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Immunology
Immunology
As a result, he had lost a significant amount of weight and was exceedingly thin. She
also saw that he had trouble walking and sitting, and that his hands shook when he
tried to pick something up. A chronic cough was also a source of concern for the
mother. Despite the fact that he had no fever or night sweats, and his cough was
ineffective, he had been afflicted with tuberculosis a year before. She had finished
treatment, and his sputum was negative, but that kid wasn't getting TB prophylaxis at
the time, and she was concerned that he might have TB as well.
From the age of one year, the mother reported sporadic occurrences of diarrhoea,
which got better at her local clinic. There were no further illnesses or hospitalizations
reported. Since birth, the child has been properly immunized and his immunizations
are up to date. Within Sandakan, their family lives in a small wood home. There are
four adults and two older siblings, ages 11 and 12, who have all been reported. The
father works and supports the family. The house has running water and electricity.
Hepatomegaly with a coarse echogenic pattern and no focal lesions was found by
his abdominal ultrasonography.
The respiratory examination revealed a symmetrical bilateral air intake and normal
bladder sounds. Investigation of the cardiovascular system revealed normal heart
sounds without murmurs. There was no neck stiffness or other meningeal signs.
Ocular and otorhinolaryngological examinations were normal. The boy is diagnosed
with splenic tuberculosis. While splenic tuberculosis is uncommon, it is considered
an important manifestation of abdominal TB, especially in developing countries. Its
prevalence is increasing with the epidemic of HIV-TB co-infection and the
subsequent rise in extrapulmonary TB. To best understand this disease process, one
must look at the immunological processes that occur with the spread of
mycobacteria to extrapulmonary sites and HIV spread to secondary lymphoid tissue.
Spread of mycobacteria from the lungs to other organs can occur when
macrophages become infected with bacteria after phagocytosis Migration of
activated macrophages to secondary lymphoid tissue for antigen presentation to
CD4+ helper T lymphocytes can spread the bacteria to other tissues such as liver,
lymph nodes, spleen, intestine and bone marrow.
Metabolism is a sequence of chemical events in the cells of the body that transform
the energy humans obtain from meals into the fuel the body utilizes to perform
cellular operations. Tuberculosis remains an international health issue with
significant morbidity and mortality rates, particularly in underdeveloped countries,
where approximately 10 million new infections and 1600 deaths occur each year.
The Mycobacterium tuberculosis complex causes tuberculosis. It is both treatable
and avoidable. If not treated effectively, certain factors that include human
immunodeficiency virus (HIV) infection and other co-morbidities could have an
impact on the result.
Unlike tuberculous splenic abscesses involving other organs, the five described
cases of primary tuberculous splenic abscesses were diagnosed histopathologically
by spleen biopsy, drainage of the splenic abscess, exploratory laparotomy and
splenectomy after treatment failure. However, the diagnosed primary splenic
abscess by radiological findings and biochemical markers: interferon-gamma assay
and ADA (Ferluga et al., 2020).
Non-invasive imaging modalities, such as ultrasound and CT, play an important role
in assessing the extent of organ involvement, the need for surgical intervention and
the therapeutic response. In contrast to these common imaging modalities,
abdominopelvic CT played a crucial role in the diagnosis of tuberculous abscess in
the spleen in our patient, as he had only spleen lesions and refused percutaneous
spleen biopsy.
Typical CT findings are multiple, round or egg-shaped lesions of low density and
without calcification, as in our case. Lymphoma, hydatidosis and metastases should
be considered in the differential diagnosis of CT findings. In addition to the typical
radiological findings, the interferon-gamma release assay also played an important
role. The interferon-gamma release assay is an in vitro laboratory diagnostic test
using a whole blood sample. It is an indirect test for detecting M. tuberculosis
complex infection.
Given that biochemistry explores how living organisms react to various chemicals or
chemical reactions that take place in the body, the involvement of biochemists in
pharmacology is quite essential. Thus, biochemistry enables pharmacologists to
design and develop safe and effective drugs after conducting numerous in vivo and
in vitro experiments to test the effects of drugs on biological systems. The specificity
of the test for the low-risk group was 98.1% and the sensitivity for patients with M.
tuberculosis infection was 89.0%. Another important biochemical marker was ADA in
ascites and serum. Levels above 36 IU/L in ascites fluid (sensitivity: 100%,
specificity: 97.1%) and above 54 IU/L in serum (sensitivity: 81.5%, specificity: 97.6%)
suggest tuberculosis. ADA ratio between ascites fluid and serum higher than 0.984
indicates tuberculosis (sensitivity: 57.1%, specificity: 87.7%). Our patient's ADA in
ascites fluid and serum was 76.9 IU/L and 67.5 IU/L, respectively.These biochemical
tests helped us to be sure that our patient had tuberculous splenic abscess and
tuberculous peritonitis (Grover et al., 2021).
The common symptoms include fever, abdominal pain, diarrhoea and generalised
weakness. There are often significant delays in diagnosis due to inconsistent
symptomatology. Ultrasound and CT scan of the abdomen are the first-line
investigations. Tissue aspiration or biopsy is indispensable for diagnostic
confirmation in cases where splenectomy is not performed. Administration of ATT
may result in a favourable outcome and may obviate the need for splenectomy.
Doctors should be aware of isolated splenic involvement in tuberculosis, and tissue
diagnosis should be performed as early as possible in suspected cases (Kumar et
al., 2018) .
The effectiveness of Mycobacterium tuberculosis as a human pathogen depends
largely on its ability to subvert host immune responses and persist in a latent state
(Lin et al., 2016). M. bovis Bacille Calmette-Guerin (BCG) is currently the only TB
vaccine approved for human use. It has been used to vaccinate more than 4 billion
people worldwide and remains part of the childhood immunisation programme in
most countries because of its ability to confer effective protection against TB in
children. However, the protective immunity generated by BCG wanes with age and
its efficacy against the disease has been less than satisfactory in adults and the
elderly. In addition, the inability of BCG to provide sterilising immunity at the time of
primary infection results in a huge reservoir of asymptomatically infected individuals
worldwide (∼2 billion) (Metlo et al., 2019). These latently infected individuals are at
persistent risk of developing clinical disease due to endogenous reactivation if the
immune system is compromised for various reasons, such as HIV infection or
malnutrition. Latency-associated antigens are expressed by M. tuberculosis as it
adapts to long-term persistence; however, BCG, being an attenuated strain, does not
persist long enough to express these antigens (Shaker et al., 2022).
References
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