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Fulltext Multi-organ involvement of tuberculosis--case report of an atypical presentation

Simon GK, Ahmad N

Med J Malaysia, 1990 Mar;45(1):78-80.
PMID: 2152074

A case involving tuberculosis of multiple organs and mimicking carcinoma in several respects is presented.

Matched MeSH terms: Tuberculosis, Pulmonary/diagnosis*
Fulltext Dermatomyositis masquerading musculoskeletal tuberculosis

Rajalingham S, Said MS, Shaharir SS, AbAziz A, Periyasamy P, Anshar FM

BMJ Case Rep, 2011;2011.
PMID: 22675098 DOI: 10.1136/bcr.08.2011.4675

Dermatomyositis is a rare rheumatic disease which predominantly affects the muscles and skin requiring a protracted course of immunosuppressants which may predispose the patients to opportunistic infections. A 49-year-old lady was diagnosed to have dermatomyositis in August 2010 based on history, significantly raised creatine kinase level and muscle biopsy findings. She had recurrent admissions due to fever, myalgia and muscle weakness. She had spiking temperature despite high dose steroids, broad-spectrum antibiotics and antifungal agents. This prompted extensive investigation which leads us to the additional diagnosis of disseminated tuberculosis involving the lungs, muscles and bones. This case demonstrates the challenge in controlling the disease activity of dermatomyositis with immunosuppressants in the setting of disseminated tuberculosis.

Matched MeSH terms: Tuberculosis, Pulmonary/diagnosis*
Fulltext Clinical analysis of foreign-born patients with tuberculosis found in Malaysia

Nissapatorn V, Kuppusamy I, Wan-Yusoff WS, Anuar AK

Southeast Asian J. Trop. Med. Public Health, 2005 May;36(3):713-21.
PMID: 16124444

In this retrospective study, we investigated 263 foreign patients who were diagnosed as having tuberculosis at the National Tuberculosis Center (NTBC) from January 2001 to December 2002. The age range was 14-72 years, with a mean of 33.3 +/- 9.95 years. The study subjects were predominantly males (60%) and females comprised 40%, where the greater impact of tuberculosis was observed in the young and active ones (up to 34 years of age), than middle-age (up to 54). A significantly higher percentage of these patients were from the Southeast Asian countries (87%) and particularly occurred in single male (47.5%) and married female (71.4%) patients (p<0.05). We also found that tuberculosis was significantly higher in female (50.5%) and male (64%) with smoking laborers (p<0.05). Fever (70%), cough (90.5%) and BCG vaccination status showed a significantly higher percentage in male patients (p<0.05), whereas lymphadenopathy (22%) was found in a significantly higher percentage in females (p<0.05). Overall, pulmonary disease (94.3%) occurred more commonly in males and the pleura (3.2%) was the most common site of disseminated tuberculosis. By contrast, the lymph node (11.4%) and miliary (4.8%) forms were the more common extrapulmonary tuberculosis in females. More males had higher percentage of treatment completed at > or = 6 (38%) and > or = 9 (13.3%) months in pulmonary tuberculosis, whilst, more females showed higher percentage of treatment completed (8.7%) in extrapulmonary tuberculosis. Surprisingly, more women showed non-compliance to the anti-tubercular therapy than their counterpart in this study.

Matched MeSH terms: Tuberculosis, Pulmonary/diagnosis
Fulltext Impact of tuberculosis treatment on health-related quality of life of pulmonary tuberculosis patients: a follow-up study

Atif M, Sulaiman SA, Shafie AA, Asif M, Sarfraz MK, Low HC, et al.

Health Qual Life Outcomes, 2014;12:19.
PMID: 24528499 DOI: 10.1186/1477-7525-12-19

At present, much of the attention within tuberculosis (TB) management is spent on microbiological cure, and its impact on health-related quality of life (HRQoL) is either undervalued or seldom considered. The aim of this study was to evaluate the impact of TB treatment on HRQoL of new smear positive pulmonary tuberculosis (PTB) patients. Moreover, we also aimed to determine whether the selected socio-demographic and clinical variables were predictive of variability in the HRQoL scores over time.

Matched MeSH terms: Tuberculosis, Pulmonary/diagnosis
Fulltext Diagnostic delay among pulmonary tuberculosis patients in Sarawak, Malaysia: a cross-sectional study

Chang CT, Esterman A

Rural Remote Health, 2007 Apr-Jun;7(2):667.
PMID: 17511524

Delayed diagnosis of tuberculosis (TB) can lead to an increased period of infectivity in the community, a delay in treatment and a severe form of the disease. The objective of this study was to determine the length of delay, and factors linking the delay from the onset of symptoms of pulmonary tuberculosis (PTB) until the commencement of treatment in Sarawak, Malaysia.

Matched MeSH terms: Tuberculosis, Pulmonary/diagnosis*
Fulltext Dental technician pneumoconiosis mimicking pulmonary tuberculosis: a case report

Tan HL, Faisal M, Soo CI, Ban AY, Manap RA, Hassan TM

BMC Pulm Med, 2016 09 07;16(1):131.
PMID: 27604085 DOI: 10.1186/s12890-016-0293-2

BACKGROUND: Dental laboratory technicians are at risk of developing occupational respiratory diseases due to exposure to various potentially toxic substances in their working environment. Since 1939, few cases of silicosis among dental technician have been reported.

CASE PRESENTATION: We illustrate a 38 year-old female, who worked in a dental laboratory for 20 years, initially treated as pulmonary tuberculosis and chronic necrotising aspergillosis without much improvement. Computed tomography guided lung biopsy and bronchoscopic transbronchial lung biopsy were performed. Lung tissue biopsies showed presence of refractile dental materials within the areas of histiocyte proliferation. The diagnosis of dental technician pneumoconiosis was obtained and our patient underwent pulmonary rehabilitation.

CONCLUSIONS: This case highlights the importance of obtaining a detailed occupational history in tuberculosis endemic area, as pulmonary tuberculosis is a great mimicker of other respiratory diseases.

Matched MeSH terms: Tuberculosis, Pulmonary/diagnosis
Fulltext Case-finding for pulmonary tuberculosis in Penang

Hooi LN

Med J Malaysia, 1994 Sep;49(3):223-30.
PMID: 7845270

The process of case-finding was studied in 100 consecutive patients with pulmonary tuberculosis treated by the Chest Clinic, Penang Hospital. The median time from the onset of the illness until the initial medical consultation was two weeks (patient's delay). This delay was longer in males, patients with lower than secondary education and drug abusers. Only 47% of patients were put on treatment with a correct diagnosis within one month of the first consultation (doctor's delay). Almost all patients had at least one symptom suggestive of tuberculosis at presentation and the mean number of consultations before diagnosis was three. Patients who first visited government medical facilities had shorter doctor's delay than those who first saw private practitioners, and patients who first consulted a private practitioner were the least likely to be appropriately investigated by sputum examination and chest radiography. The median total delay was three months and at the time of diagnosis, 95% of patients had moderate or far advanced disease radiologically. In order to shorten doctor's delay, all medical practitioners, especially those in the private sector, should be made aware of the importance of early diagnosis and the proper management of tuberculosis. Health education campaigns for the public should also be undertaken to shorten patient's delay.
Study site: Chest clinic, Hospital Pulau Pinang, Malaysia

Matched MeSH terms: Tuberculosis, Pulmonary/diagnosis*
Pulmonary tuberculosis in a rural area of Sarawak, Malaysia

Yano K, Goto S, Sado M, Takeuchi M, Iguchi M

Southeast Asian J. Trop. Med. Public Health, 1974 Sep;5(3):417-23.
PMID: 4215145
Matched MeSH terms: Tuberculosis, Pulmonary/diagnosis
Fulltext Pulmonary tuberculosis--a review of clinical features and diagnosis in 232 cases

Ismail Y

Med J Malaysia, 2004 Mar;59(1):56-64.
PMID: 15535337

The diagnosis of pulmonary tuberculosis is often delayed due to atypical clinical features and difficulty in obtaining positive bacteriology. We reviewed 232 cases of pulmonary tuberculosis diagnosed in Kedah Medical Centre, Alor Setar from January 1998 to December 2002. All age groups were affected with a male predominance (Male:Female ratio = 60:40). Risk factors include underlying diabetes mellitus (17.7%), positive family history (16.8%) and previous tuberculosis (5.2%). Nearly half (45.3%) of patients had symptoms for more than one year. Only 22% of patients had typical symptoms of tuberculosis (prolonged recurrent fever, cough, anorexia and weight loss), whilst others presented with haemoptysis, chronic cough, COPD, bronchiectasis, general ill-health, pyrexia of unknown origin or pleural effusion without other systemic symptoms. Fifteen percent of the patients presented with extrapulmonary diagnosis. Ninety percent of the patients had previous medical consultations but 40% had no chest radiograph or sputum examination done. The chest radiographs showed 'typical' changes of tuberculosis in 62% while in the other 38% the radiological features were 'not typical'. Sputum direct smear was positive for acid-fast bacilli in only 22.8% of patients and 11.2% were diagnosed base on positive sputum culture. Sputum may be negative even in patients with typical clinical presentations and chest radiograph changes. Bronchial washing improved the diagnosis rate being positive in 49.1% of cases (24.1% by direct smear and the other 25.0% by culture). In 16.8% of cases, the diagnosis was based on a good response to empirical anti-tuberculosis therapy in patients with clinical and radiological features characteristic of tuberculosis. In conclusions, the clinical and radiological manifestations of pulmonary tuberculosis may be atypical. Sputum is often negative and bronchoscopy with washings for Mycobacterium culture gives a higher yield for diagnosis. In highly probable cases, empirical therapy with antituberculosis drugs should be considered because it is safe and beneficial.

Matched MeSH terms: Tuberculosis, Pulmonary/diagnosis*
Fulltext Tuberculosis--are we missing the diagnosis?

Ismail Y

Singapore Med J, 2002 Apr;43(4):172-6.
PMID: 12188060

We reviewed the 52 new cases of pulmonary tuberculosis diagnosed at Pusat Pakar Utara, Kedah in 1998. It was found that the majority of the patients had symptoms for many years. They had seen many doctors but were not diagnosed. In 40% of the patients, no investigations for tuberculosis were done and in the others tuberculosis was excluded because of negative sputum smear examination. Many had typical history and X-ray changes suggestive of tuberculosis but more sensitive investigations such as sputum culture for Mycobacterium or bronchoscopy were not performed. Cases are presented to illustrate the problems in the diagnosis.

Matched MeSH terms: Tuberculosis, Pulmonary/diagnosis*
Fulltext Development of sandwich-form biosensor to detect Mycobacterium tuberculosis complex in clinical sputum specimens

Shojaei TR, Mohd Salleh MA, Tabatabaei M, Ekrami A, Motallebi R, Rahmani-Cherati T, et al.

Braz J Infect Dis, 2014 Nov-Dec;18(6):600-8.
PMID: 25181404 DOI: 10.1016/j.bjid.2014.05.015

Mycobacterium tuberculosis, the causing agent of tuberculosis, comes second only after HIV on the list of infectious agents slaughtering many worldwide. Due to the limitations behind the conventional detection methods, it is therefore critical to develop new sensitive sensing systems capable of quick detection of the infectious agent. In the present study, the surface modified cadmium-telluride quantum dots and gold nanoparticles conjunct with two specific oligonucleotides against early secretory antigenic target 6 were used to develop a sandwich-form fluorescence resonance energy transfer-based biosensor to detect M. tuberculosis complex and differentiate M. tuberculosis and M. bovis Bacille Calmette-Guerin simultaneously. The sensitivity and specificity of the newly developed biosensor were 94.2% and 86.6%, respectively, while the sensitivity and specificity of polymerase chain reaction and nested polymerase chain reaction were considerably lower, 74.2%, 73.3% and 82.8%, 80%, respectively. The detection limits of the sandwich-form fluorescence resonance energy transfer-based biosensor were far lower (10 fg) than those of the polymerase chain reaction and nested polymerase chain reaction (100 fg). Although the cost of the developed nanobiosensor was slightly higher than those of the polymerase chain reaction-based techniques, its unique advantages in terms of turnaround time, higher sensitivity and specificity, as well as a 10-fold lower detection limit would clearly recommend this test as a more appropriate and cost-effective tool for large scale operations.

Matched MeSH terms: Tuberculosis, Pulmonary/diagnosis*
Tuberculoid granulomatous lesion of the pharynx--review of the literature

Sharma HS, Kurl DN, Kamal MZ

Auris Nasus Larynx, 1998 May;25(2):187-91.
PMID: 9673733

Pharyngeal involvement in tuberculosis is rare and is usually secondary to pulmonary tuberculosis. We report a very rare case of chronic granulomatous pharyngitis, which later turned out to be due to primary tuberculosis of the pharynx. The clinical presentation, diagnosis, treatment and complications of this rare clinical entity are presented.

Matched MeSH terms: Tuberculosis, Pulmonary/diagnosis
Fulltext The diagnostic performance of a single GeneXpert MTB/RIF assay in an intensified tuberculosis case finding survey among HIV-infected prisoners in Malaysia

Al-Darraji HA, Abd Razak H, Ng KP, Altice FL, Kamarulzaman A

PLoS One, 2013;8(9):e73717.
PMID: 24040038 DOI: 10.1371/journal.pone.0073717

Delays in tuberculosis (TB) diagnosis, particularly in prisons, is associated with detrimental outcomes. The new GeneXpert MTB/RIF assay (Xpert) offers accurate and rapid diagnosis of active TB, but its performance in improving case detection in high-transmission congregate settings has yet to be evaluated. We assessed the diagnostic accuracy of a single Xpert assay in an intensified case finding survey among HIV-infected prisoners in Malaysia.

Matched MeSH terms: Tuberculosis, Pulmonary/diagnosis*
The causes of haemoptysis in malaysian patients aged over 60 and the diagnostic yield of different investigations

Wong CM, Lim KH, Liam CK

Respirology, 2003 Mar;8(1):65-8.
PMID: 12856744

OBJECTIVE: In southeast Asia, pulmonary tuberculosis (TB) is the most frequently presumed diagnosis for haemoptysis. This study was designed to assess the causes of haemoptysis, the diagnostic yield of causes in different diagnostic modalities and the distribution of older patients.
METHODS: All patients presenting to the University of Malaya Medical Centre, Kuala Lumpur, Malaysia with haemoptysis were recruited prospectively and evaluated.
RESULTS: One hundred and sixty patients were evaluated for haemoptysis; 71 (44.4%) were aged 60 years or more. Significantly more patients smoked in the older age group (P = 0.002). The main causes of haemoptysis in the older patients were bronchogenic carcinoma (49.3%), pneumonia (11.3%), bronchiectasis (8.6%), cryptogenic (5.6%) and active TB (4.2%). Significantly more older patients had carcinoma (P < 0.001), while the younger patients more often had TB (P < 0.001). Chest pain was significantly more common in the older patients (P = 0.025), particularly in patients with carcinoma. Bronchoscopy alone or combined with CT of the thorax was significantly more diagnostic in the older patient (P = 0.006).
CONCLUSION: Bronchogenic carcinoma is the commonest cause of haemoptysis in patients aged 60 years and above. Presumptive anti-TB therapy should not be encouraged despite the regional high prevalence of TB.

Matched MeSH terms: Tuberculosis, Pulmonary/diagnosis
Diagnosis and treatment of tuberculosis in rural Malaysia

Marks A

Can J Public Health, 1974 7 1;65(4):305-9.
PMID: 4851355
Matched MeSH terms: Tuberculosis, Pulmonary/diagnosis*
Characteristics of HIV-infected tuberculosis patients in Kota Bharu Hospital, Kelantan from 1998 to 2001

Mohammad Z, Naing NN

Southeast Asian J. Trop. Med. Public Health, 2004 Mar;35(1):140-3.
PMID: 15272757

To characterize the demographic profiles, clinical features, radiological patterns and outcomes of treatment of HIV-infected TB patients, a descriptive study was carried out on 149 HIV-infected TB cases diagnosed from 1998 through 2001 at Kota Bharu Hospital, Kelantan, Malaysia. The majority of the patients were males (94.6%), single (45.0%), ethnic Malay (94.0%) with a mean age of 34 years (standard deviation 7.8, range 18-76). The most common HIV transmission category was through injecting drug use (73.8%) and being the inmates or former inhabitants of drug rehabilitation centers and prisons were the commonest high-risk groups. One hundred and seventeen patients were diagnosed as having pulmonary TB, while about 20% were extra-pulmonary in type with 9 cases of milliary TB. The majority (45%) presented with cough symptoms while only 51% had a positive sputum smear. Fifty-five percent were found to have pulmonary lesions on chest x-ray, such as localized, milliary or diffuse pulmonary infiltrates, or opacities. Eight (5.4%) had pleural lesions while another 8 cases had hilar or mediastinal lymph node lesions. Overall, fifty-eight (38.9%) patients had died by the completion of data collection. The median weeks or survival from the time of starting TB treatment was 13.5 (range 1-56) and the majority of them (74%) died without completing the 6-month regime of treatment.

Matched MeSH terms: Tuberculosis, Pulmonary/diagnosis*
Fulltext Coinfection of leprosy and tuberculosis

Shetty S, Umakanth S, Manandhar B, Nepali PB

BMJ Case Rep, 2018 Mar 15;2018.
PMID: 29545426 DOI: 10.1136/bcr-2017-222352

Leprosy and tuberculosis (TB) are endemic to India, however, their coinfection is not frequently encountered in clinical practice. Here, we report a 32-year-old female patient who presented with a history of high-grade intermittent fever, cough and painless skin lesions since a month, along with bilateral claw hand (on examination). The haematological profile was suggestive of anaemia of chronic disease, chest radiograph showed consolidation, sputum smears were positive for Mycobacterium tuberculosis, and skin slit smear confirmed leprosy. The patient was prescribed WHO recommended multidrug therapy for multibacillary leprosy with three drugs. Additionally, prednisolone was added to her regimen for 2 weeks to treat the type 2 lepra reaction. For treatment of TB, she was placed on the standard 6-month short course chemotherapy. She was lost to follow-up, and attempts were made to contact her. Later, it came to our notice that she had discontinued medications and passed away 3 months after diagnosis.

Matched MeSH terms: Tuberculosis, Pulmonary/diagnosis*
The manual MGIT system for the detection of M. tuberculosis in respiratory specimens: an experience in the University Malaya Medical Centre

Fadzilah MN, Ng KP, Ngeow YF

Malays J Pathol, 2009 Dec;31(2):93-7.
PMID: 20514851

A prospective study was conducted on 510 respiratory specimens for the presence of M. tuberculosis detected by direct acid-fast bacilli (AFB) smear examination, culture in the Manual Mycobacteria Growth Indicator Tube (BBL MGIT, Becton-Dickinson) and culture on Lowenstein-Jensen (LJ) medium. From positive BBL MGIT tubes, Ziehl-Neelsen and Gram stains were performed and subcultures were put up on LJ medium. A total of 101 (19.8%) specimens were positive by the BBL MGIT, 60 (11.8%) by primary LJ medium culture, 31 (6.1%) by direct smear examination and 29 (5.7%) by all three methods. Using primary LJ culture as the gold standard, the sensitivity and specificity of the BBL MGIT were 90% and 89.6% respectively but the sensitivity of AFB smear microscopy was only 48.3%. About half (51.1%) of the BBL MGIT false positives were due to contamination by non-AFB bacteria. The remaining false positives comprised specimens that were AFB microscopy positive but LJ culture negative. Of the AFB isolates obtained on LJ primary and sub-cultures, almost all (93.3%) were identified as Mycobacterium tuberculosis complex. The mean time-to-detection was significantly shorter (p < 0.0001) for the BBL MGIT than for LJ culture. For the former, positive results were available within 14 days for both AFB smear-positive and AFB smear-negative specimens. On the average, positive results were obtained 1.8 days earlier for direct AFB smear-positive samples than for AFB smear-negative samples. On the other hand, positive growth on LJ medium appeared after at least 33 days of incubation. These findings suggest that the BBL MGIT system will be a suitable alternative to LJ culture for the routine diagnosis of pulmonary tuberculosis, but a combination of liquid and solid cultures is still required for the highest diagnostic accuracy.

Matched MeSH terms: Tuberculosis, Pulmonary/diagnosis*
Fulltext Tuberculosis: an eight year (2000-2007) retrospective study at the University of Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

Jetan CA, Jamaiah I, Rohela M, Nissapatorn V

Southeast Asian J. Trop. Med. Public Health, 2010 Mar;41(2):378-85.
PMID: 20578521

This was an eight year (2000-2007) retrospective study of tuberculosis in patients admitted to the UMMC. A total of 131 cases were analyzed. Malays constituted the most cases, (43%), followed by Chinese (22%), Indians (17%) and others (18%). The majority of cases were within the 21-60 year old age group, which constituted 69.5% of the total. Males were more commonly affected (65%). Most cases were reported among Malaysians (83%). The majority of patients were unemployed (39%), followed by housewives (10%), laborers (9%), students (8%), shop assistants (7%), and other occupations (27%). The most common presenting complaints were prolonged productive cough, night sweats, fever, anorexia, weight loss (57%), hemoptysis (34%), and undifferentiated symptoms, such as prolonged diarrhea and dysphagia (9%). Sputum was positive for acid-fast bacilli (AFB) in 89%, but only 69% of cases had abnormal chest radiographs. The majority of patients (65%) developed no complications. The most common complications were pleural effusion, pneumothorax and pulmonary fibrosis. The majority of patients (82%) suffered either from diabetes mellitus, hypertension, ischemic heart disease or all 3 conditions. Regarding risk factors for tuberculosis, two were HIV positive and two were intravenous drug users. The majority of the patients (85%) did not complain of any side effects from their anti-tuberculosis treatment. Among those who did complain of side effects, the most common were nausea and vomiting (41%), drug induced hepatitis (37%), blurring of vision (11%) and skin rashes (11%). Two cases of death were reported.

Matched MeSH terms: Tuberculosis, Pulmonary/diagnosis
Near miss diagnosis of childhood tuberculosis

Norlijah O, Intan HI, Feizel AM, Kasim MS, Noh LM

Southeast Asian J. Trop. Med. Public Health, 2006 Sep;37(5):953-7.
PMID: 17333739

Tuberculosis (TB) remains a public health problem in Malaysia. We describe three atypical cases of serious tuberculosis in children. The potential diagnostic pitfall in these cases is highlighted by its unusual presentation in a setting of culture-negative infection. A positive polymerase chain reaction (PCR) in each case assists in gauging the diagnosis in concordance with appropriate clinical findings.

Matched MeSH terms: Tuberculosis, Pulmonary/diagnosis*

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