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Hingorani A, Ascher E, Hingorani A. The Great Masquerader - TB Osteoarthritis. Ann Vasc Surg 2022; 78:377.e1-377.e3. [PMID: 34481885 DOI: 10.1016/j.avsg.2021.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/26/2021] [Accepted: 06/17/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES TB arthritis is a rarely reported entity in Western literature and its ability to masquerade as many other diseases makes it difficult to diagnose. We report an interesting case of TB arthritis of the ankle. METHODS We present a 44 year-old diabetic Chinese male with a recent history of worsening pain, swelling, and redness in his left foot with an abscess and X-ray findings consistent with Charcot foot. RESULTS At first, the presentation was believed to be Charcot's foot with MSSA osteomyelitis but after the wound culture and bone biopsy were both positive for Mycobacterium tuberculosis as well, the diagnosis of tuberculous arthritis was confirmed. CONCLUSIONS While the prevalence of TB and other diseases is low in the majority of the United States, we still need to be aware of such diseases in populations with increasing migration and be cognizant of the potential impact of a patient's background on a diagnosis is critical to properly diagnosing and treating patients. Vascular surgeons may be seeing patients with abscesses of the lower extremities and may miss the diagnosis if cultures for TB are not sought.
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MESH Headings
- Adult
- Ankle Joint/diagnostic imaging
- Ankle Joint/microbiology
- Ankle Joint/surgery
- Antibiotics, Antitubercular/therapeutic use
- Arthritis, Infectious/diagnosis
- Arthritis, Infectious/microbiology
- Arthritis, Infectious/surgery
- Debridement
- Humans
- Male
- Mycobacterium tuberculosis/isolation & purification
- Osteoarthritis/diagnosis
- Osteoarthritis/microbiology
- Osteoarthritis/surgery
- Treatment Outcome
- Tuberculosis, Miliary/diagnosis
- Tuberculosis, Miliary/microbiology
- Tuberculosis, Miliary/surgery
- Tuberculosis, Osteoarticular/diagnosis
- Tuberculosis, Osteoarticular/microbiology
- Tuberculosis, Osteoarticular/surgery
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2
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Barry M, Akkielah L, Askar MA, Bin Nasser AS. Miliary tuberculosis with delayed-onset total knee arthroplasty Mycobacteria tuberculosis infection successfully treated with medical therapy alone: A case report and literature review. Knee 2019; 26:1152-1158. [PMID: 31427242 DOI: 10.1016/j.knee.2019.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/01/2019] [Accepted: 07/17/2019] [Indexed: 02/07/2023]
Abstract
Tuberculosis (TB) affecting a prosthetic knee is an unusual and diagnostically challenging presentation of this disease. This study reported a case of an 80-year-old man with a left total knee arthroplasty (TKA) performed eight years before his presentation. He presented with left knee swelling and pain for one month. Knee X-rays showed a normal joint space with no loosening of his prosthesis. His chest X-ray showed miliary disease, and microbiological studies of his sputum and synovial fluid aspirate grew Mycobacteria tuberculosis complex. He was successfully medically treated with anti-tuberculous therapy alone for one year. His knee hardware was retained, and he did not require debridement, resection, or revision. It is believed that this is the first reported case of miliary TB with delayed-onset TKA prosthetic joint infection (PJI) in which the prosthesis was successfully retained. Thirty-eight published TB TKA PJI cases in medical literature were also reviewed.
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Affiliation(s)
- Mazin Barry
- Division of Infectious Diseases, Department of Internal Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Layan Akkielah
- Division of Infectious Diseases, Department of Internal Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Manar A Askar
- Division of Infectious Diseases, Department of Internal Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed S Bin Nasser
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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3
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Wakamiya A, Seguchi O, Shionoiri A, Kumai Y, Kuroda K, Nakajima S, Yanase M, Matsuda S, Wada K, Matsumoto Y, Fukushima S, Fujita T, Kobayashi J, Fukushima N. Paradoxical Reaction of Tuberculosis in a Heart Transplant Recipient During Antituberculosis Therapy: A Case Report. Transplant Proc 2018; 50:947-949. [PMID: 29661467 DOI: 10.1016/j.transproceed.2018.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 01/17/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Tuberculous paradoxical reactions (PRs) are excessive immune reactions occurring after antituberculosis (TB) treatment and are commonly observed in immunocompromised hosts such as patients infected with the human immunodeficiency virus. CASE REPORT We recently encountered a 63-year-old male heart transplant recipient who developed tuberculous PR after treatment for miliary TB. The patient had been receiving immunosuppressive therapy with cyclosporine and mycophenolate mofetil for over 15 years. The diagnosis of miliary TB was made based on the presence of intermittent fever and fatigue; thus, anti-TB treatments (isoniazid, levofloxacin, ethambutol, and pyrazinamide) were started, which led to rapid defervescence and regression of the granular shadow and pleural effusion. However, a new persistent fever and confused state developed 1 month after the anti-TB therapy was started. After excluding possible etiologies of the patient's symptom, a PR was suspected, and anti-TB drugs were continued; corticosteroids were added as anti-inflammatory agents. After that, he has shown a favorable course with long-term anti-TB chemotherapy. CONCLUSION A PR should always be considered when the patients' symptoms of tuberculosis re-exacerbate after an appropriate anti-TB therapy. A PR commonly occurs in patients with various immunologic conditions including heart transplant recipients.
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Affiliation(s)
- A Wakamiya
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - O Seguchi
- Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - A Shionoiri
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Y Kumai
- Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - K Kuroda
- Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - S Nakajima
- Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - M Yanase
- Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - S Matsuda
- Department of Pharmacy, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - K Wada
- Department of Pharmacy, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Y Matsumoto
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - S Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - T Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - J Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - N Fukushima
- Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan.
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4
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Yokoyama T, Kinoshita T, Okamoto M, Matsunaga K, Kamimura T, Kinoshita M, Rikimaru T, Taguchi K, Hoshino T, Kawayama T. High Detection Rates of Urine Mycobacterium tuberculosis in Patients with Suspected Miliary Tuberculosis. Intern Med 2017; 56:895-902. [PMID: 28420836 PMCID: PMC5465404 DOI: 10.2169/internalmedicine.56.7792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective The utility of detecting Mycobacterium tuberculosis in urine samples from patients with pulmonary tuberculous with diffuse small nodular shadows (suspected miliary tuberculosis (MTB)) is still unclear in Japan. A retrospective cross-sectional study was conducted to investigate the detection rates of M. tuberculosis in urine of patients with suspected MTB. Methods Among 687 hospitalized patients with tuberculosis, 45 with culture-confirmed suspected MTB and the data of culture and polymerase chain reaction (PCR) for M. tuberculosis in urine and sputum samples were investigated. The detection rates of M. tuberculosis in urine using cultures and PCR were calculated. The detection rate of urine was then compared with that of bone marrow aspiration. Results Fourteen patients with suspected MTB were ultimately analyzed. A diagnosis of miliary tuberculosis was suspected in all patients before anti-tuberculosis chemotherapy. Positive results by PCR (11 [78.6%] cases) and culture (8 [57.1%]) were obtained from urine samples. In patients with suspected MTB, there was no significant difference in the detection rates between M. tuberculosis in urine using a combination of PCR and culture (85.6% [12/14 cases]) and bone marrow aspiration (66.7% [8/12 cases]) (p>0.05). Conclusion Using PCR and culture, we demonstrated high detection rates of M. tuberculosis in the urine of patients with suspected MTB. A combination of PCR and culture compared favorably with the detection rates achieved with bone marrow aspiration. We believe that detection of M. tuberculosis from urine and sputum samples may be easy and safe for patients with disseminated tuberculosis infections such as definitive MTB.
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Affiliation(s)
- Toshinobu Yokoyama
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
- Higashiaburayama Clinic, Japan
| | - Takashi Kinoshita
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
| | - Masaki Okamoto
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
| | | | - Tomoko Kamimura
- Respiratory Medicine, Asakura Medical Association Hospital, Japan
| | | | | | | | - Tomoaki Hoshino
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
| | - Tomotaka Kawayama
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
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5
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Larcher R, Sotto A, Mauboussin JM, Lavigne JP, Blanc FX, Laureillard D. A Case of Miliary Tuberculosis Presenting with Whitlow of the Thumb. Acta Derm Venereol 2016; 96:560-1. [PMID: 26554624 DOI: 10.2340/00015555-2285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
MESH Headings
- Aged
- Antitubercular Agents/therapeutic use
- Female
- Hand Deformities, Acquired/diagnosis
- Hand Deformities, Acquired/drug therapy
- Hand Deformities, Acquired/immunology
- Hand Deformities, Acquired/microbiology
- Humans
- Immunocompromised Host
- Immunosuppressive Agents/adverse effects
- Mycobacterium tuberculosis/drug effects
- Mycobacterium tuberculosis/immunology
- Mycobacterium tuberculosis/isolation & purification
- Opportunistic Infections/diagnosis
- Opportunistic Infections/drug therapy
- Opportunistic Infections/immunology
- Opportunistic Infections/microbiology
- Thumb/microbiology
- Thumb/pathology
- Treatment Outcome
- Tuberculosis, Cutaneous/diagnosis
- Tuberculosis, Cutaneous/drug therapy
- Tuberculosis, Cutaneous/immunology
- Tuberculosis, Cutaneous/microbiology
- Tuberculosis, Miliary/diagnosis
- Tuberculosis, Miliary/drug therapy
- Tuberculosis, Miliary/immunology
- Tuberculosis, Miliary/microbiology
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Affiliation(s)
- Romaric Larcher
- Infectious disease department, University Hospital Caremeau, Nîmes, France
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6
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Arbonés L, Capdevila JA, Ruiz MDLN, Carrion S. [Spontaneous splenic rupture as a complication of extrapulmonary tuberculosis]. Rev Esp Quimioter 2016; 29:109-110. [PMID: 26946525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Laia Arbonés
- Laia Arbonés. Hospital de Mataró. Carretera Cirera 230. 08304 Mataró, Spain.
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7
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Koda K, Enomoto Y, Omae M, Akahori D, Abe T, Hasegawa H, Matsui T, Yokomura K, Suda T. [A CASE OF MILIARY TUBERCULOSIS ORIGINATED FROM CUTANEOUS INFECTION]. Kekkaku 2016; 91:59-63. [PMID: 27263227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
An 86-year-old woman with severe dementia had been treated with oral prednisolone at 2 mg/day for autoimmune bullous dermatosis for several years. One year ago, she referred to our hospital due to an ulcerative skin lesion over the right tibial tuberosity. The lesion was treated by an iodine-containing ointment, but did not heal. Subsequently, a new skin lesion appeared in the right popliteal fossa. One month ago, the patient had increased sputum production that was accompanied by fever, anorexia, and dyspnea; consequently, she visited our department. Chest computed tomography revealed diffuse micronodules with ground-glass attenuation. Acid-fast bacteria staining of the sputum was positive and the polymerase chain reaction detected Mycobacterium tuberculosis. In addition, the bacilli were also found in the skin lesions of the right limb. Therefore, a diagnosis of cutaneous, and miliary tuberculosis was made. Although the anti-tuberculous combination chemotherapy consisting of isoniazid, rifampicin, and ethambutol was immediately initiated, her condition did not improve. She died on day 19 of hospitalization. Drug susceptibility testing revealed no resistance to all the three drugs; hence, it was concluded that the time-delay in diagnosis of cutaneous tuberculosis lead to the progression to miliary tuberculosis and subsequent death.
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MESH Headings
- Aged, 80 and over
- Antitubercular Agents/administration & dosage
- Diagnosis, Differential
- Drug Therapy, Combination
- Ethambutol/administration & dosage
- Fatal Outcome
- Female
- Humans
- Isoniazid/administration & dosage
- Mycobacterium tuberculosis/isolation & purification
- Rifampin/administration & dosage
- Tomography, X-Ray Computed
- Tuberculosis, Cutaneous/complications
- Tuberculosis, Cutaneous/diagnosis
- Tuberculosis, Cutaneous/microbiology
- Tuberculosis, Miliary/diagnosis
- Tuberculosis, Miliary/etiology
- Tuberculosis, Miliary/microbiology
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8
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Zaibi H, Akrout I, El Fekih L, Fenniche S, Ben Miled K, Megdiche ML. [A febrile hemiplegia revealing a cerebral tuberculous arteritis]. Tunis Med 2015; 93:392-393. [PMID: 26644106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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9
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Antohe I, Dascalescu A, Burcoveanu C, Ghiorghiu D, Dascalu A, Danaila C. Pact with the devil: alemtuzumab therapy, immune suppression and infectious complications in chronic lymphocytic leukemia. Rev Med Chir Soc Med Nat Iasi 2014; 118:92-95. [PMID: 24741782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Infectious complications are an important cause of hospitalization in patients diagnosed with chronic lymphocytic leukemia. The pathogenesis of infection is complex, involving both disease-induced and treatment-related immune depression. During the last decade, the management of chronic lymphocytic leukemia (CLL) has been redefined by the approval of monoclonal antibody-based treatment, which resulted in improved therapeutic responses. Nonetheless, the profound lymphopenia induced by monoclonal agents was accompanied by increased incidence of infections caused by a new spectrum of opportunistic microorganisms. We report the case of a patient with hypercellular CLL who received Alemtuzumab as first line therapy and obtained a satisfactory therapeutic response, but developed subsequent atypical infectious complications.
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MESH Headings
- Adult
- Alemtuzumab
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/adverse effects
- Antitubercular Agents/therapeutic use
- Humans
- Immunocompromised Host
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Male
- Splenectomy
- Treatment Outcome
- Tuberculosis, Miliary/diagnosis
- Tuberculosis, Miliary/drug therapy
- Tuberculosis, Miliary/microbiology
- Tuberculosis, Splenic/diagnosis
- Tuberculosis, Splenic/microbiology
- Tuberculosis, Splenic/therapy
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10
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Silva R, Jara J, Soto T, Sepúlveda P. [Severe disseminated tuberculosis in a patient on immunosuppressive treatment. Report of one case]. Rev Med Chil 2011; 139:774-778. [PMID: 22051759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Patients on immunosuppressive therapy are at increased risk of developing tuberculosis. We report a 39-year-old female with an ulcerative colitis receiving prednisone, azathioprine and azulfidine that was admitted to hospital due to fever, anemia, diarrhea and hematochezia. A chest CT scan showed multiple miliary micronodular images diffusely distributed and mediastinal enlarged lymph nodes with central necrosis, suggestive of disseminated tuberculosis. Antituberculous treatment was started but discontinued and the patient was treated as a bronchiolitis obliterans with methylprednisolone pulses and discharged. She was readmitted in shock one week later and died. After her death cultures for Mycobacterium tuberculosis were informed as positive. The clinical picture of the patient is known as sepsis tuberculosa gravissima.
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Affiliation(s)
- Rafael Silva
- Servicio de Medicina-Unidad de Enfermedades Respiratorias Hospital Regional de Talca.
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11
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Cobas Paz A, García Tejedor JL, González Piñeiro A, Fernández-Villar A. [Miliary tuberculosis due to BCG in an asymptomatic patient: initial onset or a condition not yet described?]. Arch Bronconeumol 2010; 46:394-5. [PMID: 20171773 DOI: 10.1016/j.arbres.2010.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2009] [Accepted: 01/06/2010] [Indexed: 11/16/2022]
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12
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Taniguchi H, Izumi S. [Case of miliary tuberculosis during treatment with infliximab for rheumatoid arthritis]. Kekkaku 2008; 83:431-434. [PMID: 18536334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A 70-year-old woman afflicted with rheumatoid arthritis was consulted another hospital because of fever and abnormality in chest X-ray. She had been treated with methotrexate and infliximab for seven months. She was diagnosed as methotrexate-induced pneumonia, and was administrated large therapeutic doses of corticosteroid, but finding of her chest X-ray exacerbated. Her sputum examination was positive for Mycobacterium tuberculosis complex by nucleic-acid amplification test, and she was diagnosed as miliary tuberculosis. She was treated with INH, RFP, EB, and PZA, and showed good clinical response to treatment. When infliximab is prescribed, we have to bear in mind possible complication of tuberculosis.
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Affiliation(s)
- Hirokazu Taniguchi
- Department of Internal Medicine, Toyama Prefectural Central Hospital, 2-2-78, Nishinagae, Toyama-shi, Toyama 930-8550, Japan.
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13
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Padmavathy L, Lakshmana Rao L, Ethirajan N, Ramakrishna Rao M, Subrahmanyan EN, Manohar U. Tuberculosis verrucosa cutis (TBVC)--foot with miliary tuberculosis. Indian J Tuberc 2007; 54:145-8. [PMID: 17886704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Tuberculosis Verrucosa Cutis (TBVC) or warty tuberculosis is a variant of cutaneous tuberculosis in patients with good cell mediated immunity (CMI) to Mycobacterium Tuberculosis, while Miliary Tuberculosis is associated with very poor CMI. Two widely different clinical presentations in the same patient are very rare and being reported.
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Affiliation(s)
- L Padmavathy
- Urban Health Centre, Division of Community Medicine, Rajah Muthiah Medical College, Annamalai University, Annamalai Nagar, Chidambaram.
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14
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Irfan M, Hussain SF, Jabeen K, Islam M. Drug susceptibility pattern of Mycobacterium tuberculosis in adult patients with miliary tuberculosis. Trop Doct 2007; 37:182-4. [PMID: 17716515 DOI: 10.1258/004947507781524755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Miliary tuberculosis (TB) is a fatal form of TB. Although drug resistance in TB patients has increased worldwide, there is limited information on drug resistance in miliary TB. This study from Pakistan evaluated drug susceptibility pattern among miliary TB patients of a high TB-burden country. All adult patients with miliary TB, admitted between 1994 and 2001, were identified using a computerized database. Culture-positive isolates were evaluated for drug susceptibility using middle brook 7H10 agar according to National Committee for Clinical Laboratories Standard criteria. Of 110 patients diagnosed with miliary TB, 32 (30%) were culture positive (yielding 35 culture isolates). The sources of positive cultures were sputum (37%), cerebrospinal fluid (18%), lymph nodes (12%), bone marrow (9%), bronchial wash (9%), urine (6%), lungs (6%) and liver (3%). Isoniazid resistance was found in three (9%) isolates. All the isolates were sensitive to rifampicin, ethambutol, pyrazinamide and streptomycin. Despite a worldwide increase in TB drug resistance, patients with miliary TB have infection with drug-sensitive mycobacterium. First-line anti-TB drugs should be used as initial therapy in miliary TB patients.
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15
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16
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17
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Koretskaia NM, Iarygina IV. [Comparative characteristics of disseminated pulmonary tuberculosis in patients isolating Mycobacterium tuberculosis with a high and low viability]. Probl Tuberk Bolezn Legk 2007:17-20. [PMID: 17419328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The specific features of disseminated pulmonary tuberculosis were studied in patients isolating Mycobacterium tuberculosis (MBT) with a high (n = 135) and low (n = 50) viability. The degree of the pathogen's viability was shown to determine the clinical characteristics of a specific process and the efficiency of its treatment. It is speculated that there is a direct relationship between the viability ofmycobacteria and their virulence. There are differences in the nature of primary drug resistance in MBT with their varying variability.
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18
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Del Castillo Duran Y, Santos Bodí F, Castander Serentill D, Jubert Montaperto P, Espinosa Valencia P, Rabassó Sole C. [Tuberculosis miliar in a patient treated with intravesical instillations of bacillus Calmette-Guérin]. Med Intensiva 2006; 30:116-9. [PMID: 16729480 DOI: 10.1016/s0210-5691(06)74485-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Tuberculosis miliar is a very rare complication of bacillus Calmette-Guérin (BCG) immunotherapy that is associated to high mortality. Thus, early diagnosis and treatment is essential. At present, there is a polymerase chain reaction technique (PCR) which is a rapid diagnostic method with elevated sensitivity. Treatment with tuberculostatic agents should be initiated as soon as possible, the combination of corticosteroids and cycloserine in serious cases being advisable. A case of a 75 year old patient with intravesical BCG instillations after a transurethral resection of bladder cancer is presented. He was admitted to the Intensive Care Unit (ICU) due to severe acute respiratory failure evolving to acute respiratory distress syndrome (ARDS). Mycobacterium bovis DNA was identified by PCR in blood samples and bronchoaspirate (BAS). He was treated with tuberculostatic agents and corticosteroids, dying due to respiratory failure.
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Affiliation(s)
- Y Del Castillo Duran
- Unidad de Cuidados Intensivos, Hospital de Sant Pau i Santa Tecla, Tarragona, España.
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19
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Salerno D, Gottlieb J, Nguyen C. Disseminated tuberculosis. Intern Med J 2006; 36:675-6. [PMID: 16958648 DOI: 10.1111/j.1445-5994.2006.01178.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- D Salerno
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
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20
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Sánchez-Hurtado LA, Zapata-Altamirano LE, Pérez-Sáleme L. [A fifty-six year old woman with painful nodules and skin ulcers]. GAC MED MEX 2006; 142:333-5. [PMID: 17022309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
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21
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Njock R, Abena Messomo P, Mvouni Oyono S, Luma Namme H. [Tuberculosis of the tonsil and miliary lung disease]. Med Trop (Mars) 2006; 66:98. [PMID: 16615626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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22
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Abstract
A 61-year-old woman was admitted with fever and headache of 10-day duration. She was found to have anemia, jaundice, and signs of meningitis. The erythrocyte sedimentation rate was increased and the tuberculin skin test was positive. A provisional diagnosis of miliary tuberculosis was made and antituberculous therapy was started, although no miliary lesions were seen on chest radiography. However, her condition rapidly deteriorated with diffuse opacification of both lungs and she died on the 7th hospital day. Postmortem examination revealed miliary tuberculosis in several organs but not in the lungs with acute respiratory distress syndrome accounting for the lung pathology. It should be noted that on rare occasions the lungs may not be involved by miliary tuberculosis.
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Affiliation(s)
- Isao Miyoshi
- Department of Hematology and Respiratory Medicine, Kochi University School of Medicine
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23
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Abstract
Cutaneous involvement is an unusual presentation of tuberculosis (TB) and is rarely reported in renal transplant recipients. We describe a 37-year-old renal transplant recipient with disseminated Mycobacterium tuberculosis infection that presented as cellulitis. The organism was isolated from tissue and blood cultures. The patient was treated with quadruple anti-TB therapy for 12 months. Anti-TB therapy led to a complete resolution of TB lesions. We also provide a review of the literature on cutaneous TB in renal transplant recipients. Skin TB in renal transplant recipients usually occurs with nontuberculous mycobacteria. The spectrum of the skin lesions can be quite different and can mimic bacterial infections. Mycobacteriosis should always be included in the differential diagnosis of a skin lesion in renal transplant recipients.
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Affiliation(s)
- N Seyahi
- Department of Nephrology, Istanbul University, Cerrahpasa Medical Faculty, Turkey.
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24
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Abstract
Tuberculous meningitis (TBM) develops most often when a caseating meningeal or sub-cortical focus, the Rich focus, discharges its contents into the subarachnoid space. It is recognized that TBM is frequently accompanied by miliary tuberculosis, but the relationship between the development of the Rich focus and miliary tuberculosis remains controversial. The original descriptions of Arnold Rich and Howard McCordock are reviewed together with the work of other pathologists and the observations of the natural history of tuberculosis by astute clinicians such as Arvid Wallgren and Edith Lincoln. Rich and McCordock dissociated miliary tuberculosis from a role in the pathogenesis of TBM, and this view continues to appear in reviews and textbooks dealing with TBM. We suggest, particularly in childhood, that miliary tuberculosis is indeed directly involved in the pathogenesis of TBM in as much as that the overwhelming bacillaemia that accompanies miliary tuberculosis serves to increase the likelihood that a meningeal or sub-cortical Rich focus will be established, which may in its turn caseate and give rise to TBM.
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Affiliation(s)
- P R Donald
- The Department of Paediatrics and Child Health, Tygerberg Children's Hospital and The Faculty of Health Sciences, The University of Stellenbosch, P.O. Box 19063, 7505 Tygerberg, South Africa.
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25
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Valerga M, Viola C, Thwaites A, Bases O, Ambroggi M, Poggi S, Marino R. [Mycobacterium bovis tuberculosis in a female patient with AIDS]. Rev Argent Microbiol 2005; 37:96-8. [PMID: 16178466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
M. bovis, the agent of bovine tuberculosis, was in other times, the main ethiological agent of tuberculosis (TBC) in industrialized countries. At the moment, the human cases have become not very frequent, except in those countries where the illness is even endemic. In patients with immunodeficiency syndrome, it usually presents as a systemic illness. We present the case of a woman with AIDS and disseminated TBC caused by M. bovis. The isolated micobacteria turned out to be resistant to rifampin and pyrazinamide. She was treated with isoniazid, ethambutol and ofloxacin with good clinical evolution. This case turned out to be the first isolation of M. bovis in a patient with AIDS, in Muñiz hospital.
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MESH Headings
- AIDS-Related Opportunistic Infections/microbiology
- Adult
- Alcoholism/complications
- Antitubercular Agents/therapeutic use
- Argentina/epidemiology
- Cocaine-Related Disorders/complications
- Disease Susceptibility
- Drug Therapy, Combination
- Ethambutol/therapeutic use
- Female
- Humans
- Isoniazid/therapeutic use
- Meningitis, Cryptococcal/complications
- Mycobacterium bovis/drug effects
- Mycobacterium bovis/isolation & purification
- Ofloxacin/therapeutic use
- Pneumocystis carinii/isolation & purification
- Pneumonia, Pneumocystis/complications
- Pneumonia, Pneumocystis/microbiology
- Pyrazinamide/pharmacology
- Rifampin/pharmacology
- Tuberculosis, Miliary/complications
- Tuberculosis, Miliary/epidemiology
- Tuberculosis, Miliary/microbiology
- Tuberculosis, Multidrug-Resistant/complications
- Tuberculosis, Multidrug-Resistant/epidemiology
- Tuberculosis, Multidrug-Resistant/microbiology
- Tuberculosis, Pulmonary/complications
- Tuberculosis, Pulmonary/epidemiology
- Tuberculosis, Pulmonary/microbiology
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Affiliation(s)
- M Valerga
- Unidad XVI y Laboratorio Cetrángolo, Hospital de Enfermedades Infecciosas Francisco J. Muñiz, Uspallata 2272 (1282) Ciudad Autónoma de Buenos Aires, Argentina.
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Abstract
An epidemic outbreak of tuberculosis resulting from exposure at an autopsy occurred at the National Defense Medical College Hospital. It consisted of 3 tuberculosis patients and 68 infected staff members over a 6-year observation period from 1997 to 2002 after exposure to an index patient. We report the incident and the background of the tuberculosis infection in our hospital. A 72-year-old man with myelodysplastic syndrome was admitted to our hospital and later died. Miliary tuberculosis was diagnosed at autopsy. The first non-periodic health examination was performed on the hospital staff who had contact with the patient. Tuberculosis infection was defined as an area of erythema not less than 30 mm in diameter in the tuberculin skin test. 13 of the 39 hospital staff members who had had contact with the patient were infected, and 3 developed tuberculosis. Of the latter 3 secondary tuberculosis patients, the only contact point two had had with the index case was in the autopsy room, and the other had had contact both in the autopsy room and on the ward. The incidence of tuberculosis infection among the staff who had had contact in the autopsy room alone was higher than among the staff who had had contact on the ward alone (odds ratio = 5.04; 1.08-23.42: 95% confidence interval). Because one of the secondary tuberculosis patients had bronchial tuberculosis, which is a strong source of infection, the second non-periodic health examination was performed on the staff who had had contact with the secondary tuberculosis patient, and 69 inpatients who had had contact with the staff were carefully observed over a two-year period. 58 of the 171 staff members were infected, and none developed tuberculosis. However, 23 patients were diagnosed with active tuberculosis after admission to our hospital during the 6 years from 1997 to 2002. Many of them were elderly patients with underlying diseases. An autopsy was performed on 6 of those who died, but only one was diagnosed with active tuberculosis before death. Five of the six autopsied patients had old, healed tuberculous lesions. This outbreak underlines the need for standard precautions, including anti-air droplet infection at autopsy, because antemortem diagnosis of tuberculosis is not always possible, and there is a risk of elderly hospitalized patients developing tuberculosis if they have been previously infected with Mycobacterium tuberculosis.
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Affiliation(s)
- Yasumi Okochi
- Department of Pathology, National Defense Medical College
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28
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Uthman I, Kanj N, El-Sayad J, Bizri AR. Miliary tuberculosis after infliximab therapy in Lebanon. Clin Rheumatol 2004; 23:279-80. [PMID: 15168166 DOI: 10.1007/s10067-004-0873-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2003] [Accepted: 12/12/2003] [Indexed: 11/29/2022]
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Escobedo-Jaimes L, Cicero-Sabido R, Criales-Cortez JL, Ramirez E, Romero M, Rivero V, Islas F, Olivera H, Gonzalez S, Escobar-Gutierrez A. Evaluation of the polymerase chain reaction in the diagnosis of miliary tuberculosis in bone marrow smear. Int J Tuberc Lung Dis 2003; 7:580-6. [PMID: 12797702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVE Miliary tuberculosis (MTB) is difficult to diagnose. When prompt diagnosis is necessary, the polymerase chain reaction (PCR) to detect mycobacterial DNA may be valuable. SETTING Tuberculosis clinic in an academic tertiary-level hospital in Mexico. DESIGN Bone marrow (BM) aspiration samples from 30 consecutive clinically suspected MTB patients and 58 non-tuberculosis hematologic patients were evaluated by in-house PCR using a fragment of the insertion sequence IS6110; results were compared with those obtained by acid-fast-stained smears, culture in Löwenstein-Jensen medium, histology, and serology. RESULTS Tuberculosis diagnosis was confirmed in all MTB suspects, 28 by microscopy and culture in pulmonary or extra-pulmonary samples other than BM, and two by clinical and radiologic improvement after antituberculosis treatment. In fresh BM specimens, in-house PCR was positive in 21/30 (70%) suspects, contrasting with only one positive (3.3%) in staining and culture, and four with compatible histologic findings (13.3%). BM samples from the control group showed negative results in bacteriologic and histologic studies, except in nine who had positive PCR results. These nine control cases had malignant processes. CONCLUSION PCR in aspirates of BM is a useful diagnostic assay in cases of MTB, mainly when bacteriological results are negative.
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Abstract
The aim of this investigation was to quantify dissemination of Mycobacterium tuberculosis infection in patients with pulmonary tuberculosis and to show the pattern of eradication during treatment. The study is based on 98 out of the 113 patients with pulmonary tuberculosis who died during their admission to hospital in the Municipality of Copenhagen from 1963 to 1971. These patients had cultures for M. tuberculosis performed from different organs at autopsy: 78% treated <=100 days had dissemination of bacteria, cultured with decreasing frequency in the lungs, spleen, liver, and kidneys, respectively. In comparison, 23% treated >100 days had dissemination of bacteria, among which 50% occurred in patients with records of poor treatment compliance, 14% in patients with good treatment compliance. 81% of all patients had at least one chest x-ray judged to be without a miliary pattern. This study emphasizes that M. tuberculosis is often disseminated to organs other than the lungs in severe pulmonary tuberculosis. Eradication of bacteria in these organs can take several months. This observation adds to our understanding of the natural history of tuberculosis: M. tuberculosis is a resilient organism that can adapt to a wide variety of environmental conditions.
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Affiliation(s)
- Troels Lillebaek
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, National Institute for Prevention and Control of Infectious Diseases and Congenital Disorders, Artillerivej 5, Copenhagen S, Denmark.
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Ashino J, Ohno I, Okada S, Nishimaki Y, Saito Y, Endo M, Kaku M, Sasano H, Hattori T. [A case of disseminated tuberculosis requiring extended period for the identification of Mycobacterium tuberculosis on culture]. Kekkaku 2002; 77:73-7. [PMID: 11905031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
A 80-year-old male visited an outpatient department of a nearby hospital complaining of fever, cough, and poor appetite on June 2000. The patient was diagnosed as bacterial pneumonia and was treated with antibiotics although specific cause could not be identified. After one month, he was hospitalized due to lack of improvement. After admission, acid-fast bacilli (AFB) was found from the bronchial washing. The patient was then transferred to our hospital. Upon admission, sputum smear examination was positive for AFB and MTB was confirmed by PCR. Therapy was initiated with INH 300 mg, RFP 450 mg, EB 1000 mg, and PZA 1000 mg, orally daily. However, on the day following the admission, he became unconscious. Brain MRI showed several small granulomas on the cortex of the bilateral anterior and temporal brain. Although AFB was not detected from the cerebrospinal fluid, tuberculous meningitis was suspected and steroid was given. Nine days after admission, the patient died due to tuberculous meningitis. The isolation of MTB had been attempted on Ogawa culture medium using patient's sputum and liquor, and it took 14 weeks to find colony growth both from sputum and liquor. In the autopsy, numerous granulomas were detected in his lung, liver, kidney, and pancreas. These findings indicate that disseminated growth of MTB occurred in vivo in spite of very slow growth of MTB in vitro.
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Affiliation(s)
- Junko Ashino
- Department of Respiratory & Infection Diseases, Tohoku University Hospital, 1-1, Seiryo-cho, Aoba-ku, Sendai-shi, Miyagi 980-8574, Japan.
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33
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Affiliation(s)
- B S Menon
- Department of Paediatrics, Universiti Sains Malaysia, Kelantan, Malaysia
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34
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Bogadel'nikova IV, Sagalovich VI, Perel'man MI. [The efficacy of the ambulatory treatment of patients with newly detected pulmonary tuberculosis]. Probl Tuberk 2001:23-8. [PMID: 11077847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Scientific rationale has been provided for the fact that new cases of pulmonary tuberculosis can be successfully treated in the outpatient setting. The paper suggests that the pattern of a tuberculous process and the patient's socioeconomic status and education level should be taken into account while choosing a treatment regimen. Indications, contraindications, necessary conditions for outpatient treatment are defined. General recommendations how to use an antibacterial treatment regimen and its methods are given. The efficiency of outpatient and inpatient treatment regimens is compared in the matched groups of patients and the advantages of treatment in the outpatient setting are noted. Treatment in the outpatient setting shows a 2-fold decrease in the likelihood of preschedule discontinuation of the basic course of antibacterial therapy as compared to that in a 24-o'clock hospital, a 2.4-fold reduction in the length of temporary disability and it can also decrease the basic course of antibacterial therapy by 1.5-2.5 months. With this, its therapeutical efficiency does not drop.
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Abstract
In Western Europe, awareness of tuberculous lymphadenitis (TLA) has declined. This report describes a patient who had suspected sarcoidosis for 3.5 y, who eventually died from miliary tuberculosis due to delay in diagnosis. The report includes a discussion of the differential diagnosis of TLA and sarcoidosis.
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Affiliation(s)
- T Lillebaek
- Department of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
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36
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Bukharin OV, Usviatsov BI, Golanov VS. [The antilysozyme activity of Mycobacterium tuberculosis L forms]. Zh Mikrobiol Epidemiol Immunobiol 2000:27-8. [PMID: 10925868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The method for the detection of antilysozyme activity (ALA) in M. tuberculosis L forms was developed. The level of ALA in M. tuberculosis L forms isolated from patients with different clinical forms of the disease varied within 1-5 micrograms. M. tuberculosis L forms with the ALA level > 4 micrograms were isolated from patients with the progressing course of the disease. The method for the prognostication of the course of the tuberculous process in the lungs by the results of the antilysozyme test was proposed.
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Affiliation(s)
- O V Bukharin
- Institute of Cellular and Intracellular Symbiosis, State Medical Academy, Orenburg, Russia
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37
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Mert A, Bilir M, Ozturk R, Tabak F, Ozaras R, Tahan V, Senturk H, Aktuglu Y. Tuberculous subcutaneous abscesses developing during miliary tuberculosis therapy. Scand J Infect Dis 2000; 32:37-40. [PMID: 10716075 DOI: 10.1080/00365540050164191] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Although rare, paradoxical subcutaneous abscesses may develop during appropriate treatment of miliary tuberculosis. While the pathogenesis of this phenomenon is not clear, some theories have been postulated. A case of a 37-y-old woman diagnosed as having miliary tuberculosis who developed subcutaneous abscesses within the 5 months of antituberculous treatment is described and all 6 similar cases published in English from 1954 to 1999 are discussed.
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Affiliation(s)
- A Mert
- Department of Internal Medicine, Cerrahpasa Medical Faculty, University of Istanbul, Turkey
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38
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Mulkens RH. [Intracerebral tuberculomas in a pregnant Somalian woman]. Ned Tijdschr Geneeskd 2000; 144:582. [PMID: 10746054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
MESH Headings
- Choroid/microbiology
- Diagnosis, Differential
- Female
- Humans
- Infant, Newborn
- Mycobacterium tuberculosis/isolation & purification
- Ophthalmoscopy
- Pregnancy
- Tuberculoma, Intracranial/diagnosis
- Tuberculoma, Intracranial/drug therapy
- Tuberculoma, Intracranial/ethnology
- Tuberculoma, Intracranial/microbiology
- Tuberculosis, Miliary/diagnosis
- Tuberculosis, Miliary/drug therapy
- Tuberculosis, Miliary/ethnology
- Tuberculosis, Miliary/microbiology
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39
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del Giudice P, Bernard E, Perrin C, Bernardin G, Fouché R, Boissy C, Durant J, Dellamonica P. Unusual cutaneous manifestations of miliary tuberculosis. Clin Infect Dis 2000; 30:201-4. [PMID: 10619756 DOI: 10.1086/313587] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Cutaneous manifestations of miliary tuberculosis are extremely rare. We describe a 62-year-old woman with leukopenia who developed infiltrated dermal-hypodermal and ulcerative cutaneous lesions during the course of miliary tuberculosis. Miliary tuberculosis was diagnosed when Mycobacterium tuberculosis bacilli were isolated by cultures of the bronchoalveolar lavage fluid and blood and when acid-fast bacilli were detected on histopathologic examination of hepatic, pulmonary, and cutaneous biopsy specimens. With the increasing incidence of immunocompromised patients, unusual presentations of tuberculosis may be observed more often. Acute miliary tuberculosis of the skin is an exceptional manifestation that is due to acute hematogenous dissemination of M. tuberculosis to the skin. We describe a patient who had unusual cutaneous manifestations of miliary tuberculosis.
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Affiliation(s)
- P del Giudice
- Unité des Maladies Infectieuse et Dermatologie, Hôpital Bonnet, 83608 Fréjus, France.
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Crump JA, Tyrer MJ, Lloyd-Owen SJ, Han LY, Lipman MC, Johnson MA. Military tuberculosis with paradoxical expansion of intracranial tuberculomas complicating human immunodeficiency virus infection in a patient receiving highly active antiretroviral therapy. Clin Infect Dis 1998; 26:1008-9. [PMID: 9564502 DOI: 10.1086/517636] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- J A Crump
- Department of HIV and Thoracic Medicine, Royal Free Hospital, London, United Kingdom
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Affiliation(s)
- L M Valdez
- Center for the Study of Emerging and Reemerging Pathogens, Department of Internal Medicine, The University of Texas Medical School at Houston 77030, USA
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Long R, O'Connor R, Palayew M, Hershfield E, Manfreda J. Disseminated tuberculosis with and without a miliary pattern on chest radiograph: a clinical-pathologic-radiologic correlation. Int J Tuberc Lung Dis 1997; 1:52-8. [PMID: 9441059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
SETTING Province of Manitoba, Canada. OBJECTIVE To describe the characteristics of disseminated tuberculosis (TBD) with and without a miliary pattern on chest radiograph, to determine the mortality, and to identify the demographic and clinical features associated with survival. DESIGN A retrospective case review. RESULTS Of 2013 cases of active tuberculosis reported to the Provincial Tuberculosis Registry between January 1979 and December 1993, 56 had disseminated disease. The odds of developing TBD were significantly higher in females. Compared to those with a miliary pattern (n = 42), those without a miliary pattern on chest radiograph (n = 14) were significantly more likely to have a risk factor for tuberculosis (86% vs 52%, P < 0.05) and to die (86% vs 21%, P < 0.001). The diagnosis of TBD was significantly more likely to be made at postmortem in non-miliary compared to miliary patients (43% vs 5%, P < 0.05). Amongst patients with a miliary pattern, the presence of one or more risk factors for tuberculosis was associated with a significantly higher mortality (P < 0.05). Meningitis was very uncommon and did not determine the outcome. CONCLUSION Disseminated tuberculosis patients without a miliary pattern on chest radiograph have an extremely high mortality rate; those with a miliary pattern may also succumb, especially if co-morbid with a condition known to increase the risk of tuberculosis.
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Affiliation(s)
- R Long
- Department of Medicine, University of Manitoba, Winnipeg, Canada
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Abstract
Clinical and radiologic findings in a 73-year-old man who developed a systemic illness while receiving intravesical bacillus Calmette-Guérin (BCG) immunotherapy for bladder cancer are presented. Thin-section chest computed tomographic findings included a diffuse pattern of small nodules consistent with miliary disease. Potential mechanisms explaining the pulmonary disease resulting from intravesical BCG treatment include a hypersensitivity reaction or actual BCG infection of the lungs.
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Affiliation(s)
- R M Jasmer
- Department of Medicine, University of California, San Francisco Medical Center 94143, USA
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Fariña MC, Gegundez MI, Piqué E, Esteban J, Martín L, Requena L, Barat A, Fernández Guerrero M. Cutaneous tuberculosis: a clinical, histopathologic, and bacteriologic study. J Am Acad Dermatol 1995; 33:433-40. [PMID: 7657867 DOI: 10.1016/0190-9622(95)91389-0] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND In recent years cutaneous infections with Mycobacterium tuberculosis with an atypical clinical appearance have become more common because of the increasing number of immunocompromised patients. OBJECTIVE We report the clinical, histopathologic, and bacteriologic data of 11 patients with several forms of cutaneous tuberculosis seen during the past 14 years. METHODS Patients from whom M. tuberculosis was isolated from culture of skin biopsy specimens, sinus drainage, or material aspirated from cutaneous abscesses were included. In all but two patients a biopsy specimen was obtained for histopathologic study. All but one patient received combined antituberculous therapy. RESULTS The clinical diagnoses were scrofuloderma (four cases), cutaneous miliary tuberculosis (two), lupus vulgaris (two), tuberculous gumma (two), and one unclassified. All but three patients had evidence of either previous or simultaneous tuberculous foci other than in the skin. Histopathologic findings varied according to the type of cutaneous tuberculosis. CONCLUSION In some patients with cutaneous tuberculosis, lesions are atypical in appearance because of immunodeficiency. Culture for M. tuberculosis should be performed in all suspected cases, even in those in whom special stains for acid-fast bacilli are negative.
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Affiliation(s)
- M C Fariña
- Department of Dermatology, Fundación Jímenez Díaz, Clínica Nuestra Señora de la Concepción, Universidad Autónoma, Madrid, Spain
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46
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Abstract
We studied eight patients with miliary tuberculosis (TB). In all instances, tuberculomatous lesions were demonstrated in the aspirated bone marrow. We conclude that the bone marrow aspiration has great value in diagnosing miliary TB because it provides sufficient material to permit examination of serial sections as needed to confirm the diagnosis. The bone marrow aspiration also is safer than the alternative procedures of lung or liver biopsies.
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Affiliation(s)
- M Kinoshita
- First Department of Internal Medicine, Kurume University School of Medicine, Japan
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47
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Nogales MC, Aretio R, Beiztegui A, Muñoz F, Martín E. [An evaluation of the blood culture in disseminated mycobacteriosis]. Arch Bronconeumol 1994; 30:181-4. [PMID: 8025782 DOI: 10.1016/s0300-2896(15)31085-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The objective of this study was to evaluate the usefulness of blood culture in the diagnosis of disseminated mycobacteria (DMB). This prospective study included all blood cultures done for patients with fever and under suspicion of having DMB between January 1991 and July 1992. Fifty-seven blood samples from 16 patients were cultured; 14 (87.5%) patients were HIV positive and all were diagnosed as having DMB. The cultures were processed by lysis-centrifugation and identification of mycobacteria was by hybridization with a DNA probe. Mycobacterial growth was detected in 5 cultures (8.7%) from 4 patients (25%) (3 HIV positive). M. tuberculosis was isolated in 3 and M. avium in 1. Mean time until isolation was 46 days. In all cases mycobacteria were isolated in other samples before they were found in cultures: M. tuberculosis was isolated in 2 bronchial aspirates (BAS), 2 in liver tissue (L), 2 in spleen tissue (S), one in alveolar bronchial lavage, one in sputum, one in spinal fluid (SF) and one in urine. M. avium was isolated in sputum and ALB. The three patients in whom M. tuberculosis was found died 1.4 and 32 days after admission. In samples from the 12 DMB patients with negative cultures (11 HIV positive, 92%), M. tuberculosis was isolated in 100% of ganglion and S samples, 90% in urine, 69% in sputum, 67% in ABL and LB, 63% in BAS and 33% in SF. None of these patients died in hospital. We find blood culture to be of little use in the diagnosis of DMB. Analysis of other samples leads to faster diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M C Nogales
- Servicio de Microbiología, Hospital Universitario de Valme, Sevilla
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48
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Lombard EH, Victor T, Jordaan A, van Helden PD. The detection of Mycobacterium tuberculosis in bone marrow aspirate using the polymerase chain reaction. Tuber Lung Dis 1994; 75:65-9. [PMID: 8161769 DOI: 10.1016/0962-8479(94)90106-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
SETTING Tygerberg Hospital, South Africa. OBJECTIVE Bone marrow aspirate and biopsy were obtained from 37 patients who were in-patients at the Tygerberg hospital. The specificity and sensitivity of the polymerase chain reaction (PCR) in the detection of Mycobacterium tuberculosis in bone marrow aspirate was evaluated. DESIGN The PCR was compared to standard culture as well as to clinical and bone marrow biopsy data in 24 patients with suspected tuberculosis (TB). RESULTS 12 of the 24 patients eventually had definite or probable TB and in these 12 patients the detection incidence was 42% for PCR and 25% for culture. CONCLUSION This study confirms that it is possible to use PCR to detect M. tuberculosis in bone marrow aspirate material and that this technique is more sensitive than culture methods. The PCR technique has the added advantage of being a rapid test yielding results within 2 days of sampling. Overall sensitivity for the detection of M. tuberculosis in bone marrow aspirate may be improved to 58% [corrected] by using both culture and PCR techniques.
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Affiliation(s)
- E H Lombard
- Department of Haematological Pathology, University of Stellenbosch, South Africa
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Reparaz J, Uriz J, Castiello J, Sola J. [Miliary tuberculosis after intravesical Bacillus Calmette-Guerin administration]. Enferm Infecc Microbiol Clin 1993; 11:570. [PMID: 8142511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Henderson CE, Turk R, Dobkin J, Comfort C, Divon MY. Miliary tuberculosis in pregnancy. J Natl Med Assoc 1993; 85:685-7. [PMID: 8120929 PMCID: PMC2568134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Although miliary tuberculosis is uncommon in pregnancy, it is difficult to diagnose when present and is often associated with a maternal history of intravenous drug abuse, malignancy, alcoholism, or human immunodeficiency virus infection. This article reports two antepartum cases of miliary tuberculosis without any of these risk factors. Bronchial washings for Pneumocystis carinii and HIV screening were negative for both patients. Acid-fast bacilli stains of the bronchial washing and ascitic fluid were also negative. Several weeks were required for ascitic fluid and bronchial biopsy Mycobacterium cultures to be positive. In contrast, acid-fast bacilli were seen within 24 hours in multiple sections of the delivered placentas. Confirming the diagnosis of miliary tuberculosis is an arduous process requiring a high index of suspicion. During pregnancy, pathologic examination of tissue obtained by placental biopsy may facilitate making an early diagnosis of extrapulmonary tuberculosis.
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Affiliation(s)
- C E Henderson
- Department of Obstetrics and Gynecology, Jack D. Weiler Hospital, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
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