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Computed Tomography: coronal view of the thorax; Calcified lymph node. Noncontrast coronal computed tomography scan shows hyperattenuation of paratracheal lymph nodes
Source publication
A 21-year-old woman presented with left hemiparesis, fever, dyspnea, tachycardia, and pericardial rub on examination. She was provisionally diagnosed with infective endocarditis and received the final diagnosis of the primary pulmonary tuberculosis (PTB) and extra PTB (EPTB) with pericardial effusion and thoracic lymphadenitis. Left hemiparesis due...
Context in source publication
Context 1
... two-dimensional echocardiogram showed moderate pericardial effusion with fibrous strands suggestive of tuberculous etiology, heart valves that appeared normal, and preserved ejection fraction [ Figure 1]. High-resolution computed tomography (CT) of the thorax was performed, showed necrotizing pneumonia, segmental atelectasis in the superior segment of the left lower lobe, focal consolidation, and subsegmental atelectasis in the superior segment of the right lower lobe, multiple enlarged lower paratracheal lymph nodes with central necrosis, and diffuse pericardial thickening with minimal pericardial effusion [ Figures 2 and 3]. A cardiologist's opinion was obtained, who suggested performing CT-guided pericardial fluid aspiration. ...
Citations
... PT could be divided into two classes: (i) primary pulmonary tuberculosis (PPT) [6], (ii) secondary pulmonary tuberculosis (SPT) [7]. SPT is investigated because most PT cases belong to SPT. ...
Secondary pulmonary tuberculosis (SPT) is one of the top ten causes of death from a single infectious agent. To recognize SPT more accurately, this paper proposes a novel artificial intelligence model, which uses Pseudo Zernike moment (PZM) as the feature extractor and deep stacked sparse autoencoder (DSSAE) as the classifier. In addition, 18-way data augmentation is employed to avoid overfitting. This model is abbreviated as PZM-DSSAE. The ten runs of 10-fold cross-validation show this model achieves a sensitivity of 93.33% ± 1.47%, a specificity of 93.13% ± 0.95%, a precision of 93.15% ± 0.89%, an accuracy of 93.23% ± 0.81%, and an F1 score of 93.23% ± 0.83%. The area-under-curve reaches 0.9739. This PZM-DSSAE is superior to 5 state-of-the-art approaches.
... 6 Since then, acute ischemic stroke has been reported in patients with active pulmonary tuberculosis, which seems to further suggest a relationship between pulmonary tuberculosis and ischemic stroke. [7][8][9] In 2010, in order to explore the relationship between pulmonary tuberculosis and ischemic stroke, Sheu et al performed a population-based three-year followup study using an insurance database, in which 2283 tuberculosis patients were included as the experimental group and 6849 patients without tuberculosis were included as the comparison group, and the study found that the risk of ischemic stroke in patients with pulmonary tuberculosis was 1.52 times higher than that of the patients without tuberculosis, suggesting that pulmonary tuberculosis might directly or indirectly lead to ischemic stroke and that TBRIS clinically exists. 10 However, in 2014, Wu and his teams carried out another 3-year follow-up study, by using a similar insurance database, and the study found that pulmonary tuberculosis did not increase the risk of ischemic stroke. ...
Objective
There have been only a few studies of ischemic stroke in patients with pulmonary tuberculosis (pTB). This study aimed to explore the clinical features and the underlying pathogenesis of pulmonary tuberculosis-related ischemic stroke (TBRIS).
Methods
Active pulmonary tuberculosis patients with acute ischemic stroke (without conventional vascular risk factors) were recruited as the TBRIS group. Patients who solely had active pulmonary tuberculosis were recruited as the control group (pTB group). Clinical data were collected, and multiple logistic regression analysis was applied to analyze the independent risk factors for TBRIS.
Results
A total of 179 TBRIS patients and 179 pTB patients were enrolled. Most (56.42%) of the TBRIS patients experienced the ischemic stroke events within 3 months after the diagnosis of tuberculosis. The multiple logistic regression analysis revealed that an increased mean platelet volume; elevated plasma D-dimer, C-reactive protein, and serum ferritin levels; and an increased monocyte percentage were independent risk factors for TBRIS. The AUC of the identification model was 0.778, with a sensitivity of 70.30% and a specificity of 78.90%.
Conclusion
The findings in the present study suggested that most of the TBRIS patients experienced ischemic stroke within 3 months after the diagnosis of tuberculosis. And the more intensive immune response to the tuberculosis infection in the TBRIS group contributed to the initiation of platelet activation and to the development of a hypercoagulable state, which were attributed to the pathogenesis of TBRIS. Index of TBRIS equaling to 0.3234 facilitates clinicians to identify the pTB patients who were at higher risk for TBRIS, and allow physicians to take further effective measures to prevent ischemic stroke in patients with pTB. However, our findings will need to be confirmed by further studies.
... India comprises one-fourth of the global tuberculosis burden. According to WHO estimated incidence of tuberculosis was 211 in 1 lakh people and the associated mortality is 32 in 1 lakh people [1,2] . In postnatal life, the lung is the commonest site for tuberculosis infection which is transmitted by aerosol [3] . ...
