Search Results (5,131)

Background: Bone marrow abnormalities in people living with HIV may reflect infectious, neoplastic, or inflammatory processes, particularly in advanced disease presenting with fever of unknown origin or unexplained cytopenias. In Latin America, contemporary data on the causes and diagnostic contribution of bone marrow evaluation remain limited, especially in resource-constrained settings. Aim: To characterize the etiologies, histopathological patterns, and diagnostic contribution of bone marrow evaluation in adults living with HIV at a tertiary referral center in Venezuela. Methods: We conducted a cross-sectional study with retrospective and prospective case ascertainment among adults with confirmed HIV infection who underwent bone marrow aspiration, biopsy, or both for suspected infiltrative disease between January 2019 and April 2024. We analyzed clinical, laboratory, histopathological, microbiological, and molecular data at the index bone marrow evaluation. Test-specific denominators are reported because diagnostic investigations were not uniformly available. Results: Forty-two patients were included (35 retrospectively and 7 prospectively); 59.5% were male and the median age was 39 years (IQR: 31.75–50.0). At presentation, 67% were newly diagnosed with HIV and 79% were ART-naive; the median CD4+ T-cell count was 98.5 cells/mm³. Histopathology was evaluable in 37/42 patients; 31/37 (83.8%) showed findings compatible with infectious involvement and 6/37 (16.2%) showed malignancy. Histoplasma capsulatum was isolated in 17/35 fungal cultures (48.6%), Mycobacterium tuberculosis in 13/33 mycobacterial cultures (39.4%), and CMV PCR on bone marrow aspirate was positive in 2/3 patients tested. The final etiologic classification was infectious in 36/42 patients (85.7%) and neoplastic in 6/42 (14.3%). Conclusions: In this highly selected cohort of adults with advanced HIV disease, infectious etiologies-particularly histoplasmosis and tuberculosis-predominated. Bone marrow aspiration and biopsy, interpreted together with microbiological and molecular testing, provided clinically relevant diagnostic information in patients with prolonged fever, cytopenias, or otherwise inconclusive investigations. The findings support earlier HIV diagnosis and ART initiation and improved access to fungal, mycobacterial, and molecular diagnostics in resource-limited settings. Full article

Background: Tuberculous pleural effusion (TPE) occasionally presents with polymorphonuclear leukocyte (PMN)-predominant pleural fluid (PF) and elevated serum C-reactive protein (CRP), mimicking parapneumonic effusion (PPE). We investigated factors distinguishing TPE from PPE in this diagnostically challenging setting. Methods: We retrospectively reviewed consecutive patients with confirmed TPE or PPE at a tertiary referral center (2010–2024). Patients with serum CRP ≥ 10 mg/dL were classified according to PF PMN-predominance. Independent discriminators between PMN-predominant TPE and PPE were identified using multivariable Firth logistic regression. Results: Among 414 patients with confirmed TPE, 108 (26%) had serum CRP ≥ 10 mg/dL, including 20 with PMN-predominance and 88 without. Anti-tuberculosis treatment was modestly delayed in the PMN-predominant group (p = 0.017). These 20 patients were compared with 335 PPE patients showing the same CRP/PMN profile. Pulmonary nodular lesions on chest computed tomography and PF adenosine deaminase (ADA) were independent discriminators. A composite two-tier rule—nodular lesions present or PF ADA > 80 IU/L if absent—achieved an AUROC of 0.925, 80.0% sensitivity, and 86.2% specificity. Conclusions: In patients with PMN-predominant pleural effusion and elevated serum CRP, this simple, readily available rule may help identify patients warranting early pleural biopsy and heightened suspicion for TPE before microbiological confirmation. Full article

Background/Objectives: The rapid diagnosis of tuberculous pleural effusion (TPE) presents significant challenges for clinicians due to its paucibacillary nature. Routine biochemical markers may complement microbiological and molecular tests, especially in resource-limited settings. The objective of this study was to evaluate the diagnostic performance of pleural fluid adenosine deaminase (ADA), lactate dehydrogenase (LDH), total protein (TP), and the ADA/LDH and ADA/TP ratios for tuberculous pleural effusion, using Löwenstein–Jensen culture and Xpert MTB/RIF as microbiological reference standards Methods: We conducted a retrospective study (2016–2024) including 325 consecutive patients investigated for suspected TPE in a tertiary hospital. ADA, TP and LDH were measured, and additional ratio-based indices (ADA/TP, ADA/LDH) were calculated for 325 pleural fluid (PF) samples. Löwenstein–Jensen (LJ) culture (with MPT64 confirmation) and GeneXpert MTB/RIF (Xpert MTB/RIF) were used as separate microbiological reference standards. Sensitivity (Se), specificity (Sp), and areas under the ROC curve (AUC) were estimated, and optimal thresholds were determined using the Youden index. Results: Among 325 pleural fluid samples, 23 (7.1%) were culture-positive. Xpert MTB/RIF was performed in 73/325 patients (22.5%), with Mycobacterium tuberculosis detected in 19/73 (26.0%) tested samples. In PF, ADA provided the best performance against culture, with Se of 100%. Correlation analysis in PF showed a moderate positive association between TP and LDH (p < 0.0001). Conclusions: Among routine biochemical markers, PF ADA shows high NPV. Integrating these rapid, low-cost tests alongside LJ culture and Xpert MTB/RIF may streamline the diagnostic pathway for TPE. Full article

Introduction: Medications with sedative and hypnotic properties, such as benzodiazepines, the so-called ‘Z-drugs’, and hydroxyzine, are used in primary care. However, data regarding their prescribing patterns, particularly in the context of seasonality, remain limited. Aim: This review aims to assess the current knowledge regarding primary care prescribing patterns for medications with potential sedative and hypnotic effects, with particular emphasis on benzodiazepines, ‘Z-drugs’, and hydroxyzine. Material and Methods: The systematic review was conducted following the PRISMA guidelines. The PubMed, Web of Science and Scopus databases were searched. Fourteen original English-language publications from 2015 to 2026, which focused on the primary care prescription of selected groups of medications with hypnotic properties, were included. Results: Most of the studies included concerned benzodiazepines, with inconsistent prescribing patterns. Some studies reported a decrease in the rate of their prescription, whilst others indicated an increase, particularly among older people and patients with multimorbidity. Data concerning ‘Z-drugs’ were less extensive and showed heterogeneous prescribing trends across countries and study periods. Overall, the findings indicate substantial international variability in hypnotic prescribing in primary care. Evidence regarding hydroxyzine prescribing was particularly limited, with only one study specifically examining its prescribing patterns in primary care. Data on the seasonal prescribing patterns for all groups of medications were limited. Conclusions: Prescription of medications with sedative and hypnotic properties remains an important part of primary healthcare practice. Yet, significant research gaps remain regarding hydroxyzine prescribing and the seasonal variation in hypnotic and sedative prescribing. Full article

Lower respiratory tract infections (LRTIs) are a leading infectious cause of death in children worldwide. Complete blood count (CBC)-derived inflammatory ratios are low-cost and widely available, yet their reported performance varies. We reviewed 46 PubMed-indexed studies (2016–2026) in children aged 0–18 years with viral, bacterial, or mycobacterial LRTI. The findings were mapped across diagnosis, etiological differentiation, severity, and outcome prediction. The neutrophil-to-lymphocyte ratio (NLR) was the most investigated marker, with the broadest evidence base for severity assessment and for separating bacterial from viral disease, although its performance remained pathogen-, population-, and endpoint-dependent; it was elevated in severe pertussis, tuberculosis, Mycoplasma pneumoniae, Streptococcus pneumoniae, and SARS-CoV-2 infection, whereas findings in respiratory syncytial virus infection were conflicting. The platelet-to-lymphocyte ratio had the next broadest evidence base for severity, and the systemic immune-inflammation index was consistently elevated in Mycoplasma pneumoniae and SARS-CoV-2 infection. No single ratio performed consistently across all etiologies. Ratios governed by one dominant immunopathogenic mechanism behaved predictably; those whose numerator and denominator respond to the same process did not. Cut-offs were neither standardized, age-specific, nor externally validated, and most estimates derived from retrospective cohorts in few countries; reported values therefore represent association and discrimination rather than validated prediction. Standardized, age-specific thresholds are needed before these markers can support routine risk stratification. Full article

Background/Objectives: Major pathological response (MPR) has been suggested as a potential surrogate marker for assessing the efficacy of neoadjuvant therapy. However, its prognostic value and association with postoperative recurrence patterns remain unclear in patients with locally advanced oesophageal squamous cell carcinoma (ESCC) treated with neoadjuvant immunochemotherapy. This multicentre study aimed to investigate the relationship between MPR status, survival outcomes, and recurrence characteristics in this population. Methods: A total of 305 patients with locally advanced ESCC who received neoadjuvant immunochemotherapy followed by surgical resection at four medical centres in China between December 2019 and April 2024 were retrospectively enrolled in this study. Prognostic factors for overall survival (OS) and recurrence-free survival (RFS) were analyzed using Cox proportional hazards regression models. Propensity score matching (PSM) was performed to balance baseline characteristics between patients with and without MPR, and survival outcomes and postoperative recurrence patterns were subsequently compared. Results: Among the 305 patients, 115 (37.7%) achieved MPR. Multivariate analysis identified MPR and the number of neoadjuvant treatment cycles as independent prognostic factors for both OS and RFS (p < 0.05). After PSM, patients with MPR showed significantly improved OS and RFS compared with those without (p < 0.05). Postoperative recurrence occurred less frequently in the MPR group than in the non-MPR group (13.9% vs. 42.1%, respectively; p < 0.05), with reductions in both locoregional and distant recurrence. Conclusions: In patients with locally advanced ESCC receiving neoadjuvant immunochemotherapy and surgery, achieving MPR is associated with improved survival outcomes and a lower risk of postoperative recurrence. MPR may serve as a useful prognostic indicator for this population. Full article

Tuberculosis (TB) remains a major global health burden, and diabetes mellitus increases the risk of active TB. Thiazolidinediones (TZDs) have immunomodulatory effects, but their association with TB remains unclear. This study investigated the associations between TZD use and TB-related events in patients with type 2 diabetes (T2D), including TB requiring anti-TB treatment, pulmonary TB, and TB-related hospitalization. Using Taiwan’s National Health Insurance Research Database, adults with newly diagnosed T2D between 2000 and 2017 were identified. Propensity score matching and Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for TB requiring anti-TB treatment, pulmonary TB, and TB-related hospitalization. After 1:1 matching, 44,095 TZD user–nonuser pairs and 9225 rosiglitazone user–nonuser pairs were identified. Overall, TZD use was not significantly associated with TB-related outcomes. However, rosiglitazone use was associated with lower risks of TB requiring anti-TB treatment (aHR, 0.56; 95% CI, 0.36–0.86), pulmonary TB (aHR, 0.79; 95% CI, 0.68–0.92), and TB-related hospitalization (aHR, 0.59; 95% CI, 0.43–0.81). Rosiglitazone use was associated with lower risks of TB-related outcomes in the primary Cox analyses; however, these associations were attenuated in time-dependent analyses and were no longer statistically significant after accounting for death as a competing event. These observational findings should therefore be considered hypothesis-generating rather than evidence of a causal or protective effect and require confirmation using more robust causal-inference approaches. Full article

Interleukin-11 (IL-11) is implicated in epithelial dysfunction, fibroblast activation, tissue remodeling, and chronic inflammatory responses; however, the clinical value of circulating IL-11 in airway disease remains uncertain. This single-center retrospective exploratory observational study included 88 adults: 31 with allergic rhinitis, 15 with non-allergic asthma, 22 with allergic asthma associated with allergic rhinitis, and 20 healthy controls. Serum IL-11 concentrations were measured using a quantitative sandwich enzyme-linked immunosorbent assay. Between-group differences were assessed using the Kruskal–Wallis test followed by Holm-adjusted pairwise Mann–Whitney U tests. Associations with disease-specific ordinal clinical categories were evaluated using Spearman rank correlation, with GINA treatment Steps used for asthma phenotypes and ARIA severity categories for allergic rhinitis. Median IL-11 concentrations were 62.01 pg/mL in non-allergic asthma, 78.87 pg/mL in allergic rhinitis, 61.92 pg/mL in allergic asthma associated with allergic rhinitis, and 95.46 pg/mL in healthy controls. The primary global comparison was not statistically significant (H = 5.667, p = 0.129), and no pairwise comparison remained significant after Holm correction. Six measurements (6.8%) were below the assay detection limit; replacing these values with 4.0 pg/mL in a sensitivity analysis did not materially alter the global result (H = 5.671, p = 0.129). Serum IL-11 was not significantly associated with GINA treatment step in non-allergic asthma (rho = −0.170, p = 0.544) or allergic asthma associated with allergic rhinitis (rho = 0.052, p = 0.818), nor with ARIA severity category in allergic rhinitis (rho = 0.046, p = 0.805). In an exploratory analysis adjusted for age, sex, body-mass category, and current smoking status, IL-11 concentrations were lower in each clinical phenotype relative to healthy controls; given the modest group sizes and baseline imbalance, this finding was considered hypothesis-generating. Overall, the primary analysis did not demonstrate significant differences in circulating IL-11 across study groups, and serum IL-11 was not associated with disease-specific ordinal clinical categories. These findings do not support the use of a single serum IL-11 measurement as a stand-alone biomarker of airway disease phenotype or clinical category in this cohort and warrant confirmation in larger, prospectively characterized cohorts. Full article

Non-marneffei Penicillium species are ubiquitous molds usually dismissed as contaminants in respiratory cultures; invasive disease is rare and may mimic malignancy, tuberculosis, or sarcoidosis. A 39-year-old apparently immunocompetent man with asthma, a smoking history, and tuberculosis exposure presented with chronic cough, fever, night sweats, and weight loss. Chest computed tomography (CT) showed right lower-lobe subpleural consolidation, bilateral nodules, and mediastinal lymphadenopathy. Sputum and bronchoalveolar lavage (BAL) studies for tuberculosis were repeatedly negative; CT-guided lung biopsy showed a non-necrotizing granuloma, suggesting sarcoidosis. Five months later, the original lesions had regressed, and new contralateral pleural-based nodules appeared, establishing a migratory pattern. Repeat BAL grew a Penicillium species, a second recovery after an earlier isolate was dismissed as contamination. Surgical mediastinal lymph-node biopsy showed necrotizing granulomatous inflammation containing PAS- and GMS-positive septate hyphae, establishing proven invasive fungal disease, and fungal culture of the same tissue grew a Penicillium species; HIV and hepatitis serologies were negative. Liposomal amphotericin B followed by oral voriconazole produced near-complete radiological resolution. Attribution to Penicillium rests on recovery of the mold from the surgical tissue itself; identification nevertheless remained at genus level, because molecular identification, susceptibility testing, and fungal biomarkers were unavailable, and invasion of lung parenchyma was never demonstrated histologically. Migratory infiltrates should prompt reconsideration of fixed diagnoses; repeated mold recovery with tissue-invasive hyphae and treatment response warrants reassessment rather than dismissal as contamination. Full article

Background: Monitoring treatment outcomes is central to evaluating drug-resistant tuberculosis (DR-TB) programmes and ensuring accountability, particularly in high-burden settings such as South Africa. However, routine surveillance data are often constrained by small sample sizes and incomplete reporting. The increasing proportion of outcomes classified as “not evaluated” raises critical concerns about the validity and interpretability of reported treatment success rates. This study examines longitudinal trends in DR-TB outcomes in two rural Eastern Cape facilities (2020–2024), conceptualising routine outcomes as governance signals reflecting health system performance and data management capacity, rather than clinical performance alone. Methods: A retrospective analysis of aggregated DR-TB treatment outcomes from 2020 to 2024 was conducted using routine programme data. Outcomes included treatment success, failure, loss to follow-up (LTFU), death, and “not evaluated.” Proportions were estimated using Wilson 95% confidence intervals, and year-to-year differences were assessed using chi-square tests, with cautious interpretation due to small sample sizes. Bounding analyses were applied to assess the sensitivity of treatment success estimates to alternative assumptions about incomplete outcome reporting. Results: Treatment success declined over time for both rifampicin-resistant TB (RR-TB) and multidrug-resistant TB (MDR-TB), with a significant decrease observed in MDR-TB (80.9% in 2021 to 38.5% in 2024; p = 0.007). Concurrently, the proportion of outcomes classified as “not evaluated” increased substantially from 2023 onward, reaching 25.8% in RR-TB and 30.8% in MDR-TB by 2024 (p < 0.001). Mortality remained persistently high in RR-TB, while MDR-TB exhibited higher levels of treatment failure and LTFU. Analyses for pre-XDR-TB and XDR-TB were limited by small sample sizes. Bounding analyses demonstrated that treatment success estimates were highly sensitive to incomplete reporting of outcomes. Conclusions: Declining DR-TB treatment success in this setting is closely associated with increasing incomplete outcome reporting, suggesting that observed trends may reflect challenges in surveillance and governance systems rather than clinical deterioration alone. Interpreting routine DR-TB outcomes as governance signals provides a novel systems-based perspective for programme evaluation. Strengthening data completeness, patient tracking, and surveillance systems is essential to improve the reliability of programme indicators and support effective TB control in resource-constrained rural settings. Full article

Bovine tuberculosis (bTB), caused by Mycobacterium bovis (M. bovis), is a chronic zoonotic disease with buffaloes as maintenance hosts, yet global pooled prevalence of bTB in buffaloes has not been systematically quantified. This systematic review and meta-analysis estimated the global prevalence, distribution, and risk factors (spatio-temporal, geographical and socioeconomic, host characteristics, and research design and methodology) of bTB in buffaloes. Six electronic databases (PubMed, ScienceDirect, Web of Science, CNKI, VIP, and WanFang) were systematically searched for studies published between 1963 and 2025. Of 1731 records, 104 studies (385,616 buffaloes, 17 countries) were included. Estimates a global pooled prevalence of 7.4% for buffaloes, which is higher than recent global estimates for cattle (reported at 3.98% and, in a 2024 meta-analysis, 3.27% at the animal level); this cross-species comparison should be interpreted cautiously given differences in diagnostics, regions and time periods. Key risk factors identified were advanced age (15–20 years, 34.2%), draught use (28.0%), free-ranging management (12.0%), large herd size (9.9%), low-income economies (13.7%), and tropical savanna climate (10.1%). Publication bias was detected but did not substantially alter the overall pooled prevalence estimate. The persistently high burden in Africa and developing countries highlights the urgent need for integrated One Health surveillance and targeted control strategies. Full article

This review describes the cellular and molecular mechanisms underlying multi-dose bacille Calmette-Guérin (BCG) as an investigational immunotherapy for glycemic improvement in autoimmune diabetes. The BCG data is most often human clinical trial data over the last 15 years paired with mechanistic insights. BCG as a vaccine has an excellent safety record with a century-long safety record in tuberculosis prevention worldwide and, for 36 years, has been FDA-approved at higher doses for the treatment of bladder cancer. Our group and others have conducted multiple clinical trials evaluating multi-dose BCG immunotherapy in adults with the two forms of longstanding autoimmune diabetes. In type 1 diabetes (T1D), clinical trials of multi-dose BCG have shown stable repeated reductions in the FDA-recommended biomarker glycated hemoglobin (HbA1c) to near-normal levels (vs placebo) for at least 8 years. This improvement paradoxically occurs without any recovery of pancreatic function from its negligible baseline level. Evidence from long-term trials, together with companion global mechanistic studies, indicates that glycemic improvement is associated with BCG-induced correction of aerobic glycolysis defects in lymphoid and myeloid cells, an outcome also observed in the granuloma of BCG’s close relative, tuberculosis. Restoration of energy metabolism to aerobic glycolysis in diabetic lymphoid cells increases glucose utilization, thereby enhancing systemic glucose uptake from the bloodstream, as demonstrated by longitudinal PET/CT imaging. In contrast, latent autoimmune diabetes in adults (LADA), a form of slow autoimmune diabetes that occurs late into adulthood, has minimal or lacks the clinically significant aerobic glycolysis defect. In LADA with multi-dose BCG immunotherapy glycemic improvement in BCG-treated patients does not occur commonly, based on 8 years of data. LADA nevertheless displays other favorable immune and clinical responses suggestive of BCG-induced regulatory T cell (Treg) induction. In LADA, multi-dose BCG decreases inflammation, thus halting pancreatic autoimmunity with insulin rescue and also halts inflammatory driven insulin resistance. BCG’s consistent clinical benefits in autoimmune diabetes coincide with the gradual pace of upstream epigenetic reprogramming of genes involved in metabolic and T cell pathways without changing genotype. Understanding the mechanistic chain linking BCG-induced epigenetic changes to clinical efficacy may offer insights into the treatment and potential prevention of autoimmune diabetes. Full article

Tuberculous meningitis (TBM) is a critically severe form of extrapulmonary tuberculosis in pediatric patients, presenting a significant diagnostic challenge during the early stages of clinical manifestation. Delayed recognition of meningeal tuberculous inflammation leads to the involvement of the brain parenchyma (encephalitis) and may result in irreversible neurological sequelae. Objective: To evaluate the clinical features, the spectrum of complications, and the acute outcomes of tuberculous meningitis in pediatric patients managed at a tertiary reference center. Materials and Methods: A retrospective observational study of 21 medical records was conducted for pediatric patients aged 3 months to 17 years (mean age: 6.7 ± 5.8 years) with a confirmed TBM diagnosis. The study included pediatric patients treated in the inpatient pediatric department (n = 6) or evaluated through the national telemedicine consultation system (n = 15) between 2017 and 2025. Results: A history of contact with a tuberculosis patient was established in 62% (13/21) of cases. At initial presentation, fever was recorded in 67% (14/21) of patients, nausea and/or vomiting in 52% (11/21), headache in 33% (7/21), and meningeal signs in 38% (8/21). The majority of patients (52%, 11/21) had not received BCG vaccination. Mycobacterium tuberculosis (MTB) was microbiologically confirmed in 19 patients (90.5%). MTB DNA was detected in the cerebrospinal fluid (CSF) in 71.4% of all patients (15/21; 78.9% of confirmed cases). Drug resistance (DR) was confirmed in 47.4% of confirmed patients (9/19; 42.9% of the total cohort), comprising MDR (15.8%, 3/19), pre-XDR (15.8%, 3/19), and XDR (15.8%, 3/19) strains. Neurological complications included hydrocephalus in 47.6% (10/21), motor deficits in 38.1% (8/21), and epileptic syndrome in 19.0% (4/21). In-hospital mortality was 0%, while four patients (19.0%) with critically severe irreversible brain damage were transitioned to palliative care. Conclusion: In this tertiary pediatric cohort, TBM presented predominantly as a severe form of meningoencephalitis with extensive brain parenchymal involvement and high rates of systemic dissemination, frequently complicated by hydrocephalus, motor deficits, and seizures. Epileptic seizures showed an exploratory statistical trend toward an association with unfavorable neurological outcomes (p = 0.052). These findings underscore the urgent need to optimize early diagnostic strategies within general healthcare networks. Full article

Background: While non-specific pleural empyema in children can be successfully managed with conservative drainage and thoracentesis in 80–84% of cases, tuberculous pleural empyema (TB empyema) exhibits high resistance and frequently requires extensive thoracic surgery. The choice of surgical scope depends directly on disease stage and secondary complications. Methods: We conducted a retrospective cohort study of 85 pediatric patients (aged 4 to 17 years) with confirmed TB empyema treated between 1984 and 2022, and followed until 2025. Disease staging followed a predefined adaptation of the American Association for Thoracic Surgery (AATS) consensus classification. The study adhered strictly to STROBE guidelines, incorporating temporal stratification across three historical eras and standardized Clavien–Dindo complication reporting. This study describes a 38-year surgical experience at a tertiary pediatric phthisiosurgical center; non-operated patients successfully cured with exclusive chemotherapy were excluded. Results: Stage I empyema was identified in three patients, Stage II in seven, and Stage III in 75 patients (79 total procedures). Stage I–II patients underwent video-assisted thoracoscopic (VATS) debridement. In Stage III, advanced reconstructive interventions were required (39 VATS pleurectomies, 21 segmental resections, eight pleuropneumonectomies, six lobectomies, two thoracomyoplasties, two open resections, and one bronchus occlusion). Postoperative complications occurred in two patients (2.35% patient-level; categorized as Clavien–Dindo Grade IIIa and Grade IIIb), presenting as delayed lung re-expansion managed via secondary minor interventions. Overall 30-day postoperative mortality was 0.0%. Over a median follow-up of 48 months (database lock: 31 December 2025; 97.65% 36-month completeness), zero disease recurrences were documented (0.0%). Conclusion: In this tertiary surgical cohort, combined management incorporating stage-dependent surgical intervention achieved durable clinical cure. Early VATS debridement represents an effective option for Stage I–II patients who fail initial drainage, potentially reducing progression to a rigid fibrothorax and the subsequent need for extensive pulmonary resections. Full article

Tuberculosis (TB) is a leading global cause of infectious disease. Growing evidence suggests that TB significantly increases the risk of comorbidity in HIV+ patients, particularly acute ischemic stroke (AIS). Prognosis is often poor, highlighting the need for early prevention and intervention. However, exact mechanisms linking HIV-Mtb coinfection and stroke remain poorly understood. A review of articles from 2016 to 2026 was conducted to study the risk of ischemic stroke and treatment strategies in HIV-Mtb coinfection. Both HIV and Mtb can increase stroke risk, but pathogenesis of the coinfection and relationship between the coinfection and stroke remain as proposals. Antiretroviral therapy (ART) has shown variable success rates; it may increase the risk of stroke or be associated with worse outcomes. Multi-drug-resistant TB (MDR-TB) can be treated with a combination of bedaquiline, linezolid, and pretomanid (BPaL). Steroids and vitamin D supplementation with ART are associated with improved outcomes. For coinfection screening, the monocyte-to-lymphocyte ratio (MLR) and a clinical scoring system for triage may prove useful for early detection, leading to prompt intervention. A clearer understanding of the association between HIV-Mtb coinfection and stroke is essential for developing effective prevention strategies and eliminating transmission. Advancement of current treatments will help improve long-term outcomes in HIV-Mtb coinfection. Full article