Tuberculous pericarditis (TBP) is a potentially severe manifestation of extrapulmonary tuberculosis that may lead to pericardial effusion and constrictive physiology and, in some patients, progress to fixed constrictive pericarditis. Diagnosis can be particularly challenging in young immunocompetent patients without overt pulmonary involvement. We report the case of a 20-year-old immunocompetent man presenting with a one-month history of weight loss, profuse night sweats, nocturnal fever, and typical pericarditic chest pain. Clinical examination revealed fever and signs of systemic venous congestion. Transthoracic echocardiography demonstrated marked pericardial thickening, moderate circumferential effusion, septal bounce, approximately 25% respiratory variation in transmitral flow, annulus reversus, and annulus paradoxus, supporting the presence of pericardial effusion with constrictive physiology. Contrast-enhanced computed tomography confirmed diffuse pericardial thickening and effusion without calcification or pulmonary parenchymal involvement. At the same time, cardiac magnetic resonance demonstrated intense late gadolinium enhancement of the thickened pericardium, supporting active pericardial inflammation. Xpert Mycobacterium tuberculosis/Rifampicin assay (Xpert MTB/RIF; Cepheid, Sunnyvale, CA, USA) testing of the pericardial fluid detected Mycobacterium tuberculosis, subsequently confirmed by positive mycobacterial culture. Following multidisciplinary discussion, a six-month antituberculous regimen combined with adjunctive corticosteroid therapy was initiated, with close clinical and multimodality imaging follow-up and reassessment for pericardiectomy according to clinical evolution. This case highlights the complementary value of echocardiography, computed tomography, and cardiac magnetic resonance in characterizing tuberculous pericardial disease associated with constrictive physiology and defining its inflammatory substrate. Identification of active pericardial inflammation in the presence of constrictive physiology may indicate a potentially reversible component; however, actual reversibility requires confirmation during longer-term follow-up.

A 66-year-old Chinese man with chronic hepatitis B treated with tenofovir disoproxil fumarate, a history of liver transplantation approximately 17 months earlier, hypertension, and atrial fibrillation treated with apixaban presented with progressive weakness, weight loss, and inability to ambulate. His only anti-rejection agent was tacrolimus. One month earlier, he had been hospitalized for multifocal pneumonia and treated with intravenous piperacillin-tazobactam for seven days after outpatient cefdinir failed. He was discharged without antibiotics. Bronchoscopy showed no endobronchial lesions or mucosal abnormalities. The initial routine microbiologic results were negative, but mycobacterial cultures remained in prolonged incubation. After discharge but before his subsequent readmission, a sputum culture from the prior hospitalization identified Mycobacterium fortuitum. On readmission, he had profound hyponatremia with a serum sodium concentration of 105 mmol/L, requiring intensive care and hypertonic saline. Imaging showed progressive right upper lobe consolidation concerning for infection or malignancy. Several days into the readmission, a biopsy of a technically accessible right lower lobe nodule showed inflammation without malignancy or caseating granulomas. Shortly thereafter, a bronchoalveolar lavage culture obtained during the prior hospitalization identified Mycobacterium tuberculosis after prolonged incubation. Tissue culture from the lung biopsy later identified Nocardia beijingensis. Given the patient's immunosuppression and progressive pulmonary abnormalities, all three isolates were treated as potentially pathogenic with imipenem, trimethoprim-sulfamethoxazole, moxifloxacin, isoniazid, pyrazinamide, and a rifamycin, with tacrolimus adjustment for drug interactions. The relative contribution of each organism could not be established with certainty. This case highlights the diagnostic and therapeutic complexity of concurrent pulmonary organism detection in a transplant recipient.

The taxonomic position of an actinomycete, strain 15-116A[T], isolated from a blood culture of a 31-year-old male from the United States was determined using polyphasic taxonomic analysis. Genome-based phylogeny showed that the strain was closely related to Streptomyces composti, Streptomyces thermocarboxydovorans, and Streptomyces thermospinosisporus species. Digital DNA-DNA (dDDH) relatedness and average nucleotide identity (ANI) between the draft genome sequence of the strain and those of its closest phylogenomic neighbors listed above were between 35.9% and 37.3% (< 70%) and 88.5%, 88.1%, and 88.6% (95%-96.7%), respectively. However, the dDDH and ANI values between the genome sequence of S. thermocarboxydovorans JCM 10367[T] and S. thermospinosisporus JCM 11756[T] were 72.3% and 96.7%, respectively. These values are above the defined thresholds for prokaryotic species demarcation (70% dDDH and 95%-96.7% ANI) and fall within the dDDH range of 70%-79% for subspecies designation. Based on these findings and in accordance with the priority rule in nomenclature, S. thermospinosisporus is considered a later heterotypic synonym of S. thermocarboxydovorans and is classified as a subspecies of S. thermocarboxydovorans, for which the name S. thermocarboxydovorans subsp. thermospinosisporus subsp. nov. is proposed. Consequently, S. thermocarboxydovorans subsp. thermocarboxydovorans is created. Strain 15-116A[T] was characterized by the presence of LL-diaminopimelic acid in its peptidoglycan; diphosphatidylglycerol, phosphatidylethanolamine, and phosphatidylinositol as the major phospholipids; MK-9(H8) and MK-9(H6) as the predominant menaquinones (> 10%); and iso-C15:0, anteiso-C15:0, iso-C16:0, and anteiso-C17:0 as the major fatty acids (> 10%). Morphological, phenotypic, and genomic traits distinguished strain 15-116A[T] from its closest phylogenetic neighbors and highlighted the assignment of strain 15-116A[T] (= DSM 106436[T] = ATCC BAA-2935[T]) to a novel species of the genus Streptomyces, for which the name Streptomyces sanguinis sp. nov. is proposed. Genome screening for virulence factor-associated genes showed that the strain harbored a gene encoding isocitrate lyase, which is required for persistent infection of Mycobacterium tuberculosis (YP_177728), as well as gene clusters associated with phenazine biosynthesis (NP_252902), unlike its close relatives. Moreover, strain 15-116A[T] possessed a gene encoding elongation factor Tu (WP_003028672), which plays an important role in the bacterium's ability to adhere to host cells. However, further experimental studies are required to evaluate the pathogenic potential of this strain.

Drug-resistant Mycobacterium tuberculosis and non-tuberculous mycobacteria infections are a threat to global healthcare. The scarcity of therapeutic options highlights the urgent necessity to discover efficacious drug targets and inhibitors. Protein synthesis has been clinically proven to be an excellent target for antibiotic development. Translation involves three well-defined steps: initiation, elongation and termination. The crucial elongation stage utilizes elongation factors (EFs: EF thermo unstable, EF thermo stable and EF G) that facilitate the sequential addition of amino acids. This review provides a perspective on the potential of mycobacterial EFs as innovative targets because of their vital role in translation, trans-translation and other alternative functions.

The introduction of Competency-Based Medical Education (CBME) in India emphasizes outcome-oriented training and provides a framework for implementing integrated teaching strategies. Traditional discipline-based medical education often limits the ability of learners to integrate knowledge across domains required to manage such complex comorbidities. Evidence suggests that integrated teaching approaches improve knowledge acquisition, clinical reasoning, and learner engagement. The coexistence of tuberculosis (TB) and diabetes mellitus (DM) represents a significant and evolving public health challenge, particularly in high-burden countries such as India. Diabetes increases the risk of developing active TB and is associated with adverse treatment outcomes, including delayed sputum conversion, treatment failure, relapse, and increased mortality. This bidirectional interaction necessitates an integrated approach to both clinical management and medical education for TB and DM. This review synthesizes existing literature on the epidemiological and clinical interplay between TB and DM, along with educational frameworks supporting integration. This review of literature additionally presents a curriculum innovation comprising structured aligned integrated teaching (AIT) modules that integrate TB and DM across the MBBS curriculum using both horizontal and vertical integration strategies. The proposed framework may serve as a practical model for institutions implementing CBME. Adoption of structured integrated modules may enhance undergraduate medical training and better prepare future physicians for managing TB-DM comorbidity in high-burden settings.

Background Latent tuberculosis infection (LTBI) screening in healthcare settings remains crucial for tuberculosis control. Current screening methods include the Mantoux tuberculin skin test (TST) and interferon-gamma release assay (IGRA), but their comparative effectiveness in healthcare worker screening remains unclear. Objective This study aims to compare the diagnostic performance of the TST and the IGRA QuantiFERON-TB Gold Plus (QFT-Plus) in the detection of LTBI among healthcare workers at King Fahad Armed Forces Hospital in Jeddah. As no definitive gold standard for LTBI exists, QFT-Plus was used as the reference comparator: the primary objective was to quantify agreement between the two tests, while identification of an ROC (receiver operating characteristic)-derived optimal TST induration threshold was a secondary, exploratory objective. Methods A retrospective cohort study was conducted between January and November 2020, analyzing data from immunocompetent employees with documented Bacillus Calmette-Guérin (BCG) vaccination status. TST was performed using the Mantoux technique, and QFT-Plus testing was conducted according to manufacturer protocols. Statistical analysis included determination of sensitivity, specificity, and predictive values and ROC curve analysis. Because no gold standard for LTBI exists, these measures describe agreement with QFT-Plus rather than true diagnostic accuracy. Follow-up data were obtained from electronic medical records to assess progression to active tuberculosis over a five-year period. Results Among 201 participants, QFT-Plus and TST identified 11.4% and 38.3% positive cases, respectively. TST demonstrated 87.0% sensitivity and 68.0% specificity compared to QFT-Plus, with positive and negative predictive values of 26.0% and 97.6%, respectively. Receiver operating characteristic (ROC) analysis identified an optimal TST threshold of 10.5 mm, with an AUC (area under the curve) of 0.871 (95% CI: 0.805-0.937). This threshold was derived and assessed in the same dataset without independent validation and is therefore exploratory. Demographic analysis revealed no significant differences in TB positivity rates across age groups, gender, or nationality (p > 0.05). Most participants (99.0%) had documented BCG vaccination, which may explain the higher rate of TST positivity relative to QFT-Plus, consistent with reduced TST specificity in this cohort. Additionally, during a five-year follow-up period, none of the individuals with discordant results (TST-positive/IGRA-negative) progressed to active tuberculosis. Conclusion Relative to QFT-Plus, TST showed higher comparator-based sensitivity but lower comparator-based specificity, suggesting potential for over-diagnosis in BCG-vaccinated healthcare workers. Because QFT-Plus is an imperfect comparator rather than a gold standard, and because the 10.5 mm threshold was not independently validated, these findings are preliminary and apply to the healthcare worker cohort studied; they should not be read as definitive diagnostic accuracy or as a generalizable screening recommendation. A five-year follow-up demonstrated no progression to active tuberculosis among individuals with discordant TST-positive/IGRA-negative results.

Intrapulmonary solitary fibrous tumours (SFTs) are exceptionally rare mesenchymal neoplasms, particularly when presenting as giant thoracic masses. We report a case of a 57-year-old woman with progressive chest pain and dyspnoea who initially presented with pleural effusion and hypoglycaemia and received empirical anti-tuberculosis therapy without improvement. Contrast-enhanced CT revealed a left lower lobe mass enlarging to 11 × 16.5 × 15.2 cm on repeat imaging, with rightward cardiac displacement, pericardial effusion and a hepatic nodule suspicious for metastasis to the liver. Core needle biopsy revealed a low-grade spindle cell neoplasm. Immunohistochemistry revealed diffuse STAT6 positivity, partial CD34 positivity, Ki-67 < 5%, and negativity for CK7, desmin, SMA and S100, supporting the diagnosis of SFT. Following a multidisciplinary evaluation, six cycles of systemic chemotherapy were administered, and the patient remained clinically stable. This case highlights the diagnostic challenges of giant intrapulmonary SFT and the pivotal role of STAT6 immunohistochemistry in establishing the diagnosis.

Community health workers (CHWs) are central to primary health care in low- and middle-income countries, yet their engagement is often uneven across health domains. In Madagascar, approximately 50,720 CHWs serving on a voluntary, unsalaried basis link communities to the formal health system, but only a minority is actively engaged in tuberculosis (TB) or HIV service delivery despite substantial disease burden. This community case study describes a two-stage initiative by a consortium of government disease programmes, an NGO, and an academic partner to strengthen CHW engagement in TB and HIV care in Madagascar. Stage 1 combined a cross-sectional survey of CHWs across four regions with a nested qualitative component identifying system-level constraints. Stage 2 convened national, sub-national, and community-based stakeholders across sectors in a three-day design-thinking workshop, producing PROFESS, a seven-lever framework operationalised as a guide for strengthening CHW support including concrete measures related to Protection (financial), Recognition, Coordination, Formation (training), Equipment, Supervision, and Security of CHWs. PROFESS has been validated by the Malagasy Ministry of Public Health and published as an operational guide. This case highlights two key lessons for fragmented, evidence-scarce settings: workforce-support frameworks anchored in foundational system functions are transferable across disease domains, and co-design produces institutionally adoptable outputs only when paired with operational elaboration. Remaining challenges include the definition of minimum support packages and the sequencing of implementation across levers. A pilot implementation of PROFESS is currently underway, with first results expected in 2027.