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1

Dermoscopic evaluation of two patients with lupus miliaris disseminatus faciei.  

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Lupus miliaris disseminatus faciei (LMDF) is a chronic and uncommon inflammatory dermatosis, characterized by yellowish-red papules, especially on the face and around the eyelids. It is considered to be a reaction to destroyed hair follicles. We dermoscopically evaluated two patients diagnosed with LMDF. Dermoscopy revealed follicular keratotic plugs and vascular structures. We discuss these cases and other diseases dermoscopically showing keratotic plugs. PMID:24825140

Ayhan, E; Alabalik, U; Avci, Y

2014-06-01

2

Scarring of lupus miliaris disseminatus faciei: treatment with a combination of trichloroacetic acid and carbon dioxide laser.  

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We present a case of a 35-year-old man having a 12-month history of multiple reddish-brown papules on the chin, forehead, cheeks, and eyelids. Histopathologic findings revealed epithelioid cell granulomas with central necrosis consistent with a diagnosis of lupus miliaris disseminatus faciei. After 9 months of combined treatment with ethambutol, rifampin, and pyrazinamide, most lesions gradually resolved but remained as severe disfiguring scars. After 10 sessions of treatments with 100% trichloroacetic acid and CO2 laser, the lupus miliaris disseminatus faciei scars have been much improved and the patient has never experienced a recurrence of disease during subsequent years of follow-up. PMID:24283357

Kang, Boo Kyoung; Shin, Min Kyung

2014-05-01

3

Atypical manifestations of tinea faciei  

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Full Text Available A study of 58 paitents of tinea faciei was conducted. Twenty five (43.1% patients had history of photosensitivity. Twenty eight (48.2% patients were applying topical steroids, 2 (3.4% patients were on 10 mg of prednisolone daily. Associated tinea of other sites were observed in 14 (24.13%. 23 (39.6% patients had typical circinate, arcuate, annular plaques with raised margin showing vesiculo-pustules. Atypical manifestations were in the form of arcuate plaques on the pinna in 4 patients, erythematous plaques full of vesiculo-pustules without central clearing in 3. Thirty two (55.17% patients had plaques with broad edges and indistinct central clearing. In 2 patients lesions resembled discoid lupus erythematosus. Skin scrapings for fungus was positive in 36 (62.06% cases. All patients responded to systemic griseofulvin 10mg/kg with 1% clotrimazole topicaly in 4-8 weeks.

Mittal R

1996-01-01

4

Tinea faciei caused by Trichophyton rubrum var. raubitschekii in Germany  

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Full Text Available We report the case of a 35-year-old female patient presenting facial erythematous circinate and scaling lesions that had slowly developed over the last nine years. The patient was born in Angola but has lived in Germany for the last ten years. A clinical diagnosis of tinea faciei was made and proven by fungal elements in lesional skin. A darkly pigmented dermatophyte with multiple trichophyton macroconidia was grown in the culture medium, which was subsequently identified as Trichophyton rubrum var. raubitschekii. Combined topical and systemic antimycotic treatment resulted in the complete resolution of the lesions. The variant raubitschekii of Trichophyton rubrum is mostly found in Africa, Asia and South America; in Germany only isolated infections have been seen in immigrants from Africa. In comparison to previous observations our case is noteworthy for two reasons: it is the first communication of tinea faciei caused by Trichophyton rubrum var. raubitschekii in Germany and the patient history suggests that the infection was acquired in Germany. Therefore, Trichophyton rubrum var. raubitschekii should be monitored as an upcoming pathogen in Europe.

Jochen Brasch

2008-06-01

5

Miliary tuberculosis presenting with thyrotoxicosis.  

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A male patient is described who presented with thyrotoxicosis, and a large painful neck mass. From the excised mass and stomach aspiration Mycobacterium tuberculosis was cultured and a diagnosis of miliary tuberculosis was made. The thyrotoxicosis was attributed to tuberculous thyroiditis.

Nieuwland, Y.; Tan, K. Y.; Elte, J. W.

1992-01-01

6

Miliary pattern in neonatal pneumonia  

International Nuclear Information System (INIS)

We have seen 10 newborn babies who developed respiratory distress and whose chest radiographs showed a miliary nodular pattern of disease. Of these infants only 3 had blood cultures that were positive for staphylococcus aureus. Of the remaining 7, 2 had conjunctivitis from which staphylococcus aureus was cultured, 4 had negative cultures and 1 did not have a blood culture done. All patients were diagnosed as having bacterial pneumonia and appeared to respond favourably to antibiotic therapy. The pulmonary abnormalities resolved. The children were clinically well in less than 3 weeks. The author suggests that the miliary pattern is one of the radiological patterns of neonatal pneumonia possibly produced by hematogenous bacterial dissemination. (orig.)

1988-01-01

7

Miliary Tuberculosis: A Case Report  

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Full Text Available Problem statement: During the last years it is more than evident that the prevalence of pulmonary and extrapulmonary Tuberculosis (TB, mainly in western European countries, has risen significantly. The aetiology of this phenomenon is multifactorial. Miliary tuberculosis is a form of tuberculosis that is characterized by millet-like seeding of TB bacilli in the lung, as evidenced on chest radiography. Approach: A 17-year-old woman with headache, nausea-vomiting and fever of two months before. The patient's symptoms exacerbate and had weight that referred to the emergency department with severe headache and frequently vomiting. Bilateral coarse ceracel without wheezing. In primary CXR, diffuse reticulonodular two lungs with opened with pleural open angles. In thoracic HRCT images, diffuse micronodular lesions in throughout the lung Parenchyma, peribronchovascular thickening in parahilar areas and significant increases in the thickness of several upper lobe bronchus. In brain MRI, multiple micronodular lesions with probably miliary TB were reported. AFB of BAL sample was 1+ and cytology of BAL was negative for malignancy. HIV Ab, HBS Ag, HCV Ab and IgM HAV were negative. U/A, U/C B/C was normal. Conclusion: Results of BAL culture were positive for TB and Granulomatous inflammation, surrounded by mile lymphocytic infiltrate, with central necrosis, suggestive of TB were reported in endobronchial biopsy.

Zhinous B. Makoo

2010-01-01

8

Chronic miliary tuberculosis with tuberculous gummas  

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Full Text Available A 25 year old manual labourer presented with recurrent attacks of multiple abscesses and ulcers with generalised lymphadenopathy, hepato-splenomegaly and hypertension. Treatment with anti - tuberculous drugs produced dramatic improvement of the disease of 15 years duration, confirming the diagnosis of chronic miliary tuberculosis and tuberculous gummata in an untreated male.

Thankappan T

1990-01-01

9

Challenges in the diagnosis & treatment of miliary tuberculosis  

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Miliary tuberculosis (TB) is a potentially lethal disease if not diagnosed and treated early. Diagnosing miliary TB can be a challenge that can perplex even the most experienced clinicians. Clinical manifestations are nonspecific, typical chest radiograph findings may not be evident till late in the disease, high resolution computed tomography (HRCT) shows randomly distributed miliary nodules and is relatively more sensitive. Ultrasonography, CT and magnetic resonance imaging (MRI) are useful...

2012-01-01

10

Acute respiratory distress syndrome with miliary tuberculosis.  

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A 71-year-old man was admitted to the hospital complaining of productive cough and weight loss. Physical examination showed fine bilateral basal crackles. Laboratory findings showed elevated liver enzymes. Tuberculin skin test and sputum smear for acid-fast bacilli were negative. On the fifth day of admission, he deteriorated and developed severe respiratory distress. A chest radiograph demonstrated worsening pulmonary infiltrates. He was electively intubated and was put on a mechanical ventilator. The chest CT scan revealed diffuse bilateral pulmonary nodules and airspace disease. Based upon the clinical suspicion of acute respiratory distress syndrome associated with miliary tuberculosis (TB), empiric treatment with antituberculosis and systemic steroids was started. He was extubated after 6 days. The diagnosis of miliary TB was confirmed by a thoracoscopic lung biopsy. He was discharged with a near normal chest radiograph and was followed up as an outpatient. PMID:22273654

Khadawardi, Hadeel A; Gari, Abdul-Ghafoor A

2012-01-01

11

Miliary tuberculosis with empyema, a case report  

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Full Text Available We report a 39 year-old patient who presented with chest pain, malaise, lassitude, anorexia, weight loss, fever, chills, productive coughs, pleural pain in the left thorax area and septic empyema without hemoptysis. Laboratory investigations’ including tuberculosis (TB skin test by PPD, HIV, HBV and HCV serologic tests were negative. The CBC showed anemia and leucocytosis. The ESR was elevated and he had hypoalbuminaemia. Both chest radiograph and high-resolution CT scan showed miliary infiltrates and diffused reticulonodular lung lesions. He was diagnosed with miliary tuberculosis (MTB via direct staining, PCR and culture from open window region washing sample but not from bronco-alveolar lavage. He was treated with antituberculosis drugs.

Abbas Ali Imani Fooladi

2010-07-01

12

Gujjar Lung: A Disease Mimicking Miliary Tuberculosis  

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Gujjar lung is a chronic lung disease caused due to the long-term exposure to pinewood smoke inhalation in Gujjar community and the people residing at the hilly regions of the Indian sub-continent. This is characterized clinically by progressive cough and dyspnea, distinct radiological patterns and pathological features of anthracotic nodules and fibrosis. A typical case with miliary mottling on chest radiograph is presented and the relevant literature reviewed.

2008-01-01

13

An unusual presentation of miliary tuberculosis.  

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A young Bangladeshi woman presented to the emergency department with vaginal discharge on a history of fevers and rigours. Although initially treated for pelvic inflammatory disease, the patient rapidly developed respiratory failure with acute respiratory distress syndrome. An axillary biopsy and a high-resolution CT of the chest confirmed miliary tuberculosis (TB). She was initiated on anti-TB medication and made a rapid recovery. PMID:24748138

Sundaralingam, A; Potter, J L; White, V L C; Emmanuel, J

2014-01-01

14

A case report of multiple miliary osteoma  

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The author observed a multiple miliary osteoma which was found in the 70-year-old male patient at routine dental examination and obtained the following features; 1. The osteomas are situated in the buccal cheeks of both side, but overlying skin shows normal. 2. The small osteomas range from 0.5 mm to 2.0 mm in diameter. 3. The osteomas appeared in proximity to the surface at a special radiograph which made with the tube directed parallel to the surface of the face when the cheek is being blown outwardly. 4. Each osteoma appears as a small doughnut-shaped shadow with a radiolucent center.

Choi, Gab Shik; Ryu, Jung Soo; Choi, Soon Chul [Department of Dental Radiology, College of Dentistry, Kyungpook National University, Daegu (Korea, Republic of)

1985-11-15

15

Recurrent pneumothorax developing during chemotherapy in a patient with miliary tuberculosis  

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Full Text Available Despite the fact that miliary tuberculosis is frequently seen, associated pneumothorax developing during antitubercular chemotherapy for miliary tuberculosis is rare. Pneumothorax is potentially life threatening in association with miliary tuberculosis; and its symptoms may be masked by those of miliary tuberculosis, leading to avoidable delay in the diagnosis of pneumothorax. Here we describe a 24-year-old female patient developing recurrent pneumothorax while on antitubercular chemotherapy for miliary tuberculosis.

Gupta Prem

2007-01-01

16

Teleradiology : detectability of pneumothorax and miliary tuberculosis  

International Nuclear Information System (INIS)

To evaluate the clinical utility of the teleradiology system using the information super highway communication network. Two radiologists selected 101 cases of pneumothorax and 20 cases of miliary tuberculosis. There were scanned and transmitted to our hospital at a speed of 640 Kbps and displayed on a video monitor with a resolution of 1280 pixels/line x 1024 lines. Four radiologists divided into three groups:read the images group A read the images without image processing;group B read the images with image processing, group C read the radiographic films on the view box. The authors compared sensitivity and specificity between the groups and checked their statistical significance using the Chi-square test. According to the location of the pleural line, we divided the pneumothorax into four types:continve on this live type 1, pleural line confined to the apex;type 2, to the upper half;type 3, to the lower half;type 4, to the upper through lower half. We then compared sensitivity between the Three groups. In the pneumothorax group, the average sensitivity of group A, B and C was 79%, 90% and 96%, and average specificity was 99%, 99% and 94%, respectively. There were statistically significant differences in seasitivity between group A and B and between group B and C (p<0.017). There were no statistically significant difference in specificity between group A and B or between group B and C. In the miliary tuberculosis group, the average sensitivity of group A, B and C was 73%, 78%, and 90%, and average specificity was 95%, 95% and 100%, respectively. With regard to sensitivity and specificity, there was no statistically significant difference between group A and B or between group B and C but there was a statistically significant difference between group A and C (p<0.017). According to the location of the pneumothorax, for all types, the sensitivity of group A was less than that of group B and group B was less than that of group C. All groups showed reduced observer performance in the detection of pneumothorax and miliary tuberculosis when reading a transmitted image on the monitor-workstation compared with reading conventional radiographs on the view box. To improve the clinical utility of the teleradiology system, a higher resolution workstation and adequate image processing are required

1996-07-01

17

Misdiagnosed zoophile tinea faciei and tinea corporis effectively treated with isoconazole nitrate and diflucortolone valerate combination therapy.  

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There have been few published reports on the human transmission of Trichophyton mentagrophytes, a zoophilic fungus frequently occurring in pets. Here we report on 2 girls, living with a pet dwarf rabbit, who presented with inflammatory skin lesions positive for T. mentagrophytes and subsequently diagnosed as zoophile tinea faciei and tinea corporis. The patients were successfully treated with systemic terbinafine and 2-week therapy with Travocort cream containing isoconazole nitrate 1% and diflucortolone valerate 0.1%. PMID:23574022

Czaika, Viktor A

2013-05-01

18

Disseminated histoplasmosis simulating miliary tuberculosis: a case report  

International Nuclear Information System (INIS)

Histoplasmosis is a disease caused by inhalation of the fungus Histoplasma capsulatum. In rare cases the disease affects immunocompetent individuals. Disseminated and severe disease is seen in immunocompromised patients. We report a case of a 45 year old immunocompromised patient presenting with weight loss and abdominal pain. Chest x-ray and computerized tomography examinations showed interstitial infiltrate and diffuse micro nodules. The initial diagnosis was miliary tuberculosis. However, the definitive diagnosis of miliary histoplasmosis was made later on. (author)

2007-04-13

19

Miliary tuberculous peritonitis mimicking advanced ovarian cancer.  

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Primary peritoneal tuberculosis is a rare presentation of this disease. It is usually associated with ascites and raised CA-125 levels. Occasionally a pelvic mass may be present making the preoperative differential diagnosis from advanced ovarian cancer extremely difficult. Acid-fast stains and special cultures of the ascitic fluid for Mycobacterium tuberculosis are frequently negative, and confirmation of the diagnosis commonly requires histologic examination of biopsy specimens, in which epithelioid granulomas with central caseous necrosis can be identified. We present a case of unexplained pyrexial ascites in a postmenopausal woman in whom the diagnosis of miliary peritoneal tuberculosis was confirmed laparoscopically. The role of noninvasive tools such as measurement of ascitic fluid adenosine deaminase levels is also discussed. PMID:12920345

Protopapas, Athanasios; Milingos, Spiros; Diakomanolis, Emmanuel; Elsheikh, Alexander; Protogerou, Athanasios; Mavrommatis, Konstantinos; Michalas, Stylianos

2003-01-01

20

Recurrent pneumothorax developing during chemotherapy in a patient with miliary tuberculosis  

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Despite the fact that miliary tuberculosis is frequently seen, associated pneumothorax developing during antitubercular chemotherapy for miliary tuberculosis is rare. Pneumothorax is potentially life threatening in association with miliary tuberculosis; and its symptoms may be masked by those of miliary tuberculosis, leading to avoidable delay in the diagnosis of pneumothorax. Here we describe a 24-year-old female patient developing recurrent pneumothorax while on antitubercular chemotherapy ...

Gupta, Prem Parkash; Mehta, Dinesh; Agarwal, Dipti; Chand, Trilok

2007-01-01

 
 
 
 
21

A Rare Case of Non-Small Cell Carcinoma of Lung Presenting as Miliary Mottling  

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Miliary mottling on chest radiography is seen in miliary tuberculosis, certain fungal infections, sarcoidosis, coal miner’s pneumoconiosis, silicosis, hemosiderosis, fibrosing alveolitis, acute extrinsic allergic alveolitis, pulmonary eosinophilic syndrome, pulmonary alveolar proteinosis, and rarely in hematogenous metastases from the primary cancers of the thyroid, kidney, trophoblasts, and some sarcomas. Although very infrequent, miliary mottling can be seen in primary lung cancers. Herei...

2013-01-01

22

[Miliary tuberculosis in Mali during the decade 2000-2009].  

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In order to describe the epidemio-clinical and evolutionary aspects of miliary tuberculosis (TB) in Mali, a retrospective study of 10 years (1 January 2000 to December 31, 2009) was conducted in the service of pneumo-phtisiology at the university hospital of point G. It concerned all patients with radiological images compatible with miliary TB, signs of bacillary impregnation, bacillus or not, treated with antituberculosis drugs. Of 3630 TB patients all forms recorded during the study period, 183 miliary were recorded (5%) including 117 men and 66 women. Young adults between 29-45 years were more represented (52%). The average diagnostic delay was 3.7 months. The symptomatology was dominated by the fever (100%), cough (90.1%) and asthenia (86.3%), anorexia (81.9%). The radiological images types of micronodular opacities were the most frequent in 147 cases (80.3%) against 36 cases of (19.7%) macronodular types. Bacteriological examination of sputum was negative in 139 patients (76%) and positive in 44 patients (24%). There was a statistically significant relationship between the presence of an excavation in Chest radiography and smear positivity (P<0.001). The clinical improvement observed (55.7%) depended on the time of the diagnosis (P<0.001). The serology HIV was positive at 29 patients on 124 tested. Also, in areas with high prevalence TB/HIV, any miliary fever in the absence of other obvious etiologies should undertake without delay TB proper treatment. PMID:22305133

Toloba, Y; Diallo, S; Maïga, Y; Sissoko, B F; Keïta, B

2012-02-01

23

MRI findings of miliary tuberculosis of the brain  

International Nuclear Information System (INIS)

To evaluate MRI(Magnetic Resonance Imaging) findings of miliary tuberculosis of the brain Six patients with miliary tuberculosis of the brain diagnosed by characteristic clinical or laboratory findings were studied with spin echo MRI before and after contrast enhancement. We retrospectively evaluated MRI findings according to the appearance, distribution, location, and enhancement pattern of the granulomas as well as associated other abnormalities. In six patients, contrast-enhanced MRI of the brain showed numerous punctate, contrast enhancing lesions scattered throughout the brain. Unenhanced MRI failed to demonstrate small granulomas except a few small foci of high signal intensity on T2-weighted images. The shapes of enhancing granulomas were homogeneous nodular enhancement in 86% of cases and small ring enhancement in 14%. 98% of granulomas were smaller than 3-mm and 2% were larger. Although several lesions were located in the basal ganglia, thalamus, and brain stem, the majority were located in the subpial and subarachnoid space. There was no significant difference in distribution of granulomas between the supratentorial and the infratentorial areas. Other associated abnormalities were focal meningitis in five cases and focal cerebritis in one. On chest radiograph, all patients had miliary tuberculosis in the lungs. Contrast-enhanced T1-weighted MR imaging showed numerous round, very small enhancing lesions scattered throughout the brain. The majority of lesions were located in the subpial and subarachnoid space. Contrast-enhanced T1-weighted images are helpful in the detection and diagnosis of miliary disseminated tuberculous granulomas and meningitis

1996-07-01

24

A case of anxiety associated with miliary tuberculosis  

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Full Text Available Fahad D Alosaimi,1 Feras A Alkharboush,2 Maram H Altuwariqi11Department of Psychiatry, King Saud University, Riyadh, Kingdom of Saudi Arabia; 2College of Medicine, King Saud University, Riyadh, Kingdom of Saudi ArabiaAbstract: Miliary tuberculosis (TB is a serious infection with various presentations that can perplex even the most experienced clinicians. To our knowledge, there is a lack of published reports that link psychiatric symptoms directly with miliary TB (either alone or co-occurring with other medical symptoms. Mental health workers may, therefore, not consider, and consequently miss, this important diagnosis. Here we are reporting a case of cyclical anxiety occurring in a 67-year-old patient. For 3 years prior to admission, the patient failed to respond to multiple courses of different antianxiety medications. The patient required hospital admission as he deteriorated and had a reduced level of consciousness. A chest X-ray revealed bilateral nodules and a magnetic resonance imaging scan showed multiple enhancing tuberculous lesions in the cerebral white matter, brain stem, and cerebellum. A diagnosis of miliary TB was finally made. Several characteristics of this case suggest that the diagnosed anxiety disorder was due to miliary TB. However, we cannot exclude the possibility that generalized anxiety disorder preceded the onset of miliary TB or that both diseases were coincidental. The report serves as a reminder that organic causes for psychiatric symptoms always need to be considered, particularly if they follow an atypical pattern or fail to improve with usual psychiatric medications.Keywords: anxiety disorder, elderly, psychosomatic, case report, Saudi Arabia

Alosaimi FD

2014-06-01

25

Tuberculous meningitis with pulmonary miliary tuberculosis: A clinicoradiological study  

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Full Text Available BACKGROUND AND AIMS: This study aims at evaluating the clinical and radiological outcome of tuberculous meningitis (TBM patients with pulmonary miliary tuberculosis. MATERIAL AND METHODS: Diagnosis of TBM was based on clinical, CT scan or MRI and CSF criteria, and that of miliary tuberculosis on chest radiograph. Detailed clinical evaluation was done in all. Severity of meningitis was graded into Grades I, II and III. Complete hemogram, serum chemistry and Montaux tests were performed. The recovery was defined on the basis of 6 months Barthel index score as poor, partial or complete. RESULTS: 20 out of 165 patients with TBM had pulmonary miliary tuberculosis. Their mean age was 30 years; there was one child and 13 patients were females. The mean duration of symptoms was 6.3 months. Montoux test was negative in 9 patients. Six patients were in stage I, 3 in stage II, and 11 in stage III meningitis. Hemoglobin was below 12 gm% in 13 and liver dysfunction and hypocalcaemia was present in 8 and 18 patients respectively. CT scan was abnormal in 16 patients and revealed hydrocephalus (10, granuloma (7, exudates (3 and infarction (1. MRI was abnormal in 7 out of 8 patients and 3 of these patients had normal CT scan. MRI revealed multiple granuloma in 7 patients and exudates in 2. At 6 months, 2 patients died, 10 had complete, 2 had partial and 4 had poor recovery. CONCLUSION: TBM with pulmonary miliary tuberculosis was commoner amongst females who were anemic and hypocalcaemic. MRI revealed multiple granuloma and the majority of the patients improved.

Kalita J

2004-04-01

26

Miliary nodules in a patient of allergic bronchopulmonary aspergilosis.  

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Allergic bronchopulmonary aspergilosis (ABPA) is immunological pulmonary disease caused by hypersensitivity of aspergillus fumigatus usually occurs in patients with chronic asthma, cystic fibrosis and bronchiactasis. This disease may present with divers radiological presentation like; fleeting pulmonary opacities, bronchiactasis, mucoid impaction, perihilar opacity (hailer lymphadenopathy), and lung mass or pleural effusion. We describe the case of a 30 year old housewife who presented with progressive dysponea, low grade fever, dry cough, weight loss and miliary nodule in chest radiograph and high-resolution CT (HRCT) in a tertiary level hospital of Bangladesh. A diagnosis of ABPA was established on the basis of sputum routine microscopy and culture examination for fungus (Aspergillus). PMID:24858168

Khan, N A; Sumon, S M; Rahman, A; Hossain, M A; Ferdous, J; Bari, M R

2014-04-01

27

A Rare Case of Non-Small Cell Carcinoma of Lung Presenting as Miliary Mottling  

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Miliary mottling on chest radiography is seen in miliary tuberculosis, certain fungal infections, sarcoidosis, coal miner’s pneumoconiosis, silicosis, hemosiderosis, fibrosing alveolitis, acute extrinsic allergic alveolitis, pulmonary eosinophilic syndrome, pulmonary alveolar proteinosis, and rarely in hematogenous metastases from the primary cancers of the thyroid, kidney, trophoblasts, and some sarcomas. Although very infrequent, miliary mottling can be seen in primary lung cancers. Herein, we report the case of a 28-year-old female with chest X-ray showing miliary mottling. Thoracic computed tomography (CT) features were suggestive of tuberculoma with miliary tuberculosis. CT-guided fine needle aspiration cytology confirmed the diagnosis as lower-lobe, left lung non-small cell carcinoma (adenocarcinoma). It is rare for the non-small cell carcinoma of the lung to present as miliary mottling. The rarity of our case lies in the fact that a young, non-smoking female with miliary mottling was diagnosed with non-small cell carcinoma of the lung.

Jayaram Subhashchandra, Ballaekere; Ismailkhan, Mohammed; Chikkaveeraiah Shashidhar, Kuppegala; Gopalakrishna Narahari, Moda

2013-01-01

28

A Rare Case of Non-Small Cell Carcinoma of Lung Presenting as Miliary Mottling  

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Full Text Available Miliary mottling on chest radiography is seen in miliary tuberculosis, certain fungal infections, sarcoidosis, coal miner’s pneumoconiosis, silicosis, hemosiderosis, fibrosing alveolitis, acute extrinsic allergic alveolitis, pulmonary eosinophilic syndrome, pulmonary alveolar proteinosis, and rarely in hematogenous metastases from the primary cancers of the thyroid, kidney, trophoblasts, and some sarcomas. Although very infrequent, miliary mottling can be seen in primary lung cancers. Herein, we report the case of a 28-year-old female with chest X-ray showing miliary mottling. Thoracic computed tomography (CT features were suggestive of tuberculoma with miliary tuberculosis. CT-guided fine needle aspiration cytology confirmed the diagnosis as lower-lobe, left lung non-small cell carcinoma (adenocarcinoma. It is rare for the non-small cell carcinoma of the lung to present as miliary mottling. The rarity of our case lies in the fact that a young, non-smoking female with miliary mottling was diagnosed with non-small cell carcinoma of the lung.

Ballaekere Jayaram Subhashchandra

2013-03-01

29

A rare case of non-small cell carcinoma of lung presenting as miliary mottling.  

Science.gov (United States)

Miliary mottling on chest radiography is seen in miliary tuberculosis, certain fungal infections, sarcoidosis, coal miner's pneumoconiosis, silicosis, hemosiderosis, fibrosing alveolitis, acute extrinsic allergic alveolitis, pulmonary eosinophilic syndrome, pulmonary alveolar proteinosis, and rarely in hematogenous metastases from the primary cancers of the thyroid, kidney, trophoblasts, and some sarcomas. Although very infrequent, miliary mottling can be seen in primary lung cancers. Herein, we report the case of a 28-year-old female with chest X-ray showing miliary mottling. Thoracic computed tomography (CT) features were suggestive of tuberculoma with miliary tuberculosis. CT-guided fine needle aspiration cytology confirmed the diagnosis as lower-lobe, left lung non-small cell carcinoma (adenocarcinoma). It is rare for the non-small cell carcinoma of the lung to present as miliary mottling. The rarity of our case lies in the fact that a young, non-smoking female with miliary mottling was diagnosed with non-small cell carcinoma of the lung. PMID:23645961

Jayaram Subhashchandra, Ballaekere; Ismailkhan, Mohammed; Chikkaveeraiah Shashidhar, Kuppegala; Gopalakrishna Narahari, Moda

2013-03-01

30

Magnetic resonance imaging of miliary tuberculosis of the central nervous system in children with tuberculous meningitis  

International Nuclear Information System (INIS)

Tuberculous meningitis (TBM) is closely associated with miliary tuberculosis and a pathogenetic relationship is suspected, although it has been proposed that the two processes are unrelated. To describe miliary tuberculosis of the central nervous system (CNS) on MRI in children with TBM. A retrospective descriptive study of 32 paediatric TBM patients referred for MRI. The presence of miliary nodules in the CNS was recorded. Lesions were categorized according to their distribution, enhancement pattern, size and signal characteristics. A miliary distribution of nodules was present in 88% of patients. All patients with a miliary distribution had leptomeningeal nodules and 18% of these patients had deep parenchymal nodules in addition. At least one tuberculoma with central T2 hypointensity was identified in 39% of patients. The high prevalence of miliary leptomeningeal nodules in the CNS of children with TBM is significant because it points to a pathogenetic relationship that has long been suspected on epidemiological grounds. Our findings challenge the concept that miliary tuberculosis is only an incidental finding in TBM patients and suggest that it plays an integral part in the pathogenesis. (orig.)

2008-12-01

31

Miliary nodules due to secondary pulmonary hemosiderosis in rheumatic heart disease  

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Pulmonary hemosiderosis is defined as the clinical and functional consequence of iron overload of the lungs, which usually occurs due to recurrent intra-alveolar bleeding. It can manifest as miliary mottling and should be entertained in the differential diagnosis of patients presenting with miliary nodules on chest radiography, especially those with mitral stenosis. The management of secondary pulmonary hemosiderosis secondary to valvular heart disease includes valvuloplasty and/or valve repl...

2011-01-01

32

Disseminated histoplasmosis simulating miliary tuberculosis: a case report; Histoplasmose disseminada simulando tuberculose miliar: relato de caso  

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Histoplasmosis is a disease caused by inhalation of the fungus Histoplasma capsulatum. In rare cases the disease affects immunocompetent individuals. Disseminated and severe disease is seen in immunocompromised patients. We report a case of a 45 year old immunocompromised patient presenting with weight loss and abdominal pain. Chest x-ray and computerized tomography examinations showed interstitial infiltrate and diffuse micro nodules. The initial diagnosis was miliary tuberculosis. However, the definitive diagnosis of miliary histoplasmosis was made later on. (author)

Tavares Junior, Wilson Campos; Madureira, Marcus Magalhaes; Andrade, Diego Correa de; Guimaraes, Silvana Mangeon Meireles; Queiroz, Leonardo Campos [Minas Gerais Univ., Belo Horizonte, MG (Brazil). Hospital das Clinicas. Dept. de Radiologia e Diagnostico por Imagem]. E-mail: wilsontavaresjrmd@yahoo.fr; Avila, Renata Eliane de [Minas Gerais Univ., Belo Horizonte, MG (Brazil). Hospital das Clinicas. Servico de Doencas Infecciosas e Parasitarias; Lambertucci, Jose Roberto [Minas Gerais Univ., Belo Horizonte, MG (Brazil). Faculdade de Medicina. Clinica Medica

2005-04-15

33

An autopsy case of miliary tuberculosis in a young adult.  

Science.gov (United States)

A 23-year-old woman who had worked as a hostess at a nightclub was found dead in her house. The cause of death was diagnosed as miliary tuberculosis from the findings of medico-legal autopsy. Recently, tuberculosis (TB) has re-emerged as a health problem due to recurrence in the aged, and infections among health care workers and young adults like the present case. Currently, the common source of TB transmission is recurrence in the aged, but global migration, difficulty to achieve permanent immunity by BCG vaccination, immunodeficiency such as HIV infection, and drug abuse and/or sexual intercourse are also thought to be associated with tuberculosis in young adults. Forensic pathologists should be aware of such connections with TB, and should take care not to become mediators of TB infections. PMID:12935641

Uchigasaki, Seisaku; Kumagai, Tetsuo; Isahai, Isamu; Oshida, Shigemi; Morita, Kaoru

2003-03-01

34

Miliary tuberculosis in Qatar: A review of 32 adult cases  

International Nuclear Information System (INIS)

This study was conducted to define the demographic, clinical andlaboratory features, methods of diagnosis and outcome, in patients withmilitary tuberculosis (TB) in Qatar, and compare the findings with otherreported studies. A retrospective review of 32 cases of military TB treatedat the Hamad Medical Corporation during a seven year period (1992 to 1998)was undertaken. The 32 patients comprised 24 males and 8 females, and theirmean age was 33.3 years. The majority (90%) were expatriates. The clinicalfeatures of the patients were similar to those of previously reported series.The most common presenting symptoms were fever, cough, night sweats, weightloss and sputum production. Fever, rales, lymphadenopathy, alerted mentalstatus and hepatomegaly were the most common signs. Chest radiograph wasabnormal in 94% of patients, and showed a military pattern in 69%. Sputum,cerebrospinal fluid, bronchial washings and urine smears for acid-fastbacilli were rarely positive, however, cultures for Mycobacteriumtuberculosis were positive in 54.8%, 37.5%, 33% and 25% respectively. Thediagnoses in the majority of patients were made on the basis of the clinicalpresentation and supported by a military pattern on chest radiograph. Inthose whom chest radiograph did show the classic military pattern,transbranchial biopsy was diagnostic in 1 of 2 patients (50%), bone marrowbiopsy in 5 of 11 (45%), liver biopsy in 1 of 2 (50%) and lymph node biopsyin all 7 patients (100%). Thirty patients were treated with a four-drugregimen consisting of isoniazid, rifampin, pyrazinamide and streptomycin orethambutol. Mortality due to miliary TB was 3%. Miliary TB is common inQatar, especially among expatriates. Because the clinical features of thedisease are nonspecific, a high index of suspicion is essential for earlydiagnosis in order to avoid delays in therapy and poor outcome. (author)

2001-01-01

35

Diagnosis and management of miliary tuberculosis: current state and future perspectives  

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Full Text Available Sayantan Ray, Arunansu Talukdar, Supratip Kundu, Dibbendhu Khanra, Nikhil SonthaliaDepartment of Medicine, Medical College and Hospital, Kolkata, West Bengal, IndiaAbstract: Tuberculosis (TB remains one of the most important causes of death from an infectious disease, and it poses formidable challenges to global health at the public health, scientific, and political level. Miliary TB is a potentially fatal form of TB that results from massive lymphohematogenous dissemination of Mycobacterium tuberculosis bacilli. The epidemiology of miliary TB has been altered by the emergence of the human immunodeficiency virus (HIV infection and widespread use of immunosuppressive drugs. Diagnosis of miliary TB is a challenge that can perplex even the most experienced clinicians. There are nonspecific clinical symptoms, and the chest radiographs do not always reveal classical miliary changes. Atypical presentations like cryptic miliary TB and acute respiratory distress syndrome often lead to delayed diagnosis. High-resolution computed tomography (HRCT is relatively more sensitive and shows randomly distributed miliary nodules. In extrapulmonary locations, ultrasonography, CT, and magnetic resonance imaging are useful in discerning the extent of organ involvement by lesions of miliary TB. Recently, positron-emission tomographic CT has been investigated as a promising tool for evaluation of suspected TB. Fundus examination for choroid tubercles, histopathological examination of tissue biopsy specimens, and rapid culture methods for isolation of M. tuberculosis in sputum, body fluids, and other body tissues aid in confirming the diagnosis. Several novel diagnostic tests have recently become available for detecting active TB disease, screening for latent M. tuberculosis infection, and identifying drug-resistant strains of M. tuberculosis. However, progress toward a robust point-of-care test has been limited, and novel biomarker discovery remains challenging. A high index of clinical suspicion and early diagnosis and timely institution of antituberculosis treatment can be lifesaving. Response to first-line antituberculosis drugs is good, but drug-induced hepatotoxicity and drug–drug interactions in HIV/TB coinfected patients create significant problems during treatment. Data available from randomized controlled trials are insufficient to define the optimum regimen and duration of treatment in patients with drug-sensitive as well as drug-resistant miliary TB, including those with HIV/AIDS, and the role of adjunctive corticosteroid treatment has not been properly studied. Research is going on worldwide in an attempt to provide a more effective vaccine than bacille Calmette–Guérin. This review highlights the epidemiology and clinical manifestation of miliary TB, challenges, recent advances, needs, and opportunities related to TB diagnostics and treatment.Keywords: Mycobacterium tuberculosis, human immunodeficiency virus, diagnostic tests, biomarkers, antituberculosis drugs, vaccine

Ray S

2013-01-01

36

Miliary nodules due to secondary pulmonary hemosiderosis in rheumatic heart disease  

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Full Text Available Pulmonary hemosiderosis is defined as the clinical and functional consequence of iron overload of the lungs, which usually occurs due to recurrent intra-alveolar bleeding. It can manifest as miliary mottling and should be entertained in the differential diagnosis of patients presenting with miliary nodules on chest radiography, especially those with mitral stenosis. The management of secondary pulmonary hemosiderosis secondary to valvular heart disease includes valvuloplasty and/or valve replacement. The radiological opacities may disappear with successful treatment of the underlying valvular disease in many patients. However, they may persist with no physiological impairment to the patient. Here, we present a 32-year-old man with mitral stenosis who presented with fever and miliary shadows on chest radiography, which was ultimately diagnosed as secondary pulmonary hemosiderosis.

Gyanendra Agrawal

2011-02-01

37

Miliary Tuberculosis with Concurrent Brain and Spinal Cord Involvement: A Case Report  

International Nuclear Information System (INIS)

Central nervous system involvement by tuberculosis is rare, and intramedullary involvement is even more rare. A patient that developed intermittent amnesia during anti-tuberculous therapy underwent brain CT and MRI and spine MRI. The latter showed multiple small enhancing nodules in the brain and spinal cord. The patient was treated with anti-tuberculous medication and steroids under the suspected diagnosis of miliary tuberculosis. Follow-up CT showed decreased nodule size and number. We report a case of miliary tuberculosis in the brain and spinal cord and present a review of the literature related to similar cases

2008-11-01

38

X-ray findings in patients with miliary appearance of metallic mercury after suicide attempt  

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This case report evaluates X-ray findings in patients with miliary accumulation of mercury observed after parenteral application of metallic mercury in a suizide attempt. There are certain discrepancies between clinical symptoms and the X-ray findings. A clear demonstration of mercury in coronary blood vessels is possible by fluoroscopy.

Bonse, G.; Neuhaus, R.; Gunkel, L.V.

1985-03-01

39

X-ray findings in patients with miliary appearance of metallic mercury after suicide attempt  

International Nuclear Information System (INIS)

This case report evaluates X-ray findings in patients with miliary accumulation of mercury observed after parenteral application of metallic mercury in a suizide attempt. There are certain discrepancies between clinical symptoms and the X-ray findings. A clear demonstration of mercury in coronary blood vessels is possible by fluoroscopy. (orig.)

1985-03-01

40

Varicella Vaccination During Early Pregnancy: A Cause of in utero Miliary Fetal Tissue Calcifications and Hydrops?  

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Full Text Available Background: It is the purpose of this article to describe a suspected association of inadvertent vaccination with varicella vaccine during early pregnancy with the subsequent development of in utero miliary fetal tissue calcifications and fetal hydrops detected by sonogram at 15 weeks of gestation.

Anthony Al-Khan

2002-01-01

 
 
 
 
41

Varicella Vaccination During Early Pregnancy: A Cause of in utero Miliary Fetal Tissue Calcifications and Hydrops?  

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Background: It is the purpose of this article to describe a suspected association of inadvertent vaccination with varicella vaccine during early pregnancy with the subsequent development of in utero miliary fetal tissue calcifications and fetal hydrops detected by sonogram at 15 weeks of gestation.

Joseph Apuzzio; Vijaya Ganesh; Leslie Iffy; Anthony Al-Khan

2002-01-01

42

Uncommon presentation of cryptogenic organizing pneumonia with miliary pattern in the thorax  

International Nuclear Information System (INIS)

A 28-year-old female with worsening dyspnea showed miliary nodules of 2 mm in diameter on chest X-ray and high-resolution CT (HRCT). Histological evaluation and clinical outcome revealed an uncommon presentation of cryptogenic organizing pneumonia. (orig.)

2008-03-01

43

The reproductive response of the sea urchins Paracentrotus lividus (G.) and Psammechinus miliaris (L.) to an hyperproteinated macrophytic diet  

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The sea urchins Paracentrotus lividus and Psammechinus miliaris are submitted to the same environmental conditions in the Bay of Brest. The relationship between seasonal changes in food source quality and their gonad production was investigated in reproducing experimentally these conditions. In a first stage two macroalgae (Palmaria palmata and Laminaria digitata) were tested. P. miliaris showed a stronger preference for P. palmata and over a year-long experiment both urchins progressively pr...

Jacquin, Anne-gaelle; Donval, Anne; Guillou, Jacques; Leyzour, Sandra; Deslandes, Eric; Guillou, Monique

2006-01-01

44

Subclinical miliary Mycobacterium bovis following BCG immunotherapy for transitional cell carcinoma of the bladder.  

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The authors present an unusual case of a 51-year-old man who developed relatively mild non-specific symptoms following intravesical BCG instillation for superficial transitional cell carcinoma of the bladder, with radiological investigations demonstrating typical features of miliary tuberculosis (TB). Transbronchial biopsy showed small foci of poorly formed granuloma suggestive of Mycobacterium infection. The patient's respiratory symptoms only became apparent 7 days after discharge having had 4 weeks of unremarkable inpatient stay where he remained clinically well. Prompt anti-TB treatment resulted in a remarkable improvement in his symptoms and radiological appearance, supporting the diagnosis of disseminated Mycobacterium bovis infection. This case highlights the importance of recognising miliary M bovis as a potential complication in patients receiving BCG immunotherapy, and that the disease course can be subclinical with delayed onset of symptoms. PMID:24811557

Choi, Chang-Ho Ryan; Lee, Sang Oh; Smith, Geoff

2014-01-01

45

Pulmonary intravascular talcosis mimicking miliary tuberculosis in an intravenous drug addict.  

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Pulmonary foreign body granulomatosis following intravenous administration of medications meant for oral use among drug addicts has been occasionally reported. This condition is often misdiagnosed because of its rarity, but rather due to its similarity to other pulmonary diseases that are more common. Here we report a case of pulmonary intravascular talcosis mimicking miliary tuberculosis in a young male intravenous drug addict from North-Eastern Estonia, known as a hotspot for tuberculosis and drug misuse. The condition was caused by intravenous administration of crushed tablets of diphenhydramine, but miliary tuberculosis was misdiagnosed on patient's demographical, clinical and radiological grounds and a decision to start treatment with four first-line antituberculosis drugs followed. The current report refers to the importance of considering rare causes of pulmonary disseminations with attempts to identify the causative agent and warns against the use of antituberculosis treatment without confirmation of microbiological diagnosis of tuberculosis. PMID:24713715

Altraja, Alan; Jürgenson, Katre; Roosipuu, Retlav; Laisaar, Tanel

2014-01-01

46

Varicella vaccination during early pregnancy: a cause of in utero miliary fetal tissue calcifications and hydrops?  

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BACKGROUND: It is the purpose of this article to describe a suspected association of inadvertent vaccination with varicella vaccine during early pregnancy with the subsequent development of in utero miliary fetal tissue calcifications and fetal hydrops detected by sonogram at 15 weeks of gestation. CASE: This is a case presentation of a pregnant patient who received varicella vaccination during the same menstrual cycle that she became pregnant, and is supplemented by a literary review. The fe...

Apuzzio, Joseph; Ganesh, Vijaya; Iffy, Leslie; Al-khan, Anthony

2002-01-01

47

Gonadal lesions of female sea urchin (Psammechinus miliaris) after exposure to the polycyclic aromatic hydrocarbon phenanthrene  

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Abstract Histopathological alterations in the reproductive tissue of the female sea urchin Psammechinus miliaris after exposure to the polycyclic aromatic hydrocarbon (PAH) phenanthrene were investigated using light microscopy. Sexually mature sea urchins were exposed to 500 ?g L-1 phenanthrene for 20 days. A severe disorganisation of the acinal structure of the gonads was observed in phenanthrene-treated animals, mainly as a result of aggregates of degenerating previtellogenic oo...

2009-01-01

48

Early life developmental effects of marine persistent organic pollutants on the sea urchin Psammechinus miliaris  

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A new 16-day echinoid early life stage (ELS) bioassay was developed to allow for prolonged observation of possible adverse effects during embryogenesis and larval development of the sea urchin Psammechinus miliaris. Subsequently, the newly developed bioassay was applied to study the effects of key marine persistent organic pollutants (POPs). Mortality, morphological abnormalities and larval development stages were quantified at specific time points during the 16-day experimental period. In co...

2011-01-01

49

Development of miliary tuberculosis under infliximab in a patient with spondyloarthritis and suspected Crohn's disease.  

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Tuberculosis (TB) infection is a major concern in patients with chronic autoimmune conditions under immunosuppressive therapy. Gastrointestinal tuberculosis can be misdiagnosed as Crohn's disease with detrimental consequences for the patient. We report on a 40-year old ethnic Turkish patient with HLA-B27 positive spondyloarthritis who developed gastrointestinal symptoms under immunosuppressive treatment with infliximab. Crohn's disease was diagnosed at a primary care hospital and immunosuppressive treatment was escalated. Initial diagnostic tests for tuberculosis were negative. When the clinical condition deteriorated, the patient was transferred to our intensive care unit for further diagnosis and treatment. Tuberculosis was suspected due to clinical presentation and radiological signs and anti-tuberculous treatment was initiated. After the onset of treatment, first microbiological results confirmed the diagnosis of miliary TB with Mycobacterium bovis. As an infection route we assume primary gastrointestinal infection with M. bovis during the patient's annual holidays in Turkey with a rapid development of miliary TB under infliximab and escalated immunosuppressive therapy. This case report demonstrates the difficulties in differentiating intestinal TB from other granulomatous conditions such as Crohn's disease. The diagnostic tools for gastrointestinal tuberculosis are discussed in detail regarding their sensitivity, specificity as well as positive and negative predictive values. PMID:24122379

Koschny, R; Junghanss, T; Mischnik, A; Karner, M; Kreuter, M; Roth, W; Stremmel, W; Merle, U

2013-10-01

50

A 5-year-old boy with miliary and osteoarticular tuberculosis.  

Science.gov (United States)

Osteoarticular involvement is one manifestation of extrapulmonary tuberculosis (TB). We present a 5-year-old Burmese boy with 10?months of right hip pain and decreased range of motion. The patient also had low-grade fever, cough and decreased appetite. The patient was undocumented and had recently moved from Myanmar. He was thin, in moderate distress with bilateral lung rhonchi, mild subcostal retractions, low back pain, right hip tenderness and painful and limited right range of motion. The patient's chest and pelvis radiographs showed a miliary pattern and right acetabulum osteolytic lesions, respectively. He was started on anti-TB medication and cefotaxime. Ofloxacin was added because of the concern of drug-resistant TB. The patient underwent a right hip debridement. His symptoms improved markedly, with improved mobility. TB is a challenging infection to diagnose, which can cause significant delays in management. PMID:24872489

Washington, Charles Henry; Oberdorfer, Peninnah

2014-01-01

51

Salmonella Infection Superimposed on Letterer-Siwe's Disease Resembling Miliary Tuberculosis  

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Full Text Available A 2 ½-year old boy in presented with a history of purulent otitis media and cutaneous abscesses in the frontal and occipital region since one year prior to admission. Later, hepatosplenomegaly, adenopathies and skin lesions developed. X-rays showed osteolysis of the skull over the abscess and military image of the lungs as well as a small lytic defect in the proximal left humerus. With respect to the high occurrence of Tuberculosis in this country an antituberculosis therapy was started without any noticeable effect. A skin biopsy revealed histiocytosis X and in cultures from abscesses grew Salmonella typhi B. Thus, Letterer-Siwes disease was diagnosed on which a Salmonella infection was superimposed mimicking miliary Tuberculosis.

M Ghorbanian

1986-07-01

52

Gonadal lesions of female sea urchin (Psammechinus miliaris) after exposure to the polycyclic aromatic hydrocarbon phenanthrene.  

Science.gov (United States)

Histopathological alterations in the reproductive tissue of the female sea urchin Psammechinus miliaris after exposure to the polycyclic aromatic hydrocarbon (PAH) phenanthrene were investigated using light microscopy. Sexually mature sea urchins were exposed to 500 microg L(-1) phenanthrene for 20 days. A severe disorganisation of the acinal structure of the gonads was observed in phenanthrene-treated animals, mainly as a result of aggregates of degenerating previtellogenic oocytes. Growth and maturation of previtellogenic oocytes were inhibited, whereas there were no obvious effects on vitellogenic oocytes and mature ova. The acinal wall showed signs of fibrosis as well as dilation of the two epithelial layers. Phenanthrene severely affected the reproductive function of the sea urchins since a proper oogenesis of the ovarian tissue is very unlikely. Generally, the observed alterations are similar to histopathological changes in reproductive tissue in other invertebrates after exposure to PAHs and oil. PMID:19527915

Schäfer, S; Köhler, A

2009-09-01

53

Anti-TNF treatment and miliary tuberculosis in Crohn’s disease  

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Full Text Available Introdution. Tumour necrosis factor alpha (TNF? has a central role in the host immune response to mycobacterial infection. TNF? blockade may therefore result in reactivation of recent or remotely acquired infection. In reported mycobacterium tuberculosis infections, extra-pulmonary and disseminated tuberculosis (TB was common, appeared rapidly, and if unrecognized, with fatal outcome. We present a female patient with miliary TB following treatment with infliximab for fistulizing Crohn’s disease. Case Outline. Five years before admission, the patient was diagnosed with Crohn’s disease, with inflammation limited to the terminal ileum and sigmoid colon and has been on azathioprine 100 mg/day for the last 10 months. Three months before admission to the hospital she developed an enterocutaneous fistula for which therapy with infliximab was started in addition to azathioprine therapy. A tuberculin skin test and a chest x-ray were performed prior to the first infusion with normal findings. She presented with a 6-week history of fever, weakness, weight-loss and a 2-week dry cough. Chest x-ray and computed tomography displayed remarkable bilateral hilar and mediastinal lymphadenopathy and uniformly distributed fine nodules throughout both lung fields varying in size from 2 to 3 mm, without any signs of cavitation. Since there were clinical and morphological signs that indicated miliary TB, the treatment with antituberculous therapy was started and six weeks later all of the symptoms completely resolved and the lesions visible on x-ray diminished. Conclusion. The clinical use of TNF-inhibitors is associated with increased risk of developing tuberculosis. Physicians should be aware of the increased risk of reactivation of TB among patients treated with anti-TNF agents and regularly look for usual and unusual symptoms of TB.

Milenkovi? Branislava

2011-01-01

54

Bio-conventional bleaching of kadam kraft-AQ pulp by thermo-alkali-tolerant xylanases from two strains of Coprinellus disseminatus for extenuating adsorbable organic halides and improving strength with optical properties and energy conservation.  

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Two novel thermo-alkali-tolerant crude xylanases namely MLK-01 (enzyme-A) and MLK-07 (enzyme-B) from Coprinellus disseminatus mitigated kappa numbers of Anthocephalus cadamba kraft-AQ pulps by 32.5 and 34.38%, improved brightness by 1.5 and 1.6% and viscosity by 5.75 and 6.47% after (A)XE(1) and (B)XE(1)-stages, respectively. The release of reducing sugars and chromophores was the highest during prebleaching of A. cadamba kraft-AQ pulp at enzyme doses of 5 and 10 IU/g, reaction times 90 and 120 min, reaction temperatures 75 and 65°C and consistency 10% for MLK-01 and MLK-07, respectively. MLK-07 was more efficient than MLK01 in terms of producing pulp brightness, improving mechanical strength properties and reducing pollution load. MLK-01 and MLK-07 reduced AOX by 19.51 and 42.77%, respectively at 4% chlorine demands with an increase in COD and colour due to removal of lignin carbohydrates complexes. A. cadamba kraft-AQ pulps treated with xylanases from MLK-01 to MLK-07 and followed by CEHH bleaching at half chlorine demand (2%) showed a drastic reduction in brightness with slight improvement in mechanical strength properties compared to pulp bleached at 4% chlorine demand. MLK-01 reduced AOX, COD and colour by 43.83, 39.03 and 27.71% and MLK-07 by 38.34, 40.48 and 30.77%, respectively at half chlorine demand compared to full chlorine demand (4%). pH variation during prebleaching of A. cadamba kraft-AQ pulps with strains MLK-01 and MLK-07 followed by CEHH bleaching sequences showed a decrease in pulp brightness, AOX, COD and colour with an increase in mechanical strength properties, pulp viscosity and PFI revolutions to get a beating level of 35 ± 1 °SR at full chlorine demand. PMID:22805918

Lal, Mohan; Dutt, Dharm; Tyagi, C H

2012-04-01

55

MRI of the brain in patients with miliary pulmonary tuberculosis without symptoms or signs of central nervous system involvement  

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MRI was performed on patients with miliary pulmonary tuberculosis to look for brain involvement and to study the features sequentially, during treatment. We studied seven patients with typical radiographic tuberculosis, and no symptoms or signs of central nervous system involvement. Conventional spin-echo (SE) imaging, including contrast enhanced images, was performed in all cases. All patients showed brain involvement: four patients showed lesions mainly less than 3 mm in diameter, better seen on contrast-enhanced images. These patients showed oedema around the lesions after 2 months of treatment, with subsequent regression on follow-up. The remaining three patients had multiple lesions, 3 mm or more in diameter, which showed a gradual decrease on follow-up. We conclude that the brain may commonly be involved in miliary pulmonary tuberculosis. The response to treatment depends on the stage of the granuloma and shows a definite pattern of healing on follow-up. (orig.). With 2 figs., 1 tab.

Gupta, R.K.; Gaur, V.; Lal, J.H. [MR Section, Department of Radiology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow 226014 (India); Kohli, A. [Department of Neurology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow (India); Kishore, J. [Department of Microbiology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow (India)

1997-10-01

56

MRI of the brain in patients with miliary pulmonary tuberculosis without symptoms or signs of central nervous system involvement  

International Nuclear Information System (INIS)

MRI was performed on patients with miliary pulmonary tuberculosis to look for brain involvement and to study the features sequentially, during treatment. We studied seven patients with typical radiographic tuberculosis, and no symptoms or signs of central nervous system involvement. Conventional spin-echo (SE) imaging, including contrast enhanced images, was performed in all cases. All patients showed brain involvement: four patients showed lesions mainly less than 3 mm in diameter, better seen on contrast-enhanced images. These patients showed oedema around the lesions after 2 months of treatment, with subsequent regression on follow-up. The remaining three patients had multiple lesions, 3 mm or more in diameter, which showed a gradual decrease on follow-up. We conclude that the brain may commonly be involved in miliary pulmonary tuberculosis. The response to treatment depends on the stage of the granuloma and shows a definite pattern of healing on follow-up. (orig.). With 2 figs., 1 tab

1997-10-01

57

Miliary tuberculosis in human immunodeficiency virus infected patients not on antiretroviral therapy: Clinical profile and response to shortcourse chemotherapy  

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Full Text Available Background: An increase in tuberculosis (TB incidence has been associated with human immunodeficiency virus (HIV. Aims: To describe the clinical characteristics and treatment outcome of patients with HIV and miliary TB treated with short-course intermittent chemotherapy in the absence of access to highly active antiretroviral therapy (HAART. Settings and Design: Prospective study of HIV infected adults referred to a TB clinic between July 1999 and July 2004. Materials and Methods: On diagnosis of miliary TB, patients were treated with a standard regimen of two months of isoniazid, rifampicin, ethambutol and pyrazinamide followed by four months of isoniazid and rifampicin (2EHRZ 3 /4RH 3 thrice weekly and followed up for 24 months. Patients were reviewed clinically every month and two sputa were collected. Chest radiographs and blood investigations were done at two months, end of treatment and every six months thereafter. Results: Of 498 patients with HIV and tuberculosis, 31 (6% were diagnosed as miliary tuberculosis. At diagnosis, sputum smear was positive for acid-fast bacilli (AFB in 14 patients (45% and Mycobacterium tuberculosis was isolated in 21 (68%. The mean CD4 cell count was 129 ± 125 cells/mm 3 . Twenty-five patients were declared cured at the end of treatment (81% while one (3% died and five (16% failed. The recurrence rate was 19.4/100 person-years and the median survival was 17 months (95% CI 14 to 20. None of the patients received antiretroviral therapy. Conclusions: Miliary TB tends to occur among HIV infected patients with severe immunosuppression. Though the initial response to short-course chemotherapy was encouraging, a high recurrence rate and mortality was observed indicating poor prognosis in HIV.

Swaminathan S

2007-01-01

58

Fatty acid compositions of gonadal material and diets of the sea urchin, Psammechinus miliaris: trophic and nutritional implications.  

Science.gov (United States)

The fatty acid compositions of gonadal material was examined for the sea urchin Psammechinus miliaris (Gmelin) held in aquaria and fed either salmon feed pellets or the macroalga, Laminaria saccharina for 18 months. Gonadal material was also examined from P. miliaris collected from four field sites, including commercial scallop lines encrusted with the mussel, Mytilus edulis, sea cages stocked with Atlantic salmon Salmo salar and two intertidal sea-loch sites, characterised by either a fine mud or a macroalgal substratum. The fatty acid compositions of known and potential dietary material was examined. The proportions of certain fatty acids in the gonads of P. miliaris were significantly affected by diet type and location. Docosahexaenoic acid (DHA) 22:6 n-3 was significantly higher in the gonads of the sea urchins fed salmon feed in aquaria and collected from the salmon cages and scallop lines than in the gonads of the sea urchins fed L. saccharina in aquaria and collected from the intertidal sea loch sites. The salmon feed and the mussel tissue also contained a high proportion of this fatty acid. Stearidonic acid 18:4 n-3 and arachidonic acid 20:4 n-6, however, were found in significantly higher proportions than DHA in the gonads of the sea urchins fed L. saccharina and collected from the two intertidal sea-loch sites. L. saccharina was also found to contain high proportions of stearidonic and arachidonic acid. The gonads of the sea urchins collected from the intertidal site, characterised by a mud substratum, and from the scallop lines were found to contain a lower 18:1 n-9/18:1 n-7 ratio and a higher proportion of branched and odd-chained fatty acids, signifying a high dietary bacterial input, than the sea urchins held in the aquaria and collected from the salmon cage. 20:2 and 22:2 non-methylene-interrupted dienoic fatty acids (NMIDs) were found in P. miliaris fed diets lacking these fatty acids suggesting de novo biosynthesis. These results, therefore, suggest that the proportions/ratios of certain fatty acids in the gonads of P. miliaris could be used to give an indication of the predominant diet type of this species in the wild. PMID:11108856

Cook; Bell; Black; Kelly

2000-12-20

59

Miliary pulmonary metastases of well-differentiated thyroid carcinoma (medullary excluded) about 10 cases  

International Nuclear Information System (INIS)

Thyroid cancer is relatively a rare cancer; about 1% from all cancers: between 10 and 1591 of patients with differentiated thyroid cancer develop micro or macro-nodular pulmonary metastases. In this study we examined the characteristics and evolution after treatment of 10 patients with micro-nodular or miliary metastases of well-differentiated thyroid carcinoma. Total body scintigraphy with 131 iodine, chest X-ray or CT scan, and thyroglobulin assay were performed for all patients. The treatment was iodine 131 (3. 7 GBq). therapeutic 131 iodine scan was done for all patients seven days after the 131 administration. The effect of 131 iodine treatment was evaluated by means of changes in the number and size of lung metastases on the total body scintigraphy with 131 iodine and by serum thyroglobulin levels six months after 131 iodine ablation, they all received L-thyroxine (2,4 ?g/kg/j). The minimum duration of follow-up was 12 months. There were six females and four males within a range of 13-70 years old. Eight had papillary and two follicular thyroid cancer. These 10 patients benefited 131 iodine therapy. The effect of 131 iodine treatment and the prognostic values of the following variables mere examined: age at the time of 131 iodine. treatment and histological findings. The miliary was rarely diagnosed on the initial investigation. only in to o cases by 131 iodine scar. alter surgery. two cases by chest X-ray, and two cases by CT scan, the initial thyroglobulin levels was very high in seven cases, between 10 and 40 ng/ml in one case and less than 10 ng/ml in two cases. These results indicate that age, 131 iodine uptake. histological findings and the presence of other metastases are important factors in predicting the effects of 131 treatment for pulmonary metastases of well-differentiated thyroid carcinoma. Among all the variables studied. the best prognosis for survival was demonstrated by increased 131 uptake in pulmonary metastases and by early diagnosis during post surgery 131 iodine scanning of radiologically non-apparent metastases. (authors)

2007-03-01

60

Tuberculosis congénita asociada con tuberculosis materna miliar diseminada / Congenital tuberculosis associated with maternal disseminated miliary tuberculosis  

Scientific Electronic Library Online (English)

Full Text Available SciELO Colombia | Language: Spanish Abstract in spanish La tuberculosis sin tratamiento en mujeres gestantes es un riesgo definido para la transmisión de la enfermedad al recién nacido y para resultados adversos, obstétricos y perinatales. La tuberculosis en mujeres gestantes y la tuberculosis congénita son afecciones infrecuentes y de difícil diagnóstic [...] o por la falta de especificidad de las manifestaciones clínicas. Se presenta el caso de una mujer primigestante con tuberculosis miliar diseminada, con inicio de las manifestaciones en el puerperio inmediato, diagnóstico en el segundo mes del puerperio y desenlace fatal. Además, se presenta el caso de su hijo prematuro con manifestaciones desde el nacimiento, evidencia de complejo pulmonar primario, atelectasia persistente por obstrucción bronquial por las adenopatías e infección por citomegalovirus; recibió tratamiento estándar con mejoría. Abstract in english Untreated tuberculosis during pregnancy presents a serious risk for transmission of disease to the newborn and can result in adverse perinatal and obstetrical outcomes. Tuberculosis during pregnancy and congenital tuberculosis are infrequent conditions and are difficult to diagnose due the non-speci [...] ficity of the symptoms. A case report is presented of a woman who had no children previously with disseminated miliary tuberculosis. Tuberculosis symptoms appeared immediately after birth of the first child, with a clinical diagnosis on the second month after childbirth, whereupon the patient died. The son, a premature infant, showed disease symptoms from the first day, with primary pulmonary complex and persistent atelectasis due to bronchial obstruction. The obstruction was due to thoracic lymphadenitis and coinfection with cytomegalovirus. The infant received standard treatment and his condition improved.

Luis Miguel, Sosa; Luz Libia, Cala; Julio César, Mantilla.

 
 
 
 
61

Tuberculose miliar e febre Q em doente imunocompetente / Miliary tuberculosis and Q fever in an immunocompetent Patient  

Scientific Electronic Library Online (English)

Full Text Available SciELO Portugal | Language: Portuguese Abstract in portuguese A tuberculose miliar é a forma de doença progressiva resultante da disseminação hematogénea maciça do Mycobacterium tuberculosis (MT). Afecta imunodeprimidos e idosos e tem manifestações clínicas insidiosas e inespecíficas. O caso clínico descrito refere-se a um homem adulto, sem imunodeficiência, c [...] om infecção simultânea por Coxiella burnetti e MT. A raridade desta associação e a sua forma de apresentação sublinham a necessidade de alto grau de suspeição clínica para a formulação dos diagnósticos, sendo este o segundo caso descrito na literatura. Abstract in english Miliary tuberculosis is a progressive disease resulting from the massive hematogeneous dissemination of Mycobacterium tuberculosis. Immunocompromised and elderly patients are the most affected. A case of an immunocompetent 45 year old man, with miliary tuberculosis and a simultaneous infection by Co [...] xiella burnetti is presented. The clinical presentation demands a high awareness for the presence of tuberculosis. The rarity of this association, only one case reported in literature, appears to be a fortuity coincidence.

Simões, Sandra; Santos, Arsénio; Vaio, Teresa; Leitão, Sara; Santos, Rui M; Costa, Nascimento.

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Uncommon presentation of cryptogenic organizing pneumonia with miliary pattern in the thorax; Ungewoehnliche Manifestation einer kryptogen organisierenden Pneumonie mit miliarem Verschattungsmuster im Thorax  

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A 28-year-old female with worsening dyspnea showed miliary nodules of 2 mm in diameter on chest X-ray and high-resolution CT (HRCT). Histological evaluation and clinical outcome revealed an uncommon presentation of cryptogenic organizing pneumonia. (orig.) [German] Bei einer 28-jaehrigen Patientin mit zunehmender Dyspnoe wurden auf der Thoraxroentgenaufnahme und in der hochaufloesenden CT (HRCT) homogen verteilte monomorphe miliare Fleckschatten von ca. 2 mm Durchmesser nachgewiesen. Die histologische Sicherung und der klinische Verlauf ergaben eine kryptogen organisierende Pneumonie, die sich bildmorphologisch ungewoehnlicherweise nur mit miliaren Knoetchen manifestierte. (orig.)

Langen, H.J.; Biewener, C. [Missionsaerztliche Klinik, Radiologische Abteilung, Wuerzburg (Germany); Ruediger, T. [Universitaet Wuerzburg, Pathologisches Institut, Wuerzburg (Germany); Jany, B. [Missionsaerztliche Klinik, Abteilung fuer Innere Medizin, Wuerzburg (Germany)

2008-03-15

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Differential adaptations between cold-stenothermal environments in the bivalve Lissarca cf. miliaris (Philobryidae) from the Scotia Sea islands and Antarctic Peninsula  

Science.gov (United States)

The cold stenothermal nature of the Southern Ocean, and highly adapted fauna living within, raises the question of how much intra-specific variation there is among invertebrate populations, and how variation may have a role in speciation processes through ecological divergence, natural selection, and reproductive isolation. Despite decades of collecting biological material, this question remains largely unanswered, and many studies compare 'populations' of pooled material from wide geographic ranges to compensate for sampling constraints. In this study, variations in ecophysiological traits are explored by measuring growth, reproduction, and shell morphology among six populations of the small bivalve Lissarca cf. miliaris (Philippi, 1845) from the Southern Ocean, which experience subtle differences in temperature, disturbance, and food availability. There are significant differences in shell morphology and growth among different populations and slower growth rates at higher latitude populations. Prodissoconch sizes show an inverse 'U' shaped relationship with latitude, and are correlated with egg size at South Georgia and King George Island's Potter Cove. Higher brood sizes at the South Georgia population represent a trade-off with lower egg size, and correlate with shell morphology by offering lower internal capacity to brood young. Lower investment into offspring and morphological variations in L. cf. miliaris highlight the importance of local scale environmental variations on species' ecology. These variations in physical traits appear to be underestimated in the Southern Ocean, but may be important drivers of ecological divergence and speciation, which should be considered in future genetic investigations on different invertebrate populations.

Reed, Adam J.; Linse, Katrin; Thatje, Sven

2014-04-01

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Significance of localized miliary subdiaphragmatic seeding and size of initial postsurgical residual in patients with epithelial ovarian cancer  

International Nuclear Information System (INIS)

Objective: Despite multimodality treatment regimens the survival rates for patients with stage III epithelial ovarian cancer have shown minor improvement in the last decade and remain poor. An analysis of the results of our trimodality treatment regimens was undertaken to identify prognostic factors for progression-free survival (PFS) and to correlate these with patterns of failure. Materials and Methods: Between May 1985 and December 1994, 52 patients with FIGO stage III ovarian cancer underwent maximum cytoreductive surgery, followed by chemotherapy (1-10 cycles, median: 6) and external beam irradiation. Radiation treatment consisted of whole abdominal irradiation (30 Gy), pelvic boosts (21,6 Gy), diaphragmatic boosts (12 Gy) and paraaortic nodal boosts (12 Gy) if the latter were involved. Patient age ranged from 31-79 years (median: 59). Follow-up for all patients was from 1-127 months (median: 25) and 38-127 months (median: 76) for patients at risk. Factors analysed for their impact on PFS and patterns of failure included postsurgical size and site of residual tumor, age, tumor grade, unilateral or bilateral ovarian involvement, presence of ascites, number of cycles of chemotherapy, and completion of radiotherapy. Results: Actuarial survival and PFS rates at 5 years were 30% and 29%. The presence of localized miliary seeding at the dome of the right diaphragm (MDS; 14 patients) as well as residual disease >2 cm after surgical debulking (6 patients) strongly influenced PFS. Patients with MDS or >2 cm residual disease had a PFS of 0% with a median survival of 6 and 8 months, respectively. These results were significantly worse (p=0.0006) than those obtained for the 16 patients with no macroscopic tumor or the 15 patients with macroscopic residuals 2 cm residual (67%) compared with patients who had no or 2 cm) were found to be strongly prognostic and are associated with a high incidence of distant failure. If our finding of the prognostic significance of MDS can be confirmed, it is suggested that Taxol containing chemotherapy regimens be employed in the treatment of such patients as are now being utilized in the treatment of patients with suboptimal debulked disease

1997-01-01

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[Detection of lesions in bone marrow for the diagnosis of miliary tuberculosis: reliability of bone marrow aspiration and biopsy in view of distribution pattern of lesions in autopsy cases].  

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The usefulness of the serial section method was investigated in four bone marrow aspirates, four biopsies and nine autopsy specimens obtained from patients with miliary tuberculosis who were admitted to our hospital between 1974 and 1994. In original sections, granulomas consistent with tuberculosis were found in two out of four aspirate specimens (50%) but in none of the four bone marrow biopsies. By using serially out sections, however, granulomas were detected in two more aspirate specimens and two biopsies which were negative in original sections. Consequently four of four aspirates (100%) and two of four biopsies ((50%) became positive. In addition, the distribution of granulomas was investigated using vertebral bone marrows obtained from 12 autopsy cases. We divided the vertebral bone marrows obtained from 12 autopsy cases. We divided the vertebra into the peripheral and central portions. Granulomas were more frequently found in the peripheral portions than in the central. The higher detection rate of granulomas in the peripheral bone marrow when the biopsy and aspiration needles easily reach, suggests that bone marrow aspiration and/or biopsy would be a useful procedure for the diagnosis miliary tuberculosis. Therefore if serial sections were utilized for such samples in the miliary tuberculosis patients, the detection rate is expected to became much higher. PMID:8921680

Nakajima, M; Niki, Y; Manabe, T; Matsushima, T

1996-09-01

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Culturable bacterial flora associated with the dinoflagellate green Noctiluca miliaris during active and declining bloom phases in the Northern Arabian Sea.  

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A massive algal bloom of the dinoflagellate Noctiluca miliaris (green) was located in the Northern Arabian Sea by IRS-P4-2 (OCM-II) for microbiological studies, during two consecutive cruises of February-March 2009. Culturable bacterial load during bloom were ? 2-3-fold higher in comparison to non-bloom waters and ranged from 3.20 × 10(5) to 6.84 × 10(5) cfu ml(-1). An analysis of the dominant heterotrophs associated with Noctiluca bloom resulted in phylogenetic and a detailed metabolic characterization of 70 bacterial isolates from an overlapping active and declining bloom phase location near north-central Arabian Sea. The active phase flora was dominated by Gram-positive forms (70.59 %), a majority of which belonged to Bacillus (35.29 %) of Firmicutes. As the bloom declined, Gram-negative forms (61.11 %) emerged dominant, and these belonged to a diverse ?-proteobacterial population consisting of Shewanella (16.67 %) and equal fractions of a Cobetia-Pseudomonas-Psychrobacter-Halomonas population (36.11 %). A Unifrac-based principal coordinate analysis of partial 16S rDNA sequences showed significant differences among the active and declining phase flora and also with reported endocytic flora of Noctiluca (red). A nonparametric multidimensional scaling (NMDS) of antibiogram helped differentiation among closely related strains. The organic matter synthesized by N. miliaris appears to be quickly utilized and remineralized as seen from the high efficiency of isolates to metabolize various complex and simple C/N substrates such as carbohydrates, proteins/amino acids, lipids, sulfide production from organic matter, and solubilize phosphates. The ability of a large fraction of these strains (50-41.67 %) to further aerobically denitrify indicates their potential for nitrogen removal from these high-organic microniches of the Noctiluca bloom in the Arabian Sea, also known for high denitrification activity. The results indicate that culturable euphotic bacterial associates of Noctiluca are likely to play a critical role in the biogeochemical ramifications of these unique seasonally emerging tropical open-water blooms of the Northern Arabian Sea. PMID:23280496

Basu, Subhajit; Deobagkar, Deepti D; Matondkar, S G Prabhu; Furtado, Irene

2013-05-01

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Tuberculosis miliar, ganglionar, pancreática y costal: Presentación clínica y revisión bibliográfica / Miliary, ganglionar, pancreatic and costal tuberculosis: Clinical presentation and bibliography review  

Scientific Electronic Library Online (English)

Full Text Available SciELO Spain | Language: Spanish Abstract in spanish Se presenta un paciente de 42 años que ingresa en nuestro hospital con fiebre, dolor abdominal y patrón radiológico miliar. Tenía un aumento de amilasemia y amilasuria y de la lipasa sérica. El mantoux era negativo. En el estudio de TAC había engrosamiento costal, lesiones hepáticas focales múltiple [...] s y adenopatías necrosadas en zona peripancreática. Las biopsias transbronquiales y la punción pancreática mostraron lesiones granulomatosas necrotizantes, cultivándose M. tuberculosis complex en el broncoaspirado. El tratamiento específico normalizó todas las alteraciones pulmonares, costales y pancreáticas. Abstract in english A 42-year-old man was admitted to the hospital with fever, abdominal pain and miliary radiological pattern.The amylase and lipase in serum, and the amylase in urine were increased. The tuberculin skin test was negative. The thoracic and abdominal CT scan showed costal afectation, multiple focal hepa [...] tic lesions and large necrosing peripancreatic lymphadenopathies. The transbronchial biopsy and the pancreatic punction demostrated granulomatous necrotic lesions, and M. tuberculosis growed in the bronchial washing culture. The specific treatment normalized the pulmonary, costal and pancreatic lesions.

I., Inchaurraga Álvarez; A., Herrejón Silvestre; P., Plaza Valía; R., Blanquer Olivas.

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[Miliary tuberculosis after kidney transplantation].  

Science.gov (United States)

The authors describe a case of tuberculosis after kidney transplantation. They discuss diagnostic and therapeutical problems arising from the specific course of this disease which appears in patients with chronic renal insufficiency treated with immunosuppressives after kidney transplantation. PMID:2790890

Nouza, M; Jirka, J; Reneltová, I; Chadimová, M; Dráb, K; Krofta, K

1989-07-14

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Miliary pulmonary metastases of well-differentiated thyroid carcinoma (medullary excluded) about 10 cases; Les metastases pulmonaires micronodulaires de type miliaire dans le cancer thyroidien bien diff encie (medullaires exclus) a propos de dix cas  

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Thyroid cancer is relatively a rare cancer; about 1% from all cancers: between 10 and 1591 of patients with differentiated thyroid cancer develop micro or macro-nodular pulmonary metastases. In this study we examined the characteristics and evolution after treatment of 10 patients with micro-nodular or miliary metastases of well-differentiated thyroid carcinoma. Total body scintigraphy with 131 iodine, chest X-ray or CT scan, and thyroglobulin assay were performed for all patients. The treatment was iodine 131 (3. 7 GBq). therapeutic 131 iodine scan was done for all patients seven days after the 131 administration. The effect of 131 iodine treatment was evaluated by means of changes in the number and size of lung metastases on the total body scintigraphy with 131 iodine and by serum thyroglobulin levels six months after 131 iodine ablation, they all received L-thyroxine (2,4 {mu}g/kg/j). The minimum duration of follow-up was 12 months. There were six females and four males within a range of 13-70 years old. Eight had papillary and two follicular thyroid cancer. These 10 patients benefited 131 iodine therapy. The effect of 131 iodine treatment and the prognostic values of the following variables mere examined: age at the time of 131 iodine. treatment and histological findings. The miliary was rarely diagnosed on the initial investigation. only in to o cases by 131 iodine scar. alter surgery. two cases by chest X-ray, and two cases by CT scan, the initial thyroglobulin levels was very high in seven cases, between 10 and 40 ng/ml in one case and less than 10 ng/ml in two cases. These results indicate that age, 131 iodine uptake. histological findings and the presence of other metastases are important factors in predicting the effects of 131 treatment for pulmonary metastases of well-differentiated thyroid carcinoma. Among all the variables studied. the best prognosis for survival was demonstrated by increased 131 uptake in pulmonary metastases and by early diagnosis during post surgery 131 iodine scanning of radiologically non-apparent metastases. (authors)

Ennibi, G. [Hopital Hassan-2, Service de Medecine Nucleaire, Agadir (Morocco); Ben Rais, N. [Centre Hospitalier Universitaire IBN Sina, Service de Medecine Nucleaire, Rabat (Morocco)

2007-03-15

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Associação de osteomielite tibial e pneumonite por tuberculose miliar em paciente com lúpus eritematoso sistêmico / Association of tibial osteomyelitis and pneumonitis due to miliary tuberculosis in a patient with systemic lupus erythematosus  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese O lúpus eritematoso sistêmico (LES) é uma doença autoimune multissistêmica na qual há grande prevalência e manifestações incomuns de doenças infecciosas oportunistas, principalmente pelas múltiplas anormalidades no sistema imunológico e pelo efeito imunossupressor das medicações utilizadas em seu tr [...] atamento. Pacientes com LES têm incidência aumentada de tuberculose, e o acometimento osteoarticular ocorre em 1%-3% desses casos. Manifesta-se com dor, diminuição da mobilidade e aumento do volume osteoarticular, e os achados radiográficos costumam ser inespecíficos. A ressonância magnética nuclear (RMN) é exame útil para definir o grau de acometimento ósseo; entretanto, o diagnóstico etiológico é dado apenas pela cultura de líquido sinovial, pela cultura óssea ou pela histologia dessas regiões. Devido à inespecificidade dos achados, geralmente há atraso diagnóstico, em média de 11 meses. Relata-se o caso de uma paciente do gênero feminino com LES apresentando fatores predisponentes para a infecção/reativação da tuberculose. A RMN foi importante para definir o acometimento ósseo, e o diagnóstico etiológico foi dado pela biópsia óssea. A paciente também apresentava acometimento pulmonar devido à tuberculose, em sua forma miliar, demonstrado pela radiografia simples de tórax e pela tomografia computadorizada e confirmado pela cultura do bacilo de Koch no escarro. Houve demora de 1,5 mês para o início da terapêutica, tempo considerado curto em relação à literatura. Conclui-se dessa maneira que a tuberculose óssea, apesar de rara, deve sempre ser lembrada como diagnóstico diferencial nos pacientes lúpicos com osteomielite, principalmente naqueles com antecedente de tuberculose pulmonar. Abstract in english Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease, which has great prevalence and uncommon manifestations of opportunistic infectious diseases, mainly due to the multiple abnormalities of the immune system and the immunosuppressive effect of the medications used in its treatment [...] . Patients whit SLE have an increased incidence of tuberculosis, and osteoarticular involvement occurs in 1%-3% of the cases, manifesting as pain, reduction in mobility, and increased osteoarticular volume. The radiographic findings are often nonspecific. Magnetic resonance imaging (MRI) is an useful test to define the severity of bone involvement; however, the etiological diagnosis can only be established by use of synovial fluid or bone cultures or the histological study of the affected areas. Due to the lack of specificity of the findings, there is usually a mean diagnosis delay of 11 months. We report the case of a female patient with SLE and predisposing factors for tuberculosis infection/reactivation. The MRI was important to define bone involvement, and the etiological diagnosis was established by use of bone biopsy. The patient also had lung involvement due to miliary tuberculosis, shown on plain chest radiography and CT scan and confirmed on culture of Mycobacterium tuberculosis in the sputum. There was a 1.5-month delay in beginning therapy, which is considered a short time when compared to the reports in the literature. In conclusion, bone tuberculosis, although rare, should always be remembered as a differential diagnosis of patients with SLE and osteomyelitis, mainly those with history of pulmonary tuberculosis.

Vitor Emer Egypto, Rosa; Daniel, Martin; André Marun, Lyrio; Maria Aparecida Barone, Teixeira; José Roberto, Provenza.

71

CLINICO-PATHOLOGY AND ULTRASTRUCTURAL ETUDY OF NEPHROPATHY CHANGES DUE TO LUPUS ERYTHEMATOSIS DISSEMINATUS  

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Full Text Available Nephrotic syndrome _ Nephrotic syndrome is found in 30% of all of the cases of systematic LE. Nephropathy Changes Due to Lupus Erythematosus 21 (15,16 in peripheral blood may confirm definitively lupus cryhcrornatosus. Additional serological evidence such as hyper g-gJobu":nemia, and 19_s-g_ globulin may then positively confirm the (17. Supporting evidence of 11 specific type of glomerular substantiates prior clinical and paracIinical evidence: The foregoing ultrasnucturat chnracteristtcs are then seen to represent an additional check of routine diagnostic procedures In addition observed permits an opportunity to• correlate• min~te changes with known biochemical changes previosly A. Modjtabai et at Diagnostically the presence of kidney disease and the presence of L.E. Urine albumin _ The appearance of urine albumin to the extent of 8-10 mgm.mil is a sign of kidney damage. This may be accompanied by acute kidney inadequacy, cyrtitis with fever and pain. There may be a varying globulin excretion which is taken by some as a precursor of ensuing damage. This point, of course, has been debated. When clinical and paraclinical signs indicate LE. definitive conclu, sions may be. reached utilizing electron microscopy. The disease occurs more frequently in women than in men and especially among young people. More than one person in a family may bevaffectcd leading to the assumption that the trait is inherited. The hereditary nature of the disease, however, has not been definitely estab., lishcd. Basically the disease appears to original as an abnormal imrnu., nological reaction to external or internal causes or perhaps even auto.; immunological. Causative or aggravating factors may be long exposure to sunlight, and ultraviolet rays which may free lysozyrnes or other proteolytic enzymes which attack the ground substance of the cell membranes of the endothelium. Drugs such as penicillin, sulfonamide and hydralyzin have caused allergic reactions resulting in lupus although differences of opinions exist as to the roles these drugs may play, as a causative agent since in some patients a withdrawal at medication results in accessation of the symptoms but in other patients there is no apparent change. It has been proposed that the above mentioned drugs react with body proteins to form the antibodies causative .of the disease. Infections also have been mentioned as a causative factor as well as rheumatic factors and rheumatic arthritis. 20 Differences exist as to the physical manifestation of the L. E. syndrome however certain basic symptoms appear in all cases of the disease. These basic cyrnptorns may not be accompied by other peripheral manifestations,

A. Modjtabai

1969-01-01

72

Unusual cutaneous ulcers in a case of miliary tuberculosis  

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Full Text Available A 3-year old girl had multiple, large, deep, infected ulcers on the extremities and buttocks for 1½ years. Additional features included malnutrition, Cushingoid facies with buffalo hump, and absence of any underlying bony involvement. Edge biopsy showed a tuberculous picture without vasculitis or acid-fast bacilli; X-ray of the chest revealed military tuberculosis. The ulcers, although atypical, healed completely and rapidly on anti-tuberculous therapy.

Amladi Sangeeta

1993-01-01

73

"Scleroderma linearis: hemiatrophia faciei progressiva (Parry-Romberg syndrom) without any changes in CNS and linear scleroderma "en coup de sabre" with CNS tumor  

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Abstract Background Hemifacial atrophy (Parry-Romberg syndrome) is a relatively rare disease. The etiology of the disease is not clear. Some authors postulate its relation with limited scleroderma linearis. Linear scleroderma "en coup de sabre" is characterized by clinical presence of most commonly one-sided linear syndrome. In a number of patients, neurological affection is the medium of the disease. The treatment of both scleroderma varieties is similar to the treatment of ...

Bergler-Czop Beata; Lis-?wi?ty Anna; Brzezi?ska-Wcis?o Ligia

2009-01-01

74

"Scleroderma linearis: hemiatrophia faciei progressiva (Parry-Romberg syndrom) without any changes in CNS and linear scleroderma "en coup de sabre" with CNS tumor  

Science.gov (United States)

Background Hemifacial atrophy (Parry-Romberg syndrome) is a relatively rare disease. The etiology of the disease is not clear. Some authors postulate its relation with limited scleroderma linearis. Linear scleroderma "en coup de sabre" is characterized by clinical presence of most commonly one-sided linear syndrome. In a number of patients, neurological affection is the medium of the disease. The treatment of both scleroderma varieties is similar to the treatment of limited systemic sclerosis. Case presentation We present two cases of a disease: a case of a 49-year-old woman with a typical image of hemifacial atrophy, without any changes of the nervous system and a case of a 33-year-old patient with an "en coup de sabre" scleroderma and with CNS tumor. Conclusion We described typical cases of a rare diseases, hemifacial atrophy and "en coup de sabre" scleroderma. In the patient diagnosed with Parry-Romberg syndrome, with Borrelia burgdoferi infection and with minor neurological symptoms, despite a four-year case history, there was a lack of proper diagnosis and treatment. In the second patient only skin changes without any neurological symptoms could be observed and only a precise neurological diagnosis revealed the presence of CNS tumor.

Bergler-Czop, Beata; Lis-Swiety, Anna; Brzezinska-Wcislo, Ligia

2009-01-01

75

"Scleroderma linearis: hemiatrophia faciei progressiva (Parry-Romberg syndrom without any changes in CNS and linear scleroderma "en coup de sabre" with CNS tumor  

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Full Text Available Abstract Background Hemifacial atrophy (Parry-Romberg syndrome is a relatively rare disease. The etiology of the disease is not clear. Some authors postulate its relation with limited scleroderma linearis. Linear scleroderma "en coup de sabre" is characterized by clinical presence of most commonly one-sided linear syndrome. In a number of patients, neurological affection is the medium of the disease. The treatment of both scleroderma varieties is similar to the treatment of limited systemic sclerosis. Case presentation We present two cases of a disease: a case of a 49-year-old woman with a typical image of hemifacial atrophy, without any changes of the nervous system and a case of a 33-year-old patient with an "en coup de sabre" scleroderma and with CNS tumor. Conclusion We described typical cases of a rare diseases, hemifacial atrophy and "en coup de sabre" scleroderma. In the patient diagnosed with Parry-Romberg syndrome, with Borrelia burgdoferi infection and with minor neurological symptoms, despite a four-year case history, there was a lack of proper diagnosis and treatment. In the second patient only skin changes without any neurological symptoms could be observed and only a precise neurological diagnosis revealed the presence of CNS tumor.

Brzezi?ska-Wcis?o Ligia

2009-07-01

76

Tuberculosis congénita asociada con tuberculosis materna miliar diseminada Congenital tuberculosis associated with maternal disseminated miliary tuberculosis  

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La tuberculosis sin tratamiento en mujeres gestantes es un riesgo definido para la transmisión de la enfermedad al recién nacido y para resultados adversos, obstétricos y perinatales. La tuberculosis en mujeres gestantes y la tuberculosis congénita son afecciones infrecuentes y de difícil diagnóstico por la falta de especificidad de las manifestaciones clínicas.
Se presenta el caso de una mujer primigestante con tuberculosis miliar d...

Luis Miguel Sosa; Luz Libia Cala; Julio César Mantilla

2007-01-01

77

Acute Miliary Tuberculosis Of Skin - A Case Report And Review Of Literature  

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Full Text Available Acute military tuberculosis of skin is a rare manifestation of tuberculosis. A 7 month old female presented with multiple subcutaneous nodules all over the body. Fine needle aspiration cytology and biopsy from the nodule showed tuberculous lesion with demonstration of acid-fast bacilli (AFB. A typical presentation of cutaneous tuberculosis in HIV era and its diagnosis by AFB stain is stressed.

Raut W .K

2002-01-01

78

El “Tentamen medicum de morbo miliari infantum, muguet, millet, blanchet, gallico idiomate appellate" (1786, de Francisco Sanponts  

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Full Text Available A medical text on aphtae, writed in 1786 and printed in 1788, is analized. Its author was the catalan physician Francisco Sanponts y Roca (1756-1821. This work was awarded with the first prize by the Société Royal de Médecine from Paris, in a competition to study and solve the problem of the wide diffusion of Aphtae (Muguet among the orphanages' children. This was the first description of this disease in Spain. The author was influenced by the antisystematic mentality and by the anatomoclinical empiricism; he widely refers to Van Swieten and Nils Rosen, besides other 65 authors. Through his references he proved that he was well informed about the European medicine and pediatrics, although he was not apparently acquainted with the work of Underwood, the first known description of this disease, that was published two years earlier.

Se analiza un texto de 1786 impreso en 1788, cuyo autor es el médico catalán Francisco Sanponts y Roca (1756-1821, que mereció el primer premio de la Real Sociedad de Medicina de París en un certamen convocado para estudiar y solucionar el problema planteado por la amplia difusión del Muguet entre los niños acogidos en hospicios. Se trata de la primera descripción de la enfermedad hecha en España y el autor, influido por la mentalidad antisistemática y el empirismo anatomoclínico, cita de forma amplia a Van Swieten y a Nils Rosen, entre 67 autores, con lo que demuestra estar al corriente de la medicina y la pediatría europeas, aunque aparentemente desconoce el trabajo de Underwood, publicado dos años antes de la elaboración del suyo, que representa la primera descripción conocida de esta enfermedad.

Romero Maroto, Martín

1997-06-01

79

Caso para diagnóstico / Case for diagnosis  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Eritromelanose folicular faciei et colli é uma doença rara, de origem desconhecida, caracterizada por hiperpigmentação eritêmato-acastanhada e simétrica nas regiões frontal, temporal e malar, associada com envolvimento do folículo piloso. É comum apresentar ceratose pilar no pescoço e nos ombros. Su [...] a característica clínica primária é composta pela tríade: eritema (com ou sem telangiectasias), pápulas foliculares discretas e hiperpigmentação acastanhada. Abstract in english Erythromelanosis follicularis faciei et colli is a rare disease of unknown etiology characterized by symmetric erythematous brownish hyperpigmentation on the frontal, malar and temporal areas associated with involvement of the pilary follicle. It is common to present pilar keratosis on the shoulders [...] and neck. The three main clinical characteristics are: erythema (with or without telangiectasias), discrete follicular papules and brownish hyperpigmentation.

Silva, Roberto Souto da; Fonseca, João Carlos Macedo; Obadia, Daniel.

80

Caso para diagnóstico Case for diagnosis  

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Full Text Available Eritromelanose folicular faciei et colli é uma doença rara, de origem desconhecida, caracterizada por hiperpigmentação eritêmato-acastanhada e simétrica nas regiões frontal, temporal e malar, associada com envolvimento do folículo piloso. É comum apresentar ceratose pilar no pescoço e nos ombros. Sua característica clínica primária é composta pela tríade: eritema (com ou sem telangiectasias, pápulas foliculares discretas e hiperpigmentação acastanhada.Erythromelanosis follicularis faciei et colli is a rare disease of unknown etiology characterized by symmetric erythematous brownish hyperpigmentation on the frontal, malar and temporal areas associated with involvement of the pilary follicle. It is common to present pilar keratosis on the shoulders and neck. The three main clinical characteristics are: erythema (with or without telangiectasias, discrete follicular papules and brownish hyperpigmentation.

Roberto Souto da Silva

2010-12-01

 
 
 
 
81

A Case of Dermatophytic Blepharitis  

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Full Text Available Dermatophytoses are the most common fungal infections of the skin. In the clinical practise, tinea pedis is most common clinical form of dermatophytosis. Other clinical forms are tinea cruris, tinea capitis, tinea corporis and tinea faciei. Tinea faciei is a rare form of dermatophytosis of glabrous skin, characterized by a well- circumscribed erythematous patch, and is more commonly misdiagnosed with some dermatologic diseases as seborrheic dermatitis, contact dermatitis, polymorphic light eruption and lymphocytic infiltrations. In addition, it is reported its clinical forms resembling folliculitis, perioral dermatitis, impetigo and sycosis. To date, a few cases of dermatophytosis involving eyelid were presented in the literature. Here, we present a patient who has an erythematous and fine scaly patch on her eyelid and who is diagnosed as dermatophytic blepharitis by helping typical tinea corporis on her wrist.

Mustafa Kulaç

2008-07-01

82

Disseminated Mycobacterium avium complex infection in an immunocompetent pregnant woman  

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Abstract Background Disseminated mycobacterium avium complex (MAC) occurs mainly in immunocompromised hosts, which is associated with abnormal cellular immunity. Case presentation A 26-year-old pregnant woman presented with fever and general weakness. Miliary lung nodules were noted on chest X-ray. Under the impression of miliary tuberculosis, anti-tuberculosis medication was administered. However, the patient was not improved. Further work-up demonstrated MAC i...

2006-01-01

83

Dermatophytoses in a desert district of Western Rajasthan  

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Clinico-mycological study of 250 cases of dermatophytoses was undertaken in a desert district of Western Rajasthan. Incidence of dermatophytoses in this area was 8.60% with tinea cruris (34.4%) as the major clinical type followed by tinea corporis (24.0%) Incidence of tinea capitis was 16.8% and 90% of those affected were in the age group of 0-10 years. Male preponderance was observed (M:F=2:1). There were 15 cases of tinea faciei (6%), majority belon...

Karmakar Sanchita; Kalla G; Joshi K; Karmakar Somnath

1995-01-01

84

Pulmonary alveolar microlithiasis  

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Pulmonary alveolar microlithiasis is a rare disease of unknown cause. We report a case in a young boy who presented with history of failure to thrive and chest X-ray finding suggestive of miliary mottling. Open lung biopsy revealed pulmonary alveolar microlithiasis.

2011-01-01

85

[Mycoplasma pneumoniae infection: unusual thoracic presentation and bone involvement].  

Science.gov (United States)

We report an atypical presentation of Mycoplasma pneumoniae infection observed in a patient with primary hypogamma-globulinemia. Pulmonary miliary was combined with sternal and femoral osteomyelitis. These unusual CT findings could be explained by immunodeficiency with impaired antibody response. PMID:9846294

Doucet, V; Bourlière-Najean, B; Petit, P; Panuel, M; Faure, F; Devred, P

1998-11-01

86

Disseminated candidiasis 18 years after renal transplantation.  

Science.gov (United States)

Although mucocutaneous candidiasis is a common infection in renal transplant recipients, disseminated candidiasis is rare. Candida pnemonia causing miliary mottling on X-ray chest with the central nervous system involvement is still rarer. We report an unusual case with disseminated candidiasis that presented 18 years after renal transplantation and improved on conventional antifungal therapy; the relevant literature is reviewed. PMID:23439779

Bismay, K; Mathew, A; Rajesh, R; Kurian, G; Unni, V N; Kavita, R D; Sreehari, S

2012-11-01

87

Pulmonary alveolar microlithiasis.  

Science.gov (United States)

Pulmonary alveolar microlithiasis is a rare disease of unknown cause. We report a case in a young boy who presented with history of failure to thrive and chest X-ray finding suggestive of miliary mottling. Open lung biopsy revealed pulmonary alveolar microlithiasis. PMID:21712928

Gayathri Devi, H J; Mohan Rao, K N; Prathima, K M; Das, Jayanth K

2011-04-01

88

Disseminated candidiasis 18 years after renal transplantation  

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Although mucocutaneous candidiasis is a common infection in renal transplant recipients, disseminated candidiasis is rare. Candida pnemonia causing miliary mottling on X-ray chest with the central nervous system involvement is still rarer. We report an unusual case with disseminated candidiasis that presented 18 years after renal transplantation and improved on conventional antifungal therapy; the relevant literature is reviewed.

2012-01-01

89

The Use of Megestrol Acetate in Some Feline Dermatological Problems  

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Twenty-one cats were treated with megestrol acetate because they were showing clinical signs associated with one of the following problems: eosinophilic ulcer, eosinophilic plaque, neurodermatitis, endocrine alopecia and miliary dermatitis. The dosage schedule was 5 mg orally per day per cat for seven days, then 5 mg every three days for 21 days.

Gosselin, Y.; Chalifoux, A.; Papageorges, M.

1981-01-01

90

Pulmonary alveolar microlithiasis with the absence of technetium-99m MDP uptake of lungs  

Energy Technology Data Exchange (ETDEWEB)

The authors report a patient with alveolar microlithiasis who was treated for miliary tuberculosis eight years earlier and whose Tc-99m MDP scan revealed absent lung uptake. Diagnosis was established by bronchoalveolar lavage. Both the roentgenogram and computed tomography of the chest confirmed alveolar microlithiasis.

Turktas, H.; Ozturk, C.; Guven, M.; Ugur, P.; Erzen, C.

1988-12-01

91

Pulmonary alveolar microlithiasis with the absence of technetium-99m MDP uptake of lungs  

International Nuclear Information System (INIS)

The authors report a patient with alveolar microlithiasis who was treated for miliary tuberculosis eight years earlier and whose Tc-99m MDP scan revealed absent lung uptake. Diagnosis was established by bronchoalveolar lavage. Both the roentgenogram and computed tomography of the chest confirmed alveolar microlithiasis

1988-01-01

92

Mature ovarian teratoma with gliomatosis peritonei - A case report  

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Gliomatosis peritonei (GP), a rare condition related to ovarian teratomas, is characterized by miliary implants of mature glial tissues on the peritoneum or omentum. We report herein a case of mature teratoma of the ovary with GP with imaging features and pathological correlation

Das C; Sharma R; Thulkar S; Mukhopadhyay S.; Deka D; Mannan R

2005-01-01

93

Probable hepatic tuberculosis masquerading as Klatskin tumour in an immunocompetent patient.  

Science.gov (United States)

A 55-year-old immunocompetent woman was presented with features of obstructive jaundice and a clinicoradiological picture suggestive of a hilar cholangiocarcinoma (Klatskin tumour). However, caseating granulomatous lesion associated with miliary nodules were revealed intraoperatively. The lesion responded to standard antituberculous therapy. This unusual presentation highlights the considerable diagnostic challenge in such case. PMID:24343799

Hanafiah, Mohammad; Alhabshi, Sharifah Majedah Idrus; Bag, Tribeni; Low, Soo Fin

2013-01-01

94

Adult Respiratory Distress Syndrome in a Previously Healthy Young Male *  

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Infection with pneumocystis carinii and cytomegalovirus was found in a young male suspected of having miliary tuberculosis. Problems of diagnosis and predisposing factors for these infections in the patient are discussed. The patient's clinical course and management are reviewed. Autopsy findings are presented. Alternative modes of therapy are considered.

Sigal, Stephen L.; Kliger, Alan; Smith, G. J. Walker

1982-01-01

95

Trias of keratosis pilaris, ulerythema ophryogenes and 18p monosomy: Zouboulis syndrome.  

Science.gov (United States)

Keratosis pilaris and ulerythema ophryogenes (keratosis pilaris atrophicans faciei) are part of a group of hereditary disorders of hair follicle keratinization involving follicular inflammation and subsequent atrophy. Monosomy 18p refers to a chromosomal disorder resulting from the deletion of all or part of the short arm of chromosome 18. This trias was first described in a patient by Zouboulis et al. (1994) and has been reported by different authors in four additional patients since then. We have reviewed the five almost identical cases that have been reported in 20 years and we suggest the existence of a new rare syndrome characterized by the trias keratosis pilaris, ulerythema ophryogenes and monosomy 18p. Recognition of the syndrome could assist in early diagnosis of monosomy 18p in these patients. PMID:24801913

Liakou, Aikaterini I; Esteves de Carvalho, André V; Nazarenko, Lujdmila P

2014-05-01

96

Dermatophytoses in a desert district of Western Rajasthan  

Directory of Open Access Journals (Sweden)

Full Text Available Clinico-mycological study of 250 cases of dermatophytoses was undertaken in a desert district of Western Rajasthan. Incidence of dermatophytoses in this area was 8.60% with tinea cruris (34.4% as the major clinical type followed by tinea corporis (24.0% Incidence of tinea capitis was 16.8% and 90% of those affected were in the age group of 0-10 years. Male preponderance was observed (M:F=2:1. There were 15 cases of tinea faciei (6%, majority belonging to 0-10 years age group. Trichophyton violaceumwas isolated In majority (55.76% from all clinical types followed by Trichophyton rubrum(42.3%

Karmakar Sanchita

1995-01-01

97

Imaging Features of Pediatric Pentastomiasis Infection: a Case Report  

International Nuclear Information System (INIS)

We report here a case of pentastomiasis infection in a 3-year-old girl who had high fever, abdominal pain, abdominal tension and anemia. Ultrasound scanning of the abdomen revealed disseminated hyperechoic nodules in the liver and a small amount of ascites. Abdominal MRI showed marked hepatomegaly with disseminated miliary nodules of high signal intensity throughout the hepatic parenchyma on T2-weighted images; retroperitoneal lymphadenopathy and disseminated miliary nodules on the peritoneum were also noted. Chest CT showed scattered small hyperdense nodules on both sides of the lungs. The laparoscopy demonstrated diffuse white nodules on the liver surface and the peritoneum. After the small intestinal wall and peritoneal biopsy, histological examination revealed parenchymal tubercles containing several larvae of pentastomids and a large amount of inflammatory cell infiltration around them. The pathological diagnosis was parasitic granuloma from pentastomiasis infection

2010-08-01

98

Imaging Features of Pediatric Pentastomiasis Infection: a Case Report  

Energy Technology Data Exchange (ETDEWEB)

We report here a case of pentastomiasis infection in a 3-year-old girl who had high fever, abdominal pain, abdominal tension and anemia. Ultrasound scanning of the abdomen revealed disseminated hyperechoic nodules in the liver and a small amount of ascites. Abdominal MRI showed marked hepatomegaly with disseminated miliary nodules of high signal intensity throughout the hepatic parenchyma on T2-weighted images; retroperitoneal lymphadenopathy and disseminated miliary nodules on the peritoneum were also noted. Chest CT showed scattered small hyperdense nodules on both sides of the lungs. The laparoscopy demonstrated diffuse white nodules on the liver surface and the peritoneum. After the small intestinal wall and peritoneal biopsy, histological examination revealed parenchymal tubercles containing several larvae of pentastomids and a large amount of inflammatory cell infiltration around them. The pathological diagnosis was parasitic granuloma from pentastomiasis infection

Lai, Can; Wang, Xi Qun; Lin, Long; Gao, De Chun; Zhang, Hong Xi; Zhang, Yi Ying; Zhou, Yin Bao [Zhejiang University School of Medicine, Zhejiang (China)

2010-08-15

99

[Contribution of nuclear magnetic resonance in right atrial angiosarcoma. Apropos of a case].  

Science.gov (United States)

A 25-year old female patient was admitted to hospital for respiratory failure with pulmonary miliary. Subsequently, clinical signs of pericardial tamponade developed. Echocardiography showed a tumour of the right atrium. Malignancy of the tumour was strongly suspected on the basis of magnetic resonance findings. At surgery, the tumour could not be removed and multiple biopsies showed that it was an angiosarcoma with metastases in the lymph nodes and the lungs, the latter presenting as carcinomatous miliary. This case is of interest because of the unusual way the tumour was discovered with a possible alternative diagnosis of cardiac tuberculoma, and because of the usefulness of magnetic resonance imaging to diagnose cardiac tumours and evaluate the extension of those which are malignant. PMID:3147645

Aouate, P; Artigou, J Y; Rovany, X; Orion, L; Salloum, J; Chomette, G; Grosgogeat, Y

1988-12-01

100

Tuberculosis and TNF-inhibitors: history of exposure should outweigh investigations.  

Science.gov (United States)

A 39-year-old Indian man was diagnosed with ulcerative colitis on colonic biopsy and started on mesalazine, prednisolone and azathioprine. However, the colitis remained active and required antitumour necrosis factor (TNF) treatment with infliximab. Prior to starting infliximab, his chest X-ray was normal and QuantiFERON interferon ? release assay for tuberculosis (TB) was negative. However, his wife had been treated for pulmonary TB 11 years previously when they were cohabiting. On attending for his third dose of infliximab, he was feverish and tachycardic, and was admitted for investigation. Chest X-ray on admission showed changes consistent with miliary TB, and thoracic CT confirmed extensive miliary nodules with supraclavicular and mediastinal lymphadenopathy. Abdominal CT showed multiple mesenteric lymph nodes. Subsequent bronchoalveolar lavage, neck lymph node aspirate and colonic biopsies all cultured Mycobacterium tuberculosis. In retrospect, a clear history of close household TB exposure should have precipitated consideration of TB chemoprophylaxis prior to anti-TNF treatment. PMID:24798354

Reichmann, Michaela T; Marshall, Ben G; Cummings, Fraser; Elkington, Paul T

2014-01-01

 
 
 
 
101

Magnetic resonance imaging in acute intractional tuberculosis  

International Nuclear Information System (INIS)

We reported three cases of acute intracranial tuberculosis including miliary tuberculosis, basal meningitis, tuberculomas and neuritis of cranial nerves. All patients had native and contrast enhanced CT and MRI scans. MRI revealed more granulomas and a better imaging contrast in the detection of basal meningitis. Neuritis was diagnosed only with the MRI. MRI scans should be prefered as the imaging procedure in clinically presumed intracranial tuberculosis. (orig.)

1994-01-01

102

Bubo masquerading as an incarcerated inguinal hernia.  

Science.gov (United States)

A 44-year old, male, tattooed, leather jacket clad, Harley-Davidson motorcyclist arrived at the emergency room with a tender, irreducible mass, presenting at the external inguinal ring. In 1998, lung biopsy was read as miliary granuloma. No herniation was found on urgent preperitoneal exploration. Incision of the mass showed acid-fast bacilli. Culture later revealed Mycobacterium avium-intracellulare (MAI). A blood count showed CD4 lymphopenia; HIV was negative and remains so 2 years later. PMID:11505657

Hodge, K R; Orgler, R J; Monson, T; Read, R C

2001-06-01

103

[Palpebral cryptococcosis: case report].  

Science.gov (United States)

This paper is about a patient with acquired immunodeficiency syndrome empirically treated for miliary tuberculosis. During the clinical evolution the patient presented lesions compromising the right eyelid and tarsal conjunctiva. The initial diagnostic hypothesis was ocular tuberculosis with conjunctival and eyelid involvement. The biopsy of the conjunctival lesion identified an encapsulated yeast-like fungus: Criptococcus neoformans. After starting treatment with B anfotericin, the cutaneus lesions cleared. PMID:16699682

Souza, Murilo Barreto; Melo, Carlos Sergio Nascimento; Silva, Cristiana Silveira; Santo, Ruth Miyuki; Matayoshi, Suzana

2006-01-01

104

Medullary carcinoma of the thyroid presenting as multifocal bronchial carcinoid tumour.  

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A 21 year old man presented with diarrhoea and flushing after meals and later developed miliary shadowing on his chest radiograph. Multifocal bronchial carcinoid tumour was diagnosed initially, but at necropsy metastatic medullary carcinoma of the thyroid was found. Multifocal bronchial carcinoid tumour should not be accepted as a primary diagnosis without first excluding medullary carcinoma of the thyroid because of the need to screen relatives of affected patients.

Clague, J. E.; Pearson, M. G.; Sharma, A.; Taylor, W.

1991-01-01

105

Adrenal function in patients with active tuberculosis.  

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Although tuberculosis is a recognised cause of adrenal insufficiency, little is known about adrenal function in patients with active tuberculosis. Ninety Melanesian adults with active tuberculosis (30 pulmonary, 30 miliary, 30 extrapulmonary) had adrenal function assessed prospectively before and three to four weeks after starting antituberculous chemotherapy. Basal serum cortisol concentrations were normal in 55 (61%) and raised in 35 (39%) of the subjects. No patient had a low basal cortiso...

Barnes, D. J.; Naraqi, S.; Temu, P.; Turtle, J. R.

1989-01-01

106

Acute renal failure after rifampicin Insuficiência renal aguda por rifampicina  

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A patient with miliary tuberculosis and a chronic urogenital focus is described, who had a borderline renal function at diagnosis and developed overt renal failure upon daily treatment with rifampin (RMP), isoniazid (INH) and ethambutol (EMB). This is the first Brazilian report of BMP induced renal damage. A renal biopsy taken on the third day of oliguria showed recent tubular necrosis with acute interstitial inflammation and granuloma formation. The aspect of the granulomatous lesion hightly...

Adriana Weinberg; Barone, A.; Saldanha, Luis B.; Mario Shiroma

1984-01-01

107

Isolated hepatic tuberculosis  

Directory of Open Access Journals (Sweden)

Full Text Available Hepatic tuberculosis is usually associated with an active pulmonary or miliary tuberculosis, but rarely localizes as a liver tumor mass. The clinical presentation of isolated liver tuberculosis is so rare and atypical that it challenges the clinical acumen of the treating physician. Diagnostic modalities like ultrasound and computed tomography can miss the diagnosis. Ultimately, the diagnosis is confirmed by demonstrating an acid fast Mycobacterium in aspirated pus or necrotic material.

Bangroo A

2005-01-01

108

Tuberculous abscess of the pancreas presenting as obstructive jaundice: a case report  

International Nuclear Information System (INIS)

Pancreatic tuberculosis is very rare, though dissemination to the gastrointestinal tract and mesenteric lymph nodes is common. We describe a case of pancreatic tuberculosis presenting as a cystic mass in the pancreatic head, with biliary obstruction, in a patient with miliary pulmonary tuberculosis. Surgery for the curative treatment of jaundice was performed, and the histopathologic findings indicated that a pancreatic abscess with caseous necrosis was present, consistent with tuberculosis

2002-06-01

109

Multiple intestinal perforations as a primary manifestation of abdominal tuberculosis in a HIV-infected patient  

Directory of Open Access Journals (Sweden)

Full Text Available Abdominal tuberculosis (TB is the sixth commonest extra-pulmonary TB form after lymphatic, genitourinary, bone and joint, miliary and meningeal tuberculosis. Perforation is a serious and uncommon complication of abdominal tuberculosis which can occur even during the treatment. A 30-year-old man was admitted with a three-day history of abdominal pain who had emergency surgery for multiple perforations of the distal ileum.

Amir Hossein Sarrami

2010-12-01

110

Combination therapy of disseminated coccidioidomycosis with caspofungin and fluconazole  

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Abstract Background The current recommended therapy for diffuse coccidioidal pneumonia involves initial treatment with amphotericin B deoxycholate or high-dose fluconazole, followed by an azole after clinical improvement. Amphotericin B is more frequently used as initial therapy if the patient's deterioration is rapid. Case presentation A 31-year-old Korean male with coccidioidomycosis presented to the hospital with miliary infiltrates on chest X-ray (CXR) and s...

Park Dae; Sohn Jang; Cheong Hee; Kim Woo; Ja Kim Min; Kim Je Hyeong; Shin Chol

2006-01-01

111

Chest X-rays and associated clinical parameters in pulmonary Tubercolosis cases from the National Tubercolosis Program, Mumbai, India  

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The study was carried out in pulmonary tuberculosis (PTB) patients from the local Tuberculosis control programme, Mumbai, India. It examined features of chest X-rays and their correlation with clinical parameters for possible application in suspected multidrug resistant TB (MDRTB) and to predict outcome in new and treatment failure PTB cases. X-ray features (infiltrate, cavitation, miliary shadows, pleural effusion, mediastinal lymphadenopathy and extent of lesions) were analyzed to identify ...

Dholakia, Yatin N.; Souza, Desiree T. B. D.; Tolani, Monica P.; Anirvan Chatterjee; Mistry, Nerges F.

2012-01-01

112

Hepatobiliary tuberculosis in western India  

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Tuberculous involvement of liver as a part of disseminated tuberculosis is seen in up to 50-80% cases, but localized hepatobiliary tuberculosis (HBTB) is uncommonly described. During 6 years, a total of 280 consecutive patients with TB were evaluated prospectively for the presence and etiology of liver involvement. Cases with miliary TB or immunosuppression and cases receiving anti-tuberculosis drugs prior to presentation to our unit were excluded (38 cases). Details of clinical, bioch...

Amarapurkar Deepak; Patel Nikhil; Amarapurkar Anjali

2008-01-01

113

FOLLICULITIS ET PERIFOLLICULITIS CAPITIS ABSCEDENS ET SUFFODIENS CONTROLLED WITH A COMBINATION THERAPY: SYSTEMIC ANTIBIOSIS (METRONIDAZOLE PLUS CLINDAMYCIN), DERMATOSURGICAL APPROACH, AND HIGH-DOSE ISOTRETINOIN  

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Folliculitis et perifolliculitis capitis abscedens et suffodiens is a rare disease of unknown etiology. It is a suppurative process that involves the scalp, eventually resulting in extensive scarring and irreversible alopecia. The condition is also known as ‘acne necrotica miliaris’ or ‘Proprionibacterium’ folliculitis. Most often the disease affects men of African-American or African-Caribbean descent between 20 and 40 years of age. The clinical picture is determined by fluctuating p...

Tchernev, Georgi

2011-01-01

114

Concomitant pulmonary tuberculosis and tuberculous appendicitis in a recipient of a renal transplant: a case report  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Introduction Tuberculosis is still a serious infection among recipients of renal transplants. Although the ileocecal region is the most affected part in intestinal tuberculosis, acute tuberculous appendicitis is quite a rare entity. We report a case of concomitant pulmonary tuberculosis and tuberculous appendicitis in a recipient of a renal transplant. Case presentation A 27-year-old Iranian woman, who had been the recipient of a renal transplant five years earlier, presented with a two-week history of coughing, fever and weight loss. The cause of her end-stage renal disease was chronic pyelonephritis. There were fine crackles noted during a chest examination, and a plain chest radiography showed fine miliary nodules throughout her entire lung fields. Sputum and bronchial aspirate examination was positive for acid-fast bacilli, suggestive of Mycobacterium tuberculosis infection. A chest computed tomography scan revealed widespread miliary nodules, compatible with miliary tuberculosis. She developed severe abdominal pain and abdominal surgery disclosed a perforated appendicitis. Histopathological examination of the resected appendix revealed widespread caseating epithelioid granulomas, suggestive of tuberculosis. Conclusion Our case report highlights a rare presentation of tuberculosis in a patient who has undergone renal transplant. Such unusual presentation of tuberculosis, particularly among patients receiving potent immunosuppressive protocols, should be considered by clinicians.

Ghabili Kamyar

2011-05-01

115

COMPARISON OF DIET AND USE OF BROMELIADS BETWEEN A BROMELICOLOUS AND A BROMELIGENOUS ANURAN AT AN INSELBERG IN THE SOUTHEASTERN OF BRAZIL / Comparación de la dieta y el uso de bromelias entre anuros en un afloramiento rocoso en el sudeste de Brasil  

Scientific Electronic Library Online (English)

Full Text Available SciELO Colombia | Language: English Abstract in spanish Se estudiaron los anuros que usan las rosetas de 60 bromelias del género Alcantharea, en un afloramiento rocoso del sudeste de Brasil. Se encontraron 153 larvas y 21 adultos de Scinax arduous, 30 adultos de Thoropa miliaris, y dos individuos de Scinax x-signatus, éstos últimos no se incluyeron en lo [...] s análisis. Las larvas de S. arduous se encontraron en el 35% de las plantas analizadas. Los adultos de S. arduous se presentaron en el 25% de las plantas estudiadas, mientras que los adultos de T. miliaris se encontraron en el 30% de las plantas. Aparentemente, la presencia de ventosas en las patas de S. arduous permite que los individuos de esta especie ocupen la porción central de las bromelias, en tanto que los individuos de T. miliaris, los que carecen de dichas ventosas en sus patas, ocupan las axilas inferiores de las hojas de las bromelias. El número de especies de anuros y la abundancia de individuos fue relativamente baja. Esto puede ser el resultado de la apreciable altitud del área estudiada o por las restricciones impuestas por el ambiente saxícola del área investigada, la cual se caracteriza por presentar elevadas temperaturas y baja humedad durante el día. Ambas especies pueden ser consideradas como consumidores generalistas. Los formícidos constituyeron la principal presa en número, aunque éstos no se registraron en las rosetas de las bromelias. Por su parte, los Blattodea fueron muy comunes dentro de las bromelias, los cuales representaron una presa más importante en peso para las dos especies de anuros. Se puede concluir que ambas especies de anuros forrajean en la parte interna como en la externa de las bromelias. El nicho trófico de S. arduous demostró ser más amplio. Aunque ambas especies de anuros son habitantes comunes del mismo ambiente, éstas presentan una marcada segregación espacial en las bromelias. No obstante, teniendo como base su dieta, las dos especies de anuros disputan territorio por fuera de las bromelias. Abstract in english Anurans from an inselberg in southeastern Brazil were studied using a sample of sixty tank bromeliads Alcantharea sp. We found 153 tadpoles of S. arduous, 21 adults of S. arduous, 30 adults of T. miliaris, and two individuals of Scinax x-signatus, which were not considered in our analyses. Tadpoles [...] of S. arduous were present in 35% of the analyzed plants. Adults of S. arduous (bromeligeneous) occurred in 25% of analyzed plants, while adults of T. miliaris (bromelicolous) occurred in 30%. Apparently the presence of toe pads in S. arduous allows them to occupy the center portion of bromeliads, while T. miliaris, which do not have pads on their toes, used the base of the plant axils for residency. The number of anuran species and the abundance of individuals found were low. This may be a result of the high altitude of our studied site or a restriction imposed by the saxicolous environment, such as high temperatures and low humidity during the day. Both species can be considered generalist feeders due to their wide variety of ingested prey. Formicidae was their main prey but was absent inside the bromeliads. Blattodea was very common inside the bromeliad axils and represented the most significant prey by weight in both frog species. We can conclude that both anurans forage inside and outside of bromeliads. The trophic niche breadth in S. arduous was larger than in T. miliaris. Even though both species are common inhabitants of the same environment, they demonstrated a marked spatial segregation in the bromeliads. Based on their diet, however, there may be disputes for territory outside of the bromeliads.

WESLEI, PERTEL; ROGÉRIO L., TEIXEIRA; RODRIGO B., FERREIRA.

2010-06-30

116

Impact of FDG PET in optimizing patient selection for cytoreductive surgery in recurrent ovarian cancer  

International Nuclear Information System (INIS)

To investigate the impact of PET and PET/CT scanning on decision-making in management planning and to identify the optimal setting for selecting candidates for surgery in suspicious recurrent ovarian cancer. A retrospective chart review was performed in patients with possible recurrent ovarian cancer after primary optimal cytoreduction and taxane/carboplatin chemotherapy who had undergone FDG PET or FDG PET/CT scans from July 2002 to August 2008 to help make treatment decisions. The analysis included 44 patients who had undergone a total of 89 PET scans. The positive PET scans were classified as follows. (1) localized (one or two localized sites of FDG uptake), (2) multiple (three or more sites of FDG uptake), (3) diffuse (extensive low-grade activity outlining serosal and peritoneal surfaces). Of the 89 PET scans, 52 (58.4 %) led to a change in management plan. The total number of patients in whom cytoreductive surgery was selected as the treatment of choice increased from 12 to 35. Miliary disseminated disease, which was not detected by PET scan, was found in 22.2 % of those receiving surgery. Miliary disseminated disease was detected in 6 of the 12 patients with recurrent disease whose treatment-free interval (TFI) was <12 months, whereas none of those with a TFI of ?12 months had such disease (P = 0.0031). PET or PET/CT is useful for selecting candidates for cytoreductive surgery among patients with recurrent ovarian cancer. To avoid surgical attempts in those with miliary dissemination, patients with a TFI of ?12 months are the best candidates for cytoreductive surgery. (orig.)

2014-03-01

117

Impact of FDG PET in optimizing patient selection for cytoreductive surgery in recurrent ovarian cancer  

Energy Technology Data Exchange (ETDEWEB)

To investigate the impact of PET and PET/CT scanning on decision-making in management planning and to identify the optimal setting for selecting candidates for surgery in suspicious recurrent ovarian cancer. A retrospective chart review was performed in patients with possible recurrent ovarian cancer after primary optimal cytoreduction and taxane/carboplatin chemotherapy who had undergone FDG PET or FDG PET/CT scans from July 2002 to August 2008 to help make treatment decisions. The analysis included 44 patients who had undergone a total of 89 PET scans. The positive PET scans were classified as follows. (1) localized (one or two localized sites of FDG uptake), (2) multiple (three or more sites of FDG uptake), (3) diffuse (extensive low-grade activity outlining serosal and peritoneal surfaces). Of the 89 PET scans, 52 (58.4 %) led to a change in management plan. The total number of patients in whom cytoreductive surgery was selected as the treatment of choice increased from 12 to 35. Miliary disseminated disease, which was not detected by PET scan, was found in 22.2 % of those receiving surgery. Miliary disseminated disease was detected in 6 of the 12 patients with recurrent disease whose treatment-free interval (TFI) was <12 months, whereas none of those with a TFI of ?12 months had such disease (P = 0.0031). PET or PET/CT is useful for selecting candidates for cytoreductive surgery among patients with recurrent ovarian cancer. To avoid surgical attempts in those with miliary dissemination, patients with a TFI of ?12 months are the best candidates for cytoreductive surgery. (orig.)

Ebina, Yasuhiko; Yamada, Hideto [Kobe University Graduate School of Medicine, Department of Obstetrics and Gynecology, Kobe (Japan); Watari, Hidemichi; Kaneuchi, Masanori; Takeda, Mahito; Hosaka, Masayoshi; Kudo, Masataka; Sakuragi, Noriaki [Hokkaido University Graduate School of Medicine, Department of Gynecology, Sapporo (Japan)

2014-03-15

118

Sensitivity of Ocean Reflectance Inversion Models for Identifying and Discriminating Between Phytoplankton Functional Groups  

Science.gov (United States)

The daily, synoptic images provided by satellite ocean color instruments provide viable data streams for observing changes in the biogeochemistrY of marine ecosystems. Ocean reflectance inversion models (ORMs) provide a common mechanism for inverting the "color" of the water observed a satellite into marine inherent optical properties (lOPs) through a combination of empiricism and radiative transfer theory. lOPs, namely the spectral absorption and scattering characteristics of ocean water and its dissolved and particulate constituents, describe the contents of the upper ocean, information critical for furthering scientific understanding of biogeochemical oceanic processes. Many recent studies inferred marine particle sizes and discriminated between phytoplankton functional groups using remotely-sensed lOPs. While all demonstrated the viability of their approaches, few described the vertical distributions of the water column constituents under consideration and, thus, failed to report the biophysical conditions under which their model performed (e.g., the depth and thickness of the phytoplankton bloom(s)). We developed an ORM to remotely identifY Noctiluca miliaris and other phytoplankton functional types using satellite ocean color data records collected in the northern Arabian Sea. Here, we present results from analyses designed to evaluate the applicability and sensitivity of the ORM to varied biophysical conditions. Specifically, we: (1) synthesized a series of vertical profiles of spectral inherent optical properties that represent a wide variety of bio-optical conditions for the northern Arabian Sea under aN Miliaris bloom; (2) generated spectral remote-sensing reflectances from these profiles using Hydrolight; and, (3) applied the ORM to the synthesized reflectances to estimate the relative concentrations of diatoms and N Miliaris for each example. By comparing the estimates from the inversion model to those from synthesized vertical profiles, we were able to identifY those bio-optical conditions under which the inversion model performs both well and poorly.

Werdell, P. Jeremy; Ooesler, Collin S.

2012-01-01

119

Epidemiology of dermatophytosis in patients referred to the medical mycology laboratory of Afzalipoor Faculty of Medicine in Kerman in 2007-2011  

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Full Text Available Background and Aim: Dermatophytes are keratinophilic fungi that cause infection in the skin, hair and nails. Dermatophytic infections are one of the important health problems in the world that related to social and economic life of communities.Methods: This cross-sectional study was conducted on all suspected patients in the medical mycology laboratory of Afzalipoor Faculty in Kerman from March 2007 to March 2011. For each patient after obtaining the detailed history, direct smear, staining and culture on specific media were performed.Results: Out of 1800 referred cases, 166 patients were positive for dermatophytosis. The highest prevalence of infection was in the under 10 years old (28.31%, men and women were also involved equally. The most common agents of the cutaneous infection were Trichophyton mentagrophytes (45.78% and T. verrucosum (18.1%. The most common infections were tinea manuum (35.54%, tinea capitis (16.87, and the least common one was tinea faciei (4.82%.Conclusion: It is necessary to increase the level of community health in order to prevent this dermatophytosis.

Seyed Amin Ayetollahi Mosavi

2012-06-01

120

Trichophyton species of Arthroderma benhamiae - a new infectious agent in dermatology.  

Science.gov (United States)

In Germany, infections due to the zoophilic dermatophyte Trichophyton (T.) species of Arthroderma benhamiae are being more frequently diagnosed. The source of infection of this emerging pathogen overlaps with that of the zoophilic species T. interdigitale. The most common source are guinea pigs. T. species of Arthroderma benhamiae causes inflammatory dermatophytosis in children and adolescents. In addition to tinea capitis, it may cause both tinea corporis, tinea manus and frequently tinea faciei. In Germany, T. species of Arthroderma benhamiae is a frequent zoophilic dermatophyte, which in regions is probably more frequent than Microsporum canis. The mycological identification of the isolates with their yellow stained colonies is based on their macroscopic and microscopic features. However, some exhibit colony features consistent with those of T. interdigitale. These strains only can be identified unambiguously by means of molecular techniques. Using detection methods such as PCR-ELISA or real-time PCR, the dermatophyte can be identified directly from clinical material. Sequencing of the internal transcribed spacer region (ITS) of the ribosomal DNA has been approved as culture confirmation test for T. species of Arthroderma benhamiae. In addition, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI TOF MS) is useful. Widespread dermatophytosis due to T. species of Arthroderma benhamiae, in particular of tinea capitis, requires oral antifungal agents. Terbinafine is most effective, alternatives are fluconazole and itraconazole. PMID:24981469

Nenoff, Pietro; Uhrlaß, Silke; Krüger, Constanze; Erhard, Marcel; Hipler, Uta-Christina; Seyfarth, Florian; Herrmann, Jürgen; Wetzig, Tino; Schroedl, Wieland; Gräser, Yvonne

2014-07-01

 
 
 
 
121

Effects of pyrethroid insecticides on subjects engaged in packaging pyrethroids.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

A health survey was conducted on 199 workers engaged in dividing and packaging pyrethroids. The subjects were exposed to fenvalerate at 0.012-0.055 mg/m3 and deltamethrin at 0.005-0.012 mg/m3 in the air with simultaneous skin contact for 0.5-4.5 months. Burning sensations and tightness or numbness on the face appeared in two thirds of the subjects and one third had sniffs and sneezes. Abnormal facial sensations, dizziness, fatigue, and miliary red papules on the skin were more evident in summ...

He, F.; Sun, J.; Han, K.; Wu, Y.; Yao, P.; Wang, S.; Liu, L.

1988-01-01

122

CT appearances of abdominal tuberculosis  

Energy Technology Data Exchange (ETDEWEB)

The purpose of this article is to review and illustrate the spectrum of computed tomography (CT) appearances of abdominal tuberculosis. Tuberculosis can affect any organ or tissue in the abdomen, and can be mistaken for other inflammatory or neoplastic conditions. The most common sites of tuberculosis in the abdomen include lymph nodes, genitourinary tract, peritoneal cavity and gastrointestinal tract. The liver, spleen, biliary tract, pancreas and adrenals are rarely affected, but are more likely in HIV-seropositive patients and in miliary tuberculosis. This article should alert the radiologist to consider abdominal tuberculosis in the correct clinical setting to ensure timely diagnosis and enable appropriate treatment.

Lee, W.-K., E-mail: leewk33@hotmail.com [Department of Medical Imaging, St Vincent' s Hospital, University of Melbourne, Fitzroy, Victoria (Australia); Van Tonder, F.; Tartaglia, C.J.; Dagia, C. [Department of Medical Imaging, St Vincent' s Hospital, University of Melbourne, Fitzroy, Victoria (Australia); Cazzato, R.L. [Department of Radiology, Universita Campus Bio-Medico di Roma, Rome (Italy); Duddalwar, V.A. [Department of Radiology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California (United States); Chang, S.D. [Department of Medical Imaging, Vancouver General Hospital, University of British Columbia, British Columbia (Canada)

2012-06-15

123

Perinatal tuberculosis: two unusual cases.  

Science.gov (United States)

Two immunocompromised infants with perinatal tuberculosis are reported. Both presented with bilateral miliary mottling of the lungs. The first was a 4-month-old boy with a history of prolonged administration of prednisolone. He had tuberculous meningitis. Diagnosis was confirmed by PCR in serum and CSF. His mother had tuberculous endometritis. The second was a 1-month-old boy with perinatal HIV infection. Diagnosis was made by PCR in serum. Both parents were HIV-infected and had open pulmonary tuberculosis. PMID:21262114

Basu, S; Kumar, A; Das, B K

2011-01-01

124

CT and high resolution CT in diagnosis of pulmonary complications of bone marrow transplants  

International Nuclear Information System (INIS)

The aim of this prospective study was to compare conventional and high resolution CT for demonstrating pulmonary complications. 23 patients treated by bone marrow transplantation were included in the study between December 1990 and August 1991. These patients were examined radiologically at regular intervals following the transplants. In 9 patients lung changes were detected by CT: There were pneumonic infiltrates, including one CMV pneumonia, two cases of mild parenchymal fibrosis, two cases of extensive lung fibrosis and one of miliary tuberculosis. The advantages and disadvantages of conventional and high resolution techniques are discussed in relation to our findings. (orig.)

1994-04-01

125

Tuberculous Pseudoaneurysm of the Descending Thoracic Aorta from Tuberculous Aortitis: CT Findings and Treatment with an Endovascular Stent Graft  

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Tuberculous pseudoaneurysms of the aorta are rare entities that have been reported as fatal complications requiring early diagnosis and treatment. Here, we describe a case of a tuberculous pseudoaneurysm of the descending thoracic aorta in a patient with miliary tuberculosis. The computed tomography findings of a tuberculous pseudoaneurysm and outcomes of treatment with endovascular stent graft are described. Tuberculous pseudoaneurysms of the descending thoracic aorta were treated with endovascular stent graft. However, perigraft recurrence of tuberculosis after cessation of antituberculous drugs led to surgical treatment.

Yoon, Ji Younbg; Lee, In Jae; Jeon, Eui Yong; Kim, Min Jeong; Lee, Kwan Seop; Lee, Yul [Dept. of Radiology, Hallym University College of Medicine, Chuncheon (Korea, Republic of)

2011-12-15

126

Tuberculous Pseudoaneurysm of the Descending Thoracic Aorta from Tuberculous Aortitis: CT Findings and Treatment with an Endovascular Stent Graft  

International Nuclear Information System (INIS)

Tuberculous pseudoaneurysms of the aorta are rare entities that have been reported as fatal complications requiring early diagnosis and treatment. Here, we describe a case of a tuberculous pseudoaneurysm of the descending thoracic aorta in a patient with miliary tuberculosis. The computed tomography findings of a tuberculous pseudoaneurysm and outcomes of treatment with endovascular stent graft are described. Tuberculous pseudoaneurysms of the descending thoracic aorta were treated with endovascular stent graft. However, perigraft recurrence of tuberculosis after cessation of antituberculous drugs led to surgical treatment.

2011-12-01

127

Fever of unknown origin in a Swiss-born child: don’t miss tuberculosis!  

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Full Text Available Tuberculosis incidence is low in Switzer land. We report here on a Swiss-born toddler. Tuberculosis manifested with a fever of unknown origin, mimicking an inflammatory or autoimmune disorder triggering a high dose of corticosteroid treatment. The disease went unrecognized for several weeks until development of a miliary tuberculosis with advanced central nervous system involvement. This case highlights the difficulties encountered in diagnosing tuberculosis and in identifying the origin of this case. It reminds us that this disease must never be forgotten when facing a child with persistent fever who must be screened for, before starting immunosuppressive therapy.

Katia Jaton

2012-01-01

128

Fever of unknown origin in a Swiss-born child: don’t miss tuberculosis!  

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Full Text Available Tuberculosis incidence is low in Switzer land. We report here on a Swiss-born toddler. Tuberculosis manifested with a fever of unknown origin, mimicking an inflammatory or autoimmune disorder triggering a high dose of corticosteroid treatment. The disease went unrecognized for several weeks until development of a miliary tuberculosis with advanced central nervous system involvement. This case highlights the difficulties encountered in diagnosing tuberculosis and in identifying the origin of this case. It reminds us that this disease must never be forgotten when facing a child with persistent fever who must be screened for, before starting immunosuppressive therapy.

Marie-Helene Perez

2012-03-01

129

Gliomatosis peritonei: a report of two cases and review of the literature.  

Science.gov (United States)

Gliomatosis peritonei is the implantation of miliary glial tissue within the peritoneal cavity of patients with ovarian teratomas. Up to now 86 cases of this rare entity have been reported. In addition to the small number of reported gliomatosis peritonei cases, a condition easily mistaken for peritoneal carcinomatosis, we report two further cases, one combined with endometriosis (fifth case published until now) and one without endometriosis. Both cases were followed up for more than 5.5 years. Thus, further data concerning biological behaviour and prognosis of this rare entity are made available. In addition, a review of all cases published until today is provided, thus summarising the data presently known. PMID:11750968

Müller, Annette M; Söndgen, Doris; Strunz, Reinhard; Müller, Klaus Michael

2002-01-10

130

Resolution without treatment of granulomatous pneumonitis due to intravesical BCG for bladder cancer.  

Science.gov (United States)

Granulomatous pneumonitis is a well-recognised complication of intravesical BCG therapy. The mechanism is sometimes thought to be 'hypersensitivity' rather than infection as in most cases mycobacteria are not cultured. Despite this it is usually treated with antituberculous chemotherapy with or without corticosteroid. We describe a case of bladder cancer treated with intravesical BCG followed by a febrile illness and malaise lasting for months and the development of miliary pulmonary shadowing, which markedly improved in around 1 year without any treatment. The clinical syndrome was less severe than some others described but this case provides evidence that, at least in some cases, no specific treatment may be necessary. PMID:24792029

Venn, Robert Michael; Sharma, Neel

2014-01-01

131

Obstructive jaundice: a manifestation of pancreatic tuberculosis.  

Science.gov (United States)

Tuberculosis of the pancreas is extremely rare and is most often associated with miliary tuberculosis or occurs in the immunocompromised patients. A case of isolated pancreatic tuberculosis in an immunocompetent patient is presented with constitutional symptoms and obstructive jaundice. Ultrasonography and computerised tomography showed a mass lesion in the head of pancreas. Histological examination of the peripancreatic lymph node and fine needle aspiration cytology from the head of pancreas confirmed the diagnosis following laparotomy. Patient recovered following the administration of antituberculosis chemotherapy. PMID:17824465

Pandya, Garvi; Dixit, Ramakant; Shelat, Vishal; Dixit, Kalpana; Shah, Nalin; Shah, Kusum

2007-03-01

132

Disseminated tuberculomas in spinal cord and brain demonstrated by MRI with gadolinium-DTPA  

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Intramedullary tuberculoma is rare, and there has been no report of concurrent intramedullary and intracerebral tuberculomas. We report a 30-year-old man with miliary tuberculosis of the lung. He suffered sudden paraplegia due to tuberculomas in the thoracic spinal cord and MRI showed more tuberculomas in the cervical spinal cord, brain stem, and cerebral and cerebellar hemispheres. The tuberculomas were isointense on the T1-weighted images, and hyperintense on the T2-weighted images; there was marked enhancement with intravenous gadolinium-DTPA. All the tuberculomas were very small 1 year after antituberculous chemotherapy. (orig.)

Shen, W.C. (Dept. of Radiology, Taichung Veterans General Hospital (Taiwan, Province of China)); Cheng, T.Y. (Section of Neurology, Dept. of Internal Medicine, Taichung Veterans General Hospital (Taiwan, Province of China)); Lee, S.K. (Dept. of Radiology, Taichung Veterans General Hospital (Taiwan, Province of China)); Ho, Y.J. (Dept. of Radiology, Taichung Veterans General Hospital (Taiwan, Province of China)); Lee, K.R. (Inst. of Life Science, National Tsing-Hua Univ. (Taiwan, Province of China))

1993-03-01

133

Clinical/usefulness of gallium-67 lung scan in diffuse interstitial lung diseases of various etiology  

International Nuclear Information System (INIS)

Gallium-67 lung scan was performed in fourty four patients with diffuse interstitial lung diseases of various etiology to investigate clinical usefulness of this examination. The series included cryptogenic fibrosing alveolitis (13), pneumonitis due to collagen disease (5), sarcoidosis (4), hypersensitivity pneumonitis (4), lymphangitis carcinomatosa (4), drug-induced pneumonitis (4), pneumoconiosis (3), miliary tuberculosis (2), eosinophylic granuloma (1) and others (4). In twenty five cases pathologic findings of specimens obtained by transbronchial lung biopsy were compared with gallium scan findings. Diffuse lung diseases characterized by granuloma formation such as hypersensitivity pneumonitis, sarcoidosis and miliary tuberculosis were associated with prominent 67Ga accumulation. All patients with lymphangitis carcinomatosa showed abnormal 67Ga scan. In nine out of thirteen patients with cryptogenic fibrosing alveolitis 67Ga accumulation was observed in the lung region where, roentgenologically, micronodular or ground-glass shadow was present. On the other hand, the lung region with honeycomb appearance was not associated with 67Ga accumulation. There was no close correlation between pathologic findings and Ga-study in general, however, most of the cases whose specimens had inflammatory cells more than grade +2 showed abnormal Ga-study. The follow-up study of the scan was useful for the assesment of the effect of therapy. (author)

1978-01-01

134

HRCT findings of disseminated small nodular shadow in plain chest x-ray  

International Nuclear Information System (INIS)

High Resolution Computed Tomography (HRCT) was done in 22 cases of disseminated small nodular shadow from plain chest X-ray, which was included in metastatic lesion, Miliary tuberculosis, pneumoconiosis etc. and following results were obtained. Most of metastatic nodule (n=8) showed more than 1.5mm in diameter and the margin of nodule was discrete (n=8) and many cases (n=8) were associated with thickened bronchovascular sheath or interlobular septum and hilar and mediastinal lymphnode enlargement (n=6). One case turned out to be not true nodule in HRCT but revealed thickened interlobular septum and bronchovascular bundles. All cases of miliary tuberculosis (n=8) showed even sized, well marginate and less than 3mm in diameter of nodule without evidence of thickening of bronchovascular bundle or interlobular septum. Ease cases of pneumoconiosis, histiocytosis X, diffuse panbronchiolitis (DPB) showed ill defined nodule and associate finding of DPB was peripheral bronchioloectasis. HRCT is useful method to exact evaluation of nodular lesion and find out associate findings for differential diagnosis of disseminate small nodular shadow in plain chest X-rays

1990-10-01

135

Evaluation of three-dimensional distribution of foci of diffuse lung diseases with computed tomography  

Energy Technology Data Exchange (ETDEWEB)

Three-dimensional distribution of foci of diffuse lung disease was evaluated by CT image, and it was examined whether each lung disease could be diagnosed by different distribution. Subjects were 120 cases (idiopathic interstitial pneumonia 15 cases, sarcoidosis 23 cases, miliary tuberculosis 10 cases, diffuse panbronchiolitis 7 cases, chronic pulmonary emphysema 6 cases, pulmonary metastasis 9 cases, SLE 6 cases, PSS 8 cases, dermatomyositis (DM) 6 cases, RA 7 cases, SjS 9 cases and others 14 cases). CT image was obtained from apex to base of lung with 10 mm gapless. The image was divided into three parts in both head-tail direction and back-front direction, and two parts in cortex medulla direction, and the ratio of foci to whole in each part was evaluated in five phases, and the part with the highest ratio was determined as the predominant side. In idiopathic interstitial pneumonia, sarcoidosis, miliary tuberculosis, diffuse panbronchiolitis, chronic pulmonary emphysema, pulmonary metastasis, PSS and DM, the predominant side was confirmed, respectively, and usefulness of differential diagnosis was recognized. Constant distribution wasn't recognized in SLE, RA and SjS, because the state of disease was not always same in the foci of these diseases. (K.H.)

Niwa, Masamitsu [Nagoya City Univ. (Japan). Medical School

1998-11-01

136

Ultrasonic diagnosis of hepatic metastases in patients with stomach cancer and colon cancer  

International Nuclear Information System (INIS)

To assess the value of hepatic ultrasound in cancer patients, a prospective evaluation was performed by comparing the preoperative ultrasound report and surgeon's diagnosis at the time of operation in 86 patients with stomach cancer and 26 patients with colon cancer. In a total of 112 patients considered to have a metastasis free liver on ultrasound scanning 10 patients were turned out to have had hepatic metastasis at the time of laparotomy. Among these, 4 patients had miliary metastasis, 4 patients had nodular metastasis at the dome of the right hepatic lobe, and 2 patients had surface metastasis or direct invasion from the primary tumor. These observations suggest that false negative preoperative hepatic ultrasound scanning is 9% had this is considered due to small size of the metastatic lesions, and lesions roundabout the dome of the right hepatic lobe or surface metastasis. Thus one should keep in mind the possibility of miliary metastasis in cancer patient was has coarse hepatic echotexture. In addition, the hepatic dome as well as hepatic surfaces should be searched carefully as the lesions in these areas tend to be easily neglected by ultrasound

1987-10-01

137

Radiographic study of soft tissue calcification in the oral and maxillofacial area  

International Nuclear Information System (INIS)

The radiographic findings of soft tissue calcification in the oral and maxillofacial area was analysed using panoramic, skull P-A and intraoral radiographs in 250 patients. The following results were obtained; 1. Salivary stone had the highest rate of occurrence at 46% (116 cases), followed by lymph node calcification (97 cases), phlebolith (21 cases), multiple miliary osteoma (15 cases), antrolith (1 case), vessel calcification (1 case) and cysticercosis (1 case). 2. The prevalence of salivary stone was slightly higher in females, on the right side and in the middle-aged group and was especially higher in the submandibular gland (83%). The majority of them were round-shaped, homogeneously radiopaque and associated with sialodochitis. 3. The prevalence of lymph node calcification was higher in the female and old-aged group. Irregular shape and radiopaque bodies were seen in the cervical area, bilaterally. 4. The prevalence of phlebolith was slightly higher in the male, and the third decade group. The radiopaque bodies were 4-8 mm in diameter and had laminated appearance. 5. The prevalence of multiple miliary osteoma was higher in old-aged females. The numerous doughnut-shaped radiopaque bodies, sized 2-4 mm in diameter, were seen bilaterally in the cheek and were usually associated with the edentulous ridge.

1995-02-01

138

Snakes from coastal islands of State of São Paulo, Southeastern Brazil / Serpentes das ilhas costeiras do Estado de São Paulo, Sudeste do Brasil  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese Há poucos estudos sobre a fauna de serpentes em ilhas costeiras do Estado de São Paulo, Sudeste do Brasil e um baixo número de espécies depositadas em coleções zoológicas. No Brasil, pela primeira vez, foi realizado um inventário em 18 ilhas do litoral paulista a partir de pesquisa de registros nas [...] coleções herpetológicas do Sudeste do Brasil. Também foram realizadas coletas de campo em onze ilhas. Trinta e seis espécies de quatro famílias foram registradas: uma espécie de Boidae, trinta de Colubridae, uma de Elapidae e quatro de Viperidae. Os dados de campo apresentaram treze ocorrências novas de espécies sem registro nas coleções. Para estimar a raridade das espécies utilizaram-se categorias de abundância relativa: comum, não-freqüente e rara. Das espécies amostradas, 44,4% foram consideradas raras. As espécies mais comuns foram Micrurus corallinus, presente em doze ilhas; Bothrops jararaca e Liophis miliaris, presentes em onze ilhas, B. jararacussu e Chironius bicarinatus, presentes em 10 ilhas. Foram efetuados sete novos registros para a Ilha do Cardoso (25° 05? S e 47° 59? W): C. bicarinatus, C. multiventris, Dipsas petersi, Echinanthera bilineata, E. cephalostriata, Helicops carinicaudus e Xenodon neuwiedii; três para Ilha Comprida (24° 54? S e 47° 48? W): B. jararacussu, C. bicarinatus e H. carinicaudus; um para Ilha Anchieta (23° 32? S e 45° 03? W): Spilotes pullatus; um para a Ilha das Couves (23° 25? S e 44° 52? W): L. miliaris; um para a Ilha dos Porcos (23° 23? S e 44° 54? W): B. jararaca. B. alcatraz e B. insularis, endêmicos à Ilha de Alcatrazes e à Ilha da Queimada Grande, respectivamente, são considerados criticamente em perigo segundo IUCN. Foi registrada a extinção da fauna de serpentes na Ilha Monte de Trigo. Os ecossistemas insulares, mais vulneráveis que os continentais, carecem de uma proteção mais efetiva. A maioria destas espécies (cerca de 52%) preda anfíbios, reforçando a necessidade de conservação das florestas. Abstract in english There are relatively few studies on snake fauna from coastal islands of the State of São Paulo (SSP), Southeastern Brazil and the number of species housed in Brazilian institutional zoological collections is relatively limited. In Brazil, for the first time, a snake inventory for eighteen islands of [...] coastal SSP is presented. Here we record data from sampling on eleven islands as well information on vouchered species in the main herpetological collections. Thirty-six species from four families: one Boidae, thirty Colubridae, one Elapidae and four Viperidae from eighteen islands are listed as well as the thirteen new island records for snakes. Relative abundance categories were used for species rarity: common, infrequent and rare; 44.4% of the snakes with voucher specimens were considered rare. The most common species in twelve of the eighteen islands was Micrurus corallinus; in eleven of the eighteen islands were Bothrops jararaca and Liophis miliaris; in ten of the eighteen islands were B. jararacussu and Chironius bicarinatus. The most common snake species on coastal islands were Micrurus corallinus which was found in twelve of the eighteen islands, followed by Bothrops jararaca and Liophis miliaris found on eleven of the eighteen islands and B. jararacussu and Chironius bicarinatus which were found in ten of the eighteen islands studied. There are seven new records of snake species for Cardoso Island (25° 05? S and 047° 59? W): C. bicarinatus, C. multiventris, Dipsas petersi, Echinanthera bilineata, E. cephalostriata, Helicops carinicaudus and Xenodon neuwiedii; three new records for Comprida Island (24° 54? S and 47° 48? W): B. jararacussu, C. bicarinatus and H. carinicaudus; one for Anchieta Island (23° 32? S and 045° 03? W): Spilotes pullatus; one for Couves Island (23° 25? S and 44° 52? W): L. miliaris; one for Porcos Island (23° 23? S and 44° 54? W), B. jararaca. The endemic species B. alcatra

Cicchi, Paulo José Pyles; Sena, Marco Aurélio de; Peccinini-Seale, Denise Maria; Duarte, Marcelo Ribeiro.

139

Epidemiological survey of dermatophytosis in Tehran, Iran, from 2000 to 2005  

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Full Text Available Background: Cutaneous fungal infections are common in Tehran, Iran, and causative organisms include dermatophytes, yeasts and non-dermatophyte molds. The prevalence of superficial mycosis infections has risen to such a level that skin mycoses now affect more than 20-25% of the world?s population, making them the most frequent form of infection. Aims: Our aim was to determine the prevalence of superficial cutaneous fungal infections especially dermatophytosis in our Medical Mycology Laboratory in the Pasteur Institute of Iran, Tehran. Methods: A total of 17,573 specimens were collected from clinically suspected tinea corporis, tinea cruris, tinea capitis, tinea faciei, tinea pedis, tinea manuum and finger and toe onychomycosis from 2000 to 2005. Patients were referred to our laboratory for direct examination, fungal culture and identification. The incidence of each species was thus calculated. Results: Dermatophytes remain the most commonly isolated fungal organisms, except from clinically suspected finger onychomycosis, in which case Candida species comprise> 7% of the isolates. Epidermophyton floccosum remains the most prevalent fungal pathogen and increased incidence of this species was observed in tinea cruris. Trichophyton tonsurans continues to increase in incidence. Conclusion: This study identifies the epidemiologic trends and the predominant organisms causing dermatophytosis in Tehran, Iran. These data can be used to ascertain the past and present trends in incidence, predict the adequacy of our current pharmacologic repertoire and provide insight into future developments. Consideration of the current epidemiologic trends in the incidence of cutaneous fungal pathogens is of key importance to investigational effort, diagnosis and treatment.

Bassiri-Jahromi Shahindokht

2009-01-01

140

A Molecular Epidemiological Survey of Clinically Important Dermatophytes in Iran Based on Specific RFLP Profiles of Beta-tubulin Gene  

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Full Text Available Background: Surveillance of dermatophytosis is essential to determine the likely changes in etiological trends and distribution profile of this infection. In this study beta tubulin gene (BT2, was used as the first time in a PCR-RFLP format to clarify the distribution of dermatophytosis agents in some parts of Iran.Methods: A total of 603 clinical isolates was obtained from 500 patients in Tehran, Isfahan, Mazandaran and Guilan provinces. The isolates were identified using macro/micro-morphological criteria and electrophoretic patterns of PCR amplicons of BT2after digestion with each of the restriction enzymes FatI, HpyCH4V, MwoI and Alw21I.Results: Among the patients, 59.2% were male and 40.8% female. The most prevalent clinical form was tinea pedis (42.4%, followed by tinea cruris (24.2%, tinea unguium (12.3%, tinea corporis (10.8%, tinea faciei (4%, tinea manuum (3.14%, tinea capitis (3% and tinea barbae (0.16%, respectively. Trichophyton interdigitale ranked the first, followed by T. rubrum, Epidermophyton floccosum, Microsporum canis, T. tonsurans, T. erinacei and T. violaceum (each 0.49% and the less frequent species were T. schoenleinii, M. gypseum and T. anamorph of Arthroderma benhamiae (each 0.16%. A case of scalp infection by E. floccosum was an exceptional event in the study. No case of T. verrucosum was found.Conclusion: Trichophyton species and E. floccosum are yet the predominant agents of infection in Iran, while Microsporum species are decreasing. T. interdigitale and Tinea pedis remain as the most causal agent and clinical form of dermatophytosis, respectively. It seems that BT2 can be a useful genetic marker for epidemiological survey of common pathogenic dermatophytes.

Mahdi Abastabar

2013-09-01

 
 
 
 
141

Indications, diagnostic yields and complications of transbronchial biopsy over 5 years in the State of Qatar  

International Nuclear Information System (INIS)

To review the indications, diagnostic yields and complications of transbronchial biopsy (TBB) in a tertiary hospital in the State of Qatar. A retrospective review of our records revealed 1006 adult flexible fibre optic bronchoscopies (FFB) at Hamad General Hospital, State of Qatar between January 1999 and December 2003. A total of 85 (8.4%) TBB were performed, but complete data were available for 71/85 (83.5%), which were reviewed for indications, diagnostic yields and complications. Adequate samples were obtained in 58/71 TBBs (81.7%), while 13/71 TBBs (18.3%) yielded mucosa. The main indications in 16/71 (22.5%) TBBs for radiographic localized pulmonary diseases were to rule out (TB) in 13 cases, and malignancy in 3 cases. Tuberculosis was verified in 3 (23%) of 13 cases with localized disease. 45 out of 71 (77.5%) TBBs were performed for radiographic diffuse pulmonary disease: 16/55 (29%) for miliary shadows, while 39/55 (70.9%) were carried out for reticular /reticulonodular infiltrates. Histopathology showed granulomatous lesions consistent with TB in 10/16 (62.5%) cases of miliary shadow. In other pattern of diffuse disease, the histopathological diagnosis were obtained in 25/39 (64%) cases. It showed non-specific pulmonary fibrosis in 13 cases, sarcoidosis in 4 cases, connective tissue disease associated interstitial fibrosis in 4 cases, bronchiolitis obliterans organizing pneumonia (BOOP) in one case, eosinophilic pneumonia in one case, amiodarone toxicity in one case and lymphangitis carcinomatosis in one case. The main complications were minor bleeding <50 cc in 17 cases (23.9%) pneumothorax in 7 cases (9.8%) and one case has sepsis. Our experience substantiates previous reports of the value and safety of transbronchial biopsy in rapid diagnosis smear-negative miliary TB. In diffuse lung diseases of a non-infectious nature, other than sarcoidosis, lymphangitis carcinomatosis and few other conditions, a pathological diagnosis are much less likely to be reliably made on small pieces of tissue such as those provided by TBB . (author)

2005-01-01

142

Two Polynomial-Time Algorithms for Dual Scheduling Problems  

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Full Text Available Scheduling problems with mutiple objectives play increasing important roles in solving complicated problems apparing in the fields of economy, management , engineering, miliary affairs and society etc. In this paper, we give two polynomial-time algorithms when all tardy jobs are given for the two binary NP-hard problems 1 **and **. For the problem 1 **, schedule job k last , where **, and ** is the set of jobs which are not tardy even when processed last , L is set of tardy jobs; For the problem 1 **, schedule job k last , where ** if M is empt; else choose any job in M. In the end, we give prooves of the schedule which got from the polynomial-time algorithm is an optimal solution for the scheduling problemwith weighted agreeable condition respretively.(* Indicates a formula, please see the full text

TANG Guo-chun

2010-03-01

143

The snake community of Serra do Mendanha, in Rio de Janeiro State, southeastern Brazil: composition, abundance, richness and diversity in areas with different conservation degrees / A comunidade de serpentes da Serra do Mendanha, Estado do Rio de Janeiro, Sudeste do Brasil: composição, abundância, riqueza e diversidade em áreas com diferentes graus de conservação  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese Estudamos e comparamos parâmetros da comunidade de serpentes da Serra do Mendanha, Estado do Rio de Janeiro, Brasil (22º 48'-22º 51' S e 43º 28'-43º 31' W), tais como: distribuição de abundância, riqueza e diversidade de espécies e biomassa total, entre áreas florestadas, áreas em regeneração e área [...] s agrícolas (bananais); para obter informações sobre a história natural e facilitar o desenvolvimento de futuros estudos. Para a captura dos animais foram usadas armadilhas de queda (pitfalls) com cercas-guia e procura visual (diurna e noturna) ao longo de quatro transectos por ambiente. As serpentes capturadas foram identificadas, medidas com trena e paquímetro, pesadas com dinamômetro e sexadas com uso de cateter. Um exemplar por espécie foi fixado e depositado como material testemunho no Museu Nacional, Rio de Janeiro. Os demais indivíduos coletados foram marcados (com corte de escamas ventrais) e soltos. Empreendemos um esforço de cerca de 840 h/homem, resultando na captura de 207 serpentes pertencentes a 25 espécies (Colubridae 80,2%, Elapidae 12,6%, Viperidae 6,3% e Boidae 0,9%). As três espécies mais abundantes foram Liophis miliaris (n = 33), Micrurus corallinus e Chironius fuscus (ambas com n = 26), sendo as três menos abundantes Elapomorphus quinquelineatus, Siphlophis compressus e Tropidodryas serra (todas com n = 1). Contribuíram com a maior biomassa Spilotes pullatus (7.925 g), Chironius laevicollis (4.694 g), Liophis miliaris (3.675 g) e Pseustes sulphureus (3.050 g). As que menos contribuíram foram Siphlophis compressus, Tropidodryas serra (ambas com 4 g) e Elapomorphus quinquelineatus (3 g). Encontramos diferenças significativas nos parâmetros estudados entre os três tipos de ambientes amostrados na Serra do Mendanha (mata pouco perturbada, mata secundária e monocultura de bananeiras). Os resultados indicaram uma acentuada redução na abundância, riqueza, diversidade e biomassa de serpentes quando a floresta nativa é substituída pela monocultura de bananeiras. Abstract in english We studied and compared parameters of the snake community of the Serra do Mendanha, Rio de Janeiro State, southeastern Brazil (22º 48'-22º 51' S and 43º 31'-43º 28' W), such as: abundance distribution, richness, species diversity and biomass, between forested areas, areas under regeneration and agri [...] culture areas (banana plantations); to obtain information about the natural history and facilitate the development of future research. For capturing the snakes we used: pitfall traps, drift-fences and visual search (diurnal and nocturnal) along four transects for each habitat. The captured snakes were measured with a tape and caliper, weighed with dynamometers and sexed with the use of a catheter. The animals marked (with ventral scales cut) were released for posterior recapture. One individual per species was fixed and deposited at the Museu Nacional, Rio de Janeiro. We undertook an effort of 840 man/hour, and captured a total of 207 snakes belonging to 25 species (Colubridae 80.2%, Elapidae 12.6%, Viperidae 6.3% and Boidae 0.9%). The most abundant were: Liophis miliaris (n = 33), Micrurus corallinus and Chironius fuscus (both with n = 26); the least abundant: Elapomorphus quinquelineatus, Siphlophis compressus and Tropidodryas serra (all with n = 1). The species that contributed the greatest biomass were Spilotes pullatus (7,925 g), Chironius laevicollis (4,694 g), Liophis miliaris (3,675 g) and Pseustes sulphureus (3,050 g); those that contributed the lowest biomass were: Siphlophis compressus, Tropidodryas serra (both with 4 g) and Elapomorphus quinquelineatus (3 g). We found significant differences between the sampled habitats at the Serra do Mendanha (undisturbed forest, secondary forest and banana plantations). The results showed that a great reduction in the abundance, richness, diversity and biomass of the snakes occurs when the native forest is replaced by banana plantations.

Pontes, JAL.; Pontes, RC.; Rocha, CFD..

144

Mycobacterium tuberculosis aortic graft infection with recurrent hemoptysis: a case report  

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Full Text Available Abstract Introduction Mycobacterium tuberculosis may cause a large variety of clinical presentations due to its ability to disseminate by contiguity or hematogenously. Tuberculosis may remain undiagnosed for years due to the chronic course of the disease, with potentially life-threatening long-term complications. Case presentation In this case report, we describe a tuberculous aortic graft infection in a 72-year-old man documented by polymerase chain reaction and cultures. The patient presented with three episodes of hemoptysis following a remote history of miliary tuberculosis. The infection was treated by graft replacement and prolonged antimycobacterial therapy. Conclusion Tuberculous infection of a vascular graft is an uncommon complication, but should be considered in patients with an intravascular device and a history of previous tuberculosis, especially when hematogenous spread may have occurred a few months after surgery, or when an active mycobacterial infection is present in close proximity to the graft.

Clerc Olivier

2008-07-01

145

Radiologic observation of renal tuberculosis  

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Radiographic findings of thirty eight cases of renal tuberculosis treated at this hospital during last 4 years were analysed with following results. The cases examined were 24 male and 14 female patients. Age distribution was broad and evenly distributed ranging from 2nd decades to 5th decades. Main symptoms complained were urinary frequency, hematuria, dysuria and flank pain. Findings of physical examination revealed tenderness of costovertebral angle, palpable mass on flank area and epididymal indutration. The simple chest films showed pulmonary tuberculosis in 22 cases including 6 cases of active military type. Thirty one cases showed increased ESR, 8 cases showed AFB positive in urine and 12 cases showed bilateral renal tuberculosis. Through urographic findings nonvisualization, cyceopelviectasis, motheaten appearance of minor calyx, contracted bladder, delayed visualization, ureteral stricture and beading were observed in order of frequency. Five cases with miliary tuberculosis showed advanced renal lesion on urogram.

Kim, S. W.; Ra, Y. W.; Kim, Y. J. [Yonsei University College of Medicine, Seoul (Korea, Republic of)

1981-12-15

146

Radiodiagnosis of pulmonary lesions in a severe closed chest trauma  

International Nuclear Information System (INIS)

The results of X-ray examination of 548 persons with a severe closed chest trauma were summed up. Urgent chest X-ray examination included panoramic roentgenography or electroroentgenography of the chest in two projections performed mostly in a special wheelchair without resetting and turning the patients. Dynamic X-ray control was used afterwards. Pulmonary lesions developed most frequently in a closed chest trauma. Roentgenosemiotics of lung contusion was characterized by a variety of symptoms and determined by the nature of a contusion syndrome. Infiltrate like, cavitary, miliary and peribronchial forms of lung contusion should be distinguished by an X-ray picture. In lung rupture, pneumothorax was detected in 33%, pneumohemothorax in 56%, emphysema of the chest soft tissues in 28%, mediastinal emphysema in 4% of the cases

1986-01-01

147

Criptococose palpebral: relato de caso / Palpebral cryptococcosis: case report  

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Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Relata-se o caso de uma paciente portadora de síndrome da imunodeficiência adquirida empiricamente tratada com esquema tríplice para tuberculose miliar. Durante a evolução clínica a paciente cursou com lesões comprometendo a pálpebra e conjuntiva tarsal à direita. A hipótese diagnóstica inicial foi [...] de tuberculose ocular com comprometimento conjuntival e palpebral. A biópsia da lesão conjuntival mostrou presença do Criptococcus neoformans. Após o início do tratamento específico com anfotericina B, a paciente apresentou melhora das lesões cutâneas. Abstract in english This paper is about a patient with acquired immunodeficiency syndrome empirically treated for miliary tuberculosis. During the clinical evolution the patient presented lesions compromising the right eyelid and tarsal conjunctiva. The initial diagnostic hypothesis was ocular tuberculosis with conjunc [...] tival and eyelid involvement. The biopsy of the conjuctival lesion identified an encapsulated yeast-like fungus: Criptococcus neoformans. After starting treatment with B anfotericin, the cutaneus lesions cleared.

Souza, Murilo Barreto; Melo, Carlos Sergio Nascimento; Silva, Cristiana Silveira; Santo, Ruth Miyuki; Matayoshi, Suzana.

148

Advanced microlithiasis alveolaris pulmonum  

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A severe course of microlithiasis alveolaris pulmonum in a 28-year old patient is described. The disease, which had progressed to a very advanced stage at the time of examination, produced in the plain radiograph of the thorax an extensive, homogeneous, ground-glass like shadow of practically all organs of the thorax. The typical miliary (spotlike) shadow ('sandstorm lung') is visible only in the lateral and apical parts of the lung. CT revealed massive calcareous deposits which increased in craniocaudal and ventrodorsal direction. Bullous metaplasia of the lung was particularly striking in the apical region. No effective therapy is known so far. A combined heart and lung transplantation might be the only therapy that could prolong the patient's life. (orig.)

1987-01-01

149

Advanced microlithiasis alveolaris pulmonum  

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A severe course of microlithiasis alveolaris pulmonum in a 28-year old patient is described. The disease, which had progressed to a very advanced stage at the time of examination, produced in the plain radiograph of the thorax an extensive, homogeneous, ground-glass like shadow of practically all organs of the thorax. The typical miliary (spotlike) shadow ('sandstorm lung') is visible only in the lateral and apical parts of the lung. CT revealed massive calcareous deposits which increased in craniocaudal and ventrodorsal direction. Bullous metaplasia of the lung was particularly striking in the apical region. No effective therapy is known so far. A combined heart and lung transplantation might be the only therapy that could prolong the patient's life.

Triebel, H.J.; Schofer, M.; Huelst, M. v.

1987-09-01

150

Encefalitis carcinomatosa / Carcinomatous encephalitis  

Scientific Electronic Library Online (English)

Full Text Available SciELO Argentina | Language: Spanish Abstract in spanish Se comunica un caso de encefalitis carcinomatosa, en un paciente con diagnóstico de adenocarcinoma de pulmón y síndrome confusional. Esta entidad es poco conocida en relación a otras afecciones neurológicas relacionadas al cáncer. Se discute su presentación clínica, se destaca la necesidad de sospec [...] harla aun luego de obtener una tomografía computada normal y sus típicas imágenes miliares en resonancia magnética. Abstract in english We report a case of carcinomatous encephalitis in a patient with lung adenocarcinoma and confusional syndrome. This is a rare form of brain metastases. We discuss its clinical picture, the importance of suspecting it after a normal computed tomography scan and the miliary typical images at magnetic [...] resonance.

Flavio, Sánchez; Marcelo, Zylberman; Shigeru, Kozima; Gabriela, Tossen; Nebil, Larrañaga; Reinaldo, Chacon.

151

Cloacolithiasis and intestinal lymphosarcoma in an African black-footed penguin (Spheniscus demersus).  

Science.gov (United States)

A 13-yr-old male African black-footed penguin (Spheniscus demersus) presented thrice over 7 mo with gastrointestinal obstruction secondary to cloacolithiasis. Clinical signs consistently resolved with cloacolith removal and supportive care. However, 10 mo after initial presentation, it presented with similar signs, plus significant weight loss. No cloacolith was found, and it subsequently died. Significant gross findings included bilateral cecal masses, colonic perforation, and marked secondary coelomitis, multifocal tan to pale hepatic nodules, and pale kidneys with miliary white foci. Histopathologic diagnoses were intestinal lymphosarcoma with hepatic and renal metastases, secondary intestinal rupture, and subacute severe bacterial coelomitis. To the authors' knowledge, this is the first full report of either cloacolithiasis or lymphosarcoma in a penguin. PMID:25000718

Jones, Krista L; Field, Cara L; Stedman, Nancy L; MacLean, Robert A

2014-06-01

152

Primitive retinal vascular abnormalities: tumors and telangiectasias.  

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Primitive retinal vascular abnormalities are benign conditions of the retinal circulation that comprise vascular tumors and telangiectasias. The principal vascular tumors of the retina include retinal capillary hemangioma, cavernous hemangioma of the retina, racemose hemangiomatosis of the retina and retinal vasoproliferative tumor, while primary retinal telangiectasias include Coats' disease, Leber's miliary aneurysms and idiopathic juxtafoveal telangiectasias. In most cases, these alterations result in significant visual impairment due to exudation determined by the structural abnormalities of the retinal vasculature. The aim of this review is to assess the different clinical and diagnostic features of the single pathological entities and to discuss the available treatment modalities including the onset of intravitreal antivascular endothelial growth factor therapy. PMID:22738997

Knutsson, Karl Anders; De Benedetto, Umberto; Querques, Giuseppe; Del Turco, Claudia; Bandello, Francesco; Lattanzio, Rosangela

2012-01-01

153

Snakes killed on the roads in the state of Santa Catarina, southern Brazil  

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Full Text Available Roads cause diverse impacts to ecosystems, including habitat loss and fragmentation, alteration of the natural landscape and death of animals. However, little is known about the impact of this mortality on the animal populations. The snake fauna of the state of Santa Catarina is the least studied of southern Brazil. In this work we present data on 165 snakes of 38 species found dead on the roads of the state between 2003 and 2008, which corresponds to 50% of the snake species in relation to the expected occurrence for the state of Santa Catarina. The four most frequent species were Philodryas patagoniensis (n = 22; 13.33%, Liophis miliaris (n = 21; 12.72%, P. aestiva (n = 13; 7.87% and Bothrops jararaca (n = 12; 7.27%, which represent together about 41% of the snakes found dead on the roads. We extend the known distribution of Imantodes cenchoa by about 60km southward.

Ivo Rohling Ghizoni-Jr

2009-06-01

154

[Tuberculosis after kidney transplantation].  

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The authors deal with the problem of tuberculosis in patients after transplantation of the kidney. They give an account of eight cases of the disease in 647 patients where during the last 22 years transplantations where performed in the Institute for Clinical and Experimental Medicine. The lungs were affected in six patients, incl. three with miliary dissemination affecting also other organs incl. the graft. In one instance the patient's own kidney was affected and once the talar joint. The authors emphasize this atypical course of the disease and the necessity to search for BK in patients where the febrile condition does not recede after corresponding antibiotic treatment. In case of early antituberculotic treatment the prognosis is on the whole favourable. PMID:2790881

Nouza, M; Jirka, J; Dráb, K; Krofta, K

1989-07-01

155

CT features of lymphobronchial tuberculosis in children, including complications and associated abnormalities  

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Lymphobronchial tuberculosis (TB) is tuberculous lymphadenopathy involving the airways, which is particularly common in children. To describe CT findings of lymphobronchial TB in children, the parenchymal complications and associated abnormalities. CT scans of children with lymphobronchial TB were reviewed retrospectively. Lymphadenopathy, bronchial narrowing, parenchymal complications and associations were documented. Infants comprised 51% of patients. The commonest site of lymphadenopathy was the subcarinal mediastinum (97% of patients). Bronchial compression was seen in all children (259 bronchi, of these 28% the bronchus intermedius) with severe or complete stenosis in 23% of affected bronchi. Parenchymal complications were present in 94% of patients, including consolidation (88%), breakdown (42%), air trapping (38%), expansile pneumonia (28%), collapse (17%) and bronchiectasis (9%), all predominantly on the right side (63%). Associated abnormalities included ovoid lesions, miliary nodules, pleural disease and intracavitary bodies. Airway compression was more severe in infants and most commonly involved the bronchus intermedius. Numerous parenchymal complications were documented, all showing right-side predominance. (orig.)

Lucas, Susan; Andronikou, Savvas [Faculty of Health Sciences, University of the Witwatersrand, Department of Radiology, Johannesburg (South Africa); Goussard, Pierre; Gie, Robert [Stellenbosch University, Department Paediatrics, Stellenbosch (South Africa)

2012-08-15

156

Radiodiagnostic errors by X-ray pictures of the chest taken at bed resting patients  

International Nuclear Information System (INIS)

The roentgenological findings of 383 cases have been compared with the anatomical and pathological diagnosis of the autopsy report. In 29% the radiodiagnosis was incorrect. About 70% of the X-ray examinations had to be carried out succenturiately at bed side in bedridden patients. The error rate of the interpretation of these examinations was higher than in examinations under standardized conditions. Especially, carcinomatous lymphangiosis, miliary tuberculosis and pulmonary embolism can be diagnosed badly in those incomplete X-ray pictures caused by the clinical situation of the bed resting patients. The publication analyses the most common errors in the diagnosis of cardiac and pulmonary diseases, and they will be demonstrated in examples. (orig.)

1981-01-01

157

Chest X-Ray Findings of Sputum Positive Tuberculosis Patients in Rafsanjan City  

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Full Text Available Plain chest x- ray is the first imaging modality for suspected tuberculosis patients because it is available, sensitive and inexpensive . The aim of this study was to identify the plain x- ray findings in sputum positive tuberculosis patients . One hundred and fourteen plain chest films of sputum positive tuberculosis patients that referred to health center of Rafsanjan were evaluated between 1988 and 1996 . This investigation was a retrospective cross sectional study that showed 92% of the cases had positive radiographic findings and 8% had normal chest x- ray. The most commom radiographic findings was exudative (pneumonic tubercolosis of lungs and other radiographic findings with decreasing frequency include: cavitation , fibro productive tuberculosis , pleural effusion, calcification, bronchopneumonia , atelectasis , lymphadenopathy bronchectasis and miliary tuberculosis.

H. Farahmand

2004-01-01

158

Post-kala-azar dermal leishmaniasis associated with AIDS  

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Full Text Available Post-kala-azar dermal leishmaniasis (PKDL is rarely reported in South America. In spite of the fact that there are many reports about the association of visceral leishmaniasis and AIDS, PKDL is very uncommon in HIV-positive patients, and so far only four cases have been documented in the literature. We present another case with unusual clinicopathological aspects. The patient, a 28-year-old male, from Salvador, Bahia (an endemic area presented with clinical manifestations of visceral leishmaniasis three years after the diagnosis of AIDS. During treatment for visceral leishmaniasis he developed disseminated miliary papules. Microscopically, the skin biopsy showed a "saw-tooth" pattern with a lichenoid mononuclear infiltrate simulating lichen planus. The histopathological diagnosis was achieved through the finding of amastigotes. The authors discuss the clinicopathological aspects of this case based on a review of the specific literature.

Achiléa Bittencourt

2003-06-01

159

Post-kala-azar dermal leishmaniasis associated with AIDS  

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Full Text Available Post-kala-azar dermal leishmaniasis (PKDL is rarely reported in South America. In spite of the fact that there are many reports about the association of visceral leishmaniasis and AIDS, PKDL is very uncommon in HIV-positive patients, and so far only four cases have been documented in the literature. We present another case with unusual clinicopathological aspects. The patient, a 28-year-old male, from Salvador, Bahia (an endemic area presented with clinical manifestations of visceral leishmaniasis three years after the diagnosis of AIDS. During treatment for visceral leishmaniasis he developed disseminated miliary papules. Microscopically, the skin biopsy showed a "saw-tooth" pattern with a lichenoid mononuclear infiltrate simulating lichen planus. The histopathological diagnosis was achieved through the finding of amastigotes. The authors discuss the clinicopathological aspects of this case based on a review of the specific literature.

Bittencourt Achiléa

2002-01-01

160

Radiological aspects of intrathoracir paracoccidio mycosis (PS). A review of 170 cases  

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Radiological aspects of intrathoracic paracoccidioidomycosis (PS). A review of 170 cases. A review of chest X-rays of 170 patients with PS showed predominance in males and a greater incidence in the 25-65 age-group. The authors suggest two forms of pulmonary involvement, pure and mixed respectively, each one with different pattern such as: fine reticular, coarse reticular, lymphonodular, nodular, miliary, pseudo-pneumonic and excavated. The late one was found just in association with any of the patterns described. The pure form of PS was predominantly fine reticular. Among the mixed types the reticulum-nodular pattern was most frequently found. Hyperinsulflation was frequently found and the inverted ''Y'' sign was considered important in the differential diagnosis with other fibrotic type of pulmonary infiltrates. (author)

1989-01-01

 
 
 
 
161

Combination therapy of disseminated coccidioidomycosis with caspofungin and fluconazole  

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Full Text Available Abstract Background The current recommended therapy for diffuse coccidioidal pneumonia involves initial treatment with amphotericin B deoxycholate or high-dose fluconazole, followed by an azole after clinical improvement. Amphotericin B is more frequently used as initial therapy if the patient's deterioration is rapid. Case presentation A 31-year-old Korean male with coccidioidomycosis presented to the hospital with miliary infiltrates on chest X-ray (CXR and skin rash on the face and trunk. Initially, the patient did not respond to amphotericin B deoxycholate therapy. However, following caspofungin and fluconazole combination therapy, the patient showed favourable radiological, serological, and clinical response. Conclusion This appears to be the first case of diffuse coccidioidal pneumonia with skin involvement in an immunocompetent patient who was treated successfully with caspofungin and fluconazole. Combination therapy with caspofungin and fluconazole may, therefore, be an alternative treatment for diffuse coccidioidal pneumonia that does not respond to amphotericin B deoxycholate therapy.

Ja Kim Min

2006-02-01

162

An radiography study of pediatric pulmonary cryptococcosis  

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Cryptococcosis is a cosmopolitan mycotic disease caused by a yeast like fungus, Cryptococcus neoformans. Respiratory tract, as portal of entry, is the initial focus of infection. Initial pulmonary lesion may heal with or without dissemination of the disease. Authors reviewed 8 cases of confirmed cryptococcosis during Jan. 1973 to June 1981 at Seoul National University Hospital. The results are as follows: Majority of the cases are below 5 years old. The most common symptoms are fever, abdominal pain and distension, and respiratory symptoms in only 2 cases. The involved organs are liver, lymph node, spleen, meninges, and skin in the order of frequency. Chest P-A roentgenograms show both hilar enlargement with perihilar and basilar, linear and small nodular infiltrations. Miliary nodular lesions and mediastinal lymphadenopathy were also noted.

Yeon, Kyung Mo; Kim, In One [Seoul National University College of Medicine, Seoul (Korea, Republic of)

1981-12-15

163

An radiography study of pediatric pulmonary cryptococcosis  

International Nuclear Information System (INIS)

Cryptococcosis is a cosmopolitan mycotic disease caused by a yeast like fungus, Cryptococcus neoformans. Respiratory tract, as portal of entry, is the initial focus of infection. Initial pulmonary lesion may heal with or without dissemination of the disease. Authors reviewed 8 cases of confirmed cryptococcosis during Jan. 1973 to June 1981 at Seoul National University Hospital. The results are as follows: Majority of the cases are below 5 years old. The most common symptoms are fever, abdominal pain and distension, and respiratory symptoms in only 2 cases. The involved organs are liver, lymph node, spleen, meninges, and skin in the order of frequency. Chest P-A roentgenograms show both hilar enlargement with perihilar and basilar, linear and small nodular infiltrations. Miliary nodular lesions and mediastinal lymphadenopathy were also noted

1981-12-01

164

May 2014 imaging case of the month  

Directory of Open Access Journals (Sweden)

Full Text Available No abstract available. Article truncated after first page. Clinical History: A 66-year-old woman presented with complaints of cough worsening over the previous several months. Her prior medical history was largely otherwise unremarkable. Frontal chest radiography (Figure 1 was performed for evaluation. Which of the following statements regarding the chest radiograph is most accurate? 1. The chest radiograph shows a solitary pulmonary nodule; 2. The chest radiograph shows multifocal airway thickening and bronchiectasis; 3. The chest radiograph shows multifocal, bilateral cavitary nodules and consolidation; 4. The chest radiograph shows multifocal, somewhat basal predominant linear opacities within diminished lung volumes, suggesting fibrosis; 5. The chest radiograph shows multiple small nodules, suggesting a miliary pattern ...

Gotway MB

2014-05-01

165

Cáncer tiroideo: una causa infrecuente de obstrucción de vía aérea superior en niños: Caso clínico / Thyroid carcinoma as a cause of upper airway obstruction in children: Case report  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish [...] Abstract in english Upper airway obstruction (UAO) can be a severe medical condition with a high mortality in children. We report a 10 year-old girl with UAO due to papillary thyroid carcinoma. The study confirmed a thyroid cancer. The patient was referred to our centre for the evaluation of dyspnea and hoarseness. She [...] was admitted in severe respiratory distress. Her chest X-ray revealed a critical narrowing of the cervical trachea and extensive infiltration of the lung with a miliary pattern; CT scan revealed a thyroid mass with bilateral pulmonary dissemination. An early surgical approach with total thyroidectomy and tracheotomy was performed. The study revealed a thyroid carcinoma. The patient was then referred to a specialized centre to receive chemotherapy. Recognition of thyroid carcinoma in children requires a high suspicion index. An early CT scan and fiberoptic assessment could show UAO in many unsuspected lesions

Lisbeth, Platzer M; Luis E, Vega-Briceño; Hernán, González D; Fernando, Iñiguez O; Cyntia, Escobar F; Francisco, Prado A.

166

Hepatic capillariasis in a Cape ground squirrel (Xerus inaurus : short communication  

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Full Text Available We report, for the first time, an incidental finding of Calodium hepaticum infestation in a sub-adult female Cape ground squirrel (Xerus inaurus. Post mortem examination of the squirrel revealed severe haemoperitoneum, splenomegaly and hepatomegaly with miliary white spots distributed diffusely throughout the hepatic parenchyma. Histologically the portal tracts in the liver showed granulomatous inflammation with fibrosis and numerous giant cells. Occasional adult worms were identified and there were multiple C. hepaticum eggs distributed diffusely throughout the portal tracts and the parenchyma. The spleen also contained C. hepaticum eggs. The genus Rattus is the primary host and reservoir of C. hepaticum, but C. hepaticum infections have been reported previously in other Sciuridae. Based on our findings, people should be cautious of the zoonotic potential of C. hepaticum, when they come into contact with the Cape ground squirrel.

B. Mitchell

2012-05-01

167

Disseminated tuberculosis manifesting as cholestasis in a patient with AIDS: a presentation to remember.  

Science.gov (United States)

A 48-year-old man of Indian descent and chronic untreated HIV infection presented with a 3-week history of persistent fever, jaundice and a subacute 10-pound weight loss. His presentation was notable for a painless cholestatic jaundice. An extensive evaluation was pursued around cholestasis and liver disease, with a resulting unremarkable workup for viral, bacterial and tick borne infectious aetiologies. A CT scan of the abdomen fortuitously revealed incidental pleural effusions and a subsequent CT scan of the chest demonstrated miliary infiltrates, suspicious for disseminated tuberculosis (TB). The diagnosis was confirmed by GeneXpert PCR and culture of induced sputa, which were positive for Mycobacterium tuberculosis. We have highlighted this unusual presentation of disseminated TB, manifesting initially as cholestasis in a patient with AIDS. PMID:24567181

Lee, Theresa May; Shenoi, Sheela V; Ogbuagu, Onyema

2014-01-01

168

Cerebral angiography of moyamoya's disease  

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Objective: To study the diagnostic method and bleeding mechanism of the hemorrhagic moyamoya disease. Methods: Head CT, cerebral arteriography for all and partial lumbar CSF (cerebral spinal fluid) centesis was undertaken in 67 cases of intracranial hemorrhage. Results: 67 cases of hemorrhagic moyamoya disease always involved unilateral or bilateral internal carotid and/or vertebral arterial branches with abnormal hyperplasia of small vessels at the same area. CT scan showed intracranial hemorrhagic foci in different parts clearly. Vasculitis caused by immunologic effect led to cerebral arterial stenosis or occlusion with compensatory small vascular hyperplasia. The mechanism of thinning of these vascular walls enlargement of vascular lumen, rupture of miliary or cystic aneurysms and infraependymal infarctions were due to bleeding and rebleeding. Conclusion: Percutaneous pancerebral arteriography is the main diagnostic method for Moyamoyas disease

2004-02-01

169

Ultrasonographic and CT findings of hepatosplenic tuberculosis  

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To evaluate the ultrasonographic and CT findings of hepatosplenic tuberculosis Materials and Methods: We retrospectively reviewed the ultrasonographic and CT findings of confirmed hepatosplenic tuberculosis in 12 patients. Six were men and six were women ; their average age was 41, and most were in their twenties. Lesions of the liver and spleen, as well as associated findings such as abdominal tuberculosis and other organ involvement of tuberculosis were analyzed. Results : There were three cases of hepatic tuberculosis, seven of splenic tuberculosis, and two of hepatosplenic involvement of tuberculosis. On the basis of the ultrasonographic and CT findings, hepatosplenic tuberculosis was classified as one of two patterns : miliary or micronodular, ormacronodular. The micronodular type was more common (9/12 cases) being characterized by innumerable micronodules,and with easy coalescence in the liver and spleen in five of the nine cases. The macronodular type of low density mass was noted in the other three patients. Splenomegaly was noted in 12 cases and hepatomegaly in ten. Pulmonary tuberculosis-including the miliary type(n=5)-was noted in eight patients. Associated abdominal tuberculosis such as lymphadenopathy with central low density and peripheral rim enhancement (n=6), tuberculous peritonitis(n=3),highly attenuated ascites(n=6), adrenal tuberculosis(n=1), renal tuberculosis(n=1), ovarian abscess(n=1), psoasabscess(n=1), and systemic tuberculosis such as central nervous system tuberculoma(n=2), cervical lymphadenopathy(n=4) and tuberculous spondylitis(n=1) were noted. Conclusion : Ultrasonography and CT were valuable in the detection and diagnosis of hepatosplenic tuberculosis

1998-08-01

170

Middle ear tuberculosis: Diagnostic criteria  

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Full Text Available Introduction. Tuberculous otitis is a diagnostic problem due to the difficulty to obtain microbiological, histomorphological and cytological confirmation of the disease. Objective. Our objective was to compare clinical and radiological characteristic and development of otogenic complications in patients with tuberculous otitis and otitis with cholesteatoma as the most destructive form of chronic nonspecific otitis in the purpose of establishing the diagnostic criteria for tuberculous otitis. Methods. Medical records of 12 patients with tuberculous otitis and 163 patients with cholesteatoma treated at the Institute of Otorhinolaryngology and Maxillofacial Surgery in Belgrade during the eight-year period were analyzed. All of the patients underwent otomicroscopic, audiological and radiological examination of the thorax and temporal bone, microbiological examination of the secretion and histomorphological examination of the tissue taken during middle ear surgery. Statistical analysis was done using ?2 test with Yates correction. Results. Otogenic complication as facial palsy and sensorineural hearing loss were more frequent in tuberculous otitis patients, than in cholesteatoma. Also, fistulas of the labyrinth and facial canal bone destruction were also more frequent in tuberculous otitis than in cholesteatoma. A larger extent of temporal bone destruction was noticed on CT scans of the temporal bone in half of the patents with tuberculous otitis. Coexistence with miliary pulmonary tuberculosis was detected in one third of the patients. There were no microbiological or histomorphological confirmations of the disease, except in one case with positive Ziehl-Neelsen staining. Conclusion. Tuberculous otitis media should be considered in patients with serious otogenic complications and with shorter duration of ear discharge, and in association with diagnosed miliary pulmonary tuberculosis and extensive temporal bone destruction. Polymerase chain reaction still is not reliable for diagnosis.

Ješi? Snežana

2009-01-01

171

Is laparotomy necessary in the diagnosis of fever of unknown origin?  

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Fever of unknown origin (FUO) is a diagnostic challenge for the practising physician. Detailed medical history, physical examination, non-invasive laboratory tests, and radiologic examinations compose the first level in the diagnostic approach to the FUO. When a diagnosis cannot be established with these procedures, some invasive diagnostic techniques and finally exploratory laparotomy are performed. Although advanced diagnostic measures and imaging-guided less invasive procedures have decreased the need, laparotomy remains as a final diagnostic method for FUO cases. In this study we evaluate the role and importance of laparotomy in the diagnosis of our FUO cases. In 17 out of 126 patients (8 male, 9 female, the median age 35.8 years) hospitalized in our clinic between 1982 and 2002 with the diagnosis of FUO, the diagnosis was established by laparotomy. The diagnosis was made directly in 13 patients, and indirectly (by excluding other diseases) in 2 patients. In several FUO series, the contribution of laparotomy to the diagnosis of FUO was reported as 27-100%. This rate was found to be 88% in the present study. During laparotomy on 17 cases, tissue samples were taken from spleen, liver, intra-abdominal and mesenteric lymph nodes. Pathologic examination of these tissue samples revealed miliary tuberculosis in 4; non-Hodgkin's lymphoma in 3; Hodgkin's lymphoma in 3; liver tumour in 1; hairy cell leukemia in 1; peritonitis carcinomatosis in 1. In the patients with miliary tuberculosis, the liver (3) and/or spleen (2), and/or lymph node (3) revealed caseating granulomas. Laparotomy diagnosed 3 of 5 cases whose abdominal ultrasonography and computerized tomography were normal. In conclusion, although advanced diagnostic methods decreased the need for laparotomy in FUO, if non-invasive and invasive diagnostic measures fail, laparotomy may contribute to the diagnosis. The selection of the patient and the timing are important for laparotomy. PMID:15790210

Ozaras, R; Celik, A D; Zengin, K; Mert, A; OzturkK, R; Cicek, Y; Tabak, E

2005-02-01

172

Tuberculosis mortality: patient characteristics and causes  

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Background In the antibiotic era, tuberculosis (TB) still causes a substantial number of mortalities. We aimed to identify the causes and risks of death among TB patients. Methods Medical records of mortality cases of culture-proven TB diagnosed during 2003–2007 were reviewed. All TB deaths were classified into 2 groups (TB-related and non-TB-related), based on the underlying cause of death. Results During the study period, 2016 cases (male: 71.1%) of culture-proven TB were identified. The mean age was 59.3 (range: 0.3–96) years. The overall mortality rate was 12.3% (249 cases) and the mean age at death was 74 years; 17.3% (43 cases) of all TB deaths were TB-related. Most of the TB-related deaths occurred early (median survival: 20 days), and the patient died of septic shock. Malignancy, liver cirrhosis, renal failure, and miliary and pneumonic radiographic patterns were all independent predictors for all TB deaths. Cavitary, miliary and pneumonic radiographic patterns were all significant predictive factors for TB-related death. Extrapulmonary involvement and liver cirrhosis were also factors contributing to TB-related death. Conclusions The majority of TB deaths were ascribed to non-TB-related causes. Managing TB as well as underlying comorbidities in a multidisciplinary approach is essential to improve the outcome of patients in an aging population. However, the clinical manifestations of patients with TB-related death vary; many progressed to fulminant septic shock requiring timely recognition with prompt treatment to prevent early death.

2014-01-01

173

Mimics in chest disease: interstitial opacities.  

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Septal, reticular, nodular, reticulonodular, ground-glass, crazy paving, cystic, ground-glass with reticular, cystic with ground-glass, decreased and mosaic attenuation pattern characterise interstitial lung diseases on high-resolution computed tomography (HRCT). Occasionally different entities mimic each other, either because they share identical HRCT findings or because of superimposition of patterns. Idiopathic pulmonary fibrosis (IPF), fibrosis associated with connective tissue disease, asbestosis, end-stage sarcoidosis or chronic hypersensitivity pneumonitis (HP) may present with lower zone, subpleural reticular pattern associated with honeycombing. Lymphangiomyomatosis may be indistinguishable from histiocytosis or extensive emphysema. Both pulmonary oedema and lymphangitic carcinomatosis may be characterised by septal pattern resulting from thickened interlobular septa. Ill-defined centrilobular nodular pattern may be identically present in HP and respiratory bronchiolitis-associated with interstitial lung disease (RBILD). Sarcoidosis may mimic miliary tuberculosis or haematogenous metastases presenting with miliary pattern, while endobronchial spread of tuberculosis may be indistinguishable from panbronchiolitis, both presenting with tree-in-bud pattern. Atypical infection presenting with ground-glass mimics haemorrhage. Ground-glass pattern with minimal reticulation is seen in desquamative interstitial pneumonia (DIP), RBILD and non-specific interstitial pneumonia (NSIP). Obliterative bronchiolitis and panlobular emphysema may present with decreased attenuation pattern, while obliterative bronchiolitis, chronic pulmonary embolism and HP may manifest with mosaic attenuation pattern. Various mimics in interstitial lung diseases exist. Differential diagnosis is narrowed based on integration of predominant HRCT pattern and clinical history. Teaching Points • To learn about the different HRCT patterns, which are related to interstitial lung diseases. • To be familiar with the more "classical" entities presenting with each HRCT pattern. • To discuss possible overlap of different HRCT patterns and the more common mimics in each case. • To learn about some clues that help differentiate the various diagnostic mimics on HRCT. PMID:23247773

Oikonomou, Anastasia; Prassopoulos, Panos

2013-02-01

174

Alterações fundoscópicas e sua associação clínica empacientes com tuberculose, no Distrito Federal Posterior eye lesions and their clinical association in patients with tuberculosis, in the Federal District, Brazil  

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Full Text Available OBJETIVO: Avaliar a incidência de lesões de fundo de olho em pacientes com tuberculose no Distrito Federal e identificar fatores de risco para o aparecimento dessas lesões. MÉTODOS: Em estudo prospectivo, foi realizada oftalmoscopia binocular indireta em 292 pacientes com tuberculose sistêmica. Estes pacientes foram avaliados em cinco diferentes Hospitais Regionais do Distrito Federal, entre 1ºde agosto de 1997 e 30 de julho de 1998. Análise multivariada foi aplicada para identificar associações entre a variável "lesão de fundo de olho" e as variáveis "sexo, idade, baciloscopia, HIV, localização da tuberculose, internação dos pacientes, tempo de sintomas, procedência e experiência anterior com tratamento". RESULTADOS: Os resultados deste estudo mostraram incidência de 5,5% de lesões fundoscópicas em pacientes com tuberculose. Análise multivariada mostrou que a co-infecção pelo HIV, internação dos pacientes e tuberculose miliar foram fatores de risco para a presença de lesões de fundo de olho. Quando essas características estiveram presentes simultaneamente, a probabilidade de um indivíduo apresentar estas lesões foi de 66%. CONCLUSÕES: Na avaliação da incidência de lesões de fundo de olho em pacientes com tuberculose, devem ser levadas em consideração certas características individuais, visto que fatores de risco como a co-infecção pelo HIV, tuberculose miliar, e internação, influenciaram na presença destas lesões.PURPOSE: To evaluate the incidence of eye posterior lesions in patients with tuberculosis in the Federal District, Brazil, and to identify the risk factors for the appearance of these lesions. METHODS: In a prospective study, indirect binocular ophthalmoscopy was performed in 292 patients with systemic tuberculosis. These patients were examined in five different Regional Hospitals of the Federal District, between August 1st, 1997 and July 30th, 1998. A multiple analysis was applied to identify associations between the variable "eye posterior lesion" and the variables "sex, age, bacilloscopy, HIV, tuberculosis site, patient hospitalization, duration of symptoms, origin of the patient and previous experience with treatment. RESULTS: The results showed a 5,5% incidence of posterior lesions in patients with tuberculosis. A multiple analysis showed that HIV co-infection, patient hospitalization and miliary tuberculosis were risk factors for the presence of eye posterior lesions. When these characteristics were simultaneously present, the probability of a patient to present these lesions was 66%. CONCLUSIONS: In the evaluation of the incidence of eye posterior lesions in patients with tuberculosis, certain individual characteristics should be taken in to account, since risk factors, such as HIV co-infection, miliary tuberculosis, and hospitalization, influenced the presence of these lesions.

Gustavo Federici Mendes

2003-06-01

175

Disseminated tuberculosis in a pregnant woman presenting with numerous brain tuberculomas: case report  

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Full Text Available Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis, which has the pulmonary form as the most common presentation. Dissemination of the disease is common in immunocompromised patients, but immunodeficiency related to pregnancy severe enough to cause dissemination of the Mycobacteria is exceedingly rare. When dissemination occurs, any organ may be affected and in central nervous system, the infection presents as meningitis and single brain parenchyma tuberculomas. We report the case of a 17 year-old woman at the 34th week of pregnancy with respiratory and high intracranial pressure symptoms. On the day before admission she had a sudden onset of paraparesis and urinary retention and ten hours after the delivery she presented with paraplegia . The chest X-ray and CT scan were compatible with miliary tuberculosis. The cranial CT scan revealed numerous rounded hypodense lesions located at cerebral and cerebellar hemispheres, which presented ring-like enhancement after contrast injection. The patient underwent a craniotomy with biopsy of the lesions confirming the diagnosis of brain tuberculomas. The three-drug regimen was started and the cranial CT scan performed a year after diagnosis showed no brain lesions. We emphasize the aggressive dissemination of the disease in this case associated with pregnancy and the importance of early diagnosis and institution of therapy resulting in regression of the lesions.

Gasparetto Emerson L.

2003-01-01

176

Clinical and high-resolution computed tomographic findings in five patients with pulmonary tuberculosis who developed respiratory failure following chemotherapy  

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AIM: The purpose of this study was to describe the clinical and high-resolution computed tomographic (HRCT) findings in patients with pulmonary tuberculosis who developed respiratory failure after starting chemotherapy. MATERIALS AND METHODS: The clinical records, chest radiographs, and HRCT findings in five patients with non-miliary pulmonary tuberculosis who developed respiratory failure after starting chemotherapy were reviewed. RESULTS: Chest radiographs taken early in the course of acute respiratory failure showed progression of the original lesions with (n = 4) or without (n = 1) new areas of opacity away from the site of the original lesions. HRCT demonstrated widespread ground-glass attenuation with a reticular pattern as well as segmental or lobar consolidation with cavitation and nodules, consistent with active tuberculous foci in all five cases. Prominent interlobular septal thickening was seen in two cases. Four of the five patients had received corticosteroids. Of these five, two died and three recovered with continued corticosteroid therapy. Transbronchial biopsy in three cases showed evidence of acute alveolar damage. CONCLUSION: In selected patients with tuberculosis who develop respiratory failure following the initiation of antituberculous therapy, HRCT may be a helpful adjunct to clinical evaluation in differentiating hypersensitivity reactions (presumed to be due to the release of mycobacterial antigens) from other pulmonary complications. Akira, M. and Sakatani, M. (2001)

2001-07-01

177

Comparison of Clinical and Radiology Manifestation of Pulmonary Tuberculosis in Younger and Elderly Patients  

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Full Text Available To study the differences of presentation pulmonary tuberculosis related with age. This study is a retrospective as case-control match in one hundred patients with pulmonary tuberculosis in Iran for five years. All patients had pulmonary tuberculosis divided in two group, younger (age<50 as control and older (age?50 as case group. Data was collected included; clinical presentation and radiology manifestation. Data were analyzed with chi-square and student's t test and p<0.05 levels were significant. In here showed that 46 patients in control (mean age 28.6±6.8 and 54 patients in case (mean age was 67.5±8 were evaluated. In case group fever and cough were less than control (p<0.005. Fibrosis was more (p<0.005 and miliary was less in case group than control group (p<0.01. In conclusion, absence of fever and cough and increase of fibrosis should not be delayed diagnosis of pulmonary tuberculosis in elderly and physicians need to have a high level suspicion of unusual manifestation of tuberculosis in elderly patients.

Ghorbani Gholamali

2007-01-01

178

Chest roentgenography in tuberculous cervical lymphadenopathy.  

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The primary site of infection in tuberculous cervical lymphadenitis is lungs, from where bacilli reach gland through circulation. This study was done in the department of chest medicine, NRS Medical College, Kolkata, and was designed to find out chest x-ray abnormalities in apparently chest asymptomatic confirmed tuberculous cervical lymphadenitis without associate disease. The diagnosis of tuberculous cervical lymphadenitis was confirmed by fine needle aspiration cytology and/or smear for acid-fast bacillus, and chest x-ray (PA view) was done in all confirmed cases (n = 183). Normal chest x-ray was found in 132 cases (72.13%) and abnormal chest x-ray in 51 cases (27.87%). Pulmonary infiltration, the commonest radiological finding was detected in 32 cases (17.49%), hilar enlargement in 17 cases (9.29%), right paratracheal opacity in 2 (1.09%), obliteration of costophrenic angles in 3 cases (1.64%) and miliary mottling in one case (0.55%). Upper zonal predominance of lung parenchymal infiltrations was noted in 12.57% and right lung involvement in 16.39%. Single zone was affected in 9.84% cases and multiple zones were involved in 7.65% cases. We observed right hilar enlargement in 6.56%, left hilar lymphadenopathy in 4.37% and bilateral hilar lymphadenopathy in 2.73% cases. We concluded that routine chest x-ray PA view should be done in all tuberculous lymphadenitis before categorisation and starting of treatment. PMID:24592755

Bhattacharyya, Sujit Kumar; Mandal, Pranab; Sarkar, Supriya; Shamim, Shelley; Sit, Niranjan Kumar; Ghoshal, Aloke Gopal

2013-03-01

179

[Cowpox virus infection in an alpaca (Vicugna pacos) - clinical symptoms, laboratory diagnostic findings and pathological changes].  

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Orthopoxvirus infections appear to be rare in South American Camelids, because only a few cases have been reported in the literature. Based on a generalized infection with cowpox virus in an alpaca, the clinical symptoms, laboratory diagnostic findings and the pathological changes are described. The case history showed a long treatment because of chronic skin lesions. The main clinical symptom was miliary papules over the entire skin. Furthermore, a bilateral mucopurulent conjunctivitis occurred as well as excessive salivation due to a severe erosive-ulcerative stomatitis. Although the animal received intensive treatment, it died 8 days after admission to the clinic. During necropsy, an erosive-ulcerative laryngitis as well as a necrotising pneumonia and lymphadenitis were observed. Histopathological examination of representative organ samples led to the diagnosis of a suspected orthopoxvirus infection. Electron microscopy and quantitative polymerase chain reaction (qPCR) of tissue samples confirmed this diagnosis. The virus could be isolated in tissue culture and a PCR with subsequent nucleotide sequencing identified cowpox virus as the causative agent for this generalised infection. PMID:24920091

Goerigk, D; Theuß, T; Pfeffer, M; Konrath, A; Kalthoff, D; Woll, D; Vahlenkamp, T W; Beer, M; Starke, A

2014-06-12

180

Radiological patterns of childhood pulmonary tuberculosis in Khartoum state  

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This hospital based study was undertaken to determine the commonest radiological features of childhood pulmonary tuberculosis in Khartoum, and to correlate these features with the clinical symptoms and laboratory investigations. A total of hundred patients were selected from referred clinics and the paediatric wards (inpatients) of three teaching hospitals in Khartoum, during the period february 95 to april 96. Almost all the families were from low socio economic status. The peak age incidence was at (7, 8, 10) years; 50% of children had received BCG vaccination and history of contact with TB was positive in 35%. Mantoux test was positive in 79% and four cases had smear-positive sputum for AAFB. The most frequent lesion on chest radiography was lemphadenopathy in 67% of cases followed by multiple lesions which were present in 65% of cases. Consolidation was present in 49 cases , 38 showed unilateral changes, while 11 showed bilateral changes. The right and particularly the right middle and lower lobes were more frequently affected. Seven patients had pleural effusion which was sided in five, left sided in one and bilateral in one. Cavitation was present in eight cases, broncho-pneumonic changes in three and only one case had miliary mottling. Positive mantoux test and chest x-ray were present in 72 patients, while all cases with negative mantoux and negative sputum smear showed significant radiological findings. (Author)

1996-01-01

 
 
 
 
181

Treatment of myelitis in Behçet's disease with rituximab.  

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Behçet's disease (BD) is a chronic inflammatory disorder that involves the parenchymal central nervous system (neuro-BD, NBD) approximately in 5-49% of patients, causing lesions rarely located in the spinal cord (SC). We report the first case of NBD-myelitis treated with intravenous rituximab. A 41-year-old man affected by BD presented with mild paraparesis with a miliary involvement and a 'net-like' gadolinium enhancement (Gde) of the SC. After a therapeutic attempt with pulsed cyclophosphamide and intravenous methylprednisolone, the clinical and neuroradiological course worsened. A progressive improvement was observed after rituximab administration associated with low doses of oral prednisone. No disease activity was detected and the patient reported no adverse event. After six rituximab cycles, cervical MRI was normal while thoracic MRI showed a slight T2-weighted hyperintensity of D4-D10 spinal tract without Gde. A combined use of rituximab and oral steroids resulted in a long-term suppression of NBD activity without any safety concern. PMID:24879733

Messina, Maria Josè; Rodegher, Mariaemma; Scotti, Roberta; Martinelli, Vittorio

2014-01-01

182

Cytogenetical studies in five Atlantic Anguilliformes fishes  

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Full Text Available SciELO Brazil | Language: English Abstract in english The order Anguilliformes comprises 15 families, 141 genera and 791 fish species. Eight families had at least one karyotyped species, with a prevalence of 2n = 38 chromosomes and high fundamental numbers (FN). The only exception to this pattern is the family Muraenidae, in which the eight species ana [...] lyzed presented 2n = 42 chromosomes. Despite of the large number of Anguilliformes species, karyotypic reports are available for only a few representatives. In the present work, a species of Ophichthidae, Myrichthys ocellatus (2n = 38; 8m+14sm+10st+6a; FN = 70) and four species of Muraenidae, Enchelycore nigricans (2n = 42; 6m+8sm+12st+16a; FN = 68), Gymnothorax miliaris (2n = 42; 14m+18sm+10st; FN = 84), G. vicinus (2n = 42; 8m+6sm+28a; FN = 56) and Muraena pavonina (2n = 42; 6m+4sm+32a; FN = 52), collected along the Northeastern coast of Brazil and around the St Peter and St Paul Archipelago were analyzed. Typical large metacentric chromosomes were observed in all species. Conspicuous polymorphic heterochromatic regions were observed at the centromeres of most chromosomes and at single ribosomal sites. The data obtained for Ophichthidae corroborate the hypothesis of a karyotypic diversification mainly due to pericentric inversions and Robertsonian rearrangements, while the identification of constant chromosome numbers in Muraenidae (2n = 42) suggests a karyotype diversification through pericentric inversions and heterochromatin processes.

Antonio Jales Moraes, Vasconcelos; Wagner Franco, Molina.

183

The chest radiological manifestation in psittacosis  

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Objective: To summarize the clinical characteristics and imaging features of psittacosis. Methods: The clinical features and imaging appearances of 3 cases with acute psittacosis were retrospectively analyzed. The related literature was reviewed. Results: The clinical manifestation of psittacosis was high fever in the patients. Physical findings included pulse-temperature dissociation, localized lung crackles, hepatomegaly, and splenomegaly. Laboratory findings showed elevation of ESR in all cases, and liver dysfunction was present in 2 cases. The counts of white blood cells were normal, but the percent of neutrophils might be increased. The chest X-ray and CT scan showed air-space consolidation and ground-glass attenuation in the lung, and miliary, nodular, or consolidated shadows were found in pathological areas. Pleural effusions were also present in 2 cases. Psittacosis was diagnosed from the history of exposure to infected parrots and elevation of the IgG and IgM titer for Chlamydia psittaci. Erythromycin was effective in all 3 patients. Conclusion: Although the appearance of psittacosis on clinical findings and chest X-ray and CT scan is not characteristic, psittacosis can be diagnosed with the combination of the history of exposure to infected parrots and laboratory findings. CT scan can reveal the focus earlier and accurately, and catching the imaging features of psittacosis is helpful in differential diagnosis. (authors)

2005-11-01

184

Macrofaunal involvement in the sublittoral decay of kelp debris: the detritivore community and species interactions  

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The fauna associated with sea-bed accumulations of decomposing Laminaria saccharina has been studied by year-round SCUBA diving at two sites in the Clyde Sea area. Seasonal changes in density of 64 species are reported. In the autumn, large quantities of kelp are detached by storms. This weed carries with it to the sea bed a large part of its normal fauna. Additional species settle onto the weed from the plankton whilst others migrate onto it from the surrounding sea bed. Peak densities of associated species were recorded in autumn. Litter bag experiments in situ showed that, except during the summer, weed is lost from sea-bed accumulations at a faster rate when macrofaunal animals are excluded. The macrofauna therefore inhibits decomposition. The relative importance of interactive cropping by three macrodetritivores, Psammechinus miliaris (Echinodermata), Platynereis dumerilii (Polychaeta) and Gammarus locusta (Amphipoda) was studied by in situ containment of different species combinations. The presence of Gammarus with Psammechinus resulted in less weed being lost than when Psammechinus was isolated. This is because Gammarus selectively crops rotting weed, retarding frond disintegration by microbes. Platynereis retards microbial colonization of frond tissues ruptured during its feeding by repeated cropping of the same region. Weed would decompose very rapidly were it not for macrofaunal cropping. Macroalgal decay thus differs profoundly from that of vascular plants.

Bedford, A. P.; Moore, P. G.

1984-01-01

185

Bilateral atypical optic neuritis associated with tuberculosis in an immunocompromised patient  

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A 27 year-old lady, presented with sudden loss of vision in the right eye for a week. It was followed by poor vision in the left eye after 3 days. It involved the whole entire visual field and was associated with pain on eye movement. She was diagnosed to have miliary tuberculosis and retroviral disease 4 months ago. She was started on anti-TB since then but defaulted highly active anti-retroviral therapy (HAART). On examination, her visual acuity was no perception of light in the right eye and 6/120 (pinhole 3/60) in the left eye. Anterior segment in both eyes was unremarkable. Funduscopy showed bilateral optic disc swelling with presence of multiple foci of choroiditis in the peripheral retina. The vitreous and retinal vessels were normal. Chest radiography was normal. CT scan of orbit and brain revealed bilateral enhancement of the optic nerve sheath that suggest the diagnosis of bilateral atypical optic neuritis. This patient was managed with infectious disease team. She was started on HAART and anti-TB treatment was continued. She completed anti-TB treatment after 9 months without any serious side effects. During follow up the visual acuity in both eyes was not improved. However, funduscopy showed resolving of disc swelling and choroiditis following treatment.

Jaafar, Juanarita; Hitam, Wan Hazabbah Wan; Noor, Raja Azmi Mohd

2012-01-01

186

Thoracic CT findings of behcet disease  

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Objective: To illustrate the thoracic CT findings of Behcet disease and to assess the CT diagnostic role in patients with Behcet disease. Methods: Thoracic CT images and medical records were retrospectively reviewed in 13 patients with thoracic Behcet disease. The diagnosis was based on the criteria set by the international study group for Behcet disease. Results: Of 13 patients, subpleural patchy consolidations were showed in 3, bilateral diffuse ground glass opacities in 3, left low lobe collapse with a right small nodule in 1, subpleural solitary pulmonary nodule in 1, bilateral pleural effusion in 2, mediastinal lymphoadenopathy in 2, diffuse bilateral miliary lung nodules in 1 during treatment. Thoracic vascular involvement was presented in 8 patients, two with superior vena cava thrombosis, one with left subclavicle artery aneurysm, one with left low pulmonary artery aneurysm and mural thrombosis, one with bilateral low pulmonary arteries and left basilar artery aneurysm, three with right pulmonary artery thrombosis in which there were two with left pulmonary artery occlusion and one with left basilar artery branch aneurysm. Conclusions: Thoracic CT findings of Behcet disease are variable and nonspecific. Contrast-enhanced CT scan can be helpful by showing thrombosis of the superior vena cava and pulmonary artery as well aneurysm of the pulmonary artery. (authors)

2010-01-01

187

A preliminary investigation of tuberculosis and other diseases in African buffalo (Syncerus caffer in Queen Elizabeth National Park, Uganda  

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Full Text Available A survey to determine the prevalence of bovine tuberculosis caused by Mycobacterium bovis and certain other infectious diseases was conducted on 42 free-ranging African buffaloes, (Syncerus caffer from May to June 1997 in the Queen Elizabeth National Park, Uganda. Using the gamma interferon test, exposure to M. bovis was detected in 21.6 % of the buffaloes. One dead buffalo and an emaciated warthog (Phacochoerus aethiopicus that was euthanased, were necropsied; both had miliary granulomas from which M. bovis was isolated. None of the buffaloes sampled in Sector A of the park, which has no cattle interface, tested positive for bovine tuberculosis (BTB exposure. The prevalence and distribution of BTB does not appear to have changed significantly since the 1960s, but this may be due to fluxes in the buffalo population. Serological testing for foot-and-mouth disease (FMD demonstrated positive exposure of 57.1% of the buffaloes sampled, with types A, O and SAT 1-3, which is the first known report of FMD antibodies to A and O types in free ranging African buffaloes. Foot-and-mouth disease virus types SAT 1 and SAT 3 were isolated from buffalo probang samples. Two percent of the buffaloes had been exposed to brucellosis. None of the buffaloes tested had antibodies to rinderpest, leptospirosis or Q fever.

A.L. Michel

2010-09-01

188

Radiographic findings of pulmonary tuberculosis in non-AIDS immunocompromised adult patients: comparison with immunocompetent adult patients  

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To compare chest radiographic findings of pulmonary tuberculosis in non-AIDS immunocompromised adult patients with those in immunocompetent patients. Eighty six patients who had pulmonary tuberculosis were included in the study. Of these, 41 were non-AIDS immunocompromised adult patients and 45 were immunocompetent adult patients. Chest radiographs obtained from 86 patients were retrospectively evaluated with regard to the followings; the anatomic distribution and extent of tuberculous lesions, typical or atypical patterns of radiographic findings. We then compared the results in non-AIDS immunocompromised adult patients with those in immunocompetent adult patients. The characteristic manifestation of pulmonary tuberculosis was a tendency of pulmonary lesions to localize in the apico-posterior segments of the upper lobe and the superior segment of the lower lobe in both groups but more wide distribution such as the anterior segment and the lingular segment of the upper lobe and the basal segments of the lower lobe was frequently identified in non-AIDS immunocompromised adult patients, and also bilateral, multi segmental and multi lobular extents were common findings. In immunocompetent adult patients, more common findings were in local exudative and productive lesions and several cavities in preferential sites. Atypical plain radiographic findings were more common in non-AIDS immunocompromised adult patients, and which were multiple cavitary lesions, wide extent of bronchogenic spread and tuberculous pneumonia, and miliary disseminations and mass like lesions. Pulmonary tuberculosis in non-AIDS immunocompromised adult patients is characterized by frequent bilateral distribution, wide pulmonary extent, and atypical radiographic findings.

Kim, Joung; Lee, Sun Kyoung; Lim, Chae Ha; Kim, Young Sook; Kim, Eun Gyung; Kim, Young Chul; Oh, Jae Hee [College of Medicine, Chosun University, Gwangju (Korea, Republic of)

1994-11-15

189

Demographic And Risk Factors Related To Military Tuberculosis  

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Full Text Available Background and Aim: Tuberculosis is one the major health care problems in developing countries. Miliary tuberculosis is induced by blood dissemination of multiple tubercle bacilli, the paramount importance of accurate diagnosis of military tuberculosis is because of its dismal outcome if untreated and the chance of cure if diagnosis happens early in the course of the disorder. In this study we describe the demographic and risk factors related to military tuberculosis, which enables us to control and reduce the incidence of military tuberculosis. This ultimately reduces the mortality and morbidity consistent with this disorder. Materials and Methods: we conducted a retrospective case control study, which compares 28 patients with military tuberculosis and 56 patients with pulmonary tuberculosis as control. We reviewed all the patients' documents registered between years 1994-2004, after extracting raw data we analyzed them with chi-square and Fisher exact tests. Results and Conclusion: We found that HIV (P< 0.05 infection and lack of BCG vaccination (P< 0.05 increases the number of military tuberculosis among our patients. In addition we did not find any other significant risk factor.

M. Rasolinejad

2006-05-01

190

Nontuberculous Mycobacterial (NTM) Disease in Immunocompetent Patients: Expanding Image Findings on Chest CT  

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The aim of this study was to evaluate the chest CT features of nontuberculous mycobacterial (NTM) disease regardless of the specific organisms. This study included 74 consecutive patients (35 men, 39 women; mean age, 63 years; age range, 25-89 years) who were diagnosed with NTM disease according to the American Thoracic Society Guidelines (1997 and 2007) between January 2005 and July 2007. Chest CT images were randomly reviewed by two radiologists with consensus. The most common organism associated with NTM disease is M. avium-intracellulare complex (87.8%), followed by M. abscesses, M. kansasii, and M. chelonae. The most common chest CT finding was a nodular bronchiectatic lesion (n = 35, 46.7%), followed by a cavitary lesion of the upper lobe (n = 21, 28.0%), combined lesions of two prior subtypes (n = 6, 8.0%), consolidative lesion (s) (n = 5, 6.7%), a bronchogenic spreading pulmonary tuberculosis-like lesion (n = 5, 6.7%), a cavitary mass lesion with small satellite nodules (n = 2, 2.7%), and a miliary nodular lesion (n = 1, 1.3%). More than 5 segments were involved in 60 cases (81.1%). The nodular bronchiectatic lesion or cavitary lesion of upper lobe presents with multi-segmental involvement and the occurrence of combined consolidation is indicative of NTM disease

Shin, Hyo Hyun; Seon, Hyun Ju; Kim, Mok Hee; Choi, Song; Song, Sang Gook; Shin, Sang Soo; Kim, Yun Hyeon; Park, Jin Gyoon [Chonnam National University Hospital, Gwangju (Korea, Republic of)

2010-04-15

191

Pulmonary sarcoidosis: typical and atypical manifestations at high-resolution CT with pathologic correlation.  

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Sarcoidosis is a multisystem disorder that is characterized by noncaseous epithelioid cell granulomas, which may affect almost any organ. Thoracic involvement is common and accounts for most of the morbidity and mortality associated with the disease. Thoracic radiologic abnormalities are seen at some stage in approximately 90% of patients with sarcoidosis, and an estimated 20% develop chronic lung disease leading to pulmonary fibrosis. Although chest radiography is often the first diagnostic imaging study in patients with pulmonary involvement, computed tomography (CT) is more sensitive for the detection of adenopathy and subtle parenchymal disease. Pulmonary sarcoidosis may manifest with various radiologic patterns: Bilateral hilar lymph node enlargement is the most common finding, followed by interstitial lung disease. At high-resolution CT, the most typical findings of pulmonary involvement are micronodules with a perilymphatic distribution, fibrotic changes, and bilateral perihilar opacities. Atypical manifestations, such as masslike or alveolar opacities, honeycomb-like cysts, miliary opacities, mosaic attenuation, tracheobronchial involvement, and pleural disease, and complications such as aspergillomas, also may be seen. To achieve a timely diagnosis and help reduce associated morbidity and mortality, it is essential to recognize both the typical and the atypical radiologic manifestations of the disease, take note of features that may be suggestive of diseases other than sarcoidosis, and correlate imaging features with pathologic findings to help narrow the differential diagnosis. PMID:21071376

Criado, Eva; Sánchez, Marcelo; Ramírez, José; Arguis, Pedro; de Caralt, Teresa M; Perea, Rosario J; Xaubet, Antonio

2010-10-01

192

Increased incidence of tuberculosis in patients of systemic sclerosis on dexamethasone pulse therapy: A short communication from Kashmir  

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Full Text Available Background: Systemic sclerosis is a multi-systemic autoimmune disorder affecting predominantly the skin, lungs, gut and kidneys. Purpose: To report the increased incidence of tuberculosis in patients of systemic sclerosis on dexamethasone pulse (DP therapy. Methods: Forty-seven patients of systemic sclerosis were included in the study. After taking a complete history and doing a detailed physical examination, the patients were submitted to a battery of investigations including complete hemogram(CBC with erythrocyte sedimentation rate (ESR(F, Chest X-ray CXR (PA view Mantoux test and urine analysis. CBC, ESR and urine examination was done monthly and CXR were repeated six-monthly. Findings: Seven patients on DP therapy developed genitourinary tuberculosis. Four had pulmonary tuberculosis. One patient developed tubercular lymphadenitis, one patient succumbed to miliary tuberculosis. Conclusion: There is an increased incidence of tuberculosis amongst patients of systemic sclerosis on DP therapy. Limitation of the Study: There was no control group of systemic sclerosis patients not on DP therapy to rule out the confounding effect of the disease per se predisposing to tuberculosis as all our patients as a matter of routine were put on steroid pulse. Also, the increased incidence of tuberculosis was detected incidentally while on monthly follow-up.

Ahmad Qazi

2008-01-01

193

Analysis of a sea urchin gene cluster coding for the small nuclear U7 RNA, a rare RNA species implicated in the 3' editing of histone precursor mRNAs.  

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A genomic 9.3-kilobase DNA fragment of the sea urchin Psammechinus miliaris, containing a cluster of five U7-RNA genes (or pseudogenes), has been isolated and analyzed by partial DNA sequencing. The U7-RNA coding sequences differ from one another by one or two nucleotides, one of the five gene sequences being identical to those of the cDNA U73 clone prepared earlier [Strub, K., Galli, G., Busslinger, M. & Birnstiel, M. L. (1984) EMBO J. 3, 2801-2807]. The spacer sequences separating the genes have, on the whole, a low degree of homology; hence, the five genes must have arisen by an ancient duplication event. The sequences preceding the coding portion contain three highly conserved sequence motifs but no "TATA box." The 3' flanking sequences include a highly conserved AAAGNNAGA sequence that is held in common with other U-RNA genes from both sea urchins and vertebrates. Our findings confirm our classification of the U7 RNA as a genuine, if sparsely represented, member of the U-RNA family. PMID:3458178

De Lorenzi, M; Rohrer, U; Birnstiel, M L

1986-05-01

194

Two cases of papillary thyroid carcinoma with solitary lung metastasis  

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Two cases of papillary thyroid carcinoma with solitary lung metastasis are reported. A 73-year-old woman was found to have a round, well-defined, solitary tumor shadow in S10c of the left lung on pulmonary CT on a regular follow-up examination following rectal cancer surgery. Thoracoscopic partial lung resection was performed, and the patient was diagnosed with lung metastasis of papillary thyroid carcinoma on histopathological examination. The patient subsequently underwent total thyroidectomy and radioactive iodine therapy. She has remained relapse-free for 10 years postoperatively. A 52-year-old woman, after having undergone total thyroidectomy for papillary thyroid carcinoma at the age of 50 years, underwent thoracoscopic resection two years later for a solitary lung nodule that had been simultaneously detected; the nodule was histopathologically diagnosed as papillary thyroid carcinoma. Radioactive iodine therapy was then given, and the patient has remained relapse-free for eight years. Metastases of papillary thyroid carcinoma usually present as multiple nodules or in a miliary pattern. Although solitary lung metastasis is very rare, it is important to consider atypical cases such as those described above. In cases of lung metastases presenting as large nodules, resection is recommended for the purposes of both diagnosis and treatment because radioactive iodine therapy alone may be insufficient. (author)

2012-09-01

195

First documented cure of a suggestive exogenous reinfection in polymyositis with same but multidrug resistant M. tuberculosis  

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Full Text Available Abstract Background MDR Mycobacterium tuberculosis is the major cause of treatment failure in tuberculosis patients, especially in immunosuppressed. We described a young polymyositis patient on immunosuppressive therapy who was started with antituberculosis therapy as a susceptible strain of M. tuberculosis was isolated from a single cutaneous abscess in his neck and from regional lymph nodes. Case presentation He had non-reactive miliary tuberculosis and multiple cutaneous abscesses 6 months later with the same strain, which was resistant this time to 9 antituberculosis drugs. We described clinical presentation, radiological and laboratory work-up, treatment and follow-up as the patient was cured after 1.5 years with 6 antituberculosis drugs. Conclusion To our knowledge, this is the first reported case where an immunosuppressed patient with suggestive exogenous reinfection within 6 months with the same but MDR strain of M. tuberculosis was cured. Intense management and regular follow up were important since the patient was a potent source of MDR M. tuberculosis infection and there was limited choice for therapy.

Mukhopadhyay Chiranjoy

2004-12-01

196

Folliculitis et perifolliculitis capitis abscedens et suffodiens controlled with a combination therapy: systemic antibiosis (metronidazole plus clindamycin), dermatosurgical approach, and high-dose isotretinoin.  

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Folliculitis et perifolliculitis capitis abscedens et suffodiens is a rare disease of unknown etiology. It is a suppurative process that involves the scalp, eventually resulting in extensive scarring and irreversible alopecia. The condition is also known as 'acne necrotica miliaris' or 'Proprionibacterium' folliculitis. Most often the disease affects men of African-American or African-Caribbean descent between 20 and 40 years of age. The clinical picture is determined by fluctuating painful fistule-forming conglomerates of abscesses in the region of the occipital scalp. The cause of scalp folliculitis is not well understood. It is generally considered to be an inflammatory reaction to components of the hair follicle, particularly the micro-organisms. These include: bacteria (especially Propionibacterium acnes, but in severe cases, also Staphylococcus aureus), Yeasts (Malassezia species) and mites (Demodex folliculorum). The initial histopathologic finding is an exclusively neutrophilic infiltration followed by a granulomatous infiltrate. The treatment of the disease is usually difficult and often disappointing. Successful treatment with isotretinoin 1 mg/kg body mass could be achieved only after regular systematic administration in the course of 3-4 months. Here we describe a patient with eruptive purulent form of the disease, which has been controlled with combination therapy: systemic antibiosis with metronidazole and clindamycin, dermatosurgical removal of single nodular formations, and isotretinoin 1 mg/kg body mass for 3-5 months. PMID:21772598

Tchernev, Georgi

2011-05-01

197

Bacteriological analysis of induced sputum for the diagnosis of pulmonary tuberculosis in the clinical practice of a general tertiary hospital / Análise bacteriológica do escarro induzido para o diagnóstico de tuberculose pulmonar na prática clínica de um hospital geral terciário  

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Full Text Available SciELO Brazil | Language: English Abstract in portuguese OBJETIVO: Verificar a sensibilidade diagnóstica da análise bacteriológica do escarro induzido (EI) para o diagnóstico de tuberculose (TB) pulmonar e identificar as variáveis clínicas associadas com o diagnóstico confirmado. Além disso, avaliar o rendimento diagnóstico da broncoscopia realizada se a [...] pesquisa de BAAR for negativa no EI. MÉTODOS: Estudo transversal e retrospectivo de pacientes com suspeita de TB pulmonar ativa, encaminhados ao serviço para a indução de escarro. Foram revisados consecutivamente os registros laboratoriais de todos os pacientes submetidos à indução de escarro entre junho de 2003 e janeiro de 2006, assim como o prontuário eletrônico de cada caso. Também foram revisados os resultados bacteriológicos das amostras broncoscópicas coletadas dos pacientes cujos resultados de BAAR em EI foram negativos. RESULTADOS: Dos 417 pacientes estudados, 83 (19,9%) tiveram resultados positivos (BAAR e/ou cultura) no EI. Na análise de regressão logística, os achados radiológicos de cavitação pulmonar (OR = 3,8; IC95%: 1,9-7,6) e de infiltrado de padrão miliar (OR = 3,7; IC95%: 1,6-8,6) associaram-se mais significativamente com o diagnóstico de TB pulmonar. A broncoscopia foi realizada, após resultado de BAAR negativo no EI, em 134 pacientes e acrescentou 25 (64,1%) diagnósticos confirmados de TB pulmonar. CONCLUSÕES: Na prática clínica, a frequência de diagnósticos confirmados de TB pulmonar por EI (19,9%) foi menor do que aquela previamente relatada em ensaios controlados. Cavitação e infiltrado miliar aumentam a probabilidade diagnóstica de TB pulmonar no EI. O uso de broncoscopia quando EI é negativo para BAAR melhora significativamente a sensibilidade para o diagnóstico de TB. Abstract in english OBJECTIVE: To determine the diagnostic sensitivity of bacteriological analyses in induced sputum (IS) for the diagnosis of pulmonary tuberculosis (TB) and to identify the clinical characteristics associated with the confirmed diagnosis, as well as to determine the diagnostic yield of bronchoscopy ca [...] rried out when IS tests negative for AFB in smear microscopy. METHODS: A retrospective, cross-sectional study of patients suspected of having active pulmonary TB and referred to our clinic for sputum induction. We consecutively reviewed the laboratory data of all patients submitted to sputum induction between June of 2003 and January of 2006, as well as their electronic medical records. In addition, the results of the bacteriological analysis of bronchoscopic specimens collected from the patients whose AFB tests were negative in IS were reviewed. RESULTS: Of the 417 patients included in the study, 83 (19.9%) presented IS samples that tested positive for TB (smear microscopy or culture). In the logistic regression analysis, radiological findings of cavitation (OR = 3.8; 95% CI: 1.9-7.6) and of miliary infiltrate (OR = 3.7; 95% CI: 1.6-8.6) showed the strongest association with the diagnosis of pulmonary TB. In 134 patients, bronchoscopy was carried out after negative AFB results in IS and added 25 (64.1%) confirmed diagnoses of pulmonary TB. CONCLUSIONS: In our clinical practice, the frequency of confirmed diagnosis of pulmonary TB using IS (19.9%) was lower than that previously reported in controlled trials. Cavitation and miliary infiltrate increase the diagnostic probability of pulmonary TB using IS. The use of bronchoscopy when IS tests negative for AFB significantly increases sensitivity in the diagnosis of pulmonary TB.

Garcia, Sabrina Bollmann; Perin, Christiano; Silveira, Marcel Muller da; Vergani, Gustavo; Menna-Barreto, Sérgio Saldanha; Dalcin, Paulo de Tarso Roth.

198

Fiebre, derrame pleural y lesión osteolítica en paciente con infección por VIH / Fever, pleural effusion and osteolytic lesion in a patient with HIV infection  

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Full Text Available SciELO Spain | Language: Spanish Abstract in spanish Presentamos el caso de una paciente de 28 años que consultó por fiebre de hasta 40,8ºC, dolor pleurítico en costado derecho y aparición de una masa dolorosa en la extremidad inferior izquierda de cuatro días de evolución. Mediante tomografía axial computerizada (TAC) se objetivó la existencia de una [...] condensación en el lóbulo medio del pulmón derecho con derrame pleural asociado y patrón miliar bilateral. El estudio ecográfico de la extremidad inferior izquierda mostró una masa de partes blandas de aspecto quístico con destrucción de la cortical del peroné y destrucción ósea. La resonancia magnética confirmó la presencia de osteomielitis en el peroné izquierdo y de un absceso de partes blandas asociado. En el material obtenido por punción del citado absceso así como en tres muestras de esputo se aisló Mycobacterium tuberculosis, estableciéndose el diagnóstico de tuberculosis diseminada con afectación pulmonar miliar, osteomielitis peronea y absceso tuberculoso de partes blandas. Se inició tratamiento antituberculoso (rifampicina, isoniacida y pirazinamida) seguido, dos semanas después, de tratamiento antirretroviral (AZT, 3TC y NVP). La paciente desarrolló un cuadro de erupción cutánea generalizada que desapareció tras la sustitución de la rifampicina por etambutol. Ante la persistencia de la masa de partes blandas, tras cinco semanas de tratamiento antituberculoso se procedió al drenaje quirúrgico del absceso. La evolución posterior fue favorable, permaneciendo la paciente asintomática al mes de ser dada de alta. Abstract in english We present the case of a 28 year old patient who came for consultation on a fever of up to 40.8º C, pleuritic pain on the right side and the appearance of a painful mass in the lower left extremity of four days evolution. Computerised axial tomography (CAT) showed the existence of a condensation in [...] the middle lobe of the right lung with associated pleural effusion and bilateral miliary pattern. The echographic study of the lower left extremity showed a mass of soft parts with a cystic aspect with destruction of the cortical of the fibula and osseous destruction. Magnetic resonance confirmed the presence of osteomyelitis in the left fibula and of an abscess; Mycobacterium tuberculosis was also isolated in three samples of sputum that led to a diagnosis of disseminated tuberculosis with miliary lung affectation, peroneous osteomyelitis and tuberculous abscess of the soft parts. Anti-tuberculosis treatment was started (riphampicine, isoniacide and pirazinamide) followed, two weeks later, with antiretroviral treatment (AZT, 3TC and NVP). The patient developed a clinical picture of generalised cutaneous eruption that disappeared following the replacement of the riphampicine by etambutol. Due to the persistence of the mass of soft parts following five weeks of anti-tuberculosis treatment, we proceeded to surgical draining of the abscess. The subsequent evolution was favourable, with the patient remaining asymptomatic one month after hospital discharge.

J.I., Aláez; J., Repáraz; J., Castiello; J., Úriz; M., Barber; J., Sola.

199

Fiebre, derrame pleural y lesión osteolítica en paciente con infección por VIH Fever, pleural effusion and osteolytic lesion in a patient with HIV infection  

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Full Text Available Presentamos el caso de una paciente de 28 años que consultó por fiebre de hasta 40,8ºC, dolor pleurítico en costado derecho y aparición de una masa dolorosa en la extremidad inferior izquierda de cuatro días de evolución. Mediante tomografía axial computerizada (TAC se objetivó la existencia de una condensación en el lóbulo medio del pulmón derecho con derrame pleural asociado y patrón miliar bilateral. El estudio ecográfico de la extremidad inferior izquierda mostró una masa de partes blandas de aspecto quístico con destrucción de la cortical del peroné y destrucción ósea. La resonancia magnética confirmó la presencia de osteomielitis en el peroné izquierdo y de un absceso de partes blandas asociado. En el material obtenido por punción del citado absceso así como en tres muestras de esputo se aisló Mycobacterium tuberculosis, estableciéndose el diagnóstico de tuberculosis diseminada con afectación pulmonar miliar, osteomielitis peronea y absceso tuberculoso de partes blandas. Se inició tratamiento antituberculoso (rifampicina, isoniacida y pirazinamida seguido, dos semanas después, de tratamiento antirretroviral (AZT, 3TC y NVP. La paciente desarrolló un cuadro de erupción cutánea generalizada que desapareció tras la sustitución de la rifampicina por etambutol. Ante la persistencia de la masa de partes blandas, tras cinco semanas de tratamiento antituberculoso se procedió al drenaje quirúrgico del absceso. La evolución posterior fue favorable, permaneciendo la paciente asintomática al mes de ser dada de alta.We present the case of a 28 year old patient who came for consultation on a fever of up to 40.8º C, pleuritic pain on the right side and the appearance of a painful mass in the lower left extremity of four days evolution. Computerised axial tomography (CAT showed the existence of a condensation in the middle lobe of the right lung with associated pleural effusion and bilateral miliary pattern. The echographic study of the lower left extremity showed a mass of soft parts with a cystic aspect with destruction of the cortical of the fibula and osseous destruction. Magnetic resonance confirmed the presence of osteomyelitis in the left fibula and of an abscess; Mycobacterium tuberculosis was also isolated in three samples of sputum that led to a diagnosis of disseminated tuberculosis with miliary lung affectation, peroneous osteomyelitis and tuberculous abscess of the soft parts. Anti-tuberculosis treatment was started (riphampicine, isoniacide and pirazinamide followed, two weeks later, with antiretroviral treatment (AZT, 3TC and NVP. The patient developed a clinical picture of generalised cutaneous eruption that disappeared following the replacement of the riphampicine by etambutol. Due to the persistence of the mass of soft parts following five weeks of anti-tuberculosis treatment, we proceeded to surgical draining of the abscess. The subsequent evolution was favourable, with the patient remaining asymptomatic one month after hospital discharge.

J.I. Aláez

2007-08-01

200

Bacteriological analysis of induced sputum for the diagnosis of pulmonary tuberculosis in the clinical practice of a general tertiary hospital Análise bacteriológica do escarro induzido para o diagnóstico de tuberculose pulmonar na prática clínica de um hospital geral terciário  

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Full Text Available OBJECTIVE: To determine the diagnostic sensitivity of bacteriological analyses in induced sputum (IS for the diagnosis of pulmonary tuberculosis (TB and to identify the clinical characteristics associated with the confirmed diagnosis, as well as to determine the diagnostic yield of bronchoscopy carried out when IS tests negative for AFB in smear microscopy. METHODS: A retrospective, cross-sectional study of patients suspected of having active pulmonary TB and referred to our clinic for sputum induction. We consecutively reviewed the laboratory data of all patients submitted to sputum induction between June of 2003 and January of 2006, as well as their electronic medical records. In addition, the results of the bacteriological analysis of bronchoscopic specimens collected from the patients whose AFB tests were negative in IS were reviewed. RESULTS: Of the 417 patients included in the study, 83 (19.9% presented IS samples that tested positive for TB (smear microscopy or culture. In the logistic regression analysis, radiological findings of cavitation (OR = 3.8; 95% CI: 1.9-7.6 and of miliary infiltrate (OR = 3.7; 95% CI: 1.6-8.6 showed the strongest association with the diagnosis of pulmonary TB. In 134 patients, bronchoscopy was carried out after negative AFB results in IS and added 25 (64.1% confirmed diagnoses of pulmonary TB. CONCLUSIONS: In our clinical practice, the frequency of confirmed diagnosis of pulmonary TB using IS (19.9% was lower than that previously reported in controlled trials. Cavitation and miliary infiltrate increase the diagnostic probability of pulmonary TB using IS. The use of bronchoscopy when IS tests negative for AFB significantly increases sensitivity in the diagnosis of pulmonary TB.OBJETIVO: Verificar a sensibilidade diagnóstica da análise bacteriológica do escarro induzido (EI para o diagnóstico de tuberculose (TB pulmonar e identificar as variáveis clínicas associadas com o diagnóstico confirmado. Além disso, avaliar o rendimento diagnóstico da broncoscopia realizada se a pesquisa de BAAR for negativa no EI. MÉTODOS: Estudo transversal e retrospectivo de pacientes com suspeita de TB pulmonar ativa, encaminhados ao serviço para a indução de escarro. Foram revisados consecutivamente os registros laboratoriais de todos os pacientes submetidos à indução de escarro entre junho de 2003 e janeiro de 2006, assim como o prontuário eletrônico de cada caso. Também foram revisados os resultados bacteriológicos das amostras broncoscópicas coletadas dos pacientes cujos resultados de BAAR em EI foram negativos. RESULTADOS: Dos 417 pacientes estudados, 83 (19,9% tiveram resultados positivos (BAAR e/ou cultura no EI. Na análise de regressão logística, os achados radiológicos de cavitação pulmonar (OR = 3,8; IC95%: 1,9-7,6 e de infiltrado de padrão miliar (OR = 3,7; IC95%: 1,6-8,6 associaram-se mais significativamente com o diagnóstico de TB pulmonar. A broncoscopia foi realizada, após resultado de BAAR negativo no EI, em 134 pacientes e acrescentou 25 (64,1% diagnósticos confirmados de TB pulmonar. CONCLUSÕES: Na prática clínica, a frequência de diagnósticos confirmados de TB pulmonar por EI (19,9% foi menor do que aquela previamente relatada em ensaios controlados. Cavitação e infiltrado miliar aumentam a probabilidade diagnóstica de TB pulmonar no EI. O uso de broncoscopia quando EI é negativo para BAAR melhora significativamente a sensibilidade para o diagnóstico de TB.

Sabrina Bollmann Garcia

2009-11-01

 
 
 
 
201

Correlación entre linfocitos CD4 y carga viral en pacientes infectados por el virus de la inmunodeficiencia humana con tuberculosis / Correlation between CD4 lymphocytes and viral load in HIV-TB patients  

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Full Text Available SciELO Spain | Language: Spanish Abstract in spanish Objetivo: Analizar, retrospectivamente, la correlación entre los linfocitos CD4 y la carga viral en 16 pacientes (14 hombres y 2 mujeres) infectados por el virus de la inmunodeficiencia humana (VIH) con tuberculosis activa. Material y métodos: Se organizaron los siguientes grupos o formas clínicas d [...] e presentación en relación con la(s) localización(es) de la enfermedad tuberculosa: pulmonares distinguiendo entre típicas y atípicas según el patrón radiológico; extrapulmonares; mixtas, pulmonar y extarpulmonar; y tuberculosis miliar. Resultados: En 7 casos (44%) la afectación era exclusivamente pulmonar, todas ellas atípicas, en 6 (38%) extrapulmonar, en 2 (12%) mixta y en 1 (6%) miliar. La media de linfocitos CD4 fue de 111,1 (rango 5-360), en 11 (69%) los recuentos era inferiores a 200 cels/mm³. El menor recuento de CD4 se obtuvo en las formas mixtas con una media de 45 cels/mm³ mientras que el mayor recuento se obtuvo en las pulmonares con una media de 128,3 cels/mm³. La media de la carga viral fue de 4.82 log (rango, 0-5,93) siendo el título más elevado el de las formas mixtas, con una media de 5,69 log y el más bajo el de las pulmonares con una media de 4.19 log, sin hallarse correspondencia estadísticamente significativa entre ambos parámetros: linfocitos CD4 y carga viral (coeficiente de correlación - 0,1163) Conclusiones: Aunque no hemos hallado significación estadística, por lo regular, aquellos casos con CD4 más elevados presentaron una menor carga viral y los que tienen CD4 bajos una mayor carga viral. Abstract in english Objective: A retrospective study of the correlation between CD4 lymphocytes and the viral load in 16 HIV-patients with tuberculosis. Material and methods: The clinical forms of presentation of tuberculosis were classified according to the location/s of the disease into: pulmonary, distinguishing bet [...] ween typical pulmonary and atypical according to the radiological pattern; extrapulmonary; mixed forms: pulmonary and extrapulmonary; and miliary tuberculosis. Results: Tuberculosis was exclusively pulmonary in 7 cases (44%), all were atypical; extrapulmonary 6 (38%); mixed 2 (12%); and miliary 1 (6%). The mean CD4 lymphocyte count was 111. 1 (range 5-360), in 11 (69%) the counts were below 200 cells/mm³. The lowest CD4 count was in the mixed forms with a mean of 45 cells/ mm³ whilst the highest was obtained in pulmonary forms with a mean of 128.3 cells/mm³. The mean viral load was 4.82 log (range, 0-5.93), the highest load was for mixed forms with a mean 5.69 log, whereas the lowest load was for pulmonary forms with a mean of 4.19 log. No significant correlation was observed between CD4 lymphocytes and viral load (correlation coefficient - 0.1163), Conclusions: Though no significant correlation was observed, a high CD4 was associated to a low viral load and inversely a low CD4 with a high viral load.

F. L., Lado Lado; A., Prieto Martínez; E., Losada Arias; A., Cabarcos Ortiz de Barrón; A., Aguilera Guirao; M. L., Pérez del Molino.

202

Cinco diferentes tipos de imágenes gammagráficas tiroideas en pacientes con enfermedad de graves tratados con 131I en el Paraguay.  

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Full Text Available Thyroid disease is frequent in Paraguay, a country with a prevalence of goiter 48,6% in general population located in the center of South America.Grave’s disease constitutes the most common thyroid hyperfunction observed whose treatment can be carried out with medication (propiltiouracil, metimazol, etc., surgery or iodine 131(131IWe analyzed 70 patients this type of hyperthyroidism treated with the 131I, in its clinical aspect pre and post treatment, ultrasound and nuclear scan findings of the gland thyroid, the hormonal respond Ft4, T3, TSH, thyroid antibodies TPOab, TGab, TRab.Besides the diffuse classic image observed in the thyroid scan and by ultrasonography of the gland, in Grave’s disease, 4 types of images were identified with nodules (multinodular, hot nodule, cold nodule and miliar. The group with diffuse increase in size form was the most numerous (50% continued by the variety multinodular (30%, Marin-Lenhart’s Sx (hot nodule 14%, miliary 3%, and cold nodule 3%.Three months after the treatment with the radioiodine was observed the decrease of the size and thyroid volume in 68% of the patients, thyroid uptake with 131I diminished in 75%. All patients had an increase of weight of 20% and 87% of then were feminineThe signs and symptoms were normalized in 88,5% of the patients. The levels of FT4 were normalized in 73, 8%, T3 in 66%, TSH in 47,7%, TPOab in 83%, TGab in 90%, and TRab in 84%.A received a single dose of 131I was used it in 93% of the patient The cost of the 131I in the Clinic Hospital was half of the cost of the surgery, and at private level the fourth part but cheap.

Jara Yorg J.A.

2006-10-01

203

Radiological findings of pulmonary aspergillosis  

International Nuclear Information System (INIS)

The pulmonary aspergillosis is a group of three separate disease, comprising invasive aspergillosis, aspergilloma, and allergic bronchopulmonary aspergillosis, or a disease process in which one of three entities overlap with another process such as mucoid impaction, pulmonary infiltration with eosinophilia, bronchocentric granulomatosis, microgranulomatous hypersensitivity, or asthma. The radiological findings of 24 cases of pulmonary aspergillosis diagnosed and treated at Seoul National University Hospital during the past 7 years were analyzed retrospectively. The results were as follows: 1. Final diagnosis of 24 cases of pulmonary aspergillosis was aspergilloma in 16 cases, invasive aspergillosis in 2 cases, variant form of allergic bronchopulmonary aspergillosis in 3 cases, and endobronchial aspergillosis in 3 cases. 2. The underlying causes of the aspergilloma were healed tuberculous cavity in 6 cases, bronchiectasis in 8 cases, and no underlying cause were found in 2 cases. All the 16 cases of aspergilloma were correctly diagnosed without difficultly by demonstrating the intracavitary mass or air meniscus. 3. Radiological findings of the invasive aspergillosis in kidney transplant patients were multiple round nodules with early cavitation and formation of aspergilloma which shows slowly progressive cavitation over 13 months in one case, and diffusely scattered miliary nodules with occasional cavitation in the other case. 4. Classic allergic bronchopulmonary aspergillosis were not found in our series but variant form of ABPA was found in 3 young female patients. All the three patients shows some degree of central bronchiectasis and combined aspergilloma was found in 2 cases. 5. Three patients diagnosed as endobronchial aspergillosis-saprophytic infection of aspergillus in the bronchial tree-by bronchoscopic biopsy shows nonspecific radiological findings

1985-02-01

204

Chest X-rays and associated clinical parameters in pulmonary Tubercolosis cases from the National Tubercolosis Program, Mumbai, India  

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Full Text Available The study was carried out in pulmonary tuberculosis (PTB patients from the local Tuberculosis control programme, Mumbai, India. It examined features of chest X-rays and their correlation with clinical parameters for possible application in suspected multidrug resistant TB (MDRTB and to predict outcome in new and treatment failure PTB cases. X-ray features (infiltrate, cavitation, miliary shadows, pleural effusion, mediastinal lymphadenopathy and extent of lesions were analyzed to identify associations with biological/clinical parameters through univariate and multivariate logistic regression. Failures demonstrated associations between extensive lesions and high glycosylated hemoglobin (GHb levels (P=0.028 and male gender (P=0.03. An association was also detected between cavitation and MDR (P=0.048. In new cases, bilateral cavities were associated with MDR (P=0.018 and male gender (P=0.01, low body mass index with infiltrates (P=0.008, and smoking with cavitation (P=0.0238. Strains belonging to the Manu1 spoligotype were associated with mild lesions (P=0.002. Poor outcome showed borderline significance with extensive lesions at onset (P=0.053. Furthermore, amongst new cases, smoking, the Central Asian Strain (CAS spoligotype and high GHb were associated with cavitation, whereas only CAS spoligotypes and high GHb were associated with extensive lesions. The study highlighted associations between certain clinical parameters and X-ray evidence which support the potential of X-rays to predict TB, MDRTB and poor outcome. The use of Xrays as an additional tool to shorten diagnostic delay and shortlist MDR suspects amongst nonresponders to TB treatment should be explored in a setting with limited resources coping with a high MDR case load such as Mumbai.

Anirvan Chatterjee

2012-01-01

205

Diffuse lung uptake (DLU) on Ga-67 scintigraph: Clinical, radiologic and pathologic correlation  

International Nuclear Information System (INIS)

Review, analysis and correlation (clinical, radiologic and pathologic) of 29 consecutive adults (16 drug addicts and/or homosexuals) with DLU on Ga-67 scintigraph were made. Diffuse increased uptake of at least 75% of both lungs was considered as DLU. WFOF cameras were used to obtain 24 to 96 hr. scintigraphs after IV injection of 3-5 mCi of Ga-67 citrate. In 26, tissue diagnosis established: pneumocystis carinii (PC) 15, miliary tuberculosis (TB) 3, sarcoidosis (SR) 3, drug-induced toxicity 2, and toxoplasmosis (TX), primary hyperparathyroidism and nonspecific lymphocytic pneumonia-one each. In two with breast and one with esophageal carcinomas, no lung tissue diagnosis was sought. Concurrent chest x-rays were negative in 16, but in 7/16, lung infiltrate was later documented. An average of 31 days elapsed before x-rays became positive in four with PC, 7 days in two with TB, and 22 days in one with TX. In 13, concurrent x-rays showed lung infiltrate, but in 6, only subtle, localized rather than diffuse infiltrate was noted. Fourteen of 29 had at least two Ga-67 studies. In 12 (7 PC, 2 TB, 3 SR) of 14 whose repeat studies showed significant to total disappearance of DLU, all did well clinically. In two whose initial studies were negative or equivocal, they became clinically worse when the repeat study showed DLU. In three others (2 PC, 1 TX) who died, their single studies recorded intense DLU. DLU on gallium scintigraph indicated a variety of pathology. In 55.2%, gallium scintigraph predated x-ray findings by a few days to weeks. In 20.3%, x-ray findings were only subtle or localized. Scintigraphic changes correlated well with the clinical courses in various diseases

1985-05-01

206

Cutaneous lymphomas: an update. Part 2: B-cell lymphomas and related conditions.  

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: Primary cutaneous B-cell lymphomas (PCBCL) are the second most common form of primary cutaneous lymphomas and account for approximately 25%-30% of all primary cutaneous lymphomas. Both forms of low-grade malignant PCBCL, primary cutaneous follicle center lymphoma (PCFCL) and primary cutaneous marginal zone lymphoma of mucosa-associated lymphoid tissue-type (MALT lymphoma) (PCMZL) represent the vast majority of PCBCL and show an indolent slowly progressive course and an excellent prognosis despite a high recurrence rate. Genetic analysis indicates that PCMZL differ from other forms of extranodal MALT lymphomas. The more common class-switched and the non-class-switched form of PCMZL can be distinguished as two distinctive subsets that differ in the cellular composition, IgM expression, and biological behavior with extracutaneous involvement found in the non-class-switched form. Recently, unusual clinical and histological forms of PCMZL and PCFCL manifesting with miliary or agminated lesions have been described that are diagnostically challenging. In contrast to PCMZL and PCFCL, primary cutaneous diffuse large B-cell lymphoma, leg type, and other rare forms of large B-cell lymphomas such as intravascular large B-cell lymphoma have an unfavorable prognosis. There is an emerging group of Epstein-Barr virus (EBV)-driven B-cell lymphoproliferations including posttransplant lymphoproliferative disorders and mucocutaneous ulcer occurring in immunocompromised patients and EBV-associated diffuse large B-cell lymphoma of the elderly arising in the setting of senescence-linked immunodeficiency. This review reports on recent findings expanding the spectrum of clinicopathological features, differential diagnostic aspects, and the pathogenesis of PCBCL and discusses the group of EBV-associated B-cell lymphoproliferations involving the skin. PMID:24658377

Kempf, Werner; Kazakov, Dmitry V; Mitteldorf, Christina

2014-03-01

207

[Tuberculosis among health care workers in Okinawa Prefecture].  

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In health care setting, transmission of M. tuberculosis (TB) is considerable risk not only to patients but to health care workers (HCWs). The total number of registered TB cases in Okinawa prefecture was 1,202 in 1993-1995 (incidence rate 28.3 per 100,000 in 1995) and that of HCWs was 23. Using data from TB registration system, relative risk of tuberculous disease of nurses was estimated to be 2.3 higher than general population. Nosocomial transmission of TB to HCWs in a general hospital was occurred in 1993. After 2 nurses in the same ward were diagnosed as active pulmonary TB by routine screening chest X-ray, a contact investigation was performed in their family, friends and the ward staffs. On the result of initial evaluation of PPD test, 22 of 26 HCWs were suspected to be infected and preventive therapy with isoniazid were given to 16 HCWs. Follow-up chest radiographs for 3 years revealed 5 HCWs were active TB. According to RFLP analysis of M. tuberculosis isolates, 3 HCWs and 1 patient had identical RFLP pattern to 65-year-old female SLE patient, who was admitted for fever in Nov. 1993 and was diagnosed as miliary tuberculosis after 2 weeks admission. As she had no cough and sputum, the infectiousness of the case was suspected to be increased by cough-inducing procedure. The following TB infection control measures were conducted in the hospital; (1) Education and training to all HCWs for early identification of TB patient and adequate treatment (2) Surveillance and reporting system of TB patient from laboratory and ward to infection-control committee (3) Introduction of PPD test program for HCWs (4) Use of HEPA masks as personal respiratory protection. We need further evaluation of engineering controls e.g. ventilation and isolation room. PMID:10355225

Nakasone, T

1999-04-01

208

Asociación entre tuberculosis infantil grave e inmunización previa con BCG en un hospital de referencia nacional, Perú 1990-2000 / Association between severe tuberculosis in children and previous BCG immunization in a national referral Hospital, Peru 1990-2000  

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Full Text Available SciELO Peru | Language: Spanish Abstract in spanish El objetivo del estudio fue determinar la asociación entre la inmunización con BCG y tuberculosis grave (TB). Se realizó un estudio retrospectivo, se incluyó fichas de pacientes atendidos en el servicio de neumología del Instituto Nacional de Salud del Niño de Perú, entre los años 1990-2000. Se revi [...] saron un total de 2106 casos de TB entre los que había 259 casos graves (TB miliar o meningoencefalitis por TB). Del total, 497 casos no tenían antecedente de inmunización con BCG; 202 tenían TB grave y 295 TB no grave (OR= 0,05; IC 95%= 0,03-0,07). En conclusión, los niños con diagnóstico de TB y que han sido inmunizados con BCG, tienen 94% menos riesgo de desarrollar TB grave, en comparación a los niños con diagnóstico no inmunizados con BCG Abstract in english The objective of the study was to determine the association between BCG immunization and severe tuberculosis (TB). We performed a retrospective study, including medical records from patients of the pneumology department at the National Children?s Institute in Peru, between the years 1990-2000. A tot [...] al of 2106 TB cases were reviewed, from them 259 patients were severe (miliary TB or meningoencephalitic TB). From all, 497 cases did not have history of BCG vaccination, 202 had severe TB and 295 non-severe TB (OR = 0.05, 95% CI = 0.03 to 0.07). In conclusion, children diagnosed with TB and who have been immunized with BCG, has 94% lower risk of developing severe TB, compared to children with TB non-immunized with BCG

Llanos-Tejada, Félix; del Castillo, Hernán.

209

Asociación entre tuberculosis infantil grave e inmunización previa con BCG en un hospital de referencia nacional, Perú 1990-2000 / Association between severe tuberculosis in children and previous BCG immunization in a national referral Hospital, Peru 1990-2000  

Scientific Electronic Library Online (English)

Full Text Available SciELO Public Health | Language: Spanish Abstract in spanish El objetivo del estudio fue determinar la asociación entre la inmunización con BCG y tuberculosis grave (TB). Se realizó un estudio retrospectivo, se incluyó fichas de pacientes atendidos en el servicio de neumología del Instituto Nacional de Salud del Niño de Perú, entre los años 1990-2000. Se revi [...] saron un total de 2106 casos de TB entre los que había 259 casos graves (TB miliar o meningoencefalitis por TB). Del total, 497 casos no tenían antecedente de inmunización con BCG; 202 tenían TB grave y 295 TB no grave (OR= 0,05; IC 95%= 0,03-0,07). En conclusión, los niños con diagnóstico de TB y que han sido inmunizados con BCG, tienen 94% menos riesgo de desarrollar TB grave, en comparación a los niños con diagnóstico no inmunizados con BCG. Abstract in english The objective of the study was to determine the association between BCG immunization and severe tuberculosis (TB). We performed a retrospective study, including medical records from patients of the pneumology department at the National Children?s Institute in Peru, between the years 1990-2000. A tot [...] al of 2106 TB cases were reviewed, from them 259 patients were severe (miliary TB or meningoencephalitic TB). From all, 497 cases did not have history of BCG vaccination, 202 had severe TB and 295 non-severe TB (OR = 0.05, 95% CI = 0.03 to 0.07). In conclusion, children diagnosed with TB and who have been immunized with BCG, has 94% lower risk of developing severe TB, compared to children with TB non-immunized with BCG.

Llanos-Tejada, Félix; del Castillo, Hernán.

210

Detection of Pulmonary tuberculosis: comparing MR imaging with HRCT  

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Full Text Available Abstract Background Computer Tomography (CT is considered the gold standard for assessing the morphological changes of lung parenchyma. Although novel CT techniques have substantially decreased the radiation dose, radiation exposure is still high. Magnetic Resonance Imaging (MRI has been established as a radiation- free alternative to CT for several lung diseases, but its role in infectious diseases still needs to be explored further. Therefore, the purpose of our study was to compare MRI with high resolution CT (HRCT for assessing pulmonary tuberculosis. Methods 50 patients with culture-proven pulmonary tuberculosis underwent chest HRCT as the standard of reference and were evaluated by MRI within 24 h after HRCT. Altogether we performed 60 CT and MRI examinations, because 10 patients were also examined by CT and MRI at follow- up. Pulmonary abnormalities, their characteristics, location and distribution were analyzed by two readers who were blinded to the HRCT results. Results Artifacts did not interfere with the diagnostic value of MRI. Both HRCT and MRI correctly diagnosed pulmonary tuberculosis and identified pulmonary abnormalities in all patients. There were no significant differences between the two techniques in terms of identifying the location and distribution of the lung lesions, though the higher resolution of MRI did allow for better identification of parenchymal dishomogeneity, caseosis, and pleural or nodal involvement. Conclusion Technical developments and the refinement of pulse sequences have improved the quality and speed of MRI. Our data indicate that in terms of identifying lung lesions in non-AIDS patients with non- miliary pulmonary tuberculosis, MRI achieves diagnostic performances comparable to those obtained by HRCT but with better and more rapid identification of pulmonary tissue abnormalities due to the excellent contrast resolution.

Lauria Francesco N

2011-09-01

211

Pulmonary Coccidioidomycosis: Pictorial Review of Chest Radiographic and CT Findings.  

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Pulmonary coccidioidomycosis is a fungal disease endemic to the desert regions of the southwestern United States, Mexico, Central America, and South America. The incidence of reported disease increased substantially between 1998 and 2011, and the infection is encountered beyond the endemic areas because of a mobile society. The disease is caused by inhalation of spores of Coccidioides species. Individuals at high risk are those exposed to frequent soil aerosolization. The diagnosis is established by direct visualization of mature spherules by using special stains or cultures from biologic specimens. Serologic testing of anticoccidioidal antibodies is used for diagnosis and treatment monitoring. The infection is self-limited in 60% of cases. When the disease is symptomatic, the lung is the primary site of involvement. On the basis of clinical presentation and imaging abnormalities, pulmonary involvement is categorized into acute, disseminated, and chronic forms, each with a spectrum of imaging findings. In patients with acute disease, the most common findings are lobar or segmental consolidation, multifocal consolidation, and nodules. Adenopathy and pleural effusions are also seen, usually in association with parenchymal disease. Disseminated disease is rare and occurs in less than 1% of patients. Pulmonary findings are miliary nodules and confluent parenchymal opacities. Acute respiratory distress syndrome is an infrequent complication of disseminated disease. The acute findings resolve in most patients, with chronic changes developing in approximately 5% of patients. Manifestations of chronic disease include residual nodules, chronic cavities, persistent pneumonia with or without adenopathy, pleural effusion, and regressive changes. Unusual complications of chronic disease are mycetoma, abscess formation, and bronchopleural fistula. Patients in an immunocompromised state, those with diabetes mellitus, pregnant women, and those belonging to certain ethnic groups may show severe, progressive, or disseminated disease. ©RSNA, 2014. PMID:25019431

Jude, Cecilia M; Nayak, Nita B; Patel, Maitraya K; Deshmukh, Monica; Batra, Poonam

2014-01-01

212

Urogenital tuberculosis: patient classification in seven different groups according to clinical and radiological presentation  

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Full Text Available PURPOSE: To describe and classify 80 cases of urogenital tuberculosis in seven groups of similar clinical and radiological presentation. MATERIALS AND METHODS: 80 patients (56 males, 70%; median age 34 years; age range 12 to 75 with urogenital tuberculosis were retrospectively reviewed. The patients were divided in seven groups: 1 Bilateral parenchymatous renal lesions; 2 No or minimal changes on radiographic examination; 3 Unilateral renal tuberculosis; 4 Contracted bladder; 5 Contracted bladder with renal failure; 6 Tuberculosis on a transplanted kidney; 7 Isolated genital tuberculosis. RESULTS: 1 Seven (8.8% patients had multiple bilateral parenchymatous renal lesions with fever and malaise, characteristic of miliary tuberculosis. Three of these patients had AIDS. 2 Six (7.5% cases had an early diagnosis, with minimal or no radiographic lesions. Two did not have any urologic symptoms. 3 Twelve (15% patients had unilateral renal tuberculosis with partial (1 case or total non-function kidney. 4 Thirty-seven (46.3% patients had contracted bladder associated with unilateral partial (1 case or total non-function kidney. 5 Ten (12.5% patients had end stage renal disease due to tuberculosis with contracted bladder. 6 Four (5.0% patients had tuberculosis on a transplanted kidney, with graft loss in half the cases. 7 Four (5.0% patients had prostate or epididymis tuberculosis without associated renal lesion. CONCLUSIONS: Urogenital tuberculosis is a destructive disease of the urogenital tract with variable clinical and radiographic presentation. A classification according to similar patterns correlating with disease stage is feasible although early diagnosis is the only prevention of the most severe forms.

Andre A. Figueiredo

2008-08-01

213

Extrapulmonary Tuberculosis: Mycobacterium tuberculosis Strains and Host Risk Factors in a Large Urban Setting in Brazil  

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Background Factors related to the development of extrapulmonary forms of tuberculosis (EPTB) are still poorly understood, particularly in high-endemic countries like Brazil. The objective of the paper is to determine host and Mycobacterium tuberculosis (MTB) strain-related factors associated with the development of EPTB in Espírito Santo state, Brazil. Methods and Findings We conducted a retrospective laboratory-based surveillance study of new tuberculosis (TB) cases diagnosed in Espírito Santo state, Brazil between 1998 and 2007. We genotyped 612 isolates of MTB from 606 TB patients using spoligotyping and IS6110-restriction fragment length polymorphism (RFLP) typing and compared sociodemographic and clinical characteristics of patients with pulmonary TB (PTB) and EPTB. Among 606 patients, 464 (77%) had PTB, 79 (13%) had EPTB, 51 (8%) had both, and 12 (2%) had miliary TB. The IS6110 RFLP analysis demonstrated that 250 (41%) isolates belonged to clustered RFLP patterns, 27 (11%) of which were from EPTB. We identified 73 clusters including 35 (48%) composed of 2 isolates each. By spoligotyping, 506 (83%) MTB isolates fell into known patterns and 106 (17%) fell into patterns with no family assignment; 297 (48%) isolates belonged to the Latin-American Mediterranean family. Higher school level (4-7 years OR: 0.16 95% CI 0.34-0.73 and > 8 years of education, OR 0.06 95% CI 0.009-0.50) white ethnicity (OR: 2.54 95% CI 1.03-6.25) and HIV infection (OR: 16.83 95% CI 5.23-54.18) were associated with EPTB. No specific strain lineage or percentage of clustering was associated with EPTB. Conclusions These results demonstrate that risk factors for EPTB are related more to host than to MTB strain lineage characteristics.

Gomes, Teresa; Vinhas, Solange Alves; Reis-Santos, Barbara; Palaci, Moises; Peres, Renata Lyrio; Aguiar, Paola P.; Ribeiro, Fabiola Karla Correa; Marques, Hebert Silva; Dettoni, Valderio do Valle; Johnson, John L.; Riley, Lee W.; Maciel, Ethel Leonor

2013-01-01

214

Histone genes in macronuclear DNA of the ciliate Stylonychia mytilus.  

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DNA in the macronucleus of Stylonychia mytilus exists as discrete gene-sized fragments which are derived from micronuclear DNA through a series of well-defined developmental events. It has been proposed that each of the DNA fragments might represent a gene and its controlling elements. We have investigated this possibility using genes which code for the five histone proteins. Macronuclear DNA fragments were fractionated according to size by agarose gel electrophoresis, the fragments transferred to nitrocellulose filters using the technique of Southern, and the filter-bound DNA hybridized with labeled cloned histone genes of the sea urchin, Psammechinus miliaris. Results indicate, first, that sequences homologous to the five individual histone gene probes are present in discrete macronuclear fragments which appear as bands in the gel hybridization assay. Secondly, for each of the five individual histone gene probes the homologous DNA fragments are several in number, ranging in size in from 7.6 Kb (Kilo base pairs) to 0.73 Kb. For example, the largest of six detected fragments hybridizing to the H3 gene probe contains approximately 10 times the amount of DNA required to code for a Stylonychia H3 histone. The smallest detected fragment hybridizing to the H3 probe contains enought DNA to code for approximately two copies of the histone. Finally, in general, no two histone approximately two copies of the histone. Finally, in general, no two histone gene probes hybridized to the same macronuclear DNA fragment. This result indicates that genes coding for the five histones in Stylonychia are not located together on the same macronuclear DNA fragments and implies that the five functionally related genes would not be transcribed together as a polycistronic unit. PMID:105862

Elsevier, S M; Lipps, H J; Steinbrück, G

1978-12-01

215

Diagnosis of tuberculosis in children.  

Science.gov (United States)

Diagnosis of tuberculosis (TB) in children is usually based on presumptions from several elements: clinical picture and course, x-rays, tuberculin test, and culture of pathology later on. TB is usually found in a child because of symptoms of primary disease, or through case-finding of a contact. TB is children is often a primary infection and may be gradual or acute in onset. Some of the symptoms of primary TB are low-grade fever, pallor, fatigue, and anorexia. The child may have erythema nodosum, a yellow module on the conjunctiva, hilar or mediastinal lymphadenopathy, a primary TB complex on the lung (3-10 mm), segmental density, or a positive PPD test. Children with pulmonary disease do not have adult-type cavity lesions, but may have a primary cavity that drains into the bronchi, mechanical complications, fistulas, or atelectasis. Acute TB often appears as meningitis. The pathognomonic signs are cerebrospinal fluid high in lymphocytes with very high albumin (0.6-2 g) and low glucose (0.4-0.2 g/l). TB organisms are rarely seen, but may be cultured. TB meningitis is also notable for choroidal tubercles, which are yellow nodules visible in the fundus. These presumptive signs, as well as increasing neurological findings, prompt immediate treatment. Children also may have acute miliary TB, marked by high fever, gastrointestinal symptoms, hepatosplenomegaly, dyspnea, cyanosis, and respiratory distress, with characteristic diffuse grainy spots on the chest x-ray. A child may have both conditions and may also have localized TB infection elsewhere. Thus, clinical findings may point to possible cultures of urine, gastric lavage, pleural fluid or biopsy, pericardial fluid, bone marrow, or ascitic fluid, any of which should be cultured to rule out other causes. The most common sites for extra-pulmonary TB are cervical nodes, spine, knee. shoulder, hip and peritoneum. Pelvic and urinary tract infections are rare in children. PMID:12345139

Anane, T; Grangaud, J P

1992-01-01

216

[Evaluating 82 cases of tuberculous meningitis].  

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Tuberculous meningitis (TBM) is not the most common but the most serious clinical form of extrapulmonary tuberculosis. Serious complications resulting from difficulties in diagnosis and treatment of the disease makes it an important health problem. In our study, 82 patients with TBM, followed up in our clinic between January 1998-December 2002, are evaluated with their clinical and laboratory properties. 52% of our patients were females, 48% were males and their ages ranged from 15 to 70 with a mean of 32 years. The diagnosis was based on patients' history, clinical and laboratory properties, cerebrospinal fluid (CSF) findings and radiographic findings. 59% of our patients were grade II clinically, 29% were grade I, and 23% were grade III. Mostly observed complaints were headache (87%) and nausea-vomiting (63%) and fever (45%) and mostly seen physical findings were stiff neck (70%), alterations in consciousness (57%). Pleocytosis in CSF was detected in 94%, low CSF glucose level in 87%, and elevated CSF protein level in 82% of the patients. From CSF samples of 40 patients, out of total 82, Mycobacterium tuberculosis was isolated on Loewenstein-Jensen medium (49%). Nineteen patients had tuberculomas, 13 had basal meningitis, and 11 had hydrocephalus on cranial radiographic studies. 28% had miliary pattern and 26% had active infiltration and cavities on chest roentgenogram. A four-drug antituberculous regimen was administered for 88% of the patients and dexamethasone treatment was administered for 75%; 56 (68.3%) patients recovered from the illness, 14 (17%) patients had slight and 4 (4.9%) patients had serious neurological sequeales and 8 (9.8%) patients died in spite of tuberculous therapy. As a conclusion, TBM is an infectious disease with high morbidity and mortality rates. Various prognosis patterns may be observed according to the clinical grade of the patient on application. When suspected, an early diagnosis and early treatment of the disease are the most important factors which effect complication and mortality rates. PMID:15765287

Sengöz, Gönül

2005-01-01

217

CUTANEOUS TB PROFILE IN NORTH WEST PUNJAB, INDIA: A RETROSPECTIVE DATA ANALYSIS  

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Full Text Available Introduction: Previous studies from India concluded that the incidence of cutaneous tuberculosis has fallen from 2% to 0.15%, whereas more recent reports suggest that cutaneous tuberculosis is again becoming more prevalent. Aims: To study the patterns of clinical presentation of cutaneous tuberculosis, to correlate them with histopathology, Mantoux reactivity and BCG vaccination status in the north-west region of Punjab. Methods: Analysis of the records of patients with cutaneous tuberculosis who attended the hospital between Jan 2009 to Dec 2012. Results: A total of 36 (0.02% of dermatology patients had cutaneous tuberculosis. The type of cutaneous tuberculosis in decreasing order of incidence was lupus vulgaris 16 (44.44% followed by tuberculosis verrucosa cutis 10 (27.77%, scrofuloderma 7 (19.44% and tuberculids 3 (8.33%. There were no cases of erythema nodosum or miliary tuberculosis. Multiple sites were involved in 17 (47.22% patients. Face and neck were the most common sites affectedMost of the patients (52.77% presented with single lesion. Active tuberculosis in other organs were observed in 8 (22.22% patients. Mantoux test was positive in 23 (63.88%. BCG scar was present in 23 (63.8% patients. 29 cases (80.55% showed characteristic histopathological changes of cutaneous tuberculosis. Conclusions: The incidence of cutaneous tuberculosis in the present study was found to be 0.02% which is far lower as compared to previous reports. Reason for this observation could be the effective implementation of the National Program for tuberculosis at primary and secondary level leading to early diagnosis and treatment, hence lesser number of cases reaching to a tertiary center. This study also depicts the histopathological correlation evident in 80.55% of the histopathological specimens which is highly significant.

Tejinder Kaur

2013-10-01

218

Childhood Tuberculosis in Northern Viet Nam: A Review of 103 Cases  

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Background Childhood tuberculosis causes significant morbidity and mortality in Southeast Asia, yet little is known about the epidemiology and clinical characteristics of this disease in Viet Nam. Objectives To determine the demographics, clinical presentations, radiographic and microbiologic findings, treatment regimens, and outcomes of children admitted with tuberculosis (TB) to a national referral hospital in Viet Nam. Methods We conducted a retrospective case series study of children ? 15 years old with bacteriologically confirmed or clinically diagnosed TB admitted to a national referral hospital in Ha Noi, Viet Nam from January through December 2007. Results One hundred three children were identified: median age 5 years (IQR 2-10), 44% female, 99% Kinh ethnicity, 27% residing in Ha Noi, 88% with BCG vaccination, 27% with known TB contact, and 38% malnourished. Intrathoracic TB was present in 62%, extrathoracic in 52%, both intra and extrathoracic in 19%, and undetermined site in 5%. The most common extrathoracic manifestation was peripheral lymphadenitis, and children under 5 were more likely to have miliary TB or both intra and extrathoracic TB. Fever and failure to thrive were common presenting symptoms among all participants (65% and 56%, respectively), 66% of those with intrathoracic TB presented with cough, and 92% of those with TB meningitis presented with severe neurologic impairment. Acid-fast bacilli smears and mycobacterial cultures were positive in 18% and 21% of children tested, and histopathology was positive in 88% of those biopsied. There were no adverse drug reactions necessitating change in therapy, and no inpatient mortality. Conclusions Extrathoracic TB was common, treatment well tolerated and clinical outcomes excellent. Culture confirmation rates were low and emphasize the need for improved diagnostics.

Blount, Robert J.; Tran, Bao; Jarlsberg, Leah G.; Phan, Ha; Thanh Hoang, Van; Nguyen, Nhung Viet; Lewinsohn, Deborah A.; Nahid, Payam

2014-01-01

219

The role of FDG-PET/CT in the detection of recurrent colorectal cancer  

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The conventional diagnostic techniques used to assess recurrence of colorectal cancer (CRCR) often yield unspecific findings. Integrated FDG-PET/CT seems to offer promise for the differential diagnosis of benign and malignant lesions. The aim of this study was to compare the value of FDG-PET and PET/CT in the detection of CRCR subsequent to colonic resection or rectal amputation. The population for this retrospective study comprised 84 patients with suspected CRCR. The sensitivity, specificity and accuracy of PET and PET/CT were calculated for (a) intra-abdominal extrahepatic recurrences, (b) extra-abdominal and/or hepatic recurrences and (c) all recurrences, and tumour marker levels were analysed. The sensitivity, specificity and overall accuracy of PET in detecting intra-abdominal extrahepatic CRCR were 82%, 88% and 86%, respectively, compared with 88%, 94% and 92%, respectively, for PET/CT. The corresponding figures for detection of extra-abdominal and/or hepatic CRCR were 74%, 88% and 85% for PET and 95%, 100% and 99% for PET/CT. Considering the entire population, the sensitivity, specificity and overall accuracy of PET were 80%, 69% and 75%, respectively, compared with 89%, 92% and 90%, respectively, for PET/CT. FDG-PET/CT examination correctly detected 40 out of a total of 45 patients with CRCR. Two of five patients with falsely negative FDG-PET/CT findings had local microscopic recurrences and one had miliary liver metastases. Of 39 patients without CRCR, three showed false positive FDG-PET/CT results. Two of these cases were due to increased accumulation in inflammatory foci in the bowel wall, while one was due to haemorrhaging into the adrenal gland. FDG-PET/CT appears to be a very promising method for distinguishing a viable tumour from fibrous changes, thereby avoiding unnecessary laparotomy. (orig.)

Votrubova, Jana; Belohlavek, Otakar; Jaruskova, Monika [Na Homolce Hospital, PET Centre, Prague (Czech Republic); Oliverius, Martin [Institute of Clinical and Experimental Medicine, Prague (Czech Republic); Lohynska, Radka [University Hospital Motol, Department of Radiotherapy and Oncology, Prague (Czech Republic); Trskova, Kristina [Na Homolce Hospital, Department of Oncology, Prague (Czech Republic); Sedlackova, Eva [General Teaching Hospital and 1st Faculty of Medicine, Department of Oncology, Prague (Czech Republic); Lipska, Ludmila [Thomayer' s Teaching Hospital and 1st Faculty of Medicine, Department of Surgery, Prague (Czech Republic); Stahalova, Vladimira [Na Bulovce Teaching Hospital, Institute of Radiation Oncology, Prague (Czech Republic)

2006-07-15

220

[A predisposing clinical condition for disseminated tuberculosis: hairy cell leukemia].  

Science.gov (United States)

Hairy cell leukemia (HCL), a rare and slow-progressive B-cell lymphoproliferative disease, enhances predisposition to infectious complications, especially to disseminated mycobacterial infections. Although the association between HCL and mycobacterial disease has been established, disseminated Mycobacterium tuberculosis infection has been reported only in a few case series. In this report, a disseminated tuberculosis (TB) case who had been diagnosed as HCL with histopathologic examination of the bone marrow after being investigated for the etiology of fever of unknown origin, was presented. A 56-year-old male patient who was admitted to our clinic with the complaints of three weeks' duration fever, chills, night sweats and cough was hospitalized. On physical examination, the body temperature of the patient who appeared very ill, was 39°C. Dispersed macular rash that turned pale when pressure was applied, was detected on the legs, arms and back. There were no signs of peripheral lymphadenopathy, hepatomegaly or splenomegaly. Laboratory results revealed haemoglobin 10 g/dl, white blood cell count 1000/mm3, thrombocytes 143.000/mm3, erythrocyte sedimentation rate 41 mm/h, CRP 200 mg/L, uric acid 9.5 mg/dl, AST 118 IU/L, ALT 102 IU/L and LDH 429 IU/L. Thorax computed tomography showed mediastinal and bilateral hilary lymphadenopathy. Although preliminary diagnosis was lymphoma, examination of acid-fast bacilli in three days sequential sputum samples and sputum culture for the growth of mycobacteria (Bactec MGIT 960 TB system, Becton Dickinson, Md) were performed to rule out miliary TB. Blood cultures were also performed with non-radiometric fully automated TB hemoculture bottles (Bactec TB, Becton Dickinson, Md). Sputum cultures yielded no mycobacterial growth, however M.tuberculosis growth was detected in blood culture on the 27th day of inoculation. Bone marrow biopsy revealed HCL. However the patient died on the 14th day of hospitalization. In conclusion, disseminated tuberculosis should be considered for differentional diagnosis in patients with HCL or similar hematologic malignancies since TB is endemic in Turkey. PMID:23621735

Arslan, Ferhat; Bat?rel, Ay?e; Ozer, Serdar; Ca?an Akta?, Sabahat

2013-04-01

 
 
 
 
221

Evaluation of Tl-201 lung uptake and impairment of pulmonary perfusion on scintigraphies in pulmonary tuberculosis  

International Nuclear Information System (INIS)

Tl-201 lung uptake in 74 patients (85 lesions) and pulmonary perfusion in 105 patients were studied to evaluate clinical usefulness of Tl-201 lung uptake and perfusion lung scintigraphy in pulmonary tuberculosis, using a scintillation camera with a mini-computer system. As indices of Tl-201 lung uptake, lung (lesion) to upper mediastinum uptake ratio (L/M) and visual grading were used. L/M in pulmonary tuberculosis was 1.96±0.66, which was significantly larger than 1.04±0.24 in healthy controls and lower than that in heart diseases with left heart failure and idiopathic interstitial pneumonia, and showed no significant differences with that in acute pneumonia, pyothorax, primary lung cancer and malignant mediastinal tumor. L/M in pulmonary tuberculosis did not correlate with CRP, erythrocyte sedimentation rate, Gaffky number of sputum and body temperature. It correlated with the type of pulmonary tuberculosis according to the Gakken Classification reflecting the disease activity. It was larger in the exudative type, caseo-infiltrative one, disseminated one, one with cavity in infiltrative lesion than the fibro-caseous one. On perfusion lung scintigram, impairment of pulmonary perfusion larger than area of the entire unilateral lung was observed in 68 cases (64.8%). Area of hypoperfused lung field, which correlated with % vital capacity (r=0.60, p=0.0002) and PaO2 (r=0.39,p=0.0024), was significantly larger in patients with silicosis and those with bilateral pleural involvements such as pleural callosity than in those with type III according to the Gakkai Classification. Most of the patients showed decreased pulmonary perfusion and Tl-201 accumulation of which grade reflects the disease activity in active tuberculous lesion. Patients with miliary tuberculosis and those with silicotuberculosis showed diffuse Tl-201 accumulation in the both lungs. Tl-201 lung scintigraphy seems to be useful for visualizing active tuberculous lesions, particularly the ones that could not be detected by the chest radiograph in patients with destroyed lung and with pleural callosity. Joint use of Tl-201 and perfusion lung scintigraphies provides useful informations about the pathophysiology and disease process in pulmonary tuberculosis. (author)

2000-02-01

222

Clinical manifestation of HIV/AIDS patients: differences between public and private hospitals in Jakarta  

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Full Text Available The aims of this study is to determine the demographic data, risk factors, clinical presentations, opportunistic/co-infections and its difference between public and private hospitals. A retrospective -descriptive study was conducted in Dr. Cipto Mangunkusumo National General Hospital (public hospital and Medistra Hospital (private hospital, Jakarta. The inclusion criteria were new HIV/AIDS cases admitted in year 2002-2003 and positive HIV serology (Elisa method. Secondary data were collected form medical record. Sixty-six subjects were enrolled in this study (public hospital 30 subjects and private hospital 36 subjects, consist of 59 male (89.4% and 7 female (10.6%. Thirty-seven percent subjects were defined as HIV and 62% AIDS. Risk factors obtained include drug user (59.1%, homosexual (13.6%, heterosexual (21.1%, transfusion (1.5% and maternal-child (perinatal (1.5%. The clinical symptoms mainly present as acute fever (56.2%, weight loss (39.4%, cough (38.8%, shortness of breath (27.2%, chronic diarrhea (22.8%, prolong fever (19.7%, loss of conciousness (15.3%, anorexia (15.3%. Significant differences between public and private hospitals were seen in fever and cough symptoms. Clinical presentation of HIV/AIDS patients during admission were : pneumonia (56%, oral trush (22.6%, anemia (56.5%, leucopenia (32.3%, lymphopenia (55.9%, elevated AST/ALT (66.1%, hypoalbuminemia (46.9%, limphadenopathy (10.6%, brain space occuping lesion (7.6%, encephalopathy (6.0%, pulmonary tb and pleural effusion (10.6%. The opportunistic and co-infections present were candidiasis (25.8%, chronic hepatitis C (24.2%, chronic hepatitis B and C (4.5%, pulmonary tb, lymphadenitis and miliary tb. Candidiasis and pulmonary tb were frequently found in public hospital. In conclusion from this study that clinical manifestation of HIV/AIDS were young man or woman, with one or more possible risk factor, had fever, respiratory complain, loss of body weight, chronic diarrhea, fatique, oral trush, anemia, leucopenia, lymphopenia. Patients admitted in private hospital had varied complain; and patients that admitted in public hospital had more severe and advance condition. (Med J Indones 2004; 13: 232-6Keywords: HIV, AIDS, Clinical Manifestation

Herdiman T. Pohan

2004-12-01

223

Prophylactic cranial irradiation in patients with small cell lung cancer. A retrospective study of recurrence, survival and morbidity.  

DEFF Research Database (Denmark)

BACKGROUND: Prophylactic cerebral irradiation (PCI) is a standard treatment for all small cell lung cancer (SCLC) patients with response to chemotherapy. The aims of this study were: to evaluate patients undergoing PCI with regard to cerebral recurrence rate, site of recurrence, and overall survival (OS) and to investigate the influence of steroid dose on acute toxicity. MATERIALS AND METHODS: From 2007 to 2010 a total of 118 consecutive patients underwent PCI (25 Gray in 10 fractions). In total, 114/118 received full PCI dose, all 118 were included in the study. Data were analyzed retrospectively with regard to disease stage, treatment, date of PCI, steroid dose during PCI, toxicity, time to recurrence, site of recurrence and time of death. The median follow up time was 16.6months (range 3-54months). RESULTS: Of the 118 patients undergoing PCI, 74 had limited disease (LD-SCLC) and 44 had extensive disease (ED-SCLC). The median age was 65years (range 46-80years). The median overall survival of all patients from the time of diagnosis was 16.0months (CI 95% 13.0-19.0), in LD-SCLC it was 24.0months (CI 95% 19.6-28.3), and in ED-SCLC it was 12.0months (CI 95% 9.6-14.4). Twenty-one patients (17.8%) were diagnosed with cerebral recurrence. Five of these presented with metastatic disease within the limbic system. Of these five patients, four had miliary cerebral disease and one had non-oligometastatic disease. The time from PCI to cerebral recurrence ranged from 4 to 27months. Prednisolone administration varied from 0 to 100mg/day. Forty-eight patients were not treated with steroids, 64.6% of these patients reported acute toxicity. Of the 36 patients receiving 50mg prednisolone, only 22.2% had side effects. The most common symptoms during PCI were nausea and headache. CONCLUSIONS: Twenty-one patients out of 118 developed brain metastases after PCI: five of the twenty-one had metastases located in the limbic system. The study showed that prophylactic steroid use might reduce acute toxicity to PCI. Survival data and recurrence rates are comparable to other clinical studies.

Ramlov, Anne; Tietze, Anna

2012-01-01

224

Prognostic factors predicting a fatal outcome in HIV-negative children with neurotuberculosis / Fatores prognósticos de letalidade da neurotuberculose em crianças HIV-negativas  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese OBJETIVO: Identificar elementos prognósticos para a letalidade da neurotuberculose na criança, a partir das manifestações clínicas, dados epidemiológicos e laboratoriais. MÉTODO: Registros de pacientes internados durante o período de 1982 a 2005 foram retrospectivamente avaliados. Os elementos progn [...] ósticos considerados foram: sexo, idade, história de contato íntimo com indivíduo com tuberculose, vacinação com o bacilo de Calmette-Guérin (BCG), teste tuberculínico (PPD), concomitância de tuberculose miliar, convulsões, resultados da análise do LCR e presença de hidrocefalia. RESULTADOS: 141 pacientes com diagnóstico de neurotuberculose foram incluídos. Dezessete por cento dos pacientes foram a óbito. Os fatores associados ao óbito foram história negativa de contágio, ausência de reatividade ao teste de PPD, coma e tempo de internação prolongado. Análise por regressão logística múltipla foi usada para investigar as relações entre os elementos prognósticos e o desfecho óbito. CONCLUSÃO: Os fatores prognósticos na previsão de óbito nos pacientes com neurotuberculose foram a presença de coma no momento do diagnóstico, a ausência de história de contágio e a ausência de reação ao PPD Abstract in english OBJECTIVE: To identify prognostic factors predicting a fatal outcome in HIV-negative children with neurotuberculosis based on clinical, epidemiological, and laboratory findings. METHOD: The clinical records of all in-patients diagnosed with neurotuberculosis from 1982 to 2005 were evaluated retrospe [...] ctively. The following prognostic parameters were examined: gender, age, close contact with a tuberculosis-infected individual, vaccination for bacillus Calmette-Guérin, purified protein derivative (PPD) of tuberculin results, concomitant miliary tuberculosis, seizures, CSF results, and hydrocephalus. RESULTS: One hundred forty-one patients diagnosed with neurotuberculosis were included. Seventeen percent of the cases resulted in death. The factors that were correlated with a negative outcome included lack of contact with a tuberculosis-infected individual, negative PPD reaction, coma, and longer hospitalisation time. A multiple logistic regression analysis was performed to identify which of these factors most often resulted in death. CONCLUSION: Coma at diagnosis, lack of tuberculosis contact, and a non-reactive PPD were the most important predictors of fatality in patients with neurotuberculosis

Rodrigues, Murilo Gimenes; Lin, Jaime; Masruha, Marcelo Rodrigues; Vilanova, Luiz Celso Pereira; Minett, Thais Soares Cianciarullo.

225

Vacina BCG contra tuberculose: efeito protetor e políticas de vacinação BCG vaccine against tuberculosis: its protective effect and vaccination policies  

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Full Text Available OBJETIVO: A vacina BCG é utilizada desde 1921, embora ainda apresente controvérsias e aspectos não esclarecidos. O objetivo do artigo foi analisar aspectos relacionados ao efeito protetor da primeira e segunda doses da vacina BCG e as políticas de vacinação adotadas. MÉTODOS: Foi realizada revisão sistemática da literatura publicada em inglês e espanhol, abrangendo o período compreendido entre 1948 e 2006, na base PubMed. Os principais descritores utilizados foram BCG vaccine, BCG efficacy, BCG e tuberculosis. Os estudos foram agrupados por tipo de desenho, apresentando-se separadamente os principais resultados de ensaios clínicos, estudos de caso-controle e metanálises. RESULTADOS: O efeito protetor da primeira dose da vacina BCG contra a tuberculose na forma miliar ou na meningite é elevado. No entanto, os resultados são discordantes em relação à forma pulmonar, variando de ausência de efeito a níveis próximos a 80%. Estão sendo conduzidas pesquisas sobre novas vacinas candidatas a substituir a BCG ou serem utilizadas como reforço. CONCLUSÕES: Há evidências de que a segunda dose da BCG não aumenta o seu efeito protetor. Apesar de seus limites e da expectativa futura de nova vacina para tuberculose, a vacina BCG mantém-se como importante instrumento no controle dos efeitos danosos da doença, sobretudo em países com taxas de incidência médias e elevadas.OBJECTIVE: The BCG vaccine has been in use since 1921, but still arouses controversy and uncertainties. The objective was to analyze the protective effect of the BCG vaccine in its first and second doses and the accompanying vaccination policies. METHODS: A systematic review of the literature in both English and Spanish was carried out, covering the period 1948 to 2006, using the PubMed database. The main search terms used included BCG vaccine, BCG efficacy, BCG and tuberculosis. The studies were grouped by design, with the main results from the clinic tests, case-control studies and meta-analyses presented separately. RESULTS: The protective effect of the first dose of the BCG vaccine against tuberculosis in its miliary and meningeal forms is high. However, the results vary in relation to the pulmonary form of the disease, with some indicating zero effect and others levels of nearly 80%. Research is being carried out to develop new vaccines that could substitute the BCG or be used as a booster. CONCLUSIONS: There are evidences that the protective effect of the BCG vaccine does not increase with a second dose. In spite of its limitations and the expectation that a new tuberculosis vaccine will be developed in the future, the BCG vaccine remains an important tool in controlling the harmful effects of tuberculosis, particularly in countries with medium or high incidence levels of the disease.

Susan M Pereira

2007-09-01

226

Disseminated tuberculosis in a pregnant woman presenting with numerous brain tuberculomas: case report / Tuberculose disseminada em uma paciente grávida apresentando múltiplos tuberculomas cerebrais: relato de caso  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese A tuberculose é doença infecciosa causada pelo Mycobacterium tuberculosis e tem na forma pulmonar a sua apresentação mais comum. A disseminação da doença é comum em pacientes imunodeprimidos. Entretanto, imunodeficiência relacionada à gravidez suficientemente severa para causar disseminação da micob [...] actéria é rara. Quando a disseminação ocorre, qualquer órgão pode ser afetado e, quando ela se faz para o sistema nervoso central, apresenta-se mais comumente como meningite ou tuberculoma único. Relatamos o caso de uma paciente de 17 anos na 34ª semana de gestação com sintomas pulmonares e hipertensão intracraniana. No dia anterior ao internamento a paciente apresentou episódio súbito de paraparesia e retenção urinária. A paciente evoluiu para parto normal e dez horas após apresentou paraplegia. A radiografia simples e a tomografia de tórax foram compatíveis com tuderculose miliar. A tomografia de crânio mostrou múltiplas lesões hipodensas arredondadas nos hemisférios cerebrais e cerebelares, as quais apresentaram realce anelar após injeção de contraste. A paciente foi submetida à craniotomia com biópsia de uma das lesões, que confirmou o diagnóstico de tuberculoma. Iniciou-se tratamento com regime tríplice e a tomografia de crânio realizada um ano após o diagnóstico foi normal. Abstract in english Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis, which has the pulmonary form as the most common presentation. Dissemination of the disease is common in immunocompromised patients, but immunodeficiency related to pregnancy severe enough to cause dissemination of the Mycoba [...] cteria is exceedingly rare. When dissemination occurs, any organ may be affected and in central nervous system, the infection presents as meningitis and single brain parenchyma tuberculomas. We report the case of a 17 year-old woman at the 34th week of pregnancy with respiratory and high intracranial pressure symptoms. On the day before admission she had a sudden onset of paraparesis and urinary retention and ten hours after the delivery she presented with paraplegia . The chest X-ray and CT scan were compatible with miliary tuberculosis. The cranial CT scan revealed numerous rounded hypodense lesions located at cerebral and cerebellar hemispheres, which presented ring-like enhancement after contrast injection. The patient underwent a craniotomy with biopsy of the lesions confirming the diagnosis of brain tuberculomas. The three-drug regimen was started and the cranial CT scan performed a year after diagnosis showed no brain lesions. We emphasize the aggressive dissemination of the disease in this case associated with pregnancy and the importance of early diagnosis and institution of therapy resulting in regression of the lesions.

Emerson L., Gasparetto; Priscilla, Tazoniero; Arnolfo de, Carvalho Neto.

227

Tuberculosis Frequency in Patients Taking TNF-alpha Blokers  

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Full Text Available Objective: To evaluate tuberculosis frequency in patients who take tumor necrosis factor alpha (TNF-? inhibitors for Collagen Vascular Disease (CVD.Materials and Methods: Patients who actively use or were planned to use TNF-? inhibitors for CVD between June 2007-February 2010 were prospectively included in the study.All patients had a physical examination, chest x-ray and the Tuberculin Skin Test (TST. Sputum smear and culture for acid fast bacilli (AFB was performed in patients with a suspicious lesion on chest x-ray. During follow-up, physical examination, chest x-ray and sputum smear for AFB in indicated cases were performed every 3 months. Tuberculosis was diagnosed with microbiological, radiological and histopathological methods.In case of pulmonary or extrapulmonary tuberculosis,TNF-? inhibitor medication was stopped and anti-tuberculosis therapy was began.Results: A total of 179 patients were included in the study, 91 were female and 88 were male wth a mean age of 42.8±12.0. In 141 patients, TNF-? inhibitor therapy was begun in the study although 38 were taking TNF-? inhibitor medication at the beginning of the study. The median follow-up period was 17 months and 2 (1.1% patients were diagnosed to have active tuberculosis during the study period. The TST was found to be 5-9 mm in 15% and >10 mm in 53.3% of the patients.There was a successful tuberculosis therapy history in 5 patients and at least 1 BCG scar was seen in 67 patients.In our series, 70.9% of the patients had chemoprophylaxis during the study period and new tuberculosis was diagnosed in 2 patients, consisting of one miliary tuberculosis and one pleural tuberculosis. Tuberculosis was diagnosed in 1.1% of TNF-alpha taking patients in our series. Conclusion: It is recomended that the patients taking anti TNF treatment should be evaluated and followed up regularly for tuberculosis during the treatment.

Co?kun Do?an

2012-08-01

228

Tuberculous biliary strictures: uncommon cause of obstructive jaundice  

International Nuclear Information System (INIS)

Tuberculous biliary stricture is a very rare cause of obstructive jaundice. A case of a man who had had pulmonary tuberculosis 20 years ago is reported. He now presented with obstructive jaundice due to multiple strictures just below the confluence of the hepatic ducts and in the right hepatic duct. At surgery, these turned out to be tuberculous in origin. There was also tuberculous involvement of the gall bladder and cystic duct. The commonest differential diagnosis in such cases is cholangiocarcinoma (as in the present case). Imaging helps in defining the extent of bile duct obstruction. Suspicion of the disease and establishing a tissue diagnosis is very important in treating this potentially curable condition, especially with the worldwide resurgence of tuberculosis. Imaging modalities such as US and CT may be useful in demonstrating the dilated bile ducts. As there are no specific radiological features of tuberculous biliary strictures, the radiologist should search for any associated findings in abdominal imaging, especially focal hepatic lesions, abdominal lymphadenopathy and abdominal calcification. Tuberculous hepatic involvement can have miliary, nodular and solitary abscess forms. Solitary tuberculous abscesses may be readily detected by sectional imaging such as US, CT or MRI. Ultrasound appearances encountered include well-defined hypoechoic lesions, mixed hyper/hypoechoic masses or almost solid masses. On CT, tuberculous liver abscesses have been described as having a rosette appearance or being a hypodense mass. Magnetic resonance imaging of a tuberculous solitary mass has been described as hypointense on T1-weighted images and iso- or hypointense on T2-weighted images. However, none of these findings are specific or diagnostic of tuberculous origin and, therefore, the lesions have to be sampled percutaneously to arrive at the correct diagnosis. Abdominal lymphadenopathy (mainly periductal, hepatoduodenal ligament and at the porta hepatis) can be seen in up to 35% of cases of hepatobiliary tuberculosis. Finding calcification on abdominal X-ray is another important observation which is reported to be present in 50% of cases of hepatobiliary tuberculosis. The patterns described are 'chalky' and confluent hepatic calcifications or nodal-type calcifications along the course of the CBD. It is also important to examine a recent chest X-ray as associated chest X-ray abnormalities may be seen in up to 65% of cases of hepatobiliary tuberculosis. The likelihood of having a positive yield of AFB in bile aspirate cytology from ERCP is low. Of the total 12 cases of biliary tuberculosis reported, bile cytology was done in seven, of which only two were positive for AFB. Only one of these 12 cases showed associated hepatic calcification. Copyright (2001) Blackwell Science Pty Ltd

2001-08-01

229

Postmortem Investigations Following Human Immunodeficiency Virus Infection  

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Full Text Available Background: HIV/AIDS is a global disease and despite intensive research it is one of the main causes of human death. Postmortem studies have proven accurate in determining the various pathologies in these patients. Aims & Objectives: Our aim was to analyze the post mortem results of individuals who died after HIV infection in the same geographical region. We evaluated the most frequent opportunistic diseases and their clinical and morphological outcomes. Methods: We studied case reports and autopsy research data from 32 patients who died after HIV infection in Smolensk, Russian Federation, between 2003 and 2008. All patients had been diagnosed with HIV infection before death, using HIV-specific enzyme linked immunosorbent assay (ELISA and immunoblotting. Autopsy specimens of various organs were examined histologically and microbiologically. Findings: The mean survival period from the moment of detection of seropositivity in all the patients was less than five years. Twelve patients had a parenteral mode of contact, six had been infected by sexual contact, and 14 patients had unknown modes of infection. Most patients (69% had chronic hepatitis C. The main causes of death were various infectious diseases. The most common were generalized miliary tuberculosis and progressive secondary tuberculosis of the lungs. Three (9% patients had tuberculosis of the meninges and five (16% had peritoneal infections, but tuberculous peritonitis had not been diagnosed before death. Six patients had pulmonary tuberculosis and bacterial pneumonia simultaneously. Two (6% patients died from bacterial sepsis as a result of cervical lymphadenitis, and eight (12.5% from abscess-forming pneumonia. The opportunistic infections revealed were Pneumocystis carinii pneumonia (eight patients, cytomegaloviral pneumonia (three, bronchopulmonary aspergillosis (one and mucosal candidiasis (three. In three patients, the causes of death were advanced neoplastic processes: two cases of leukemia and one case of cervical cancer. Conclusions: Tuberculosis was the most widespread among the opportunistic infections, which often had affected the entire lung and had a destructive form. In the morphological picture of tuberculous inflammation, alterative and exudative changes dominated. Moreover, HIV infection had a characteristically broad spectrum of causative agents of pneumonia, including bacteria, viruses, fungi, and protozoa.

Andrey V. Bychkov

2009-04-01

230

[Progress in management of severe tuberculosis or tuberculosis with severe complication].  

Science.gov (United States)

The management and therapy of miliary tuberculosis: Nobuharu OHSHIMA (Asthma and Allergy Center, National Hospital Organization Tokyo National Hospital). Treatment and management of severe pulmonary tuberculosis: Yuta HAYASHI, Kenji OGAWA (Department of Respiratory Medicine, National Hospital Organization Higashi Nagoya National Hospital). Death of a young (non-elderly) patient may become a large psychological burden not only for patient's family but also for medical staff. We analyzed non-elderly cases with severe pulmonary tuberculosis by comparing 13 patients who died of tuberculosis in the hospital (death group) and 31 patients who survived and were discharged from hospital (survivor group). The mean age was older and there were more patients who were out of employment in the death group compared to the survivor group. Among the factors related to the general condition evaluated on the admission, disturbance of consciousness, respiratory insufficiency, impairment in the ADL, poor dietary intake, and decubitus ulcer were more observed in the death group. Chest X-ray finding was not a predictive factor of poor prognosis. Among the laboratory findings, the numbers of peripheral blood lymphocytes, red blood cells, and thrombocytes significantly decreased in the death group. Serum level of total cholesterol, cholinesterase, and albumin were also significantly lower in the death group, indicating that malnutrition was related to the death of severe tuberculosis. Further studies are needed to establish the optimal nutritional management and evaluate the effectiveness of adjunctive use of steroid for severe tuberculosis patients. Invasive fungal infection complicated with pulmonary tuberculosis: Akira WATANABE, Katsuhiko KAMEI (Division of Clinical Research, Medical Mycology Research Center, Chiba University). Among the invasive mycoses, chronic pulmonary aspergillosis (CPA) is the most frequent disease as a sequel to pulmonary tuberculosis. However, identifying CPA early in patient with persistent pulmonary shadows from pulmonary tuberculosis is difficult. Serum microbiological tests such as Aspergillus precipitans (principally for Aspergillus IgG antibodies) are useful but sensitivity and specificity of this test are not high. Even treated, CPA has a case mortality rate of 50% over a span of 5 years. Morbidity is marked by both systemic and respiratory symptom and hemoptysis. Loss of lung function and life-threatening hemoptysis are common. As invasive pulmonary aspergillosis, early diagnosis and treatment of CPA might improve the outcome. Regarding the treatment, concomitant use of some anti-tubercular agents and antifungals is contradicted. Treatment and management for pulmonary tuberculosis complicated with COPD and interstitial pneumonia: Shinji TAMAKI, Takashi KUGE, Midori TAMURA, Sayuri TANAKA, Eiko YOSHINO, Mouka TAMURA (National Hospital Organization Nara Medical Center), Hiroshi KIMURA (Second Department of Internal Medicine and Respiratory Medicine, Nara Medical University) Recently, patients of pulmonary tuberculosis have many complications especially in the elderly population. It is recognized that patients with COPD and interstitial pneumonia (IP) have an increased risk for developing active tuberculosis. The aim of this report is to describe the clinical findings of pulmonary tuberculosis complicated with COPD and IP. We reviewed 327 patients who were diagnosed as pulmonary tuberculosis. Twenty-six cases were complicated with COPD. All patients were male, and had smoking history. Cavitary lesions were observed only in 5 cases. Acute exacerbation of COPD occurred in one fatal case. Ten cases were complicated with IP. Cavitary lesions were observed in 3 cases. Acute exacerbation of IP were observed in 7 cases, and 4 patients died during the anti-tuberculosis treatment. Careful evaluation and treatment are necessary for tuberculosis patients complicated with COPD and IP. PMID:24979949

Kimura, Hiroshi; Imaizumi, Kazuyoshi

2014-05-01

231

Fase aguda da esquistossomose mansoni  

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Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese O A. faz um estudo panorâmico sobre a fase aguda da esquistossomose mansoni, abordando o quadro clínico e seu diagnóstico, os exames subsidiários, o diagnóstico diferencial, a terapêutica e os aspectos evolutivos. As manifestações clinicas dos períodos de incubação, de estado e de supressão são abor [...] dados. O diagnóstico da fase aguda é baseado em dado epidemiológico, 110 exame fisico e em exames subsidiários. O dado epidemiológico. em geral, é positivo, com menção a banho infectante, comumente 30 a 40 dias antes do início do quadro clínico e ao exame físico, encontramos hipertermia (38 - 4G°C), prostração, micropoliadenia hepatomegalia dolorosa em 95%, dos casos e esplenomegalia em 70% dos casos. Os exames prioritários para o diagnóstico são o exame parasiiológico de fezes seriado, que é positivo para ovos viáveis de S. mansoni e o leucograma seriado, que, geralmente, acusa leucocitose com eosinofilia. Em caso de dúvida ou para complementação diagnostica, podemos recorrer à endoscovia retal, ao oograma e á biópsia hepática. A endoscopia acusa, comumente, mucosa hiperêmica, edemaciada, friável, granulosa, com pontos hemorrágicos e o exame colhido por punção biópsia revela, entre outros achados, granulomas na fase necrótica-exsudativa. O diagnóstico diferencial deve ser feito com as seguintes entidades clínicas: gastroenterites. febre tifóide, disenteria bacilar, amebíase aguda, salmonelose septicêrnica prolongada, devendo, ainda, figurar a tuberculose miliar, abdome agudo, a G.N.D.A., a mononucleose infecciosa, a leptospirose, a hepatite e as poaneurites. A terapeutica é baseada nos cuidados gerais, na córticoterapia e na terapêutica específica. Observamos regressão dramática do quadro toxinfeccioso. nas primeiras 24 a 48 horas com a córticoterapia (prednisona) que tem duração aproximada de 7 a 10 dias. A terapêutica específica (derivado nitrotiazolico = ambilhar e derivado hidroximetílico do miracil D = hycanthone) é empregada após remissão do quadro toxiinfeccioso ou em plena fase aguda; nesta eventualidade os sintomas gerais e os distúrbios intestinais desaparecem a partir do 5.° dia de terapêutica. Quando empregamos ambilhar ou hycanthone, em apenas um esquema terapêutico, observamos 40% de cura; esta cifra atinge a 80-90%, quando repetimos a medicação específica, após verificarmos recidiva. Abstract in english In this panoramic study about the acute phase of schistosomiasis mansoni the author describe its clinical picture and diagnosis, the complementary tests, the author describes its clinical picture and diagnosis, the complementary tests, ical pictures of the incubation, fastigium and suppression perio [...] ds are described. The diagnosis of the acute phase is based on epidemiologic data are often positive, there being mention to an infective bath, usually 30 to 40 days prior to the onset of the disease. Fever (38-40°C) is noticed at the physical examination, as well as prostation and microlymphadenopathy. Enlargement and tenderness of the liver are found in 95 percent and splenomegaly in 70 per cent of the cases. The most important laboratory tests for the diagnosis are: repeated direct examination in stool specimens for the detection of viable S. mansoni eggs, and repeated leukocyte count that generally shows leukocytosis and eosinophilia. When in doubt or for diagnostic complementary one may always recourse to the rectal endoscopy, the ocgrama and the liver biopsy. The endoscopy usually reveals hyperemic, edematous, friable and granulous mucosa with bleeding points. The needle-biopsy of the liver followed by the histopathologic examination of the hepatic tissue discloses granulomas in the necrotic-exudative phase, among other findings. The differential diagnosis must be made with diseases as follows: gastroenteritis, typhoid fever, bacilar disentery, acute amebiasis, and prolonged septicaemic salmonellosis, although one should also include miliary tub

Tonelli, Edward.

232

Development of Pacing, Electrophysiology and Defibrillation in India  

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Full Text Available History of cardiac pacing in India dates back to late 1960s. Kar1 reported that cardiac pacing was introduced in India in 1966. Basu2 while discussing on cardiac pacemaking in Calcutta, mentions that the first pacing was performed in April 1967 at the Institute of Post Graduate Medical Education and Research (IPGME&R. Bhatia et al3 started pacemaker implantation at AIIMS, New Delhi in 1968. Their first patient was a doctor from Assam and the pulse generator was supplied by Medtronic Inc. The pulse generator was powered by a mercury-iodide battery which lasted for about 2 ½ years, after which the patient underwent pulse generator replacement. Unfortunately he succumbed to miliary tuberculosis about a year after that. Currently around 8000 pacemakers are being implanted annually in India, in various centers around the country. G.B. Pant Hospital New Delhi has been the pioneering center in the field of Invasive Cardiac Electrophysiology in the country. Bhatia M.L et al9 and Khalilullah M et al 10,11,12,13 were the pioneers in His bundle electrography in the country. Prof. K.K. Sethi was the first to perform catheter ablation in the country. Direct Current ablation was started in 1988 followed by Radio Frequency (RF ablation later on. The number of centres having electrophysiology setup in the country has increased from about 10 in 1997 to around 30 in 2001 (Fig 4. The number of RF ablations being performed in the country has gone up from 800 to 2000 during the same period. Newer insights in the field of atrial fibrillation in rheumatic heart disease have been obtained by electrophysiological studies from the country. Atrial disease due to rheumatic carditis is an important parameter, in addition to valvular involvement in the genesis of atrial fibrillation. Multiple substrates for atrial fibrillation are present in these cases, namely: stretch, fibrosis, raised pressures, increased atrial size and increased anisotropy. Atrial fibrillation in rheumatic heart disease is generally of long duration and affects a younger population. Control of Rate versus Rhythm in Rheumatic Atrial Fibrillation Trial -?CRRAFT? conducted at Mumbai has documented the effectiveness of amiodarone in the treatment of rheumatic atrial fibrillation. Surgical RF pulmonary vein isolation using Thermaline Multi-Electrode Catheter [EP Technologies] has been done in 27 patients with rheumatic atrial fibrillation of more than one year duration. Lesions were as follows: bilateral pulmonary vein isolation, isolation of the left atrial appendage and connection lesion between left atrial appendage and pulmonary veins.Prof. K.K. Talwar, AIIMS, New Delhi and Dr. T.S. Kler, Escorts Heart Institute & Research Centre, New Delhi were the first to implant Implantable Cardioverter Defibrillators (ICD in India. Current annual ICD implantation rates stand at 60 per year.

Mohan Nair

2002-04-01

233

Mycobacterium tuberculosis and nontuberculous mycobacterial isolates among patients with recent HIV infection in Mozambique / Doença pulmonar por Mycobacterium tuberculosis e micobactérias não-tuberculosas entre pacientes recém-diagnosticados como HIV positivos em Moçambique, África  

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Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: A micobacteriose é frequentemente diagnosticada entre pacientes infectados pelo HIV. Em Moçambique, onde apenas um pequeno número de pacientes encontra-se sob tratamento anti-retroviral, e a tuberculose tem alta prevalência, existe a necessidade de melhor caracterização destes agentes bact [...] erianos, em nível de espécie, bem como de se caracterizar os padrões de resistência às drogas antituberculosas. MÉTODOS: Em uma coorte de 503 indivíduos HIV positivos suspeitos de tuberculose pulmonar, 320 apresentaram positividade para baciloscopia ou cultura no escarro e no lavado brônquico. RESULTADOS: Bacilos álcool-ácido resistentes foram detectados no escarro em 73% dos casos com cultura positiva. De 277 isolados em cultura, apenas 3 mostraram-se tratar de micobactérias não-tuberculosas: 2 Mycobacterium avium e uma M. simiae. Todos os isolados de M. tuberculosis inicialmente caracterizados através de reação em cadeia de polimerase (RCP) do gene hsp65 foram posteriormente caracterizados como tal através de RCP do gene gyrB. Resistência à isoniazida foi encontrada em 14% dos casos; à rifampicina em 6%; e multirresistência em 5%. Pacientes previamente tratados para tuberculose mostraram tendência a taxas maiores de resistência às drogas de primeira linha. O padrão radiológico mais freqüente encontrado foi o infiltrado intersticial (67%), seguido da presença de linfonodos mediastinais (30%), bronquiectasias (28%), padrão miliar (18%) e cavidades (12%). Os pacientes infectados por micobactérias não-tuberculosas não apresentaram manifestações clínicas distintas das apresentadas pelos outros pacientes. A mediana de linfócitos CD4 entre todos os pacientes foi de 134 células/mm³. CONCLUSÕES: Tuberculose e AIDS em Moçambique estão fortemente associadas, como é de se esperar em países com alta prevalência de tuberculose. Embora as taxas de resistência a drogas sejam altas, o esquema isoniazida-rifampicina continua sendo a escolha apropriada para o início do tratamento. Abstract in english OBJECTIVE: Mycobacteriosis is frequently diagnosed among HIV-infected patients. In Mozambique, where few patients are under antiretroviral therapy and the prevalence of tuberculosis is high, there is need for better characterization of mycobacteria at the species level, as well as for the identifica [...] tion of patterns of resistance to antituberculous drugs. METHODS: We studied a sample of 503 HIV-infected individuals suspected of having pulmonary tuberculosis. Of those 503, 320 tested positive for mycobacteria through sputum smear microscopy or culture of bronchoalveolar lavage fluid. RESULTS: Acid-fast bacilli were observed in the sputum of 73% of the individuals presenting positive cultures. Of 277 isolates tested, only 3 were nontuberculous mycobacteria: 2 were identified as Mycobacterium avium and one was identified as M. simiae. Strains initially characterized as M. tuberculosis complex through polymerase chain reaction restriction analysis (PRA) of the hsp65 gene were later confirmed as such through PRA of the gyrB gene. Among the M. tuberculosis isolates, resistance patterns were as follows: to isoniazid, 14%; to rifampin, 6%; and multidrug resistance, 5%. Previously treated cases showed significantly higher rates of resistance to first-line antituberculous drugs. The most common radiological pattern was interstitial infiltrate (in 67%), followed by mediastinal lymph node enlargement (in 30%), bronchiectasis (in 28%), miliary nodules (in 18%) and cavitation (in 12%). Patients infected with nontuberculous mycobacteria presented clinical profiles indistinguishable from those of other patients. The median CD4 lymphocyte count in this group was 134 cells/mm³. CONCLUSIONS: There is a strong association between tuberculosis and AIDS in Mozambique, as expected in a country with a high prevalence of tuberculosis. Although drug resistance rates are high, the isoniazid-rifampin regimen continues to be the appr

Nunes, Elizabete Abrantes; De Capitani, Eduardo Mello; Coelho, Elizabete; Panunto, Alessandra Costa; Joaquim, Orvalho Augusto; Ramos, Marcelo de Carvalho.

234

Indicadores de morbimortalidade hospitalar de tuberculose no Município de São Paulo / Indicators of tuberculosis morbimortality in hospitals in the city of São Paulo  

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Full Text Available SciELO Public Health | Language: Portuguese Abstract in portuguese INTRODUÇÃO: O tratamento de tuberculose é realizado atualmente nos serviços ambulatoriais, ficando a internação recomendada para os casos de maior gravidade ou com problemas sociais. No Município de São Paulo, contudo ainda tem sido internado um número expressivo de doentes de tuberculose. OBJETIVO [...] DO TRABALHO: Estudar as características sociodemográficas e clínico-epidemiológicas dos doentes internados com tuberculose, residentes no Município de São Paulo em 2001. METODOLOGIA: Utilizando como fonte de dados o sistema de informação em tuberculose do Estado, (EPI - TB) programa de registro, acompanhamento e análise de notificações e dados de população do Deinfo/ SEMPLA e FIPE, foram calculados indicadores de morbimortalidade segundo variáveis existentes nas fichas de notificação dos doentes internados. RESULTADOS E DISCUSSÃO: No município de S.Paulo, no ano de 2001, foram internados 2.473 doentes com tuberculose. O coeficiente de internação desses doentes foi de 23,5 casos por 100.000 habitantes, o coeficiente de mortalidade encontrado foi de 4,1 por 100.000 habitantes, tendo ocorrido 485 óbitos e sendo a taxa de letalidade de 17,4%. A taxa de coinfecção Tb/HIV foi de 32,7% entre os internados e de 12,5% entre os não internados, indicando que a epidemia de Aids exerceu forte influência tanto na magnitude quanto na gravidade da situação desses doentes, sendo a maior letalidade (48,4%) a da forma disseminada/miliar, com a maioria de casos em doentes HIV positivos. Entretanto, se excluirmos os casos dos portadores de HIV, a taxa de letalidade ainda se mantém alta, 15,1%, mostrando também a gravidade da tuberculose. CONCLUSÕES: Os resultados mostraram indicadores com valores preocupantes, ficando evidente a importância do acompanhamento dos mesmos para monitorar a situação da tuberculose. RECOMENDAÇÕES: As vigilâncias epidemiológicas municipais devem estabelecer fluxos e estratégias de acompanhamento dos doentes internados com tuberculose principalmente nos grandes centros urbanos, para garantir a continuidade do tratamento e modificar o cenário encontrado. Abstract in english INTRODUCTION: The treatment of tuberculosis is currently carried out in outpatient health services and hospitalization is only recommended for the more severe cases or for those facing social problems. In São Paulo, however, a considerable number of tuberculosis patients are still hospitalized. OBJE [...] CTIVE: To study the socio-demographic and clinical-epidemiological characteristics of hospitalized tuberculosis patients in the city of São Paulo in 2001. SPECIFIC OBJECTIVE: To calculate tuberculosis morbimortality indicators for inpatients. METHODS: Indicators of morbimortality of inpatients were calculated taking as sources, data from the São Paulo state tuberculosis information system - (Epitb) registration program, and the follow-up and analysis of reports and population data from Deinfo/ SEMPLA and FIPE. RESULTS: A total of 2,473 tuberculosis patients were hospitalized in the city of São Paulo in 2001. The hospitalization rate for these patients was 23.5 per 100,000 inhabitants, and the mortality rate found was 4.1 per 100,000 inhabitants with 485 deaths, yielding a fatality rate of 17.4%. DISCUSSION: The TB/HIV co-infection rate was of 32.7% among inpatients and 12.5% among those not hospitalized, showing that the Aids epidemic has caused a considerable impact both in the magnitude and in the severity of the situation of hospitalized tuberculosis patients. The higher fatality rate (48.4%) is of disseminated / miliary tuberculosis, of which the majority occurs in HIV-positive patients. If, however, known HIV-positive cases are excluded, the fatality rate still remains high, i.e. 15%, showing that the severity of cases is not only due to co-infection. CONCLUSIONS: Taking all points into consideration, the indicators showed an alarming situation. RECOMMENDATION: It is recommended that the epidemiological s

Galesi, Vera Maria Neder; Almeida, Margarida Maria Mattos Brito de.

235

Indicadores de morbimortalidade hospitalar de tuberculose no Município de São Paulo Indicators of tuberculosis morbimortality in hospitals in the city of São Paulo  

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Full Text Available INTRODUÇÃO: O tratamento de tuberculose é realizado atualmente nos serviços ambulatoriais, ficando a internação recomendada para os casos de maior gravidade ou com problemas sociais. No Município de São Paulo, contudo ainda tem sido internado um número expressivo de doentes de tuberculose. OBJETIVO DO TRABALHO: Estudar as características sociodemográficas e clínico-epidemiológicas dos doentes internados com tuberculose, residentes no Município de São Paulo em 2001. METODOLOGIA: Utilizando como fonte de dados o sistema de informação em tuberculose do Estado, (EPI - TB programa de registro, acompanhamento e análise de notificações e dados de população do Deinfo/ SEMPLA e FIPE, foram calculados indicadores de morbimortalidade segundo variáveis existentes nas fichas de notificação dos doentes internados. RESULTADOS E DISCUSSÃO: No município de S.Paulo, no ano de 2001, foram internados 2.473 doentes com tuberculose. O coeficiente de internação desses doentes foi de 23,5 casos por 100.000 habitantes, o coeficiente de mortalidade encontrado foi de 4,1 por 100.000 habitantes, tendo ocorrido 485 óbitos e sendo a taxa de letalidade de 17,4%. A taxa de coinfecção Tb/HIV foi de 32,7% entre os internados e de 12,5% entre os não internados, indicando que a epidemia de Aids exerceu forte influência tanto na magnitude quanto na gravidade da situação desses doentes, sendo a maior letalidade (48,4% a da forma disseminada/miliar, com a maioria de casos em doentes HIV positivos. Entretanto, se excluirmos os casos dos portadores de HIV, a taxa de letalidade ainda se mantém alta, 15,1%, mostrando também a gravidade da tuberculose. CONCLUSÕES: Os resultados mostraram indicadores com valores preocupantes, ficando evidente a importância do acompanhamento dos mesmos para monitorar a situação da tuberculose. RECOMENDAÇÕES: As vigilâncias epidemiológicas municipais devem estabelecer fluxos e estratégias de acompanhamento dos doentes internados com tuberculose principalmente nos grandes centros urbanos, para garantir a continuidade do tratamento e modificar o cenário encontrado.INTRODUCTION: The treatment of tuberculosis is currently carried out in outpatient health services and hospitalization is only recommended for the more severe cases or for those facing social problems. In São Paulo, however, a considerable number of tuberculosis patients are still hospitalized. OBJECTIVE: To study the socio-demographic and clinical-epidemiological characteristics of hospitalized tuberculosis patients in the city of São Paulo in 2001. SPECIFIC OBJECTIVE: To calculate tuberculosis morbimortality indicators for inpatients. METHODS: Indicators of morbimortality of inpatients were calculated taking as sources, data from the São Paulo state tuberculosis information system - (Epitb registration program, and the follow-up and analysis of reports and population data from Deinfo/ SEMPLA and FIPE. RESULTS: A total of 2,473 tuberculosis patients were hospitalized in the city of São Paulo in 2001. The hospitalization rate for these patients was 23.5 per 100,000 inhabitants, and the mortality rate found was 4.1 per 100,000 inhabitants with 485 deaths, yielding a fatality rate of 17.4%. DISCUSSION: The TB/HIV co-infection rate was of 32.7% among inpatients and 12.5% among those not hospitalized, showing that the Aids epidemic has caused a considerable impact both in the magnitude and in the severity of the situation of hospitalized tuberculosis patients. The higher fatality rate (48.4% is of disseminated / miliary tuberculosis, of which the majority occurs in HIV-positive patients. If, however, known HIV-positive cases are excluded, the fatality rate still remains high, i.e. 15%, showing that the severity of cases is not only due to co-infection. CONCLUSIONS: Taking all points into consideration, the indicators showed an alarming situation. RECOMMENDATION: It is recommended that the epidemiological surveillance of municipalities establish flows and follow_up strategies for tuberculosis patients who have

Vera Maria Neder Galesi

2007-03-01

236

Indicadores de morbimortalidade hospitalar de tuberculose no Município de São Paulo / Indicators of tuberculosis morbimortality in hospitals in the city of São Paulo  

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Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese INTRODUÇÃO: O tratamento de tuberculose é realizado atualmente nos serviços ambulatoriais, ficando a internação recomendada para os casos de maior gravidade ou com problemas sociais. No Município de São Paulo, contudo ainda tem sido internado um número expressivo de doentes de tuberculose. OBJETIVO [...] DO TRABALHO: Estudar as características sociodemográficas e clínico-epidemiológicas dos doentes internados com tuberculose, residentes no Município de São Paulo em 2001. METODOLOGIA: Utilizando como fonte de dados o sistema de informação em tuberculose do Estado, (EPI - TB) programa de registro, acompanhamento e análise de notificações e dados de população do Deinfo/ SEMPLA e FIPE, foram calculados indicadores de morbimortalidade segundo variáveis existentes nas fichas de notificação dos doentes internados. RESULTADOS E DISCUSSÃO: No município de S.Paulo, no ano de 2001, foram internados 2.473 doentes com tuberculose. O coeficiente de internação desses doentes foi de 23,5 casos por 100.000 habitantes, o coeficiente de mortalidade encontrado foi de 4,1 por 100.000 habitantes, tendo ocorrido 485 óbitos e sendo a taxa de letalidade de 17,4%. A taxa de coinfecção Tb/HIV foi de 32,7% entre os internados e de 12,5% entre os não internados, indicando que a epidemia de Aids exerceu forte influência tanto na magnitude quanto na gravidade da situação desses doentes, sendo a maior letalidade (48,4%) a da forma disseminada/miliar, com a maioria de casos em doentes HIV positivos. Entretanto, se excluirmos os casos dos portadores de HIV, a taxa de letalidade ainda se mantém alta, 15,1%, mostrando também a gravidade da tuberculose. CONCLUSÕES: Os resultados mostraram indicadores com valores preocupantes, ficando evidente a importância do acompanhamento dos mesmos para monitorar a situação da tuberculose. RECOMENDAÇÕES: As vigilâncias epidemiológicas municipais devem estabelecer fluxos e estratégias de acompanhamento dos doentes internados com tuberculose principalmente nos grandes centros urbanos, para garantir a continuidade do tratamento e modificar o cenário encontrado. Abstract in english INTRODUCTION: The treatment of tuberculosis is currently carried out in outpatient health services and hospitalization is only recommended for the more severe cases or for those facing social problems. In São Paulo, however, a considerable number of tuberculosis patients are still hospitalized. OBJE [...] CTIVE: To study the socio-demographic and clinical-epidemiological characteristics of hospitalized tuberculosis patients in the city of São Paulo in 2001. SPECIFIC OBJECTIVE: To calculate tuberculosis morbimortality indicators for inpatients. METHODS: Indicators of morbimortality of inpatients were calculated taking as sources, data from the São Paulo state tuberculosis information system - (Epitb) registration program, and the follow-up and analysis of reports and population data from Deinfo/ SEMPLA and FIPE. RESULTS: A total of 2,473 tuberculosis patients were hospitalized in the city of São Paulo in 2001. The hospitalization rate for these patients was 23.5 per 100,000 inhabitants, and the mortality rate found was 4.1 per 100,000 inhabitants with 485 deaths, yielding a fatality rate of 17.4%. DISCUSSION: The TB/HIV co-infection rate was of 32.7% among inpatients and 12.5% among those not hospitalized, showing that the Aids epidemic has caused a considerable impact both in the magnitude and in the severity of the situation of hospitalized tuberculosis patients. The higher fatality rate (48.4%) is of disseminated / miliary tuberculosis, of which the majority occurs in HIV-positive patients. If, however, known HIV-positive cases are excluded, the fatality rate still remains high, i.e. 15%, showing that the severity of cases is not only due to co-infection. CONCLUSIONS: Taking all points into consideration, the indicators showed an alarming situation. RECOMMENDATION: It is recommended that the epidemiological surveill

Galesi, Vera Maria Neder; Almeida, Margarida Maria Mattos Brito de.

237

Vacina BCG: eficácia e indicações da vacinação e da revacinação BCG vaccine: efficacy and indications for vaccination and revaccination  

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Full Text Available OBJETIVOS: Revisar aspectos relacionados ao efeito protetor da primeira e segunda doses da vacina BCG e discutir as suas principais indicações e contra-indicações. FONTES DOS DADOS: Utilizando o PubMed, foi realizada uma revisão sistemática da literatura abrangendo um período de, aproximadamente, 50 anos. Os estudos foram agrupados por tipo de desenho, apresentando-se separadamente os principais resultados de ensaios clínicos, estudos de caso-controle e meta-análises. Outros tópicos relevantes, como a BCG e HIV/AIDS, o uso do teste tuberculínico, aspectos relacionados à cicatriz vacinal e ao desenvolvimento de novas vacinas, dentre outros, foram também revistos. SÍNTESE DOS DADOS: A vacina BCG é utilizada desde 1921. Apesar disso, ainda apresenta controvérsias e aspectos não esclarecidos. O efeito protetor da primeira dose da vacina BCG contra a tuberculose na forma miliar ou na meningite é bastante significativa. No entanto, em relação à forma pulmonar, os resultados são discordantes, variando de ausência de efeito a níveis próximos a 80%. Há evidências de que uma segunda dose da BCG não aumenta o seu efeito protetor. Estudos demonstram proteção da vacina contra a hanseníase. Pesquisas sobre novas vacinas que, no futuro, poderão vir a substituir a BCG estão sendo realizadas. CONCLUSÕES:Apesar da expectativa de que, no futuro, venhamos a ter uma nova vacina para a tuberculose, no presente e ainda por muitos anos, a vacina BCG, apesar de suas deficiências, mantém-se como um importante instrumento nos esforços para controle dos efeitos danosos da tuberculose, sobretudo em países em que essa doença ocorre em médias e elevadas taxas de incidência.OBJECTIVES: To review the protective efficacy of the first and second doses of BCG vaccine and to assess its major indications and contraindications. SOURCES OF DATA: A systematic review of the literature was made by searching PubMed and selecting studies carried out in the last 50 years. The studies were grouped according to their design (clinical trials, case-control studies, and meta-analyses and the results were presented separately for each type of study. Other relevant topics such as BCG and HIV/AIDS, use of tuberculin skin test, issues related to vaccine scars and to the development of new vaccines were also reviewed. SUMMARY OF THE FINDINGS: BCG vaccine has been used since 1921. However, the data concerning its use are variable and inconsistent. The protective efficacy of the first dose of BCG vaccine against miliary tuberculosis or tuberculous meningitis is remarkably important. Nevertheless, results regarding pulmonary tuberculosis have been inconsistent, either showing no efficacy or a protective efficacy rate around 80%. There is some evidence that a second dose of BCG vaccine does not increase its protective efficacy. Studies have shown that BCG vaccine protects against leprosy. The development of new vaccines to replace BCG in the future has been investigated. CONCLUSIONS: Despite the hope that a new vaccine against tuberculosis will be available in the future, BCG vaccine, in spite of its deficiencies, is today and will still be for many years to come an important tool in controlling the harmful effects of tuberculosis, especially in countries where this disease has moderate to high levels of incidence.

Mauricio L. Barreto

2006-07-01

238

Pulmonary tuberculosis: relationship between sputum bacilloscopy and radiological lesions / Tuberculose pulmonar: relação entre baciloscopia do escarro e lesões radiológicas  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese OBJETIVOS: Determinar a freqüência das manifestações radiológicas da tuberculose nos pacientes do Ambulatório de Tuberculose do Departamento de Medicina da Santa Casa de Misericórdia de São Paulo, e correlacionar a manifestação radiológica e a baciloscopia direta do escarro. CASUÍSTICA E MÉTODOS: Fo [...] ram revisados os prontuários e as radiografias de tórax de todos os doentes atendidos entre janeiro/1996 e dezembro/1998. Foram selecionados os doentes com diagnóstico de tuberculose e que apresentavam manifestação intratorácica da doença e sorologia anti-HIV negativa. RESULTADOS: Foram incluídos 153 doentes, média de 37,5 anos, predominância do sexo masculino (60,8%) e da raça branca (56,9%). Lesões pulmonares estavam presentes em 121 (79,1%); no restante ocorreu envolvimento torácico sem comprometimento pulmonar. Alterações do tipo infiltrado pulmonar ocorreram em 56 (36,6%), cavidade em 55 (36,0%), derrame pleural em 28 (18,3%), nódulo isolado em 6 (3,9%), linfonodomegalia mediastinal em 4 (2,6%) e padrão miliar em 4 (2,6%). Excetuando-se as lesões extrapulmonares, cavidades estiveram presentes em 45,5% dos doentes com lesões pulmonares. Considerando o infiltrado pulmonar que acompanhou a lesão cavitária, em 105 (68,6%) o infiltrado esteve presente. Excluindo-se aqueles com lesões extrapulmonares, o infiltrado apareceu em 86,8% dos doentes com lesões pulmonares. Baciloscopia foi positiva em 76,4% dos doentes com cavidade e em 50,0% dos sem cavidade (p = 0,003). CONCLUSÕES: O infiltrado pulmonar constitui-se na manifestação radiográfica mais freqüente da tuberculose pulmonar, estando a cavidade geralmente associada às lesões do tipo infiltrado pulmonar. Existe relação entre a presença de BAAR no escarro e as lesões cavitárias pulmonares. Abstract in english OBJECTIVES: To determine the frequency of radiological manifestations of chest tuberculosis among the tuberculosis outpatients at the Santa Casa de Misericórdia de São Paulo Hospital, and to correlate these radiological findings with the sputum bacilloscopy. SAMPLE AND METHODS: A review was made of [...] the medical record cards and chest X-rays of all patients attended between January 1996 and December 1998. Patients with a diagnosis of tuberculosis who presented intrathoracic manifestations of the disease and negative anti-HIV serology were selected. RESULTS: The selection included 153 patients, with an average age of 37.5 years, who were predominantly male (60.8%) and white (56.9%). Pulmonary lesions were present in 121 (79.9%) and extrapulmonary lesions in 32 (20.1%). Parenchymal-infiltrate lesions appeared in 56 patients (36.6%), cavity lesions in 55 (36.0%), pleural effusion in 28 (18.3%), isolated nodules in 6 (3.9%), mediastinal enlargement in 4 (2.6%) and miliary pattern in 4 (2.6%). Cavities were present in 45.5% of the patients with pulmonary lesions, generally in association with the parenchymal-infiltrate lesions. Parenchymal infiltrate was present in 86.8% of the patients with pulmonary lesions. There was significant presence of alcohol-acid resistant bacillus in the sputum of patients with cavities (76.4%), in comparison with those without cavities (50%) (p = 0.003). CONCLUSIONS: Parenchymal-infiltrate lesions are the most frequent radiological manifestation of pulmonary tuberculosis, and they are generally associated with cavities. There is a relationship between the presence of acid fast bacilli in sputum and pulmonary cavity lesions.

Mauro, Gomes; Roberto, Saad Jr.; Roberto, Stirbulov.

239

Aspectos tomográficos da tuberculose pulmonar em pacientes adultos com AIDS / Computed tomography findings of pulmonary tuberculosis in adult AIDS patients  

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Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: Este trabalho tem como finalidade descrever os achados tomográficos da tuberculose pulmonar em pacientes adultos com AIDS atendidos no serviço de radiologia de um hospital de referência em doenças infecciosas, procurar associações desses achados e a contagem de CD4. MATERIAIS E MÉTODOS: Fo [...] ram estudados 45 pacientes por meio de tomografia computadorizada de tórax durante quatro anos. RESULTADOS: Foram encontrados linfonodomegalia mediastinal e/ou hilar em 31 (68,8%) dos casos, derrame pleural em 29 (64,4%), nódulos centrolobulares de distribuição segmentar em 26 (57,7%), consolidação em 24 (53,3%), confluência de micronódulos em 17 (37,7%), nódulos mal definidos com distribuição centrolobular em 16 (35,5%), padrão de "árvore em brotamento" em 13 (28,9%), espessamento de parede brônquica em 12 (26,6%), cavidade de parede espessa em 10 (22,2%), nódulos miliares em 9 (20%) e bronquiectasias cilíndricas em 6 (13,3%). Dos 45 pacientes, 35 (77,8%) apresentaram CD4 200 cel/mm³. CONCLUSÃO: Concluímos que neste estudo, diversamente do descrito na literatura, linfonodomegalia mediastinal e/ou hilar e consolidação foram significativamente mais frequentes em pacientes com CD4 > 200 cel/mm³. No entanto, linfonodos com centro hipodenso foram mais frequentemente observados em pacientes com severa imunodepressão, ou seja, CD4 Abstract in english OBJECTIVE: The present study is aimed at describing computed tomography findings pulmonary tuberculosis in adult AIDS patients assisted at a radiology unit of a reference infectious diseases hospital, in an attempt to establish the association between such findings and CD4 count. MATERIALS AND METHO [...] DS: Forty-five patients were evaluated by chest computed tomography over a four-year period. RESULTS: Mediastinal and/or hilar lymph node enlargement was found in 31 (68.8%) cases, pleural effusion in 29 (64.4%), centrilobular nodules with segmental distribution in 26 (57.7%), consolidation in 24 (53.3%), confluent micronodules in 17 (37.7%), poorly defined nodules with centrilobular distribution in 16 (35.5%), tree-in-bud pattern in 13 (28.9%), bronchial wall thickening in 12 (26.6%), thick-walled cavity in 10 (22.2%), miliary nodules in 9 (20%), and cylindrical bronchiectasis in 6 (13.3%). Among the 45 patients, 35 (77.8%) presented CD4 count 200 cel/mm³. CONCLUSION: Differently from reports in the literature, the authors conclude that mediastinal and/or hilar lymph node enlargement and consolidation were significantly most frequent in patients with CD4 count > 200 cel/mm³. However, lymph nodes with hypodense center were most often observed in severely immunosuppressed patients with CD4 count

Lanamar Aparecida de, Almeida; Mario Flores, Barba; Fernando Alves, Moreira; Sidney, Bombarda; Sebastião André de, Felice; Edenilson Eduardo, Calore.

240

Vacina BCG: eficácia e indicações da vacinação e da revacinação / BCG vaccine: efficacy and indications for vaccination and revaccination  

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Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVOS: Revisar aspectos relacionados ao efeito protetor da primeira e segunda doses da vacina BCG e discutir as suas principais indicações e contra-indicações. FONTES DOS DADOS: Utilizando o PubMed, foi realizada uma revisão sistemática da literatura abrangendo um período de, aproximadamente, 50 [...] anos. Os estudos foram agrupados por tipo de desenho, apresentando-se separadamente os principais resultados de ensaios clínicos, estudos de caso-controle e meta-análises. Outros tópicos relevantes, como a BCG e HIV/AIDS, o uso do teste tuberculínico, aspectos relacionados à cicatriz vacinal e ao desenvolvimento de novas vacinas, dentre outros, foram também revistos. SÍNTESE DOS DADOS: A vacina BCG é utilizada desde 1921. Apesar disso, ainda apresenta controvérsias e aspectos não esclarecidos. O efeito protetor da primeira dose da vacina BCG contra a tuberculose na forma miliar ou na meningite é bastante significativa. No entanto, em relação à forma pulmonar, os resultados são discordantes, variando de ausência de efeito a níveis próximos a 80%. Há evidências de que uma segunda dose da BCG não aumenta o seu efeito protetor. Estudos demonstram proteção da vacina contra a hanseníase. Pesquisas sobre novas vacinas que, no futuro, poderão vir a substituir a BCG estão sendo realizadas. CONCLUSÕES:Apesar da expectativa de que, no futuro, venhamos a ter uma nova vacina para a tuberculose, no presente e ainda por muitos anos, a vacina BCG, apesar de suas deficiências, mantém-se como um importante instrumento nos esforços para controle dos efeitos danosos da tuberculose, sobretudo em países em que essa doença ocorre em médias e elevadas taxas de incidência. Abstract in english OBJECTIVES: To review the protective efficacy of the first and second doses of BCG vaccine and to assess its major indications and contraindications. SOURCES OF DATA: A systematic review of the literature was made by searching PubMed and selecting studies carried out in the last 50 years. The studie [...] s were grouped according to their design (clinical trials, case-control studies, and meta-analyses) and the results were presented separately for each type of study. Other relevant topics such as BCG and HIV/AIDS, use of tuberculin skin test, issues related to vaccine scars and to the development of new vaccines were also reviewed. SUMMARY OF THE FINDINGS: BCG vaccine has been used since 1921. However, the data concerning its use are variable and inconsistent. The protective efficacy of the first dose of BCG vaccine against miliary tuberculosis or tuberculous meningitis is remarkably important. Nevertheless, results regarding pulmonary tuberculosis have been inconsistent, either showing no efficacy or a protective efficacy rate around 80%. There is some evidence that a second dose of BCG vaccine does not increase its protective efficacy. Studies have shown that BCG vaccine protects against leprosy. The development of new vaccines to replace BCG in the future has been investigated. CONCLUSIONS: Despite the hope that a new vaccine against tuberculosis will be available in the future, BCG vaccine, in spite of its deficiencies, is today and will still be for many years to come an important tool in controlling the harmful effects of tuberculosis, especially in countries where this disease has moderate to high levels of incidence.

Barreto, Mauricio L.; Pereira, Susan M.; Ferreira, Arlan A..

 
 
 
 
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Causas múltiplas de morte relacionadas à tuberculose no Estado de São Paulo, 1998 / Multiple-causes-of-death related to tuberculosis in the State of São Paulo, Brazil, 1998  

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Full Text Available SciELO Public Health | Language: Portuguese Abstract in portuguese OBJETIVO: Estudar a mortalidade relacionada à tuberculose no Estado de São Paulo segundo causas múltiplas de morte, e suas inter-relações com outras causas básicas. MÉTODOS: Foram estudados os óbitos ocorridos e no Estado de São Paulo, em 1998, tendo como causa a tuberculose. Os dados foram obtidos [...] na Fundação Sistema Estadual de Análise de Dados (SEADE). As causas de morte pelas formas clínicas da tuberculose foram codificadas no agrupamento A15-A19 e suas seqüelas na categoria B90, segundo as disposições da Décima Revisão da Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde. As causas associadas de morte foram processadas pelo Tabulador de Causas Múltiplas (TCM). Para análise estatística, foram usados o teste de variância, o teste t de Student e qui-quadrado. RESULTADOS: A tuberculose foi considerada a causa básica em 1.644 óbitos, correspondendo ao coeficiente de mortalidade de 4,6/100.000 habitantes. As principais causas associadas forami a insuficiência respiratória (46,9%), pneumonias (16,5%), outros sintomas e sinais especificados relativos aos aparelhos circulatório e respiratório (13,9%), caquexia (12,9%), doenças do sistema circulatório (10,3%), afecções devidas ao uso do álcool (8,4%), septicemias (7,2%) e desnutrição (7,1%). Como causa associada, a tuberculose ocorreu em outras 1.388 mortes. O coeficiente de mortalidade, incluindo a tuberculose como causa básica ou associada, foi de 8,9/100.000 habitantes, praticamente o dobro do valor do coeficiente clássico. As mortes em que a tuberculose foi mencionada como causa associada teve como principal causa básica a Aids (65,3%). As formas clínicas de tuberculose do sistema nervoso e miliar foram mais freqüentes como causas associadas de Aids que nos óbitos devido a outras causas básicas de morte (p Abstract in english OBJECTIVES: The goal of this paper is to investigate mortality related to tuberculosis in the state of São Paulo, southeastern Brazil, according to multiple causes of death and their interrelation with other underlying causes. METHODS: The study investigated deaths related to tuberculosis that occur [...] red in the state of São Paulo in 1998. Data were obtained from the Fundação Sistema Estadual de Análise de Dados (State System for Data Analysis Foundation - SEADE) database. Causes of death by clinical forms of TB were coded in block A15-A19, and by its sequelae in category B90, according to the guidelines proposed by the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems. Tabulador de Causas Múltiplas (Multiple Cause Tabulator - TCM) software was used for processing associated causes of death. Statistical analysis included analysis of variance, Student's t -distribution, and chi-squared tests. RESULTS: TB was the underlying cause of 1,644 deaths, a 4.6/100,000 population mortality rate. Main associated causes were respiratory failure (46,9%), pneumonias (16.5%), other specified symptoms and signs involving circulatory and respiratory systems (13.9%), cachexia (12.9%), diseases of the circulatory system (10.3%), conditions due to alcohol use (8.4%), septicemias (7.2%) and malnutrition (7.1%). Tuberculosis occurred as an associated cause in another 1,388 deaths. The mortality rate including TB as a both underlying and associated cause was 8.9/100,000 population, practically twice the classical rate. Deaths whose associated cause was reported as being TB had as underlying causes: AIDS (65.3%), diseases of the circulatory system (8.9%), neoplasms (7.5%), and diseases of the digestive system (4.8%). Clinical forms of nervous system and miliary TB were more frequent as a cause associated with AIDS than with other underlying causes (p

Augusto Hasiak, Santo; Celso Escobar, Pinheiro; Margarete Silva, Jordani.

242

Causas múltiplas de morte relacionadas à tuberculose no Estado de São Paulo, 1998 / Multiple-causes-of-death related to tuberculosis in the State of São Paulo, Brazil, 1998  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: Estudar a mortalidade relacionada à tuberculose no Estado de São Paulo segundo causas múltiplas de morte, e suas inter-relações com outras causas básicas. MÉTODOS: Foram estudados os óbitos ocorridos e no Estado de São Paulo, em 1998, tendo como causa a tuberculose. Os dados foram obtidos [...] na Fundação Sistema Estadual de Análise de Dados (SEADE). As causas de morte pelas formas clínicas da tuberculose foram codificadas no agrupamento A15-A19 e suas seqüelas na categoria B90, segundo as disposições da Décima Revisão da Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde. As causas associadas de morte foram processadas pelo Tabulador de Causas Múltiplas (TCM). Para análise estatística, foram usados o teste de variância, o teste t de Student e qui-quadrado. RESULTADOS: A tuberculose foi considerada a causa básica em 1.644 óbitos, correspondendo ao coeficiente de mortalidade de 4,6/100.000 habitantes. As principais causas associadas forami a insuficiência respiratória (46,9%), pneumonias (16,5%), outros sintomas e sinais especificados relativos aos aparelhos circulatório e respiratório (13,9%), caquexia (12,9%), doenças do sistema circulatório (10,3%), afecções devidas ao uso do álcool (8,4%), septicemias (7,2%) e desnutrição (7,1%). Como causa associada, a tuberculose ocorreu em outras 1.388 mortes. O coeficiente de mortalidade, incluindo a tuberculose como causa básica ou associada, foi de 8,9/100.000 habitantes, praticamente o dobro do valor do coeficiente clássico. As mortes em que a tuberculose foi mencionada como causa associada teve como principal causa básica a Aids (65,3%). As formas clínicas de tuberculose do sistema nervoso e miliar foram mais freqüentes como causas associadas de Aids que nos óbitos devido a outras causas básicas de morte (p Abstract in english OBJECTIVES: The goal of this paper is to investigate mortality related to tuberculosis in the state of São Paulo, southeastern Brazil, according to multiple causes of death and their interrelation with other underlying causes. METHODS: The study investigated deaths related to tuberculosis that occur [...] red in the state of São Paulo in 1998. Data were obtained from the Fundação Sistema Estadual de Análise de Dados (State System for Data Analysis Foundation - SEADE) database. Causes of death by clinical forms of TB were coded in block A15-A19, and by its sequelae in category B90, according to the guidelines proposed by the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems. Tabulador de Causas Múltiplas (Multiple Cause Tabulator - TCM) software was used for processing associated causes of death. Statistical analysis included analysis of variance, Student's t -distribution, and chi-squared tests. RESULTS: TB was the underlying cause of 1,644 deaths, a 4.6/100,000 population mortality rate. Main associated causes were respiratory failure (46,9%), pneumonias (16.5%), other specified symptoms and signs involving circulatory and respiratory systems (13.9%), cachexia (12.9%), diseases of the circulatory system (10.3%), conditions due to alcohol use (8.4%), septicemias (7.2%) and malnutrition (7.1%). Tuberculosis occurred as an associated cause in another 1,388 deaths. The mortality rate including TB as a both underlying and associated cause was 8.9/100,000 population, practically twice the classical rate. Deaths whose associated cause was reported as being TB had as underlying causes: AIDS (65.3%), diseases of the circulatory system (8.9%), neoplasms (7.5%), and diseases of the digestive system (4.8%). Clinical forms of nervous system and miliary TB were more frequent as a cause associated with AIDS than with other underlying causes (p

Augusto Hasiak, Santo; Celso Escobar, Pinheiro; Margarete Silva, Jordani.

243

Neurotuberculosis: Hallazgos intracraneanos en RM / Neurotuberculosis: Intracranial MRI findings  

Scientific Electronic Library Online (English)

Full Text Available SciELO Argentina | Language: Spanish Abstract in spanish Objetivos. Mostrar nuestra casuística de pacientes con diagnóstico de tuberculosis intracraneana y describir los diferentes tipos de lesiones documentadas en Resonancia Magnética (RM) que caracterizan a esta entidad. Materiales y Métodos. Para el presente trabajo fueron seleccionados, de forma retro [...] spectiva, 20 pacientes con hallazgos positivos de tuberculosis intracraneana. Doce eran de sexo masculino y 8 de sexo femenino, con un rango etario de 8 meses a 49 años de edad (edad media: 21 años). El diagnóstico clínico fue realizado con punción lumbar y cultivo de LCR. Once pacientes presentaron serología positiva para VIH. Las RM fueron realizadas en resonadores de 0.5T y 1.5T, complementadas en dos casos con Tomografía Computada (TC) de cerebro. A dos pacientes se les realizó difusión (DWI) y a un paciente espectroscopía. Resultados. Del total de pacientes (n=20), 14 presentaron compromiso subaracnoideo en la convexidad y 13 compromiso subaracnoideo cisternal basal (afectación leptomeníngea). En 13 se observaron tuberculomas y 11 presentaron angeítis de grandes vasos; mientras que 7 tuvieron angeítis de pequeños vasos, 7 hidrocefalia, 6 infartos parenquimatosos y 1 afectación paquimeníngea. Quince pacientes tenían lesiones combinadas. Conclusión. La localización más frecuente de neurotuberculosis en esta serie fue meníngea con compromiso leptomeníngeo (14 pacientes con afectación subaracnoidea, seguido de afectación cisternal en 13 pacientes) y sólo en un caso fue paquimeníngea. La manifestación parenquimatosa más frecuente fue el tuberculoma (granulomas tuberculosos) con 13 casos. De estos, 5 presentaron un patrón miliar y sólo uno comportamiento pseudotumoral. Abstract in english Purposes. To report our case series of patients with a diagnosis of intracranial tuberculosis and to describe the different types of lesions characterizing this entity on Magnetic Resonance Imaging (MRI). Materials and Methods. For the present study, we retrospectively selected 20 patients with posi [...] tive MRI findings of intracranial tuberculosis. Twelve of them were males and 8 were females, with an age range of between 8 months and 49 years (mean age: 21years). Clinical diagnosis was obtained by lumbar puncture and cerebrospinal fluid (CSF) culture. Eleven patients presented positive HIV serology. MRIs were performed using 0.5T and 1.5 T scanners and computed tomography (CT) of the brain was also performed in two patients. Diffusion-weighted technique was performed in two patients and spectroscopy in one patient. Results. Of the total patients studied (n=20), 14 presented convexity subarachnoid involvement and 13 subarachnoid basal cystern involvement (leptomeningeal involvement), 13 presented tuberculomas, 11 large-vessel angiitis, 7 smallvessel angiitis, 7 hydrocephalia, 6 parenchymatous infarction and one pachymeningeal involvement. Combined lesions were observed in 15 patients. Conclusion. The most frequent location of neurotuberculosis in this series was meningeal with leptomeningeal involvement (14 patients with subarachnoid involvement, followed by cysternal involvement in 13 patients), and only one patient had pachymeningeal involvement. The most frequent parenchymatous finding of tuberculosis was tuberculoma in 13 patients, 5 with a miliary pattern and only one with pseudo-tumoral behavior.

Jorge, Docampo; Carolina, Mariluis; Nadia, González; Carlos, Morales; Claudio, Bruno.

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Clinical application of PET/CT imaging in search of the primary carcinoma  

International Nuclear Information System (INIS)

Full text: To explore the clinical value of PET/CT scanning in search of the primary carcinoma, we selected 4 patients who were subjected to PET/CT examination during Oct. 2002 to Dec. 2002. The primary lesion in all these patients was not detected. One of them had metastasis to liver, one had metastases in both lungs and the other two were having metastases to the bones. 18F-FDG in doses of 5.55MBq / kg body weight was injected to a fasting patient (at least 6 hours). PET/CT whole body examination was done using Discovery LS-PET/CT (GE Medical System, U.S.A.) 40-60 minutes later. In the first patient with metastasis to liver, primary lesion was localized in the transverse colon near the liver. The PET/CT showed multiple high radioactive uptake lesions of different sizes in the liver. No obvious change in position of the colon uptake was seen on the delayed images. After PET/CT, barium examination showed thinned cavity of the colon near the liver with coarse ankylosis of colon wall just like saw tooth. The mucous membrane was destroyed. Of the two patients with metastases in the bone, first - a 31 years old, was diagnosed to have primary lung cancer with multiple metastases to the liver and the bones. PET/CT showed high radioactive uptake in the inferior left lobe near the hilum with irregular shaped uneven distribution. A round high radioactive uptake area of 1.82 x 1.84 x 1.46cm size was also seen in the right lobe of the liver having clear edge and uneven distribution. The destroyed bones (L-10, L-11, L-12, T-1 and ala ossis i lii) showed high radioactive uptake. Second patient, 57-year male was diagnosed to have malignant lymphoma. PET/CT fusion showed high radioactive uptake in the marrow of whole body. Few destroyed parts of bones were also seen on CT images. Several cervical and the thoracic vertebrae as well as the ninth rib showed irregular radioactive accumulation with clear edges and well-distributed tracer raising the possibility of multiple myeloma or some other blood system disease. The histopathology from the ninth rib showed diffuse cell malignant lymphoma. Fourth patient with metastasis in the lungs was diagnosed to have primary carcinoma of bronchus. PET/CT showed high radioactive uptake in left supraclavicular and upper mediastinal lymph nodes. Miliary focus of high radioactive accumulation was also seen in both lung, especially in the inferior lobe and the lateral basal segment of the left lung. No other abnormal radioactive accumulation was found in the images. PET/CT whole body scan and fusion images give easy diagnosis of primary carcinoma and metastases than PET alone. Meanwhile, we must possess abundant clinical knowledge and analyze every patient systematically, only then we can expand the clinical value of this new modality. (author)

2004-01-01

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Doença pulmonar por Mycobacterium tuberculosis e micobactérias não-tuberculosas entre pacientes recém-diagnosticados como HIV positivos em Moçambique, África Mycobacterium tuberculosis and nontuberculous mycobacterial isolates among patients with recent HIV infection in Mozambique  

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Full Text Available OBJETIVO: A micobacteriose é frequentemente diagnosticada entre pacientes infectados pelo HIV. Em Moçambique, onde apenas um pequeno número de pacientes encontra-se sob tratamento anti-retroviral, e a tuberculose tem alta prevalência, existe a necessidade de melhor caracterização destes agentes bacterianos, em nível de espécie, bem como de se caracterizar os padrões de resistência às drogas antituberculosas. MÉTODOS: Em uma coorte de 503 indivíduos HIV positivos suspeitos de tuberculose pulmonar, 320 apresentaram positividade para baciloscopia ou cultura no escarro e no lavado brônquico. RESULTADOS: Bacilos álcool-ácido resistentes foram detectados no escarro em 73% dos casos com cultura positiva. De 277 isolados em cultura, apenas 3 mostraram-se tratar de micobactérias não-tuberculosas: 2 Mycobacterium avium e uma M. simiae. Todos os isolados de M. tuberculosis inicialmente caracterizados através de reação em cadeia de polimerase (RCP do gene hsp65 foram posteriormente caracterizados como tal através de RCP do gene gyrB. Resistência à isoniazida foi encontrada em 14% dos casos; à rifampicina em 6%; e multirresistência em 5%. Pacientes previamente tratados para tuberculose mostraram tendência a taxas maiores de resistência às drogas de primeira linha. O padrão radiológico mais freqüente encontrado foi o infiltrado intersticial (67%, seguido da presença de linfonodos mediastinais (30%, bronquiectasias (28%, padrão miliar (18% e cavidades (12%. Os pacientes infectados por micobactérias não-tuberculosas não apresentaram manifestações clínicas distintas das apresentadas pelos outros pacientes. A mediana de linfócitos CD4 entre todos os pacientes foi de 134 células/mm³. CONCLUSÕES: Tuberculose e AIDS em Moçambique estão fortemente associadas, como é de se esperar em países com alta prevalência de tuberculose. Embora as taxas de resistência a drogas sejam altas, o esquema isoniazida-rifampicina continua sendo a escolha apropriada para o início do tratamento.OBJECTIVE: Mycobacteriosis is frequently diagnosed among HIV-infected patients. In Mozambique, where few patients are under antiretroviral therapy and the prevalence of tuberculosis is high, there is need for better characterization of mycobacteria at the species level, as well as for the identification of patterns of resistance to antituberculous drugs. METHODS: We studied a sample of 503 HIV-infected individuals suspected of having pulmonary tuberculosis. Of those 503, 320 tested positive for mycobacteria through sputum smear microscopy or culture of bronchoalveolar lavage fluid. RESULTS: Acid-fast bacilli were observed in the sputum of 73% of the individuals presenting positive cultures. Of 277 isolates tested, only 3 were nontuberculous mycobacteria: 2 were identified as Mycobacterium avium and one was identified as M. simiae. Strains initially characterized as M. tuberculosis complex through polymerase chain reaction restriction analysis (PRA of the hsp65 gene were later confirmed as such through PRA of the gyrB gene. Among the M. tuberculosis isolates, resistance patterns were as follows: to isoniazid, 14%; to rifampin, 6%; and multidrug resistance, 5%. Previously treated cases showed significantly higher rates of resistance to first-line antituberculous drugs. The most common radiological pattern was interstitial infiltrate (in 67%, followed by mediastinal lymph node enlargement (in 30%, bronchiectasis (in 28%, miliary nodules (in 18% and cavitation (in 12%. Patients infected with nontuberculous mycobacteria presented clinical profiles indistinguishable from those of other patients. The median CD4 lymphocyte count in this group was 134 cells/mm³. CONCLUSIONS: There is a strong association between tuberculosis and AIDS in Mozambique, as expected in a country with a high prevalence of tuberculosis. Although drug resistance rates are high, the isoniazid-rifampin regimen continues to be the appropriate choice for initial therapy.

Elizabete Abrantes Nunes

2008-10-01

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[Tuberculosis control strategy in the 21st century in Japan--for elimination of tuberculosis in Japan].  

Science.gov (United States)

Modern tuberculosis control programme has been launched in 1951 by the major revision of the previous Tb. Control Law in Japan. Main control measures were BCG vaccination programme for tuberculin negatives, annual screening of Tb. by miniature radiophotography (MMR), charge free diagnosis and treatment of Tb. patients, registration and case-holding at Health Centres throughout the country and so on. Thanks to the efforts of the Government and people concerned, Tb. incidence has decreased with the annual reduction rate of 11% during 1961 and 1977. However, Tb. decrease has stagnated after that, and it is increasing slowly in these 3 years since 1998. Moreover, regional variations of Tb. incidence are considerable, and Tb. is concentrated in specific risk groups such as elderly persons, homeless, foreign born individuals and so on. However, the present Tb. Control measures were introduced prior to the discovery of most major anti-Tb. drugs and all modern internationally accepted Tb. Control strategies, so that it is strongly desired to improve the present control programme from rather classical present Tb. control measures to global standard one to overcome the resurgence of Tb. in Japan. At first, the author stressed that the priority of Tb. Control Programme should be changed according to the development of science and the change of epidemiological situations. BCG vaccination and Tb. screening by MMR might be very important when the annual risk of Tb. infection was very high--about 4% in 1950. Now it is around 0.05% and the incidence of Tb. among 0-14 years of age is 1.1 per 100,000 so that the priority should be given on treatment of the detected cases instead of BCG vaccination or MMR. The doctors in the public health field should give more strong concern on clinical aspects of Tb. Control Programme at present. It was considered that the main urgent problems to be improved in the present Tb. control measures are as follows. 1. It is strongly recommended to spread the global standard regimen with 2HRZE/4HR (E) more widely and rapidly. Because the standard regimen is used in only 50% of new smear positive cases at present although 15.3% of Tb. patients are 80 years or more, or 56.3% of them are 60 years or more, and the side effects by PZA are higher among elderly patients. 2. Shortening of the hospitalization duration is required because 76.7% of newly detected bacilli positive cases are hospitalized at first, and the median of the period of hospitalization is 4 months, and 18.4% of them are hospitalized 6 months or more at present. 3. DOT treatment has been introduced for special groups in the big cities in 2000 for the first time in Japan, but it is needed to spread DOT treatment more widely, for example, by increasing health insurance payment for the institutions where DOT treatment is being implemented. 4. It is recommended to build special rooms to accept Tb. patient at general hospitals and/or university hospitals to avoid the neglect of Tb. by general medical doctors. 5. Follow-up of Tb. patients after treatment completion at Health Centres is not needed now, because the relapse rate is so low. 6. Indiscriminative screening programme for all the people aged 19 years old or more should be stopped, at least up to 39 years of age, because Tb. detection rate has become so low as 0.0069% at present. As Tb. decrease is so slow, or is increasing in some areas, that the contact surveys among the young aged 20 to 39 should be strengthened in the future. 7. As Japan Anti-Tb. Association is being carrying out mass screening programme extensively at present, so that the Association has started to discuss the future health check system. Because of the rapid and constant increase of the lung cancer, the Association is discussing the method to detect the lung cancer, too. In any way, it is needed to focus the screening programme for special high risk groups instead of indiscriminative screening. 8. BCG vaccination for infants should be continued a little more, because BCG vaccination can protect the development of 7 miliary Tb.

Aoki, M

2001-07-01