Challenges and Advances in Tuberculosis and Mycobacterial Lung Diseases

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Diagnostic Microbiology and Infectious Disease".

Deadline for manuscript submissions: closed (30 June 2022) | Viewed by 32764

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Guest Editor
First Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
Interests: cardiac sarcoidosis; venous thromboembolism management and treatment; interstitial lung diseases, diagnosis and treatment; COVID-19 lung disease; pericardial diseases
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
Interests: clinical microbiology; microbiological diagnostics of tuberculosis and mycobacteriosis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Tuberculosis (Tb) is the leading cause of morbidity worldwide. According to the WHO, the estimated number of active Tb cases in 2019 was 10 million, while 1,2 million died of this disease. A significant epidemiological and clinical problem concerns the coinfection of M. tuberculosis and HIV, as well as the growing number of patients diagnosed with multi-resistant (MDR) or extensively resistant (XDR) Tb.

Non-tuberculous mycobacteria (NTM) are the environmental opportunistic pathogens present in soil, water, and water-aerosols. Non-tuberculous mycobacterial lung diseases (NTMLD) are increasingly recognised all over the world, especially in the ageing populations and in patients diagnosed with chronic lung diseases. The largest clinical problem concerns differentiating respiratory colonization from NTMLD. The spectrum of responsible NTM species is evolving, requiring the application of newer methods of identification.

The presently announced Special Issue entitled “Challenges and Advances in Tuberculosis and Mycobacterial Lung Diseases” will encompass research articles, case presentations, and literature reviews concerning the epidemiology, medical surveillance, as well as diagnostic and therapeutic challenges in tuberculosis and in NTM infections.

This Special Issue will explore, but is not restricted to, the following topics:

  • Molecular and genotyping of M. tuberculosis for rapid identification of MDR and XDR clones, and surveillance of their transmission routes;
  • Latent tuberculosis testing and surveillance of active Tb in risk groups;
  • Advances in the identification of non-tuberculous mycobacteria and differentiation to the species level;
  • Drug susceptibility profile and antimicrobial resistance mechanisms; and
  • Clinical problems concerning the recognition of NTMLD in patients with chronic lung diseases.

We hope that the published data will contribute to scientific discussion concerning these global health problems.

Prof. Dr. Monika Szturmowicz
Prof. Dr. Ewa Augustynowicz-Kopeć
Guest Editors

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Keywords

  • tuberculosis
  • MDR Tb
  • XDR Tb
  • epidemiology and surveillance
  • genotyping
  • nontuberculous mycobacteria
  • treatment outcomes
  • risk groups
  • high resolution computed tomography
  • HIV-AIDS
  • COVID 19

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Published Papers (13 papers)

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Research

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13 pages, 651 KiB  
Article
New RAPMYCOI SensititreTM Antimicrobial Susceptibility Test for Atypical Rapidly Growing Mycobacteria (RGM)
by Anna Borek, Anna Zabost, Agnieszka Głogowska, Dorota Filipczak and Ewa Augustynowicz-Kopeć
Diagnostics 2022, 12(8), 1976; https://doi.org/10.3390/diagnostics12081976 - 15 Aug 2022
Cited by 4 | Viewed by 1904
Abstract
Rapidly growing mycobacteria (RGM) cause an increasing international concern, mainly due to their natural resistance to many antibiotics. The aim of this study was to conduct species identification and determine the antimicrobial susceptibility profiles of RGM isolated in Poland. Antimicrobial susceptibility was tested [...] Read more.
Rapidly growing mycobacteria (RGM) cause an increasing international concern, mainly due to their natural resistance to many antibiotics. The aim of this study was to conduct species identification and determine the antimicrobial susceptibility profiles of RGM isolated in Poland. Antimicrobial susceptibility was tested using broth microdilution and the RAPMYCOI panel. A total of 60 strains were analysed, including the following species: M. fortuitum complex (30), M. abscessus subsp. abscessus (16), M. abscessus subsp. massiliense (7), M. chelonae (5), and M. mucogenicum (2). For 12 M. abscessus subsp. abscessus strains, the presence of the erm 41T28 genotype associated with inducible macrolide resistance and a functional erm gene was confirmed. A MUT2 mutation in the rrl gene (constitutive resistance) was identified for two strains from the subtype M. abscessus subsp. massiliense. Among the 15 tested antibiotics, amikacin and linezolid had the strongest antimycobacterial activity. Most of the tested strains were resistant to doxycycline and trimethoprim/sulfamethoxazole. Tigecycline MICs were low for all tested strains. Findings from our study highlight the importance of correct identification of clinical isolates and antimicrobial susceptibility testing. Full article
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11 pages, 525 KiB  
Article
Tuberculosis in Poland: Epidemiological and Molecular Analysis during the COVID-19 Pandemic
by Dagmara Borkowska-Tatar, Anna Zabost, Monika Kozińska and Ewa Augustynowicz-Kopeć
Diagnostics 2022, 12(8), 1883; https://doi.org/10.3390/diagnostics12081883 - 3 Aug 2022
Cited by 1 | Viewed by 2108
Abstract
The COVID-19 pandemic may have a negative impact on the proper implementation of TB control programmes and may increase TB incidence rates in the near future. The aim of this study was to perform an epidemiological and molecular analysis of Mycobacterium tuberculosis strains [...] Read more.
The COVID-19 pandemic may have a negative impact on the proper implementation of TB control programmes and may increase TB incidence rates in the near future. The aim of this study was to perform an epidemiological and molecular analysis of Mycobacterium tuberculosis strains cultured from tuberculosis patients in Poland in 2020 and to compare the results of monitoring drug-resistant tuberculosis in Poland with previous studies in 2012 and 2016. The analysis was based on questionnaires and strains sent by regional laboratories during the 12 months of 2020. Molecular analysis was performed by spoligotyping 20% of the strains sensitive to the four primary antimycobacterial drugs and all of the drug-resistant strains. The number of strains sent for analysis dropped threefold, from 4136 in 2012 to 1383 in 2020. The incidence of tuberculosis among men was higher than among women. There was an increase in strains’ resistance to antimycobacterial drugs in both newly diagnosed patients, from 4.4% in 2012 to 6.1% in 2020, and previously treated patients, from 11.7% to 12.3%. Four-year resistance increased to 1% and 2.1%, respectively. The spoligotype SIT1 was the most abundant among the resistant strains (17%), and SIT53 (13.9%) was the most common among susceptible strains. Full article
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10 pages, 2447 KiB  
Article
Nontuberculous Mycobacterial Lung Disease in the Patients with Cystic Fibrosis—A Challenging Diagnostic Problem
by Dorota Wyrostkiewicz, Lucyna Opoka, Dorota Filipczak, Ewa Jankowska, Wojciech Skorupa, Ewa Augustynowicz-Kopeć and Monika Szturmowicz
Diagnostics 2022, 12(7), 1514; https://doi.org/10.3390/diagnostics12071514 - 21 Jun 2022
Cited by 3 | Viewed by 1739
Abstract
Background: Cystic fibrosis (CF) is an autosomal, recessive genetic disorder, caused by a mutation in the cystic fibrosis transmembrane conductance receptor regulator (CFTR) gene. Dysregulated mucous production, and decreased bronchial mucociliary clearance, results in increased susceptibility to bacterial and fungal infections. Recently, nontuberculous [...] Read more.
Background: Cystic fibrosis (CF) is an autosomal, recessive genetic disorder, caused by a mutation in the cystic fibrosis transmembrane conductance receptor regulator (CFTR) gene. Dysregulated mucous production, and decreased bronchial mucociliary clearance, results in increased susceptibility to bacterial and fungal infections. Recently, nontuberculous mycobacteria (NTM) infections were identified as an emerging clinical problem in CF patients. Aim: The aim of the present study was to assess the frequency of NTM isolations in CF patients hospitalized in the pulmonary department, serving as a hospital CF center, and to describe challenges concerning the recognition of NTMLD (nontuberculous mycobacterial lung disease) in those patients. Methods: Consecutive CF patients, who were hospitalized due to pulmonary exacerbations (PEX), in a single CF center, between 2010 and 2020, were retrospectively assessed for the presence of NTM in respiratory specimens. Clinical and radiological data were retrospectively reviewed. Results: Positive respiratory specimen cultures for NTM were obtained in 11 out of 151 patients (7%), mean age—35.7 years, mean BMI—20.2 kg/m2, mean FEV1—58.6% pred. Cultures and phenotyping revealed the presence of Mycobacterium avium (M. avium)—in six patients, Mycobacterium chimaera (M. chimaera) in two, Mycobacterium kansasii (M. kansasii)—in one, Mycobacterium abscessus (M. abscessus)—in one, Mycobacterium lentifavum (M. lentiflavum)—in one. Simultaneously, respiratory cultures were positive for fungi in 91% of patients: Candida albicans (C. albicans)—in 82%, Aspergillus fumigatus (A. fumigatus)—in 45%. Clinical signs of NTMLD were non—specific, chest CT indicated NTMLD in five patients only. Conclusion: Due to non-specific clinical presentation, frequent sputum cultures for NTM and analysis of serial chest CT examinations are crucial for NTMLD recognition in CF patients. Further studies concerning the predictive role of fungal pathogens for NTMLD development in CF patients are needed. Full article
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12 pages, 743 KiB  
Article
Risk Factors for the Development of Nontuberculous Mycobacteria Pulmonary Disease during Long-Term Follow-Up after Lung Cancer Surgery
by Bo-Guen Kim, Yong Soo Choi, Sun Hye Shin, Kyungjong Lee, Sang-Won Um, Hojoong Kim, Jong Ho Cho, Hong Kwan Kim, Jhingook Kim, Young Mog Shim and Byeong-Ho Jeong
Diagnostics 2022, 12(5), 1086; https://doi.org/10.3390/diagnostics12051086 - 27 Apr 2022
Cited by 2 | Viewed by 1943
Abstract
The aim of this study is to determine the cumulative incidence of, and the risk factors for, the development of nontuberculous mycobacteria pulmonary disease (NTM-PD) following lung cancer surgery. We retrospectively analyzed patients with non-small cell lung cancer who underwent surgical resection between [...] Read more.
The aim of this study is to determine the cumulative incidence of, and the risk factors for, the development of nontuberculous mycobacteria pulmonary disease (NTM-PD) following lung cancer surgery. We retrospectively analyzed patients with non-small cell lung cancer who underwent surgical resection between 2010 and 2016. Patients who met all the diagnostic criteria in the NTM guidelines were defined as having NTM-PD. Additionally, we classified participants as NTM-positive when NTM were cultured in respiratory specimens, regardless of the diagnostic criteria. We followed 6503 patients for a median of 4.89 years, and NTM-PD and NTM-positive diagnoses occurred in 59 and 156 patients, respectively. The cumulative incidence rates of NTM-PD and NTM-positive were 2.8% and 5.9% at 10 years, respectively. Mycobacterium avium complex was the most commonly identified pathogen, and half of the NTM-PD patients had cavitary lesions. Several host-related factors (age > 65 years, body mass index ≤ 18.5 kg/m2, interstitial lung disease, bronchiectasis, and bronchiolitis) and treatment-related factors (postoperative pulmonary complications and neoadjuvant/adjuvant treatments) were identified as risk factors for developing NTM-PD and/or being NTM-positive after lung cancer surgery. The incidences of NTM-PD and NTM-positive diagnoses after lung cancer surgery were not low, and half of the NTM-PD patients had cavitary lesions, which are known to progress rapidly and often require treatment. Therefore, it is necessary to raise awareness of NTM-PD development after lung cancer surgery. Full article
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Review

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12 pages, 1337 KiB  
Review
Tuberculous Pericarditis—Own Experiences and Recent Recommendations
by Małgorzata Dybowska, Katarzyna Błasińska, Juliusz Gątarek, Magdalena Klatt, Ewa Augustynowicz-Kopeć, Witold Tomkowski and Monika Szturmowicz
Diagnostics 2022, 12(3), 619; https://doi.org/10.3390/diagnostics12030619 - 2 Mar 2022
Cited by 8 | Viewed by 3739
Abstract
Tuberculous pericarditis (TBP) accounts for 1% of all forms of tuberculosis and for 1–2% of extrapulmonary tuberculosis. In endemic regions, TBP accounts for 50–90% of effusive pericarditis; in non-endemic, it only accounts for 4%. In the absence of prompt and effective treatment, TBP [...] Read more.
Tuberculous pericarditis (TBP) accounts for 1% of all forms of tuberculosis and for 1–2% of extrapulmonary tuberculosis. In endemic regions, TBP accounts for 50–90% of effusive pericarditis; in non-endemic, it only accounts for 4%. In the absence of prompt and effective treatment, TBP can lead to very serious sequelae, such as cardiac tamponade, constrictive pericarditis, and death. Early diagnosis of TBP is a cornerstone of effective treatment. The present article summarises the authors’ own experiences and highlights the current status of knowledge concerning the diagnostic and therapeutic algorithm of TBP. Special attention is drawn to new, emerging molecular methods used for confirmation of M. tuberculosis infection as a cause of pericarditis. Full article
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Other

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5 pages, 1260 KiB  
Interesting Images
Atypical Pulmonary Tuberculosis as the First Manifestation of Advanced HIV Disease—Diagnostic Difficulties
by Aneta Kacprzak, Karina Oniszh, Regina Podlasin, Maria Marczak, Iwona Cielniak, Ewa Augustynowicz-Kopeć, Witold Tomkowski and Monika Szturmowicz
Diagnostics 2022, 12(8), 1886; https://doi.org/10.3390/diagnostics12081886 - 4 Aug 2022
Cited by 1 | Viewed by 1981
Abstract
Tuberculosis (TB) is the leading cause of morbidity, hospitalisations, and mortality in people living with HIV (PLWH). The lower CD4+ T-lymphocyte count in the course of HIV infection, the higher risk of active TB, and the higher odds for atypical clinical and radiologic [...] Read more.
Tuberculosis (TB) is the leading cause of morbidity, hospitalisations, and mortality in people living with HIV (PLWH). The lower CD4+ T-lymphocyte count in the course of HIV infection, the higher risk of active TB, and the higher odds for atypical clinical and radiologic TB presentation. These HIV-related alterations in TB presentation may cause diagnostic problems in patients not knowing they are infected with HIV. We report on a patient without any background medical conditions, who was referred to a hospital with a 4-month history of chest and feet pains, mild dry cough, fatigue, reduced appetite, and decreasing body weight. Chest X-ray revealed mediastinal lymphadenopathy, bilateral reticulonodular parenchymal opacities, and pleural effusion. A preliminary diagnosis of lymphoma, possibly with a superimposed infection was established. Further differential diagnostic process revealed pulmonary TB in the course of advanced HIV-1 disease, with a CD4+ T-lymphocyte count of 107 cells/mm3. The patient completed anti-tuberculous therapy and successfully continues on antiretroviral treatment. This case underlines the importance of screening for HIV in patients with newly diagnosed TB. Full article
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9 pages, 5250 KiB  
Case Report
An Unfavorable Outcome of M. chimaera Infection in Patient with Silicosis
by Ewa Łyżwa, Izabela Siemion-Szcześniak, Małgorzata Sobiecka, Katarzyna Lewandowska, Katarzyna Zimna, Małgorzata Bartosiewicz, Lilia Jakubowska, Ewa Augustynowicz-Kopeć and Witold Tomkowski
Diagnostics 2022, 12(8), 1826; https://doi.org/10.3390/diagnostics12081826 - 29 Jul 2022
Cited by 1 | Viewed by 1936
Abstract
Mycobacterium chimaera is a slow-growing, nontuberculous mycobacterium (NTM) belonging to the Mycobacterium avium complex (MAC). It was identified as a unique species in 2004. Since 2013 it has been reported as a cause of disseminated infection in patients after cardiac surgeries. [...] Read more.
Mycobacterium chimaera is a slow-growing, nontuberculous mycobacterium (NTM) belonging to the Mycobacterium avium complex (MAC). It was identified as a unique species in 2004. Since 2013 it has been reported as a cause of disseminated infection in patients after cardiac surgeries. Only a few cases associated with underlying lung diseases have been noted. M. chimaera infection is characterized by ambiguous symptoms. There is no treatment with proven effectiveness, and it has a poor prognosis. Silicosis is a disease that can predispose to mycobacterial infection. Silica damages pulmonary macrophages, inhibiting their ability to kill mycobacteria. We present a case of M. chimaera infection in a patient with silicosis and without other comorbidities. To our knowledge, it is the first case of silicosis associated with M. chimaera disease. A 45-year-old man presented with a persistent low-grade fever. Based on the clinical and radiological picture, positive cultures, and histological examination, the nontuberculous mycobacterial disease was diagnosed. First, multidrug therapy according to the treatment guidelines for MAC was implemented, then antibiotics were administrated, based on drug sensitivity. Despite the treatment, eradication was not achieved and the patient died. The analysis of M. chimaera infection cases could contribute to developing recommendations and thus improve the prognosis. Full article
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11 pages, 19222 KiB  
Case Report
Multidrug-Resistant Tuberculosis—Diagnostic Procedures and Treatment of Two Beijing-like TB Cases
by Monika Kozińska, Marcin Skowroński, Paweł Gruszczyński and Ewa Augustynowicz-Kopeć
Diagnostics 2022, 12(7), 1699; https://doi.org/10.3390/diagnostics12071699 - 12 Jul 2022
Cited by 1 | Viewed by 1318
Abstract
The Beijing/W genotype is one of the major molecular families of Mycobacterium tuberculosis complex (MTBC), responsible for approximately 50% of tuberculosis (TB) cases in Far East Asia and at least 25% of TB cases globally. Studies have revealed that the Beijing genotype family [...] Read more.
The Beijing/W genotype is one of the major molecular families of Mycobacterium tuberculosis complex (MTBC), responsible for approximately 50% of tuberculosis (TB) cases in Far East Asia and at least 25% of TB cases globally. Studies have revealed that the Beijing genotype family is associated with a more severe clinical course of TB, increased ability to spread compared to other genotypes, and an unpredictable response to treatment. Based on the profile of spacers 35–43 in the Direct Repeat (DR) locus of the MTBC genome determined by spoligotyping, classical (typical) and modern (Beijing-like) clones can be identified within the Beijing family. While the modern and ancient Beijing strains appear to be closely related at the genetic level, there are marked differences in their drug resistance, as well as their ability to spread and cause disease. This paper presents two cases of drug-resistant tuberculosis caused by rare mycobacteria from the Beijing family: the Beijing 265 and Beijing 541 subtypes. The genotypes of isolated strains were linked with the clinical course of TB, and an attempt was made to initially assess whether the Beijing subtype can determine treatment outcomes in patients. Full article
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10 pages, 2527 KiB  
Case Report
Severe Respiratory Failure Due to Pulmonary BCGosis in a Patient Treated for Superficial Bladder Cancer
by Katarzyna Lewandowska, Anna Lewandowska, Inga Baranska, Magdalena Klatt, Ewa Augustynowicz-Kopec, Witold Tomkowski and Monika Szturmowicz
Diagnostics 2022, 12(4), 922; https://doi.org/10.3390/diagnostics12040922 - 7 Apr 2022
Cited by 3 | Viewed by 2936
Abstract
Intra-vesical instillations with bacillus Calmette-Guerin (BCG) are the established adjuvant therapy for superficial bladder cancer. Although generally safe and well tolerated, they may cause a range of different, local, and systemic complications. We present a patient treated with BCG instillations for three years, [...] Read more.
Intra-vesical instillations with bacillus Calmette-Guerin (BCG) are the established adjuvant therapy for superficial bladder cancer. Although generally safe and well tolerated, they may cause a range of different, local, and systemic complications. We present a patient treated with BCG instillations for three years, who was admitted to our hospital due to fever, hemoptysis, pleuritic chest pain and progressive dyspnea. Chest computed tomography (CT) showed massive bilateral ground glass opacities, partly consolidated, localized in the middle and lower parts of the lungs, bronchial walls thickening, and bilateral hilar lymphadenopathy. PCR tests for SARS-CoV-2 as well as sputum, blood, and urine for general bacteriology—were negative. Initial empiric antibiotic therapy was ineffective and respiratory failure progressed. After a few weeks, a culture of M. tuberculosis complex was obtained from the patient’s specimens; the cultured strain was identified as Mycobacterium bovis BCG. Anti-tuberculous treatment with rifampin (RMP), isoniazid (INH) and ethambutol (EMB) was implemented together with systemic corticosteroids, resulting in the quick improvement of the patient’s clinical condition. Due to hepatotoxicity and finally reported resistance of the BCG strain to INH, levofloxacin was used instead of INH with good tolerance. Follow-up CT scans showed partial resolution of the pulmonary infiltrates. BCG infection in the lungs must be taken into consideration in every patient treated with intra-vesical BCG instillations and symptoms of protracted infection. Full article
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7 pages, 1285 KiB  
Case Report
Use of a FluoroType® System for the Rapid Detection of Patients with Multidrug-Resistant Tuberculosis—State of the Art Case Presentations
by Anna Zabost, Dorota Filipczak, Włodzimierz Kupis, Monika Szturmowicz, Łukasz Olendrzyński, Agnieszka Winiarska, Jacek Jagodziński and Ewa Augustynowicz-Kopeć
Diagnostics 2022, 12(3), 711; https://doi.org/10.3390/diagnostics12030711 - 15 Mar 2022
Cited by 1 | Viewed by 2338
Abstract
According to the World Health Organization (WHO), there were 465,000 cases of tuberculosis caused by strains resistant to at least two first-line anti-tuberculosis drugs: rifampicin and isoniazid (MDR-TB). In light of the growing problem of drug resistance in Mycobacterium tuberculosis across laboratories worldwide, [...] Read more.
According to the World Health Organization (WHO), there were 465,000 cases of tuberculosis caused by strains resistant to at least two first-line anti-tuberculosis drugs: rifampicin and isoniazid (MDR-TB). In light of the growing problem of drug resistance in Mycobacterium tuberculosis across laboratories worldwide, the rapid identification of drug-resistant strains of the Mycobacterium tuberculosis complex poses the greatest challenge. Progress in molecular biology and the development of nucleic acid amplification assays have paved the way for improvements to methods for the direct detection of Mycobacterium tuberculosis in specimens from patients. This paper presents two cases that illustrate the implementation of molecular tools in the recognition of drug-resistant tuberculosis. Full article
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2 pages, 471 KiB  
Interesting Images
Tuberculous Abscesses in the Head and Neck Region
by Lukas D. Landegger
Diagnostics 2022, 12(3), 686; https://doi.org/10.3390/diagnostics12030686 - 11 Mar 2022
Viewed by 3888
Abstract
Tuberculosis represents a global health challenge and is one of the leading infectious killers, with over a million people succumbing to it every year. While the disease is primarily prevalent in developing countries, where 95% of cases and deaths occur, doctors around the [...] Read more.
Tuberculosis represents a global health challenge and is one of the leading infectious killers, with over a million people succumbing to it every year. While the disease is primarily prevalent in developing countries, where 95% of cases and deaths occur, doctors around the globe need to be able to recognize its diverse clinical manifestations in order to initiate appropriate treatment early. The granulomatous infection caused by Mycobacterium tuberculosis typically affects the lungs, but isolated abscesses in the head and neck region can be a less common presentation of the disease, potentially resulting in dysphagia, odynophagia, voice changes, neck swelling, bone erosion, and even life-threatening respiratory distress requiring tracheostomy. Here, characteristic imaging findings and potential surgical options are discussed. Full article
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7 pages, 5974 KiB  
Case Report
XDR-TB Transmitted from Mother to 10-Month-Old Infant: Diagnostic and Therapeutic Problems
by Monika Kozińska, Krystyna Bogucka, Krzysztof Kędziora, Jolanta Szpak-Szpakowska, Wiesława Pędzierska-Olizarowicz, Andrzej Pustkowski and Ewa Augustynowicz-Kopeć
Diagnostics 2022, 12(2), 438; https://doi.org/10.3390/diagnostics12020438 - 8 Feb 2022
Cited by 4 | Viewed by 1507
Abstract
Drug-resistant TB (DR-TB) in children is a special epidemiological, clinical, and diagnostic problem, and its global incidence remains unknown. DR-TB in children is usually of a primary nature and is most often transmitted to the child from a household contact, so these cases [...] Read more.
Drug-resistant TB (DR-TB) in children is a special epidemiological, clinical, and diagnostic problem, and its global incidence remains unknown. DR-TB in children is usually of a primary nature and is most often transmitted to the child from a household contact, so these cases reflect the prevalence of DR-TB in the population of adult patients. The risk of infection with Mycobacterium tuberculosis complex (MTBC) in children depends on age, duration of exposure, proximity of contact with the infected person, and the level of source virulence. Most cases of TB in children, especially in infants, are caused by household contacts, where the main sources of infection are parents, grandparents or older siblings. However, there are many documented cases of TB transmission outside the family. The most common source of infection is an adult who is profusely positive for mycobacteria, diagnosed too late, and inadequately treated. It has been estimated that a sputum-positive patient might infect 30–50% of their household members. For this reason, active epidemiological investigation and contact tracing in the environment of sputum-positive patients are the most appropriate methods of identifying infected family members. This paper presents a case report concerning the transmission of extensively drug-resistant TB, Beijing 265 genotype, from a mother to her 10-month-old daughter. It is the first case diagnosed in Poland, and one of very few described in the literature where treatment was effective in the mother and the infant recovered spontaneously. Full article
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11 pages, 4306 KiB  
Case Report
From NTM (Nontuberculous mycobacterium) to Gordonia bronchialis—A Diagnostic Challenge in the COPD Patient
by Monika Franczuk, Magdalena Klatt, Dorota Filipczak, Anna Zabost, Paweł Parniewski, Robert Kuthan, Lilia Jakubowska and Ewa Augustynowicz-Kopeć
Diagnostics 2022, 12(2), 307; https://doi.org/10.3390/diagnostics12020307 - 25 Jan 2022
Cited by 8 | Viewed by 4063
Abstract
In patients with chronic obstructive pulmonary disease, respiratory infections are of various aetiology, predominantly viral and bacterial. However, due to structural and immunological changes within the respiratory system, such patients are also prone to mycobacterial and other relatively rare infections. We present the [...] Read more.
In patients with chronic obstructive pulmonary disease, respiratory infections are of various aetiology, predominantly viral and bacterial. However, due to structural and immunological changes within the respiratory system, such patients are also prone to mycobacterial and other relatively rare infections. We present the 70-year old male patient with chronic obstructive pulmonary disease (COPD) and coexisting bronchial asthma, diagnosed due to cough with purulent sputum expectoration lasting over three months. The first microbiological investigation of the sputum sample revealed the growth of mycobacteria. The identification test based on protein MPT64 production indicated an organism belonging to NTM (nontuberculous mycobacterium). However, further species identification by genetic testing verified the obtained culture as not belonging to the Mycobacterium genus. Based on observed morphology, the new characterisation identified an aerobic actinomycete, possibly a Nocardia spp. The isolated strain was recultured on standard microbiological media. The growth of colonies was observed on Columbia blood agar plates and solid Löewenstein-Jensen medium. The Gram and Zhiel-Nielsen stains revealed the presence of Gram-positive acid-fast bacilli. The extraction protocol and identification were performed in two repetitions; the result was G. bronchialis, with a confidence value of 99% and 95%, respectively. The gene sequencing method was applied to confirm the species affiliation of this isolate. The resulting sequence was checked against the 16S ribosomal RNA sequences database (Bacteria and Archaea). The ten best results indicated the genus Gordonia (99.04–100%) and 100% similarity of the 16S sequenced region was demonstrated for Gordonia bronchialis. The case described indicates that the correct interpretation of microbiological test results requires the use of advanced microbiology diagnosis techniques, including molecular identification of gene sequences. From a clinical point of view, Gordonia bronchialis infection or colonization may present a mild course, with no febrile episodes and no significant patient status deterioration and thus, it may remain undiagnosed more often than expected. Full article
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