Hybrid PET/MRI findings in a case of pulmonary and extra-pulmonary tuberculosis associated with motor-neuron disease-like illness—a coincidence or a causation?: a case report

Background The association of tuberculosis and motor neuron disease-like illness has not been described previously. We present a case of co-existent pulmonary and extra-pulmonary tuberculosis in a young man whose clinical presentation was suggestive of a motor neuron disease-like illness and was subsequently diagnosed with tubercular infection. This case provokes our thought as to whether the association between tuberculosis and motor neuron dysfunction was just a co-incidence, given the high prevalence of tuberculosis in our set-up, or does it point towards a possible causative role of infection in motor neuron disease. Case presentation A 31-year-old man presented with progressive thinning of bilateral upper and lower limbs with associated pain and twitching sensation in upper and lower limb muscles. He had a history of loss of appetite and unintentional weight loss. On clinical examination, there was evidence of fasciculations in bilateral quadriceps, bilateral biceps, and paraspinal muscles which was further confirmed with electrophysiology. The work-up for underlying autoimmune, toxic and metabolic aetiology, and paraneoplastic aetiology was found to be negative. CT scan of the chest was suggestive of consolidations in bilateral upper lobes with multiple tree-in-bud nodules in both the lungs. Hybrid 18-Flourine-flourodeoxyglucose positron emission tomography and magnetic resonance imaging (F-18-FDG PET/MRI) imaging was also suggestive of pulmonary and extra-pulmonary tuberculosis. Imaging of the brain revealed atrophy along bilateral motor cortices with reduced tracer uptake. Diagnosis of tubercular infection was confirmed with nucleic acid amplification test and the patient was put on anti-tubercular therapy. On follow-up after 6 months, the patient reported improvement in the symptoms and the muscle power in bilateral upper and lower limbs. Conclusion We have described a very rare association of pulmonary and extra-pulmonary tuberculosis with motor neuron-like illness. It may be debated that such an association may just be co-incidental; however, given the improvement in the symptoms and signs of the motor neuron disease-like illness on follow-up while the patient was on anti-tubercular therapy, it may point towards a causative relationship between tubercular infection and motor neuron dysfunction. Further epidemiological studies should be sought for in order to reach a conclusive answer.

Tubercular infection in children living with adults receiving Directly Observed Treatment Short Course (DOTS): a follow up study

Background Children living with sputum smear-positive adult tuberculosis (TB) patients are vulnerable to acquire tubercular infection. Contact tracing is an important strategy to control tubercular infection in the community. This study was done to find out prevalence of tuberculosis and tubercular infection in children living with sputum smear-positive adult patients receiving DOTS at recruitment and to find out incidence of tubercular infection and disease in these children on follow up. Method Children (< 15 years) living in contact with adults on DOTS were grouped as < 6 years and 6–14 years. They were further sub grouped as being - uninfected, infected, diseased and on prophylaxis and were followed at 3, 6 and 9 months. Tuberculin skin test (TST) and chest X-ray were done. Results At recruitment 152 children were enrolled and 21.1% (n = 32) had TB. On follow up, 4.3% (n = 5), 5.8% (n = 6) and 11.6% (n = 11) children developed TB after 3, 6 and 9 months respectively.9 children did not come for the last follow up so the overall prevalence of TB disease at 9 months was 37.7% (n = 54). Out of the 128 children with TST reading 23.4% (n = 30) child contacts were found to be infected already at recruitment. The incidence of TST conversion was 20.7% (n = 18), 26.9% (n = 18) and 16.3% (n = 7) respectively. The overall prevalence of tubercular infection in the children, who were in contact with TB patients for 9 months was 74.5% (n = 73). Conclusion About half the children were either suffering from TB or tubercular infection on recruitment. During 9 months follow up 22 unaffected children developed disease and 43acquired infection.

Study of the attitude of adolescents with tubercular infection to their parents

The presented article is devoted to the study of the relationship of adolescents with tubercular infection to their parents. Tuberculosis is known to be a serious somatic infectious disease. Its treatment is carried out in a hospital and outpatiently for a long time. The prognosis of the course and cure of the disease is not always clear and predictable. The severity of the disease, side effects of drugs, changes in conditions and quality of life, disruption of social contacts, uncertainty of near and distant health prognoses, disruption of family relationships, social and material distress significantly affect attitudes toward the disease, treatment and cure for tuberculosis. Adolescence is one of the most difficult periods in every person’s life. The disease has a significant effect on the adolescent’s growing up, their ideas of future. Parental support is especially important for young people who have to be treated for a long time, who are aware of the severity of their disease, its social danger. Relations with parents play an important role in adapting to the disease, in forming adherence to treatment. However, often parents themselves become a source of infection for their child, the formation of multiple drug resistance. Improper upbringing, inadequate attitude to the child’s disease and its treatment lead to disruption of the medical-diagnostic and medical-rehabilitation processes aimed at treating tuberculosis.

Age Changes in the Indicators of Plasma Hemostasis in Tubercular Infection at the Background of Chemical Drugs

A study of plasma hemostasis in 49 patients suffering from bone tuberculosis before and after chemotherapy has been conducted. It was established that in the group of patients older than 50 years after treatment with chemotherapy drugs, there is a moderate hypocoagulation shift in the hemostasis system, expressed in a decrease in the prothrombin index, a decrease in the level of fibrinogen, an increase in the prothrombin time. The aim of the study was to study the indicators of the hemostatic system in patients of different age groups with tuberculous infection of the bone apparatus before and after chemotherapy.

Polyarthritis and erythema nodosum: an unusual presentation of tuberculosis

Reactive arthritis and erythema nodosum occur in presence of active tubercular infection and both are immunological phenomenon. Author described a case report of a 17year old female with 10months history of symmetrical polyarthritis and presence of healed lesions of erythema nodosum. She was also found to have caseating granulomatous lesion in right supraclavicular lymph node which led us to diagnosis of tuberculous lymphadenitis presenting as reactive polyarthritis (poncet’s disease) and erythema nodosum. Her joint pain and swelling dramatically resolved after 2weeks of ATT. Thus, tuberculosis may manifest as reactive polyarthritis (poncet’s disease) and erythema nodosum and they should be kept in mind even in the absence of other clinical clues of TB, to provide patients with a good clinical outcome.