees. A significant difference was found between patient delay and health system delay times in groups according to citizenship. Patient delay was statistically significant in the refugee group according to educational status. A negative correlation was found between the mean knowledge total score and diagnostic delay. As a result, it is crucial to prevent diagnostic delays in refugee and immigrant healthcare and ensure the resilience of tuberculosis management during the pandemic.
ABSTRACT Hairy vocal cords and hemoptysis A 71-year-old patient with hemoptysis, history of pulmonary tuberculosis, laryngeal cancer, and smoking habit underwent fiberoptic bronchoscopy. No endobronchial lesions were detected, but hair structures were seen on the vocal cords. Klebsiella oxytoca was grown in the non-specific culture of the lavage. Filamentous bacteria suggestive of actinomyces were also seen in the cytology. These bacteria, seen in the normal flora of the oropharynx, may be responsible for lung infection in individuals with weakened immune systems and concomitant diseases. In elderly patients with a history of pulmonary tuberculosis and cancer, as in our patient, hairs developing on the vocal cords as a complication of laryngeal surgery may cause food residues and secretions to accumulate on the hair surface and increase microaspirations. We would like to remind you that these microaspirations may affect the lower respiratory tract defense mechanisms and lead to clinical problems such as lung infection, lung abscess, aspiration pneumonia and hemoptysis in people with comorbid diseases. Key words: Complication; hair; hemoptysis; larynx cancer ÖZ Kıllı vokal kord ve hemoptiz Yetmiş bir yaşında, hemoptizisi bulunan ve özgeçmişinde akciğer tüberkülozu ve larenks kanseri öyküsü bulunan, sigara içme alışkanlığına sahip hastaya fiberoptik bronkoskopi uygulandı. Endobronşiyal lezyon saptanmadı, ancak vokal kordlar üzerinde kıl yapıları izlendi. Lavajda non-spesifik kültürde Klebsiella oxytoca üremesi tespit edildi. Sitolojisinde ise aktinomiçesi düşündüren filamentöz bakteriler gözlendi. Orofarenkste normal florada bulunan bu bakteriler, immün sistemi zayıf ve komorbid hastalığı olan kişilerde pulmoner enfeksiyona yol açabilir. Bizim hastamızdaki gibi geçmişte tüberküloz ve kanser öyküsü bulunan, ileri yaşta olan hastalarda, larenks cerrahisi sonucu vokal kordlarda gelişen kıllar, kıl yüzeyinde biriken yiyecek artıkları ve sekresyonlar ile artan mikroaspirasyonlara neden olabilir. Bu mikroaspirasyonlar, alt solunum yolu savunma mekanizmalarını etkileyerek, komorbid hastalığı olan kişilerde akciğer enfeksiyonu, akciğer apsesi, aspirasyon pnömonisi gibi klinik sorunlara yol açabilir ve bunların sonucu olarak hemoptiziye neden olabilice- ğini belirtmek istiyoruz. Anahtar kelimeler: Komplikasyon; kıl; hemoptizi; larenks kanseri
Tuberculosis (TB), a highly contagious disease, remains one of the leading causes of death globally. The proposed computer-assisted TB detection system enhances diagnostic accuracy and efficiency by integrating deep learning and segmentation techniques. It consists of two key subsystems: Automated field-ofview (FOV) recognition and TB bacilli segmentation. Using a motorized microscopic stage, the system systematically captures Ziehl-Neelsen-stained sputum smear images at 100x magnification. A customized Inception V3 model with transfer learning identifies FOVs containing TB bacilli, reducing variability and manual effort. Segmentation techniques, including coarse-level thresholding and shape descriptors like area, perimeter, and eccentricity, refine bacilli detection and eliminate artifacts. This study highlights the significant potential of deep learning and image processing techniques in advancing medical diagnostics, particularly TB detection. This framework has the potential to improve clinical outcomes and support global TB eradication efforts by providing a reliable tool for early TB diagnosis. The system achieved a mean receiver operating characteristic score of 0.9505, a precision of 0.924, a recall of 0.882, and an F1 score of 0.902, demonstrating its potential to improve TB screening, particularly in resource-limited settings. By minimizing reliance on skilled technicians and enhancing diagnostic reliability, this approach offers a scalable solution for effective TB detection and severity assessment.
Tuberculosis (TB) remains one of the leading infectious causes of mortality worldwide. The interaction between lipid metabolism and immune response plays a crucial role in TB pathogenesis. High-density lipoprotein (HDL) and other lipid parameters have increasingly attracted attention for their associations with inflammatory markers and survival. This study aimed to investigate the relationship between serum lipid levels, inflammatory markers, and survival in patients with TB. Data from TB and non-tuberculous mycobacteria (NTM) patients followed at Ege University Faculty of Medicine Hospital between January 2017 and January 2024 were retrospectively analyzed. Lipid profile [HDL, low-density lipoprotein (LDL), total cholesterol, triglycerides] and inflammatory parameters (C-reactive protein, erythrocyte sedimentation rate, ferritin, albumin, lymphocyte count) were recorded at diagnosis. Lipid levels were categorized into tertiles based on interquartile distribution. Groups were compared in terms of inflammatory response, clinical features, and survival. A total of 148 patients were included in the study, comprising 127 TB and 21 NTM cases. Median age was 59.0 years [Interquartile range (IQR): 45.0-71.0] in the TB group and 64.0 years (IQR: 38.0-72.0) in the NTM group. Among TB patients, 62.2% were male (n= 79). Mortality among TB patients was 17.3% (n= 22). Patients with low HDL levels had significantly higher CRP and ferritin levels and lower albumin levels (p< 0.05). LDL and total cholesterol levels were similarly associated with CRP, albumin, and lymphocyte count. A significant association was observed between HDL levels and sex, with low HDL levels being more frequent among males (p< 0.001). Increasing HDL and triglyceride levels were associated with a trend toward improved survival (p= 0.063; linear trend p= 0.041). No significant associations were found between lipid levels and cavity formation, pulmonary versus extrapulmonary involvement, or acid-fast bacilli smear results (p< 0.05). In multivariable analysis, older age and lower serum albumin levels were independently and significantly associated with mortality (p< 0.005). In patients with TB, serum lipid profiles show significant associations with systemic inflammatory markers. Low HDL levels were accompanied by a more pronounced inflammatory response. However, lipid biomarkers were not independently associated with mortality, suggesting that they may serve as complementary markers in the assessment of the inflammatory process rather than as direct prognostic indicators.
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This study aimed to examine and compare the characteristics of post tuberculosis (PTB) and non-tuberculosis (NTB) bronchiectasis patients of Central India retrospectively. Bronchiectasis patients who underwent bronchoscopy were diagnosed by high resolution computed tomography (CT) scans, and PTB versus NTB were assessed clinically, radiologically, microbiologically and on the basis of spirometry. Mean age of the total 90 patients was 52.54 ± 16.33 years. Maximum patients were in the age group above 60 years old. Overall major symptoms were cough (n= 78, 86.66%), dyspnea (n= 65, 72.22%) and fever (n= 44, 48.88%). The proportion of the male population was more in the PTB group (n= 26, 59.09% vs. n= 18, 40.91%, p= 0.387). Bilateral and unilateral bronchiectasis were predominantly present in NTB (n= 34, 73.91%) and PTB (n= 18; 40.91%) respectively. The most common radiological variant of bronchiectasis found in all patients was a cystic type (n= 52, 89.66%); however, the presence of varicose was significantly higher in PTB than NTB group (n= 8, 18.18% vs. n= 2, 4.35%, p= 0.037). Body mass index in NTB (21.79 ± 4.93 kg/m2) was significantly higher than that of PTB group (18.89 ± 3.60 kg/m2) with p-value of 0.004. The proportion of patients with Pseudomonas aeruginosa infection in bronchoalveolar lavage (BAL) of PTB group (n= 12, 27.27%) was more than the NTB group (n= 10, 21.74%). 22.73% (n= 10) patients had a reactivation of TB in the PTB and 8.70% (n= 04) in NTB group. On spirometry, the proportion of patients with obstructive findings was significantly higher in NTB than PTB group (30.43% vs. 6.82%, p= 0.004). The most prominent underlying cause of bronchiectasis was PTB, with unilateral, varicose subtype being significantly more prevalent on thorax CT. Re-infection was the primary cause of exacerbations in bronchiectasis patients, with Pseudomonas being the most common infectious agent. Our study also contributes to the data pool on bronchiectasis patients in India.
Pulmonary tuberculosis (PTB) remains a major global health challenge, with Indonesia bearing a substantial disease burden. Genetic predisposition, particularly vitamin D receptor (VDR) gene polymorphisms, has been implicated in PTB susceptibility. However, findings remain inconsistent across populations. This study examines the association of four VDR polymorphisms (FokI, ApaI, BsmI, and TaqI) with PTB susceptibility in three Indonesian ethnic groups, while also evaluating sociodemographic and lifestyle risk factors. A case-control study was conducted among 267 participants from Makassar, Bugis, and Toraja ethnic groups in South Sulawesi, Indonesia. Participants were categorized into active PTB (n= 88), latent PTB, and healthy control groups. Genotyping of VDR polymorphisms was performed using polymerase chain reaction-restriction fragment length polymorphism. Sociodemographic factors, smoking habits, alcohol consumption, and education levels were recorded. Statistical analyses included chi-squared tests, logistic regression for odds ratio (OR) calculations, and receiver operating characteristic (ROC) curve analysis to assess the discriminatory power of genetic markers (AUC values). The optimal diagnostic threshold was determined using the Youden index. The FokI CC genotype was significantly associated with PTB risk (p= 0.014; OR= 2.12, 95% CI: 1.18-3.79), whereas the TT genotype showed a protective effect. The ApaI TT genotype also exhibited a strong association with PTB susceptibility (p< 0.001; OR= 2.65, 95% CI: 1.63-4.29). No significant associations were found for BsmI and TaqI polymorphisms. Sociodemographic analysis revealed that lower education levels and smoking significantly increased PTB risk (p= 0.006 and p= 0.011, respectively). ROC analysis for combined FokI CC and ApaI TT genotypes yielded an AUC of 0.76 (95% CI: 0.68-0.84), demonstrating moderate predictive power. This study highlights the multifactorial nature of PTB susceptibility, emphasizing the role of VDR gene polymorphisms, education, and lifestyle factors. The findings support the integration of genetic screening into PTB risk assessment and underscore the need for targeted public health interventions in genetically diverse populations.
Tuberculosis (TB) is an airborne infectious disease caused by Mycobacterium tuberculosis (MTB). Although it typically affects the lungs (pulmonary TB), one-fifth of TB cases present as extrapulmonary TB. The diagnosis of extrapulmonary TB is often overlooked due to its atypical clinical and radiological manifestations. Differentiating TB from neoplastic conditions poses significant challenges. A 33-year-old female patient was admitted to the emergency clinic with shortness of breath, cough, and abdominal pain. Postero-anterior chest X-ray revealed massive pleural effusion leading to mediastinal shift. With a preliminary diagnosis of malignant pleural effusion, a pleural catheter was inserted, and the patient was referred for a positron emission tomography (PET/CT) to assess the primary site and the optimal location for a biopsy. The PET/CT revealed asymmetric soft tissue thickening on the left side of the nasopharynx, and increased fluorodeoxyglucose (FDG) uptake in the left cervical lymph nodes raised suspicion regarding primary nasopharyngeal cancer. Additionally, there was an increased FDG uptake observed in the mass lesion located in the right upper lobe, mediastinal lymph nodes, pleural surfaces in the left hemithorax, perihepatic areas, and peritoneum, indicating diffuse metastatic disease. Tuberculosis diagnosis was confirmed through biopsies demonstrating granulomatous inflammation in the lung and nasopharynx, along with culturing MTB from pleural effusion. Positron emission tomography played a crucial role in identifying sites of TB involvement. Despite its rarity, healthcare professionals should consider nasopharyngeal TB as a potential diagnosis when evaluating nasopharyngeal masses.
Tuberculosis (TB) is an infectious disease that can be fatal if left untreated or poorly treated, and it is associated with many morbidities. Deaths may provide better understanding of the associated factors and help guide interventions to reduce mortality. In this study, it was aimed to reveal some of the features that predict hospital mortality in patients with TB and to present some alarming findings for clinicians. Patients who had been hospitalized with the diagnosis of TB between January 2008 and December 2018 were included and analyzed retrospectively. In-hospital mortality because of any TB disease after the initiation of treatment in patients admitted to the TB Ward and the primary cause of mortality were taken as endpoint. A total of 1321 patients with a mean age of 50.1 years were examined. Total mortality was 39.4% (521 deaths) and 13.1% were in-hospital deaths (173 deaths). Of the deaths, 61.8% (n= 107) occurred during the first month after TB treatment were started. On univariate analysis, age over 48.5 years, Charlson comorbidity index, extension of radiological involvement, hypoalbuminemia and lymphopenia were most predictive variables with higher odds ratios (respectively, p<0.001 for all). In-hospital tuberculosis disease mortality is related with older age, cavitary or extensive pulmonary involvement, low albumin levels, unemployment, cigarette smoking and especially those with concomitant malignancy and chronic pulmonary disease.
Recent studies have shown that Gene Xpert MTB/RIF (Xpert) and Gene Xpert MTB/RIF ultra (Xpert-U) tests outperform traditional microbiological methods in detecting tuberculosis (TB) and identifying rifampicin resistance. This research aimed to examine their diagnostic accuracy and clinical relevance. This retrospective cohort study included patients aged 18 years and older with pulmonary or extrapulmonary samples analyzed by Xpert, Xpert-U, and conventional diagnostic methods between January 2016 and June 2020. The diagnostic performance of Xpert and Xpert-U was compared across four patient groups: A) Microscopy-culture-positive pulmonary TB, B) Microscopy-negative, culture-positive pulmonary TB, C) Pulmonary TB cases, and D) Extrapulmonary TB cases. A total of 1.366 samples (1.280 pulmonary, 86 extrapulmonary) were analyzed using Xpert and Xpert-U, including 1.042 males (76.3%) and 324 females (23.7%), with an average age of 54 years. For pulmonary TB, Xpert showed an overall sensitivity of 99.29% and specificity of 49.23%. Xpert-U demonstrated similar sensitivity at 98.56%, with an improved specificity of 89.66%. In extrapulmonary TB, Xpert-U achieved 100% sensitivity with a specificity of 70.59%. Xpert and Xpert-U tests offer high sensitivity for detecting Mycobacterium tuberculosis, greatly improving the timely diagnosis and management of TB, especially in cases with low bacterial loads or drug resistance.
Bovine tuberculosis might be seen in low-income countries, especially in children fed with raw milk. The most common transmission route is fecal-oral way, and it is most likely through unpasteurized dairy products. Although clinical and radiological findings are like non-zoonotic tuberculosis, treatment approaches may differ in individuals with zoonotic tuberculosis. Prevention of zoonotic diseases requires multidisciplinary approaches. These approaches include the development of veterinary and surveillance studies for the detection of communicable diseases in farm animals, as well as informing the public about raw milk consumption. In this case report, a patient with zoonotic pulmonary tuberculosis related to Mycobacterium bovis because of consumption of raw milk was presented. A five-month-old male was admitted to the hospital due to a persistent, feverless, non-productive cough since birth. Empirical antibiotic treatment was started with a preliminary diagnosis of pneumonia because of left upper lobe and right pericardial infiltration on chest X-ray. However, after two weeks of antimicrobial therapy, the patient's clinical and laboratory findings did not improve. This led to the referral for a computed tomography imaging, which revealed tracheomalacia, consolidation on the right upper lobe, an indistinguishable mass or consolidation on the left middle lobe of the lung, peribronchial thickening on the basal segment of the lower lobe, and mediastinal lymphadenopathy. Three consecutive days of fasting gastric lavage fluid was sent to the reference laboratory for acid-resistant bacillus examination, polymerase chain reaction (PCR) and culture studies. As the clinical findings were compatible and PCR was positive, the patient was started on quadruple antituberculous therapy. After initiation of anti-tuberculosis drugs, the patient's findings radiologically and clinically were improved. Mycobacterium bovis was grown in the culture. In the meantime, it was discovered that the patient was fed with raw milk. Due to the patient's clinical symptoms and the growth of Mycobacterium bovis in the gastric lavage fluid culture, the diagnosis of bovine tuberculosis was made. The culprit was that the milk of the cow belonging to the patient's family, which was later found to be infected with M.bovis, was milked and given to the patient without boiling. Today, unpasteurized dairy products continue to be consumed, especially in rural areas. One of the most important steps to prevent zoonotic diseases is to raise awareness about not consuming raw milk and undercooked meat. To elucidate the epidemiological link in childhood, taking a good anamnesis, including questioning raw milk consumption, is essential in the diagnosis of tuberculosis.
Non-tuberculous mycobacteria (NTM) can cause diseases not only in individuals with compromised immune systems but also in those with normal immune function. This study aimed to compare the prevalence of NTM in Türkiye and worldwide between 2012 and 2022. This study was designed following the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) procedure. A systematic search was conducted between January 2012 and September 2022 using different electronic databases, including Pubmed, Medline, Embase, Web of Science, Ebsco, Scopus, Türk Medline, and Google Scholar. During the literature review process, titles and abstracts were examined and the full texts of the studies were accessed. In 13 research articles from Türkiye included in the study, a total of 17.293 samples were studied and a total of 1304 NTM (7.54%) strains were isolated from these samples. Among the 1304 NTM strains reported from Türkiye, the top three most frequently isolated species were M. abscessus (29.83%), M. lentiflavum (14.97%), M. fortuitum (14.38%). In 35 studies included from around the world, a total of 512.626 samples were studied and a total of 12.631 NTM (2.46%) strains were isolated from these samples. Among the 12631 NTM strains isolated, the top three most frequently isolated species were M. intracellulare (28.13%), M. avium (17.70%) and M. abscessus (14.88%). This study unveiled the global prevalence of NTM-infected patients, detailing species distribution and microbiological diagnostic methods. Variations in NTM spread were observed, influenced by diverse factors.
There are limited publications about the Coronavirus disease 19 (COVID-19) clinic developing in the patients with active tuberculosis (TB). In this study, it was aimed to determine some clinical features of patients diagnosed with TB who also had COVID-19. In this retrospective cross-sectional study, 71 patients with COVID-19 were evaluated out of a total of 595 patients diagnosed with TB in our province between 2015 and 2021. After contracting COVID-19, a total of nine (12.6%) TB patients were hospitalized, five (7%) patients were admitted to the intensive care unit, three (4.2%) were intubated, and one (1.4%) died due to severe COVID-19. The frequency of such health problems was found to be higher than the normal population living in the same province. None of these complications were observed in a total of 40 female TB patients, and the hospital and intensive care unit admission rates for men were significantly higher than for women. The results of this study showed that men with active TB had more health problems due to COVID-19 than the normal population. Comprehensive studies are needed to detail the resilience of female TB patients against COVID-19.
There are more than 160 defined nontuberculous mycobacteria (NTM) species within Mycobacterium genus. In recent years, the number of NTM species associated with human infections and the infections caused by them have been reported at increasing rates. The identification of these species by phenotypic methods is difficult, laborious, and unlikely to obtain reliable results. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) MALDI-TOF MS has proven to be a good method for the identification of bacteria and yeasts in routine laboratory practices. However, Mycobacterium species differ from other bacteria by their cell wall structures, less ribosomal protein content, and slower growth rates. A standardized and efficient protein extraction protocol for MALDI-TOF MS analysis of mycobacteria is essential. The aim of our study was to investigate the efficacy of different protein extraction protocols and the MALDI-TOF MS method in the diagnosis of NTM species. A total of 73 NTM isolates, grown in both solid and liquid media and previously identified with line probe assay, were evaluated with MALDI-TOF MS (Bruker Daltonics GmbH and Co. KG, Germany). Stock isolates were homogenized and decontaminated by N-Acetyl L-cysteine (NALC)/Sodium hydroxide (NaOH) method. For solid media, isolates were inoculated on Löwenstein-Jensen medium and incubated at 35˚C in a normal atmosphere. For liquid media culture, BD BACTEC MGIT 960 automated system (Becton, Dickinson, Sparks, MD, USA) was performed according to the manufacturer's instructions. For the identification of all isolates by MALDI-TOF MS, the manufacturer's recommended protein extraction protocol (Protocol 1) was compared with the two other protocols, using a simplified extraction procedure (Protocol 2), and freezing temperature (Protocol 3). In the liquid media analysis, the rates of the isolates identified by MALDI-TOF MS (score≥ 2.0) for Protocol 1, 2, and 3 were found as 84.93% (n= 62), 63.01% (n= 46), and 43.83% (n= 32), respectively. In the solid media analysis, the rates of the isolates with an identification score of ≥ 2.0 for the protocols with the same order were determined as 87.67% (n= 64), 52.05% (n= 38), and 31.50% (n= 23), respectively. Isolates grown in both solid and liquid media were identified in the same species level in all three protocols, regardless of the identification values and misidentification was not presented. When the reliable identification score was evaluated as ≥ 2.0 in our study, the manufacturer's recommended MYCOEX IVD procedure was found to be the most effective method for the isolates grown in both liquid and solid media. In conclusion, MALDI-TOF MS has the potential to be a reliable, easy-to-use and fast method that can be used in routine practice for the identification of NTM species with its standardized protein extraction protocols.
This study aimed to evaluate attitude and practice toward use of regular tobacco cigarettes and electronic cigarettes among pregnant women. A total of 1123 pregnant women participated on a voluntary basis in this questionnaire survey. Maternal characteristics, cigarette consumption parameters, and personal opinions regarding the adverse effects of smoking during pregnancy were evaluated. Active smokers composed 12.4% (9.4%: regular tobacco cigarettes, 3.0%: electronic cigarettes) of the study population. Smoking during the current pregnancy, particularly via regular tobacco cigarettes, was more likely for women with smoking during previous pregnancies (56.0% vs. 7.8%, P < .001), previous history of low birth weight infant delivery (16.1% vs. 8.6%, P = .013), premature delivery (16.7% vs. 7.0%, P < .001), and stillbirth (22.8% vs. 11.7%, P = .002). The presence versus absence of smoking during pregnancy was associated with a lower likelihood of being a housewife (70.5% vs. 80.5%, P = .010) and a higher likelihood of having an actively smoking mother (25.9% vs. 11.2%, P < .001) or partner (65.7% vs. 46.9%, P < .001). Regular tobacco cigarette users considered electronic cigarettes to have a higher risk of adverse impacts (11.1% vs. 2.9%, P = .012), while electronic cigarette users considered regular cigarettes to have a higher risk of nicotine exposure (55.9% vs. 13.0%, P < .001). Our findings indicate being employed, having an actively smoking mother or partner, as well as smoking in previous pregnancies, to be the risk factors for increased likelihood of smoking during pregnancy.
Coronavirus disease 2019 (COVID-19) and tuberculosis are serious and mortal diseases worldwide. There are few studies about the association between tuberculosis and COVID-19 pneumonia. We aimed to describe the characteristics of tuberculosis and COVID-19 co-infection cases in light of the literature. Tuberculosis patients who applied to the tuberculosis outpatient clinic between September 1-September 30, 2020, and patients hospitalized in the COVID-19 service between June 1- September 30, 2020, were retrospectively screened. Patients with tuberculosis and COVID-19 co-infection were recorded. Clinical, radiological, laboratory data, and treatments were recorded and analyzed. For the diagnosis of tuberculosis, sputum acid-resistant bacillus (ARB) smear or culture positivity or pathological diagnosis were used. For the diagnosis of COVID-19, positive real-time reverse transcription-polymerase chain reaction and/or typical radiological findings were sought. Seven hundred and fifty-one patients' data at the tuberculosis outpatient clinic, 229 patients' data at the COVID-19 clinic were screened. Sixteen patients meet the criteria. COVID-19 infection rate in tuberculosis patients was 2.1%. Sixty-nine percent of the patients had received COVID-19 disease during diagnosis or initial tuberculosis treatment phase. There were no drugdrug interactions between anti-tuberculosis drugs and COVID-19 treatment. During the COVID-19 treatment, one patient (6%) died, 15 (94%) patients completed the treatment. : In our study, no effect of the coexistence of TB and COVID-19 on morbidity or mortality was observed. Although the number of patients is small, it can be said that patients with early TB disease and with widespread involvement may be riskier for COVID-19 infection. Frequent hospital visits by TB patients may be a risk for COVID-19. It may be beneficial to carry out the diagnosis and treatment of tuberculosis patients by tuberculosis dispensaries as in our country or authorized units to reduce the risk of hospital admissions and COVID-19 transmission.
Tuberculosis (TB) mastitis is a rare form of granulomatous mastitis. We aimed to evaluate the clinical characteristics and prognosis of patients diagnosed with TB mastitis. A descriptive study was carried out on patients who were reported to national tuberculosis control authorities as having TB mastitis between 2003 and 2021. Demographic, histopathological, and radiological data including mammography, ultrasonography (US), and magnetic resonance imaging (MRI) were reviewed. All were followed up to 24 months and prognosis was also evaluated. This study identified 29 TB mastitis patients who had been diagnosed using excisional biopsies. The mean age was 33.5 ± 10.1, all were premenopausal women. The most common symptom was breast mass (n= 24, %82.8), nearly half of the patients also had ipsilateral axillary lymphadenopathy (n= 14, 48.3). One-fourth of the patients had bilateral involvement (n= 7, 24.1%), and half of the patients (n= 16, 55.2%) presented with multiple masses. One patient had co-existing pulmonary TB. Predisposing factors for TB were not identified in any of the patients. Nearly half of the patients received prior mastitis treatment. The most common radiological finding was mass in both mammography and US. All patients received anti-tuberculosis treatment of a standard regimen for six to 21 months, three patients had a relapse but were finally cured. TB mastitis should be suspected in young and premenopausal women presenting with a breast mass and axillary lymphadenopathy in an endemic region. Radiological findings could not identify the diagnosis. A multidisciplinary approach including bacteriology and histopathology should be performed. Anti-tuberculosis treatment can be implemented successfully.
Mycobacterium bovis causes gastrointestinal tuberculosis by being transmitted through consumption of infected milk and dairy products, mostly in developing countries, and can spread to the other neighbourhood intra-abdominal tissues and organs. In addition to the symptoms such as weight loss, weakness, abdominal pain, and chronic diarrhea in female patients with abdominal tuberculosis, findings such as pelvic mass, ascites and CA-125 elevation may be encountered. Patients with these symptoms usually preliminary diagnosed as having ovarian cancer. It is very important to distinguish between these two diseases quickly, which have different treatment protocols. In this case report, a case of intra-abdominal tuberculosis caused by M.bovis, whose diagnosis was confirmed by microbiological methods with the findings mimicking ovarian cancer such as weight loss, ascites, pelvic mass and increased CA-125 was presented. Tuberculosis was considered in the differential diagnosis of a 23-yearold female patient with abdominal pain, weight loss, ascites, pelvic mass, and elevated CA-125 (643.9 U/ml) findings and a mass in the left tubaovarian region on abdominal CT. The ileum biopsy sample taken during colonoscopy and ascitic fluid sample taken with paracentesis were sent to our laboratory for acid-fast bacilli (AFB) staining and tuberculosis culture. In our laboratory, samples were incubated in both liquid culture system [BACTEC MGIT 320 Mycobacteria Culture System (Becton Dickinson,USA)] and solid culture medium [Lowenstein-Jensen Medium (Becton Dickinson,USA)] and AFB smears were performed. While AFB smears were negative, ileum biopsy material showed growth on day 14 and ascitic fluid sample on day 11 in liquid culture medium. AFB smear was prepared from broth and red bacilli were seen on a blue background that formed cord factor. The bacillus was identified as Mycobacterium tuberculosis complex by the immunochromatographic rapid test [BD MGIT TBc Identification Test (BD,USA)]. The anti-tuberculosis drug treatment was initiated with the diagnosis of intra-abdominal tuberculosis. The isolated bacillus was found to be sensitive to isoniazid, rifampicin, ethambutol and resistant to streptomycin, according the drug susceptibility test results. Subspecies identification of M.tuberculosis complex was investigated by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) but could not be determined by this method. Genotyping was performed with the GenoType MTBC VER 1.X (Hain Lifescience, HardwiesenstraBe, Germany) kit. The isolate was identified as M.bovis. In the follow-up of the patient three months later, it was determined that tumor markers, ascitic fluid and intra-abdominal lymph nodes regressed significantly and the mass in the left ovary completely disappeared. In this report, we presented a case with intra-abdominal tuberculosis whose clinical, radiological and laboratory findings mimic ovarian cancer to imply the importance of microbiological diagnosis.
In many health conditions, stigma is receiving increasing attention. Public stigmatization toward social illness can affect particularly the patients and family memberships to help seeking behavior and treatment. This study, the aim of this study was to investigate the validity and reliability of the Turkish "Stigma of Tuberculosis Scale " which was developed to evaluate of perception of stigma with tuberkulosis patient. This methodological study was conducted with 150 with tuberculosis disease people who above 18 age and without known psychological and mental disability. In the study, "Stigma of Tuberculosis Scale" was used as data collection tool. During the study, language equivalence, content validity, reliability and construct validity of the scale was performed. The data was assessed by using mean, median, standard deviation, Spearman Correlation, Cronbach Alpha coefficient and confirmatory factor analysis. The mean age of study participants was 45.6 ± 16.1 (20 - 85). years. Spearman correlation coefficient of the scale for test-retest reliability was 0.853 and the Cronbach Alpha coefficient was 0.95. According to fit indexes of confirmatory factor analysis [x2/SD= 481.38/230= 2.09; RMSEA= 0.087; GFI= 0.776; CFI= 0.776; NNFI= 0.875] it was found that one factors were appropriate for the scale. The adoption of the translated "Stigma of Tuberculosis Scale"in Turkey is found reliable and valid to evaluate of perception of stigma with tuberkulosis patient.