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Neurocysticercosis (NCC) is a common central nervous system (CNS) infection caused by Taenia solium metacestodes. Despite the well-documented importance of the granulomatous response in the pathogenesis of this infection, there is limited information about the types of cells and cytokines involved. In fact, there has been limited characterization of human brain granulomas with any infectious agent. In the present study a detailed histological and immunohistochemical analysis of the immune response was performed on eight craniotomy specimens where a granuloma surrounded each T. solium metacestode. The results indicated that in all the specimens there was a dying parasite surrounded by a mature granuloma with associated fibrosis, angiogenesis, and an inflammatory infiltrate. The most abundant cell types were plasma cells, B and T lymphocytes, macrophages, and mast cells. Th1 cytokines were prevalent and included gamma interferon, interleukin-18 (IL-18), and the immunosuppressive, fibrosis-promoting cytokine transforming growth factor ␤. The Th2 cytokines IL-4, IL-13, and IL-10 were also present. These observations indicate that a chronic immune response is elicited in the CNS environment with multiple cell types that together secrete inflammatory and anti-inflammatory cytokines. In addition, both collagen type I and type III deposits were evident and could contribute to irreversible nervous tissue damage in NCC patients.

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INTRODUCTIONThe global increase in type 2 diabetes mellitus (DM) is a recognized re-emerging risk and challenge to tuberculosis (TB) control (1). Individuals with DM have three times the risk of developing TB and there are now more individuals with TB-DM co-morbidity than TB-HIV co-infection. (2, 3) The association between DM and TB was first described by centuries ago by Avincenna, a persian philosopher, and the co-morbidity was a frequent topic in the medical literature from the first half of the XXth century.(4-7) But this literature dwindled as the association reduced notiriety with the introduction of insulin for diabetes patients and antibiotics for TB. In the 1980s the publications on joint TB-DM began to re-emerge in parallel with the DM 'pandemic': The global prevalence of DM among adults has increased by 20% in less than 30 years (8), and DM is predicted to reach 642 million worldwide by 2040 with most (80%) of the patients living in low and middle-income countries where TB is also endemic. (9) Consequently, the World Health Organization has identified DM as a neglected, important and re-emerging risk factor for TB (1). In this chapter 'DM' will refer mostly to type 2 DM since it is the most prevalent form, but type 1 DM in children has also been associated with TB.(9, 10) This chapter describes the epidemiology of TB-DM, the impact of DM on the clinical presentation and outcomes of TB, the underlying biology that favors the co-occurrence of both diseases, and the public health implications for TB control and DM management. EPIDEMIOLOGY OF TB-DM DM as a risk factor for TBDiabetes prevalence has increased worldwide as a result of population ageing, urbanisation, changes in diet and reduced physical activity patterns resulting in increasing obesity (11). About 80% of the 415 million estimated DM cases globally are from low and middle income countries and the DM prevalence is projected to rise most steeply in regions with high TB incidence over the next 30 years (9). A systematic review of 13 observational studies found that DM increases the risk of TB by three-fold (relative risk 3.11; 95% CI 2.27-4.26).(3) Even though this is the best-characterized aspect of the association between TB and DM, these findings present wide variation between studies with risk ratios ranging between

Background The coronavirus disease 2019 pandemic is predicted to have a net negative effect on tuberculosis control, with an estimated excess of 6.3 million tuberculosis cases and 1.4 million deaths by 2025. Programmatic issues such as the lockdown of tuberculosis services affect all patients, while biosocial factors have a differential impact on an individual’s risk for tuberculosis or adverse tuberculosis outcomes. Case presentation We report three Hispanic cases of incident tuberculosis (two males, 43 and 44 years old; one female, 49 years old) after resolution of coronavirus disease episodes. Coincidentally, all cases shared a common risk factor: a chronic history poorly controlled diabetes. Conclusions Our findings alert to the threat posed by the synergy between coronavirus disease and diabetes, on tuberculosis reactivation. In medium- to high-risk settings for tuberculosis, we recommend implementation of routine screening for latent tuberculosis infection in these cases, and preventive tuberculosis treatment in those who are positive.

Respiratory infections are one of the top causes of death in the elderly population, displaying susceptibility factors with increasing age that are potentially amenable to interventions. We posit that with increasing age there are predictable tissue-specific changes that prevent the immune system from working effectively in the lung. This mini-review highlights recent evidence for altered local tissue environment factors as we age focusing on increased tissue oxidative stress with associated immune cell changes, likely driven by the byproducts of age-associated inflammatory disease. Potential intervention points are presented.

Tuberculosis (TB), considered an ancient disease, is still killing one person every 21 seconds. Diagnosis of Mycobacterium tuberculosis (M.tb) still has many challenges, especially in low and middle-income countries with high burden disease rates. Over the last two decades, the amount of drug-resistant (DR)-TB cases has been increasing, from mono-resistant (mainly for isoniazid or rifampicin resistance) to extremely drug resistant TB. DR-TB is problematic to diagnose and treat, and thus, needs more resources to manage it. Together with+ TB clinical symptoms, phenotypic and genotypic diagnosis of TB includes a series of tests that can be used on different specimens to determine if a person has TB, as well as if the M.tb strain+ causing the disease is drug susceptible or resistant. Here, we review and discuss advantages and disadvantages of phenotypic vs. genotypic drug susceptibility testing for DR-TB, advances in TB immunodiagnostics, and propose a call to improve deployable and low-cost TB diagnostic tests to control the DR-TB burden, especially in light of the increase of the global burden of bacterial antimicrobial resistance, and the potentially long term impact of the coronavirus disease 2019 (COVID-19) disruption on TB programs.