Search Results (208)

Nontuberculous Mycobacteria (NTM), often referred to as environmental or atypical mycobacteria, are opportunistic pathogens phylogenetically as well as clinically distinct from both the Mycobacterium tuberculosis complex and Mycobacterium leprae. In the pediatric age group, NTM disease manifests with a diverse range of clinical phenotypes. Cervicofacial lymphadenitis stands out as the most common presentation among children who are immunocompetent. Conversely, skin and soft tissue infections, pulmonary disease and disseminated infections constitute less prevalent, yet clinically important, disease forms. Accurate identification is paramount, as differentiating NTM infections from tuberculosis (TB) remains challenging based solely on clinical symptoms, initial laboratory analyses, or standard radiological findings. This distinction is critical because treatment protocols for NTM infections differ substantially from those for tuberculosis. This narrative review offers a comprehensive and up-to-date summary of NTM infections in children. It examines the spectrum of clinical presentations and their prevalence, addresses the complexities of diagnosis and therapy, and underscores the importance of differential diagnosis against tuberculosis. Furthermore, we explore current diagnostic strategies, available therapeutic options, and the link between specific clinical syndromes and tailored management, pointing out existing knowledge gaps and suggesting priorities for future research. The absence of rapid, species-specific diagnostic tools often results in delayed initiation of targeted treatment, while overlapping clinical features with TB can lead to misdiagnosis. Therapeutic management is complicated by the necessity for prolonged drug courses, frequent occurrences of drug intolerance, limited availability of child-appropriate formulations, and the rising tide of antimicrobial resistance. Successfully tackling these issues demands enhanced surveillance, precise species-level identification, the creation of child-friendly drug formats, and the development of evidence-based treatment guidelines specifically designed for the pediatric population. Full article

Clinical indicators for pulmonary tuberculosis (PTB) among patients with community-acquired pneumonia (CAP) have been derived from studies on younger or middle-aged populations in high TB-burden countries. However, diagnostic clues specific to older adults remain insufficiently validated. This multicenter prospective observational study aimed to identify the clinical features that can help differentiate PTB from CAP among older patients. We enrolled patients aged ≥ 65 years who were diagnosed with PTB or non-TB CAP between September 2023 and September 2025. Clinical data—including demographics, symptoms, and laboratory findings, previously reported as potential discriminators of PTB—were compared between the two groups. Of 233 patients included, 57 (24%) were diagnosed with PTB. No significant difference in sex was observed between the PTB and non-TB CAP groups. The PTB group was older and had a poorer performance status than the CAP group. On multivariate logistic regression analysis, PTB was significantly and independently associated with weight loss (aOR 8.17, p < 0.001); symptoms lasting ≥ 2 weeks (aOR 5.79, p < 0.001); and absence of general fatigue (aOR 0.19, p < 0.001) and dyspnea (aOR 0.19, p = 0.002) but not with night sweats and hemoptysis. These clinical features may be valuable indicators of PTB in older adults and inform tuberculosis control strategies in regions expected to have accelerated population aging. Full article

This study aimed to identify scientific evidence that addresses women’s experiences in the process of illness and care during tuberculosis treatment. A systematic review of qualitative studies was conducted based on the Joanna Briggs Institute’s Manual for Evidence Synthesis and the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Searches were performed in the Web of Science, MEDLINE, Embase, SciVerse Scopus, and LILACS databases. The following descriptors were used: “Women,” “Tuberculosis,” “Gender Perspective,” and “Qualitative Approach.” Studies reporting the experiences of women with active tuberculosis, published in any language, without time restrictions, were included. Of the 16,029 studies initially identified, 7079 duplicates were removed and 8895 were excluded after title and abstract screening. A total of 55 studies were read in full, of which 41 did not meet the eligibility criteria, resulting in a final inclusion of 14 studies. Most selected studies were conducted in high-tuberculosis-burden, low- and middle-income countries between 2000 and 2024. All studies focused on pulmonary tuberculosis, with one addressing drug-resistant tuberculosis. The results revealed that women’s experiences with tuberculosis are shaped by the following four thematic categories: (1) stigma and social vulnerability of women with tuberculosis; (2) gender factors in access to health services and in the interruption of tuberculosis treatment among women; (3) intersectionality and social determinants of health; and (4) the importance of social, family, and healthcare support in the experience of tuberculosis illness. The experience of illness due to tuberculosis among women is profoundly shaped by vulnerabilities related to gender, stigma, and social class, which intensify social exclusion, hinder access to diagnosis and treatment, and deepen physical and emotional suffering. Stigma reinforces isolation and weakens support networks, while the burden of domestic labor, caregiving responsibilities, and economic dependence makes it difficult for women to prioritize their own health. In this context, family support and gender-sensitive, humanized healthcare are essential. Therefore, the implementation of public policies that address these specificities and confront structural inequalities is urgent to ensure comprehensive care and a dignified, effective recovery for women with tuberculosis. Full article

Background and Clinical Significance: Cutaneous lupus erythematosus (CLE) is an autoimmune condition characterized by a wide range of cutaneous manifestations, classified into three major subtypes—chronic (CCLE), subacute (SCLE), and acute (ACLE)—based on clinical morphology and lesion duration. Discoid lupus erythematosus (DLE), the most common form of CCLE, predominantly affects sun-exposed areas and presents as erythematous macules that progress to well-demarcated, disc-shaped plaques. If left untreated, DLE may lead to scarring and permanent alopecia. Diagnosis is primarily clinical, with skin biopsy performed when indicated. Management includes photoprotection and topical corticosteroids, with systemic immunosuppressive therapy reserved for severe cases. Case Presentation: We report a case of a 38-year-old female patient presenting with confluent lesions with indurated borders and multiple pustules, initially raising suspicion of cutaneous infection. A broad differential diagnosis was considered, including fungal and bacterial infections, demodicosis, and cutaneous tuberculosis, all of which were excluded through comprehensive clinical and laboratory investigations. Ultimately, DLE was diagnosed based on serologic and histopathologic findings. During the course of immunosuppressive therapy, her condition deteriorated, and she developed pulmonary tuberculosis. Conclusions: The presented case underlines the rarity and broad differential diagnosis of DLE as well as the possibility of complications. Full article

Tuberculosis (TB) remains a major global health challenge, and early, accurate diagnosis is essential for effective disease control. Chest radiography (CXR) is widely used for TB screening because of its accessibility, yet its limited specificity necessitates confirmatory molecular testing such as polymerase chain reaction (PCR) assays. This study aimed to evaluate the diagnostic performance of a deep learning model (DLM) for TB detection using CXR and to compare its predictive accuracy with PCR results, specifically in a low-burden region. A retrospective dataset of CXR images and corresponding PCR findings was obtained from two hospitals. The DLM, based on the CheXzero vision transformer, was trained on a large imaging dataset and evaluated using receiver operating characteristic (ROC) curves and area under the curve (AUC) metrics. Internal and external validation sets assessed sensitivity, specificity, and predictive values, with subgroup analyses according to imaging modality, demographics, and comorbidities. The model achieved an AUC of 0.915 internally and 0.850 externally, maintaining good sensitivity and specificity, though performance declined when limited to PCR-confirmed cases. Accuracy was lower for older adults and those with chronic kidney disease, chronic obstructive pulmonary disease, or heart failure. These findings suggest AI-assisted CXR screening may support TB detection in resource-limited settings, but PCR confirmation remains essential. Full article

Pulmonary diseases caused by nontuberculous mycobacteria are increasingly becoming common worldwide and are occurring more frequently alongside pulmonary tuberculosis. Given that pulmonary diseases resulting from nontuberculous mycobacteria and pulmonary tuberculosis display similar features—such as clinical manifestations, imaging findings, and laboratory results—the accurate differentiation of each disease type is highly challenging. Mycobacterial culture, as a gold standard method, cannot be considered completely trustworthy because of low bacterioexcretion rates among nontuberculous mycobacterial pulmonary patients. Additional problems result from poor diagnosis. The treatment of lung diseases caused by nontuberculous mycobacteria is also difficult. This could be due to the wide spectrum of bacteria belonging to nontuberculous mycobacteria, as well as low bacterioexcretion. Therefore, bacterial sensitivity to drugs is insufficient. As a result, in this article, our intention is to explain the diagnostic difficulties of pulmonary diseases caused by nontuberculous mycobacteria and the Mycobacterium tuberculosis complex. The review seeks to outline promising directions for the development of novel diagnostic approaches in order to improve clinical decision-making and ultimately treatment outcomes. Full article

Sarcoidosis is a chronic, idiopathic, multisystemic inflammatory disease characterized by non-caseating granulomas, most commonly affecting the lungs and mediastinal lymph nodes. Radiological imaging plays a fundamental role in the diagnosis, assessment of disease extent, and differentiation from other pulmonary conditions. This narrative review offers a comprehensive overview of the imaging features of pulmonary sarcoidosis, focusing on both typical patterns—such as bilateral hilar lymphadenopathy, perilymphatic nodules, and upper lobe-predominant infiltrates—and atypical manifestations—including alveolar opacities, miliary nodules, fibrocystic changes, and lower lobe involvement. Emphasis is placed on the utility of high-resolution computed tomography (HRCT) in detecting early parenchymal changes and complications such as fibrosis, bronchiectasis, and pulmonary hypertension. Differential diagnosis, including tuberculosis, silicosis, metastatic disease, organizing pneumonia, and hypersensitivity pneumonitis, are discussed to aid interpretation. Recognizing the spectrum of radiological presentations is essential for distinguishing sarcoidosis from other interstitial and granulomatous lung diseases. Radiologists play a pivotal role in the multidisciplinary diagnostic process, contributing to timely diagnosis, risk stratification, and optimized patient management. Full article

Background: The diagnosis of abdominal tuberculous lymphadenopathy (ATBL) remains challenging in clinical practice. Patients with ATBL and HIV infection may have atypical clinical and computed tomography (CT) features. The aim of this study was to investigate the impact of HIV infection on the clinical and CT features of ATBL patients. Methods: From January 2012 to March 2023, 178 patients with untreated ATBL were retrospectively analyzed. Patients with ATBL were classified into HIV-negative group (n = 152) and HIV-positive group (n = 26). In addition to the clinical characteristics of the patients, the features of ATBL (e.g., size and location) were evaluated via CT. The Mann–Whitney U test (for continuous variables) and Fisher’s exact test (for categorical variables) were used to compare clinical data and CT imaging features between the two groups. Missing values were handled using multiple imputation, and the Benjamini–Hochberg procedure was applied to control the false discovery rate (FDR) in multiple comparisons. Post hoc power analysis for key variables was performed. Results: Compared with the HIV-negative group, the HIV-positive group had older age, lower CD4⁺ T-cell counts, and larger ATBL diameter. The HIV-positive group also showed a stronger tendency for disease dissemination, with significantly higher rates of smear positivity, miliary pulmonary tuberculosis (PTB), and disseminated tuberculosis (TB). On CT imaging, the HIV-positive group had a higher frequency of ATBL involvement in the upper para-aortic region, portacaval space, and hepatogastric ligament. In contrast, abdominal distension was more common in the HIV-negative group. post hoc power analysis confirmed that most key variables had adequate statistical power (≥0.8), except for age (power = 0.597) and ATBL diameter (Power = 0.769). Conclusions: The clinical and CT features of ATBL differ significantly between HIV-negative and HIV-positive patients. Full article

This review focuses on the diverse etiologies of secondary spontaneous pneumothorax (SSP) and the crucial role of imaging in their diagnosis. Unlike primary spontaneous pneumothorax (PSP), which is typically due to ruptured blebs, SSP results from a wide array of underlying pulmonary conditions that can pose significant diagnostic challenges. These include infections like tuberculosis, airway diseases such as chronic obstructive pulmonary disease, malignancies (primary and metastatic), interstitial lung diseases like sarcoidosis, cystic lung diseases such as lymphangioleiomyomatosis, and connective tissue disorders. In women, catamenial pneumothorax secondary to endometriosis should be considered. The role of radiologists is crucial in uncovering these underlying conditions. While chest radiography is the initial imaging modality, computed tomography (CT) provides superior sensitivity for detecting subtle parenchymal abnormalities. Advanced techniques like photon-counting detector CT offer further benefits, including enhanced spatial resolution, reduced noise, and lower radiation dose, potentially revealing underlying causes that might be missed with conventional CT. This enhanced visualization of subtle parenchymal changes, small airways, and vascular structures can be the key to diagnosing the underlying cause of pneumothorax. Recognizing the diverse etiologies of SSP and utilizing advanced imaging techniques is paramount for accurate diagnosis, appropriate management, and improved patient outcomes. Full article

Background and Objectives: Active pulmonary tuberculosis (aPTB) in the Older Adults (≥75 years) is frequently under-recognized in non-pulmonology settings due to atypical symptoms and multiple comorbidities. This study aimed to develop and validate a TRIPOD-compliant clinical prediction model for early identification of atypical aPTB in this vulnerable population. Materials and Methods: We retrospectively analyzed 5651 patients aged ≥75 years with culture-confirmed aPTB and World Health Organization (WHO) symptom scores < 5. Patients were stratified into Group a (Ga, Patients with aPTB not initially suspected by non-pulmonologists (atypical presentation, WHO/CDC 7-point score < 5, n = 1155) and Group b (Gb, Patients without aPTB within the first 24 h (non-TB comparators), n = 4496). Multivariate logistic regression identified independent predictors of delayed diagnosis. A weighted scoring system was derived from β-coefficients and validated in independent derivation (2000–2020) and temporal validation (2021–2023) cohorts. Model discrimination, calibration, and decision curve analysis (DCA) were assessed following TRIPOD standards. Results: Five independent predictors—age > 85 years (OR = 6.31, 95% CI = 5.31–8.72), hypoalbuminemia (OR = 4.10, 95% CI = 3.92–7.26), cardiovascular disease (OR = 3.32, 95% CI = 1.23–5.27), diabetes mellitus (OR = 2.03, 95% CI = 1.32–4.07), and predominant lower-lung field involvement (OR = 1.25,95% CI = 1.03–2.44)—were incorporated into the scoring model. Using a cutoff ≥ 7, the model achieved excellent performance across all cohorts (AUC 0.95–0.96; sensitivity 91–94%; specificity 97–99%). Calibration plots and DCA confirmed strong agreement and high net clinical benefit. Nearly 70% of atypical cases had symptom scores ≤ 1, lacking typical signs such as fever or cough. Conclusions: Oldest-old (>85 years) emerged as the strongest independent predictor of atypical TB, surpassing conventional frailty indicators such as sarcopenia or osteoporosis. The proposed score provides a simple, accurate, and validated tool for early detection of aPTB in non-pulmonology settings. Its integration into electronic medical records may reduce diagnostic delays and improve outcomes in this high-risk, late-elderly population. Full article

Background: Tuberculosis (TB) remains a major public health challenge among children and adolescents in high-burden countries. Xinjiang, the region with the highest TB incidence in China, has limited data on the clinical and epidemiological characteristics of pediatric TB. Methods: We conducted a retrospective cross-sectional study of children and adolescents (≤17 years) hospitalized with TB at a regional referral hospital in Xinjiang between 1 January 2020 and 31 December 2022. Demographic, clinical, and laboratory data were analyzed, and risk factors for extrapulmonary TB (EPTB) and severe TB were assessed. Results: A total of 253 patients were included, of whom 54.9% (139/253) had pulmonary TB (PTB) and 45.1% (114/253) had EPTB. EPTB was more common among children <5 years (78.9%, 15/19). The predominant clinical symptoms were fever (55.7%, 141/253), cough (66.8%, 169/253), fatigue (60.9%, 154/253), and night sweats (51.8%, 131/253). Tuberculous meningitis (TBM) was the most frequent EPTB manifestation (40.4%, 46/114). Younger age, rural residence, and absence of BCG vaccination were associated with a higher risk of EPTB. Laboratory findings showed high positivity rates for tuberculin skin test (96.1%, 99/103) and interferon-γ release assay (84.5%, 196/232), but low yields for smear microscopy and Xpert MTB/RIF, especially in EPTB cases. Conclusions: Pediatric TB in Xinjiang is characterized by a high burden of EPTB, particularly TBM in young children. Strengthening early diagnosis and improving access to effective diagnostic tools are essential to reduce morbidity and improve outcomes in this vulnerable population. Full article

Introduction: Tuberculosis (TB) remains a public health concern, and people at risk for TB are hesitant to seek care. The first South African National TB prevalence survey, conducted in 2017–2019, found that most participants with TB symptoms did not seek care for TB. In 2022, an estimated 23% of people with TB in South Africa were undiagnosed, contributing to the country’s burden of “missing” TB cases. This study explores health-seeking behaviour among people with TB (PwTB) in South Africa, focussing on barriers and facilitators to care-seeking and the quantification of TB-related stigma from a patient and community perspective. Methods: We conducted a mixed-method study in the City of Johannesburg (COJ) Metropolitan Municipality from February to March 2022. PwTB aged 18 and older initiating TB treatment for microbiologically confirmed pulmonary TB were recruited from three primary healthcare facilities in the COJ. After providing written informed consent, they participated in a one-time, in-depth, face-to-face interview. The interviews were digitally recorded and conducted by trained facilitators. We used thematic analysis with deductive approaches to develop themes. We used the Van Rie TB stigma assessment scale to quantify perceived stigma. Results: We interviewed 23 PwTB with an overall median age of 39 years and 14 (61%) males. Patient-level barriers to accessing TB care included visiting traditional healers and pharmacists before their TB diagnosis; wrong or missed diagnosis by private doctors; work commitments; scarcity of resources to attend the clinic or walk long distances; perceived and experienced stigma; and a lack of TB knowledge. Facility-level barriers included long clinic queues and uncertainty about where to receive TB care in the clinic. Facilitators for TB care-seeking included being in contact with someone who had TB, receiving encouragement from family, or having knowledge about TB transmission and early diagnosis. The overall median total stigma score among 21 PwTB was 53 (IQR: 46–63), with median community and patient stigma scores of 25 (IQR: 22–30) and 31 (IQR: 21–36), respectively. Conclusions: We found important considerations for the TB programme to improve the uptake of services. Since PwTB consult elsewhere before visiting a facility for TB care, TB programmes could establish private–public partnerships. TB programmes could also increase TB awareness in the community, especially among males, and mobile clinics could be considered to assist with TB case detection and treatment provision. Applying behavioural design techniques and co-designing interventions with patients and providers could improve TB health-seeking behaviours. Full article

Background/Objectives: The diagnosis of Mycobacterium tuberculosis complex (MTBC) and nontuberculous mycobacterial (NTM) infections is accomplished by three main diagnostics methods: smear microscopy, culture, and molecular testing. Diagnostic algorithms used by laboratories can significantly impact clinical and infection control management. Current Canadian Tuberculosis Standards recommend the use of nucleic acid amplification testing (NAAT) for smear-positive patients and smear-negative patients upon request. An alternative algorithm is to utilize NAAT in the Panel approach on all samples, pulmonary and extrapulmonary, to potentially reduce time to diagnosis and treatment. This alternative approach was implemented in November 2019 at the Newfoundland and Labrador Public Health and Microbiology Laboratory (NL PHML) using a laboratory-developed multiplex real-time PCR (LDT m-qPCR) assay targeting Mycobacterium spp. (Myco spp.) and MTBC, performed in parallel with smear and culture. Methods: To investigate the impact of this alternate testing approach, we conducted an observational retrospective analysis of laboratory diagnostic and treatment data, recognizing that temporal changes in epidemiology, clinical practice, and laboratory workflow may also have influenced outcomes. To complete this, study data from three years before and four years after implementation were gathered. Results: The sensitivity/specificity of the smear, m-LDT qPCR-MTBC, m-LDT qPCR-Myco spp., and culture assays in this study were 18.1%/100%, 96.7%/99.8%, 47.6%/99.0%, and 96.8%/100%, respectively. The gold standard utilized for these calculations was clinical diagnosis for active MTBC disease and culture for NTM infections, recognizing that the use of clinical diagnosis may introduce subjectivity. The Panel approach reduced the time to diagnosis of tuberculosis MTBC by 29 days (p < 0.0001) for NL PHML, and when modelled for a laboratory with rapid culture identification, diagnosis was reduced by 14 days (p = 0.003). Among non-empirically treated tuberculosis patients, the time to treatment was decreased by 25.5 days (p < 0.001). For NTM infections, rapid diagnostics only affected one patient’s treatment. This finding agrees with clinical management guidelines, which do not routinely utilize rapid diagnostics for the diagnosis of disease or treatment decisions. The cost implications of additional NAAT testing were calculated to be an increase of CAD 23.62 per sample. Conclusions: Our findings support the adoption of a molecular assay for MTBC as an initial diagnostic tool to decrease time to diagnosis and time to treatment, depending on local epidemiology and irrespective of smear status. Utilizing a molecular assay for genus level identification of NTM had minimal impact on clinical management suggesting its limited diagnostic utility in a broad population setting. Full article

Background: Schistosomiasis, HIV, and tuberculosis frequently lead to pulmonary hypertension in low- and middle-income countries. Lack of specific testing and limited access to right heart catheterization hamper confirmation of the etiology of pulmonary hypertension due to schistosomiasis. In addition, low health literacy and poor socioeconomic status further compromise prevention, early diagnosis, and treatment. Clinical algorithms for early screening, including hand-held echocardiography and point-of-care testing performed by non-specialists, are needed in rural Sub-Saharan Africa to decentralize care and improve outcomes. Methods: We describe a case of pulmonary hypertension diagnosed in a child living in Mozambique, to discuss the challenges for the diagnosis of infectious pulmonary arterial hypertension in rural settings in Africa, based on a short literature review. Full article

Background: Lymphomatoid granulomatosis (LYG) is a rare and atypical EBV-induced B-cell lymphoproliferative disorder. Clinical manifestations are mainly respiratory, with nodular infiltrates, varying in number and size, being responsible for respiratory distress. Cutaneous, hepatic, or neurological involvement is also possible. Although pathogenesis is not clearly elucidated, quantitative or qualitative cellular immunodepression is thought to be a main factor. Here, we report a case of concomitant LYG and pulmonary tuberculosis. Case presentation: An 80-year-old female patient presented to the emergency unit for steadily increasing dyspnea, with workup revealing bilateral pulmonary nodules and mediastinal lymph node enlargement on chest imaging. Empiric antibiotic therapy was initially started with amoxicillin-clavulanate, which was later combined with azithromycin following respiratory deterioration. A CT-guided lung biopsy showed grade 2 LYG. Treatment with corticosteroids and weekly rituximab was initiated, leading to rapid improvement of respiratory symptoms. After the second dose of rituximab, sputum cultures that were initially collected were found to be positive for Mycobacterium tuberculosis. Rituximab was suspended, and antituberculous treatment was initiated. Rituximab was restarted once tuberculosis was controlled. Follow-up imaging later showed adequate control of both tuberculosis and LYG, with at least a partial remission of the latter. Conclusions: Our case highlights the importance of a complete diagnostic workup when a diagnosis of LYG is made, to avoid missing a concomitant pulmonary disease, such as tuberculosis, even when definite pathologic and clinical features of the former are present. Full article