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Sample records for miliaris disseminatus faciei

  1. Recurrent lupus miliaris disseminatus faciei: a case report

    Directory of Open Access Journals (Sweden)

    Zonunsanga

    2015-01-01

    Full Text Available Lupus miliaris disseminatus faciei (LMDF is a granulomatous eruption characterized by monomorphic, reddishbrown papules and nodules predominantly localized on the face. A 43 years old lady presented with multiple, painful, papulo-pustules over face 6 years back. Biopsy showed showed large foci of suppurative granulomatous dermatitis with a large central area of suppuration surrounded by histiocytes and occasional giant cells. Epidermis is not disrupted. Perifollicular and perivascular lymphocytic infiltrates were also seen. The lesions were healed with atrophic scars. She is now presented with multiple asymptomatic papules over bilateral periorbital regions of the face.

  2. Atypical manifestations of tinea faciei

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    Mittal R

    1996-01-01

    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.

  3. Miliary pulmonary cryptococcosis

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    Shane Kelly

    2014-10-01

    Imaging features of pulmonary cryptococcosis are generally of well-defined pleural-based nodules and less commonly alveolar infiltrates, lymphadenopathy, pleural effusions or cavitating lesions. Miliary pulmonary infiltrates are an exceptionally rare presentation.

  4. Miliary pulmonary blastomycosis

    International Nuclear Information System (INIS)

    Five patients with proved blastomycosis had a diffuse miliary nodular pattern seen on chest radiographs. These cases are presented to emphasize that blastomycosis may be the cause of a miliary pattern in an endemic area. Documentation requires recovery of the organism from body fluids or tissue since skin and serologic testing are unreliable indicators of active disease. With prompt diagnosis and appropriate treatment, the patient may recover from this form of endogenous disseminated reinfection that otherwise may be fatal, particularly in the immunocompromised host

  5. Erythromelanosis follicularis faciei et colli: Relationship with keratosis pilaris

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    Augustine M

    2008-01-01

    Full Text Available Erythromelanosis follicularis faciei et colli (EFF is an unusual condition characterized by the triad of hyperpigmentation, follicular plugging and erythema of face and neck. This is less common in women and familial case reports are few. We report EFF in three siblings in an Indian family, two of whom are females. The possibility of this condition being genetically related to keratosis pilaris as well as being a variant of keratosis rubra pilaris is also discussed.

  6. Comparison of high-resolution CT findings between miliary metastases and miliary tuberculosis

    International Nuclear Information System (INIS)

    To compare the findings of high-resolution computed tomography (HRCT) between patients with miliary metastases and miliary tuberculosis. Between May 1998 and April 2002, 11 patients with miliary metastases and 18 with miliary tuberculosis underwent HRCT, and we reviewed the findings. In miliary metastases, the primary lesions were adenocarcinoma of the lung (n=2), stomach (n=1), or pancreas (n=1), or unknown origin (n=5), and papillary carcinoma of the thyroid (n=2). Two radiologists blinded to the clinical and pathologic data reached a consensus regarding nodule size and margin, their distribution and coalescence, interstitial involvement, and other ancillary HRCT findings. Data were analyzed using the chi-square test. CT scans showed numerous 1 to 5-mm nodules randomly distributed throughout both lungs of all patients. Nodules larger than 1.5 mm in diameter were more often seen in miliary metastases (81.9%). In six (54.5%) patients with miliary metastases and in three (16.7%) with miliary tuberculosis, nodule size varied (p<0.05). Pleural effusion occurred in three (27.3%) patients with miliary metastases and three (16.7%) with miliary tuberculosis. Interlobular septal thickening (100%) and peribronchovascular thickening (63.6%) were more common in miliary metastases than in miliary tuberculosis (p<0.01). Lymph node enlargement was seen in 11 (100%) patients with miliary metastases and five (27.8%) with miliary tuberculosis (P<0.001). At HRCT, lymph node enlargement and both interlobular and peribronchovascular thickening are more commonly observed in miliary metastases than in miliary tuberculosis

  7. 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.)

  8. Erythromelanosis follicularis faciei et colli: Relationship with keratosis pilaris

    OpenAIRE

    Augustine M; Jayaseelan E

    2008-01-01

    Erythromelanosis follicularis faciei et colli (EFF) is an unusual condition characterized by the triad of hyperpigmentation, follicular plugging and erythema of face and neck. This is less common in women and familial case reports are few. We report EFF in three siblings in an Indian family, two of whom are females. The possibility of this condition being genetically related to keratosis pilaris as well as being a variant of keratosis rubra pilaris is also discussed.

  9. Chronic miliary tuberculosis with tuberculous gummas

    OpenAIRE

    Thankappan T; Sulochana G

    1990-01-01

    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.

  10. Miliary tuberculosis with empyema, a case report

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    Abbas Ali Imani Fooladi

    2010-07-01

    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.

  11. Hypercalcaemia: atypical presentation of miliary tuberculosis

    OpenAIRE

    So, Edison; Bolger, Dennis Thomas

    2014-01-01

    We report an unusual case of miliary tuberculosis in a 77-year-old Filipino man with hypertension, diabetes mellitus, nephrolithiasis status-post left nephrectomy, presenting with 1 month of fever, generalised weakness and weight loss. Laboratory data were significant for anaemia, hypercalcaemia and acute kidney injury. Chest radiograph showed ground glass opacities and interstitial infiltrates. Extensive workup was performed to evaluate fever and hypercalcaemia. Malignancy, hormonal and sept...

  12. Miliary tuberculosis with empyema, a case report

    OpenAIRE

    Abbas Ali Imani Fooladi; Mohammad Javad Hosseini

    2010-01-01

    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 infil...

  13. Miliary lung metastases of differentiated thyroid carcinoma

    International Nuclear Information System (INIS)

    Full text of publication follows. Lungs and bones are the most common distant metastases sites for differentiated thyroid cancer (DTC). Comparing with bone metastases, radioiodine therapy (RAI) has been an effective measure of treating lung metastases especially in micro-nodular (miliary) lung metastases. Management of disease differs considerably and outcome of RAI varies in series reported. The goal of this study was to evaluate characteristics and outcome of RAI in patients with miliary lung metastases of DTC, in our experience. 44 patients (34 F and 10 H), with miliary lung metastases in the first therapeutic 131I whole body scintigraphy (WBS), were retrospectively analysed, between January 2007 and December 2011. Patients with macro-nodular lung metastases and those with bone metastases were excluded. Age, gender, histological findings, diagnostic and therapeutic WBS, CT scan, thyroglobulin levels, RAI activity, evolution after de last RAI course, were studied. Patients were aged 20 to 81 years (mean of 45 years); they all underwent total thyroid surgery before being sent to nuclear medicine department for RAI. Papillary thyroid cancer was the most frequent histological variety (35%), with local lymph node metastases (50%). Miliary was diagnosed on diagnostic WBS in 13/22 cases (59%), CT scan was positive in 15/38 cases (39%). Initial stimulated thyroglobulin (Tg) level was very high in 14/22 cases (63%). All patients benefited hormone suppressive therapy and RAI. A total of 3.7-27.75 GBq (100-750 mCi) 131I was given. Effect of RAI and prognostic values of patient data were examined. Therapeutic efficacy was evaluated based on change in WBS findings and stimulated Tg level after the last RAI course. During follow-up which was between 2 and 5 years (mean: 3 years): 25% had negative WBS with stimulated Tg level under 1 ng/ml. Among all variables studied, a better prognosis would be accomplished in patients without lymph node metastases, in those who had low level of initial stimulated Tg and by early diagnosis during post surgery 131I scanning of radiologically no-apparent metastases. (authors)

  14. 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

  15. 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)

  16. A case of anxiety associated with miliary tuberculosis

    OpenAIRE

    Alosaimi FD; Alkharboush FA; Altuwariqi MH

    2014-01-01

    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-occurrin...

  17. Disseminated (miliary) abdominal tuberculosis after laparoscopic gastric bypass surgery

    OpenAIRE

    Alhajri, Khalid; Alzerwi, Nasser; Alsaleh, Khalid; Yousef, Hussam Bin; Alzaben, Mohamed

    2011-01-01

    The development of disseminated (miliary) abdominal tuberculosis (TB) in patients following operations which affect their immunity, such as laparoscopic gastric bypass, is rare. The authors report the case of middle aged woman, who a few months after undergoing laparoscopic gastric bypass surgery for morbid obesity (body mass index 49), presented with generalised fatigability and abnormal liver function. A CT scan of the abdomen was suggestive of miliary TB. The patient developed acute abdome...

  18. Amphiesmal ultrastructure in Noctiluca miliaris Suriray (Dinophyceae)

    Science.gov (United States)

    Melkonian, M.; Höhfeld, I.

    1988-09-01

    The ultrastructure of the cell covering (amphiesma) of vegetative cells of Noctiluca miliaris (Dinophyceae) was studied in detail using thin sections. The amphiesma is typically amphidinoid and contains the following components (starting from the outside): (a) a continuous outer membrane (plasmamembrane) surrounding the cell; (b) a layer of contiguous vesicles (amphiesmal vesicles) that contain a thin “honeycomb-patterned” layer of material appressed mainly to the outer portion of the vesicle membrane; (c) a finely granular pellicular layer that lies beneath the amphiesmal vesicles and (d) groups of cortical microtubules (only present in certain regions of the cell). The pellicular layer is always present but its thickness is highly variable (20 800 nm) depending on regional specializations of the amphiesma. Trichocysts and mucocysts project through the pellicular layer and amphiesmal vesicles, the apical portion of their limiting membrane docks at the plasmamembrane. Small vesicles that presumably contain material for the “honeycomb-patterned” layer traverse the pellicular layer through discontinuities and presumably fuse with the amphiesmal vesicles. We conclude that Noctiluca has a typical dinophycean (i.e. amphidinoid) cell covering, and that the most recent proposal for the developmental origin of the dinoflagellate pellicle should be revised.

  19. Asymptomatic pons tuberculoma in an infant with miliary tuberculosis

    International Nuclear Information System (INIS)

    Miliary tuberculosis is caused by the hematogenous spread of Mycobacterium tuberculosis and consists of 1.5% of all tuberculosis cases. It is seen mostly in infants because of the immature immune system, and central nervous system CNS involvement is not rare. Tuberculomas are rarely seen in the localized form of CNS tuberculosis, and only 4% are localized in the brain stem. We report a 4.5-month-old infant who deteriorated during follow-up with the diagnosis of cytomegalovirus pneumonia, and afterwards received the diagnosis of miliary tuberculosis. Although the baby had no neurologic abnormality and cerebrospinal fluid findings were normal, cranial MRI revealed contrast enhanced nodular lesions in pons, cerebellum, and right parietal region. The case is presented to intensify the importance of CNS investigation even if the patient with miliary tuberculosis has no neurologic finding. (author)

  20. 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

  1. Tuberculosis verrucosa cutis (TBVC)--foot with miliary tuberculosis.

    Science.gov (United States)

    Padmavathy, L; Lakshmana Rao, L; Ethirajan, N; Ramakrishna Rao, M; Subrahmanyan, E N; Manohar, U

    2007-07-01

    Tuberculosis Verrucosa Cutis (TBVC) or warty tuberculosis is a variant of cutaneous tuberculosis in patients with good cell mediated immunity (CMI) to Mycobacterium Tuberculosis, while Miliary Tuberculosis is associated with very poor CMI. Two widely different clinical presentations in the same patient are very rare and being reported. PMID:17886704

  2. A case of anxiety associated with miliary tuberculosis

    Directory of Open Access Journals (Sweden)

    Alosaimi FD

    2014-06-01

    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

  3. Retrospective survey of the management of miliary tuberculosis in South and West Wales, 1976-8.

    OpenAIRE

    Monie, R. D.; Hunter, A M; Rocchiccioli, K M; White, J. P.; Campbell, I A; Kilpatrick, G. S.

    1983-01-01

    In a survey of 1000 patients with tuberculosis 28 were found to have miliary disease. Half of these patients were over 60 years old. Anorexia and weight loss were present in 19 (70%) and pyrexia in 17 (63%). A factor predisposing to tuberculosis or a history of recent contact was found in 12 (43%), and 21 (75%) had positive cultures. Seventeen (61%) had classical miliary shadowing while four (14%) had cryptic miliary tuberculosis with no radiological evidence of tuberculosis. The remaining se...

  4. Action of γ-radiation on bioluminescence of Noctiluca miliaris

    International Nuclear Information System (INIS)

    Results of the study in the action of various doses of irradiation on the bioluminescence of Noctiluca miliaris are presented. The doses are found that stimulate the bioluminescence and the dose - effect curves are obtained. It has been shown that stimulation of Noctiluca luminescence by γ-radiation is not of a constant character and extinguishes after a period of time determined by a dose rate

  5. Sequential radiographic changes of nodules in patients with miliary pulmonary tuberculosis

    International Nuclear Information System (INIS)

    The purpose of this study is to evaluate sequential changes in miliary nodules, as seen on chest radiographs in patients with miliary tuberculosis. We retrospectively analyzed sequential changes in miliary nodules, as seen on the chest radiographs of 13 patients with miliary tuberculosis who recovered completely after antituberculous medication. Two were children and 11 were adults, and their ages ranged from 2 months to 73 years (mean, 38 years). In cases in which miliary tuberculosis had been diagnosed from initial chest radiographs, follow-up chest radiographs were obtained 5 to 15 (mean, 10) months later. After complete resolution of miliary nodules, as seen on chest radiographs, high-resolution CT scanning was performed in three patients. As seen on follow-up chest radiographs obtained at one week, the number and size of miliary nodules had decreased in eight to nine patients (89%), and on those obtained at one month, these decreases were seen in all 13 patients. The mean duration of complete resolution of miliary nodules was 6.3 months; in children, this was 3.5 (range, 2-5) months, and in adults, 6.8 (range, 3-10) months. In all three patients involved, high-resolution CT scans obtained after complete radiographic resolution of miliary nodules showed no recurrence. In patients with miliary tuberculosis, the size and number of nodules had decreased within one month of adequate chemotherapy and on chest radiographs, complete resolution was seen at 6.3 months, on average. (author). 17 refs., 1 tab., 3 figs

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

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    Ballaekere Jayaram Subhashchandra

    2013-03-01

    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.

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

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    Janse van Rensburg, Pieter; Andronikou, Savvas; Pienaar, Manana [University of Stellenbosch, Department of Radiology, Faculty of Health Sciences, Tygerberg (South Africa); Toorn, Ronald van [University of Stellenbosch, Department of Paediatrics and Child Health, Faculty of Health Sciences, Tygerberg (South Africa)

    2008-12-15

    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.)

  8. Radiographic findings of miliary tuberculosis: difference in patients with and those without associated acute respiratory failure

    International Nuclear Information System (INIS)

    To determine the differences in the radiography findings of miliary tuberculosis between patients with and without associated acute respiratory failure (ARF). We retrospectively 32 patients in whom miliary tuberculosis had been diagnosed, and assigned them to one of two groups: with ARF (n=10), and without ARF (n=22). Chest radiographic findings such as presence of miliary modules, consolidation, ground-glass opacity (GGO), pleural effusion, small calcified nodules and linear opacities were assessed, the size and profusion of nodules in each of four zones were analyzed and scored using the standard radiographs of the international labor organization, and the extent of consolidation and GGO were scored according to the percentage on involved lung. We compared the radiologic findings between the two groups. Ground-glass opacity, consolidation, and pleural effusion were seen more frequently in miliary tuberculosis patinets with ARF than in those without ARF. Although the size and profusion of nodules were similar in both groups (p>0.05), consolidation and ground-glass opacity in cases of miliary tuberculosis with ARF were significantly more extensive than in those without ARF (p<0.005). GGO and consolidation were more extensive in miliary tuberculosis patients with ARF. A finding of ground-glass opacity in miliary tuberculosis patients might be an early indication of developing ARF

  9. 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.)

  10. Tuberculous Enteritis: A Rare Complication of Miliary Tuberculosis.

    Science.gov (United States)

    Figueroa, Danisha; Guzman, Nilmarie; Isache, Carmen

    2016-01-01

    Tuberculous enteritis is a clinical rarity even in immunocompromised patients. We present a case of miliary tuberculosis with gastrointestinal involvement. A 47-year-old homosexual male from Philippines with no significant medical history presented with productive cough, night sweats, subjective fevers, shortness of breath, watery diarrhea, and 25-pound weight loss in past one year. On physical exam he was afebrile, mildly hypotensive, tachycardic, and tachypneic, but saturating well on room air. He was cachectic with oral thrush and bilateral fine rales. Chest X-ray revealed a miliary pattern. His sputum AFB smear was strongly positive. PCR and sputum culture were positive for Mycobacterium tuberculosis. He was started on Rifampin, Isoniazid, Ethambutol, and Pyrazinamide. He was found to be HIV positive with an absolute CD4 count of 4 cells/μL. Due to persistent diarrhea, stool was sent for AFB culture and grew M. tuberculosis. He responded well to treatment with resolution of symptoms. Tuberculous enteritis occurs in about 2% of the patients with pulmonary tuberculosis. Although it is uncommon, it should be considered in patients with active pulmonary tuberculosis and abdominal complaints. A presumptive diagnosis of tuberculous enteritis can be made in the setting of active pulmonary tuberculosis with suggestive clinical, endoscopic, and/or radiographic findings. PMID:27022494

  11. BIO-CONVENTIONAL BLEACHING OF KRAFT-AQ PULP OF A. CADAMBA BY CRUDE XYLANASES FROM COPRINELLUS DISSEMINATUS MLK-03 AND EFFECT OF RESIDUAL ENZYME ON EFFLUENT LOAD

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    Mohan Lal

    2011-04-01

    Full Text Available A new thermo-alkali-tolerant crude xylanase from Coprinellus disseminatus decreased kappa number by 34.38% and improved brightness and viscosity by 1.6 and 6.47% respectively after XE1-stage during prebleaching of Anthocephalus cadamba kraft-AQ pulp. At 2.4% chlorine demand, crude xylanase in a XECEHH (X= enzymatic prebleaching stage, E= extraction stage, C= chlorination stage, H= hypochlorite stage bleaching sequence improved pulp brightness, tensile index, burst index, and double fold numbers by 3.66%, 4.78%, 6.38%, and 11.11%, respectively with a reduction in viscosity (10.59% and tear index (10.77% compared to the control. Combined bleach effluent of the XECEHH sequence mitigated adsorable organic halides (AOX by 21% and increased chemical oxygen demand (COD, bio-chemical oxygen demand (BOD, and colour by 67.18%, 84.78%, and 97.53%, respectively, compared to the control. Residual enzymes that entered during enzymatic prebleaching stage decreased AOX, COD, BOD, and colour of combined effluent of the XECEHH bleaching sequence progressively and on 6th day, and these were reduced by 23.78%, 0.04%, 15.00%, and 0.61%, respectively, compared to the control.

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

    Energy Technology Data Exchange (ETDEWEB)

    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

    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)

  13. Miliary Osteoma Cutis of the Face: A Case

    Directory of Open Access Journals (Sweden)

    Selma Emre

    2014-03-01

    Full Text Available Osteoma cutis (cutaneous ossification (OC is a rare disorder with true bone formation within the skin. Multiple miliary osteoma cutis of the face (MMOCF is a cause of acquired OC, is characterized by multiple, small, and primary osteomas in the skin tissue of the face and is a benign extraskeletal and rare bone formation. To date, 52 cases with MMOCF have been reported in the literature. Herein, we report a 56-year-old female patient presented with multiple small, firm, skin-colored papules on the forehead and face lasting for 4 years. She had no history of preexisting acne or any local inflammatory disease at the lesional sites. The skin biopsy revealed osteoid formation with central degeneration and calcification in the dermis. Depending on these clinical and histopathological findings, the patient was diagnosed as MMOCF.

  14. 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)

  15. Locating Noctiluca Miliaris in the Arabian Sea: An Optical Proxy Approach

    Science.gov (United States)

    Thibodeau, Patricia S.; Roesler, Collin S.; Drapeau, Susan L.; Matondkar, S. G. Prabhu; Goes, Joaquim I.; Werdell, P. Jeremy

    2014-01-01

    Coincident with shifting monsoon weather patterns over India, the phytoplankter Noctiluca miliaris has recently been observed to be dominating phytoplankton blooms in the northeastern Arabian Sea during the winter monsoons. Identifying the exact environmental and/or ecological conditions that favor this species has been hampered by the lack of concurrent environmental and biological observations on time and space scales relevant to ecologic and physiologic processes. We present a bio-optical proxy for N. miliaris measured on highly resolved depth scales coincident with hydrographic observations with the goal to identify conducive hydrographic conditions for the bloom. The proxy is derived from multichannel excitation chlorophyll a fluorescence and is validated with microscopy, pigment composition, and spectral absorption. Phytoplankton populations dominated by either diatoms or other dinoflagellates were additionally discerned. N. miliaris populations in full bloom were identified offshore in low-nutrient and low-N : P ratio surface waters within a narrow temperature and salinity range. These populations transitioned to high-biomass diatom-dominated coastal upwelling populations. A week later, the N. miliaris blooms were observed in declining phase, transitioning to very-low-biomass populations of non-N. miliaris dinoflagellates. There were no clear hydrographic conditions uniquely associated with the N. miliaris populations, although N. miliaris was not found in the upwelling or extremely oligotrophic waters. Taxonomic transitions were not discernible in the spatial structure of the bloom as identified by the ocean color Chl imagery, indicating that in situ observations may be necessary to resolve community structure, particularly for populations below the surface.

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

    Directory of Open Access Journals (Sweden)

    Ray S

    2013-01-01

    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

  17. Unusual blooms of green Noctiluca miliaris (Dinophyceae) in the Arabian Sea during the winter monsoon

    Science.gov (United States)

    Rosario Gomes, Helga; Matondkar, S. G. Prabhu; Parab, Sushma G.; Goes, Joaquim I.; Pednekar, Suraksha; Al-Azri, Adnan R. N.; Thoppil, Prasad G.

    A large-scale, ongoing study conducted by the National Institute of Oceanography, India, from 2003 onward in support of India's ocean color program, has documented for the first time ever the appearance of extensive blooms of Noctiluca miliaris Suriray in late winter and early spring for several consecutive years. Until the late 1990s, N. miliaris Suriray (synonym Noctiluca scintillans Macartney), a large dinoflagellate, was a minor component of phytoplankton populations in the Arabian Sea, appearing sporadically in bloom form in coastal regions during the summer southwest monsoon (June-September). Recently, N. miliaris blooms have begun to appear with increased frequency and intensity following the winter northeast monsoon (November-mid-February). These findings contradict established notions of the predominance of diatoms in winter blooms based on large-scale studies such as the Joint Global Ocean Flux Study (JGOFS) in the early1990s and the International Indian Ocean Expeditions (IIOEs) of 1959-1965. A field program in the Gulf of Oman since February 2003 has also documented the appearance of blooms of N. miliaris blooms with increased intensity in early winter. The present study investigates the temporal evolution and spatial extent of the N. miliaris blooms using phytoplankton taxonomic and pigment data from cruises undertaken in 2003-2004 and 2007 as well as ocean color satellite data. Our findings indicate that N. miliaris blooms are becoming an annual and widespread feature in the Arabian Sea. Aqua-Moderate Resolution Imaging Spectroradiometer (MODIS) sea surface temperature and altimetry data suggest that mesoscale eddies that populate the western Arabian Sea may play a significant role in the production and dispersal of these blooms from the Gulf of Oman into the northern Arabian Sea.

  18. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    Sung, Chang Keun; Na, Hyoung Il; Yu, Hyeon; Byun, Jun Soo; Youn, Young Chul; Seo, Jae Seung; Kim, Gi Hyeon [Chung-Ang University, Seoul (Korea, Republic of)

    2008-11-15

    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.

  20. CT and pathologic correlation acute miliary pulmonary tuberculosis

    International Nuclear Information System (INIS)

    Objective: To elucidate the CT characteristics and pathology of acute miliary pulmonary tuberculosis (AMPT). Methods: The CT features of AMPT in 25 cases were analyzed retrospectively, and the CT features in HIV-seronegative and HIV-seropositive patients were compared by 2-sided exact probability Chi-square test. Two lung specimens were inflated and fixed by Heitzman's method. HRCT scans, gross specimen section (80-150 μm) and histologic section (5 μm) were performed on dry lung specimens and CT-pathologic correlation was conducted. The distribution of micronodules in the secondary lobule on HRCT and pathology in one specimen was evaluated by Chi-square test. Results: Twenty five patients with AMPT were included in this study, including 11 HIV-seropositive patients and 14 HIV- seronegative patients. HRCT showed diffuse micronodules randomly distributed throughout both lungs in 25 patients, and ground-glass opacity (17 patients) was the predominant complicated finding. Coalescence of nodules and consolidation in HIV-seropositive patients (5 and 6 patients) were markedly higher than that in HIV-seronegative patients (none). In lung specimens, most nodules located in the lung parenchyma between the central bronchovascular bundle and the perilobular structures (792 and 560 nodules), which located in the interlobular septum pathologically. The distribution of micronodules in the secondary lobule showed on HRCT (1060 nodules) and pathology (864 nodules) was not significantly difference (χ2=2.814, P>0.05) . HRCT showed ground-glass opacities when ARDS occurred, which were pulmonary edema, inflammation and hyaline membrane on alveolar wall pathologically. Conclusions: The HRCT characteristic of nodule distribution in AMPT is random. ARDS should be suspected when diffuse ground-glass opacities appear on HRCT. (authors)

  1. Unusual blooms of green Noctiluca miliaris (Dinophyceae) in the Arabian Sea during the winter monsoon

    Digital Repository Service at National Institute of Oceanography (India)

    Gomes, H.R.; Matondkar, S.G.P.; Parab, S.G.; Goes, J.I.; Pednekar, S.; Al-Azri, A.R.N.; Thoppil, P.G.

    blooms using phytoplankton taxonomic and pigment data from cruises undertaken in 2003-2004 and 2007 as well as ocean color satellite data. Our findings indicate that N. miliaris blooms are becoming an annual and widespread feature in the Arabian Sea. Aqua...

  2. 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.)

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

    OpenAIRE

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

    2006-01-01

    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...

  4. Fatal miliary Coccidioidomycosis in a patient receiving infliximab therapy: a case report

    Directory of Open Access Journals (Sweden)

    Rogan Mark P

    2007-09-01

    Full Text Available Abstract A 78-year-old white male from Iowa in the United States of America receiving the anti- tumor necrois factor (TNF agent infliximab therapy for rheumatoid arthritis developed a cheek ulcer which failed to respond to empiric antibiotic therapy. He subsequently presented with progressive respiratory failure from miliary coccidioidomycosis which proved fatal. The patient vacationed in Arizona 6 months previously and likely contracted the organism there as Iowa is not an endemic area for coccidioidomycosis. Respiratory failure from miliary infiltration is an uncommon presentation of coccidioidomycosis. Physicians should be aware of the importance of travel history and potential for life-threatening coccidioidomycosis in patients receiving tumor necrosis factor inhibitors.

  5. Miliary brain metastases from papillary adenocarcinoma of the lung – unusual MRI pattern with histopathologic correlation

    International Nuclear Information System (INIS)

    Miliary brain metastases are very rarely described in the literature but if they are, they are quite obvious on magnetic resonance imaging (MRI) and enhance after intravenous administration of the contrast medium. The authors presented a case of miliary metastatic spread to the brain which was invisible on computed tomography and hardly visible on MRI, i.e. as countless, tiny, slightly T1-hyperintense foci that did not enhance. The authors discussed a few T1-hyperintense brain lesions which did not include metastases (except for metastatic melanoma which was a radiological suggestion after brain MRI). Autopsy revealed papillary adenocarcinoma of the lung with numerous metastatic lesions in both cerebral and cerebellar hemispheres and the meninges

  6. Two Cases of Miliary Tuberculosis and Increasing Level of CA-125

    OpenAIRE

    2006-01-01

    Two cases of miliary tuberculosis and elevated levels of cancer antigen 125 Ovarian carcinoma is one of the most dangerous malignancies in women. The serum level of cancer antigen (CA) 125, as a tumour marker, is useful in the diagnosis of ovarian cancer. CA 125 serum level is also elevated in ascites (1), ovarian tube abscess (2,3), biliary duct cancer and periampullary tumours (4), cholangitis (5), cancer of pancreas (6) and cervical adenocarcinoma (7). Additionally, sometimes the serum lev...

  7. ECF and TCF bleaching of Saccharum officinerum-CO89003 bagasse soda-AQ pulp with alkali-thermo-tolerant crude xylanase from Coprinellus disseminatus SW-1 NTCC1165

    Directory of Open Access Journals (Sweden)

    Swarnima Agnihotri

    2012-11-01

    Full Text Available An alkali-thermo-tolerant crude xylanase from Coprinellus disseminatus SW-1 NTCC1165 produced under solid-state fermentation conditions improves the brightness of sugarcane bagasse soda-AQ pulp by 7.3, 4.7, 6.1, and 8.2% in XODED, XOD(EOPDP, OX(EOPP, and XO(EOPP bleaching sequences, respectively, at an enzyme dose of 8IU/g, a reaction time of 120 min, a consistency of 10%, and a pH of 6.4 at 55 oC. An improvement in brightness by 2.1% for pulp bleached by XO(EOPP compared to OX(EOPP sequence validates that xylanase treatment is more effective for hydrolysing lignin-carbohydrates complexes before oxygen treatment. AOX after XODED and XOD(EOPDP sequences is reduced by 41.43 and 40%, respectively, compared to controls, but an increase in COD and color in studied bleaching sequences is attributable to the hydrolysis of hemicelluloses and the release of lignin-carbohydrates complexes after xylanase treatment. Xylanase treatment modifies fibre surface by introducing cracks, peelings, swelling, and external fibrillation, which facilitates faster penetration of bleach chemicals by disrupting physical barriers, as revealed by scanning electron microscopy.

  8. Miliary brain metastases from adenocarcinoma of the lung: MR imaging findings with clinical and post-mortem histopathologic correlation

    International Nuclear Information System (INIS)

    Miliary dissemination is a rare form of brain metastasis. The clinical and pathologic features of this form are unclear. We report a 66-year-old man with miliary brain metastases from adenocarcinoma of the lung, describing MRI and neuropathologic findings in the context of previously reported cases. Initial disorientation progressed to an apallic state within 6 months. Although, CT with administration of contrast agent failed to demonstrate any lesions, MRI with Gd-DTPA administration showed multiple enhancing miliary nodules in the cerebral cortex, basal ganglia, thalamus, cerebellum, and brainstem. Some of those nodules also could be seen on T2-weighted imaging without Gd-DTPA, but were difficult to identify conclusively. A histopathologic examination at autopsy disclosed diffusely distributed miliary tumor nodules in a perivascular distribution without surrounding focal edema or reactive gliosis. Notably, this patient with miliary brain metastases developed disorientation followed by unconsciousness, which overshadowed other focal neurologic signs at that time. We should consider this pattern of brain dissemination when a cancer is associated with unexplained disturbance of consciousness. (orig.)

  9. BCG pneumonitis with a miliary radiological pattern complicating intravesical BCG immunotherapy

    Directory of Open Access Journals (Sweden)

    Evangelia Fouka

    2010-01-01

    Full Text Available SUMMARY. The case is described of a 42 year-old male who presented with fever, haematuria, hypoxaemia, impaired liver function and a miliary pattern on chest X-ray while receiving intravesical BCG treatment for superficial bladder cancer. Initiation of antituberculous therapy resulted in rapid amelioration of the symptoms and the X-ray findings, and the patient left hospital in a good general state of health. Although M. bovis was not isolated from samples of sputum, bronchioalveolar lavage fluid (BALF or bronchial biopsy tissue, the prompt response to antituberculous therapy suggests an infectious aetiology due to microbial dissemination. Pneumon 2010, 23(4:388-391.

  10. 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.

    Science.gov (United States)

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

    2012-04-01

    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

  11. Blooms of Noctiluca miliaris in the Arabian Sea—An in situ and satellite study

    Science.gov (United States)

    Gomes, Helga do Rosario; Goes, Joaquim I.; Matondkar, S. G. Prabhu; Parab, Sushma G.; Al-Azri, Adnan R. N.; Thoppil, Prasad G.

    2008-06-01

    Phytoplankton cell density, chlorophyll a (chl a) concentration and pigment data collected during a series of five cruises in the northern Arabian Sea in the Northeast Monsoon (NEM, Nov-Jan) and the Spring Intermonsoon (SIM, Mar-May) since 2003 contradicted the established notion that winter blooms mainly consist of diatom communities. Recent data show that following the NEM and well into the SIM, phytoplankton populations are dominated by the dinoflagellate Noctiluca miliaris Suriray (synonym Noctiluca scintillans Macartney). In the SIM they were often in association with the well-known blooms of the diazotroph Trichodesmium sp. Large blooms of N. miliaris have also begun making their appearance annually in the Gulf of Oman and off the coast of Oman. This study uses NASA's recently developed product of merged SeaWiFS and Aqua-MODIS chl a data to investigate the temporal evolution and spatial extent of these taxonomically validated blooms. Satellite chl a in relation to Aqua-MODIS SST and altimetry data suggest that mesoscale eddies that populate the western Arabian Sea during the NEM contribute to the genesis and dispersal of these blooms from the Gulf of Oman into the central Arabian Sea.

  12. The bloom of the dinoflagellate (Noctiluca miliaris) in the North Eastern Arabian Sea: Ship and Satellite study

    Digital Repository Service at National Institute of Oceanography (India)

    Matondkar, S.G.P.; Basu, S.; Parab, S.G.; Pednekar, S.; Dwivedi, R.M.; Raman, M.; Goes, J.I.; Gomes, H.

    Feb. N. miliaris is characterized by the presence of the symbiont Pedimonas noctilucae. This organism shows a predominantly green colouration due to the presence of high chlorophyll b along with chlorophyll a. Time series of OCM I and OCM II images...

  13. Disseminated tuberculosis with paradoxical miliary tuberculomas of brain in a child with rickets

    Directory of Open Access Journals (Sweden)

    Nehal H Patel

    2013-01-01

    Full Text Available Intracranial tuberculomas continue to be a serious complication of central nervous system tuberculosis. Multiple central nervous system tuberculoma is commonly associated with human immunodeficiency virus (HIV infection. The development of intracranial tuberculomas has been thought to be caused by hematogenous spread of tubercle bacilli on the surface of brain parenchyma from the primary site of infection. Here, we describe the case of a 5-year-old male child with severe protein energy malnutrition (Marasmus having large cervical lymphadenopathy and severe nutritional rickets with deformity at presentation. The child developed convulsions 20 days after initiation of antituberculous drugs, and neuroimaging confirmed multiple miliary tuberculomas of brain as primary etiology for the convulsions.

  14. Peripheral ulcerative keratitis associated with chronic malabsorption syndrome and miliary tuberculosis in a child

    Directory of Open Access Journals (Sweden)

    Tarun Arora

    2015-01-01

    Full Text Available A 16-year-old girl presented with pain, redness, watering, and blurring of vision in her right eye. Slit lamp examination revealed the presence of peripheral ulcerative keratitis (PUK and nodular scleritis. On clinical examination, the patient had stunted growth, low body mass index, and enlarged axillary nodes. Giardia cysts were present in the stool sample and histopathology of axillary lymph nodes showed caseating necrosis suggestive of tuberculosis (TB. A diagnosis of PUK with chronic malabsorption syndrome secondary to giardiasis and miliary TB was made. Oral metronidazole, anti-tubercular treatment, high protein diet and vitamin supplements were started. Topical steroids were started for peripheral ulcerative lesions following, which the PUK resolved.

  15. Peripheral ulcerative keratitis associated with chronic malabsorption syndrome and miliary tuberculosis in a child.

    Science.gov (United States)

    Arora, Tarun; Sharma, Namrata; Shashni, Adarsh; Titiyal, Jeewan S

    2015-01-01

    A 16-year-old girl presented with pain, redness, watering, and blurring of vision in her right eye. Slit lamp examination revealed the presence of peripheral ulcerative keratitis (PUK) and nodular scleritis. On clinical examination, the patient had stunted growth, low body mass index, and enlarged axillary nodes. Giardia cysts were present in the stool sample and histopathology of axillary lymph nodes showed caseating necrosis suggestive of tuberculosis (TB). A diagnosis of PUK with chronic malabsorption syndrome secondary to giardiasis and miliary TB was made. Oral metronidazole, anti-tubercular treatment, high protein diet and vitamin supplements were started. Topical steroids were started for peripheral ulcerative lesions following, which the PUK resolved. PMID:26903734

  16. Miliary tuberculosis with atypical presentation in an immunocompetent young African man.

    Science.gov (United States)

    Albrecht, Nicole; Cottagnoud, Philippe; Chatterjee, Bidisha

    2014-01-01

    We present an atypical case of tuberculosis in an immunocompetent man from west Africa living in Europe. The patient entered the hospital with a painful lump of 3 cm on his right clavicule which he noticed 2 weeks before and back pain. During the examinations for further evaluation his condition deteriorated within short time. Tuberculosis was diagnosed, treatment started but he needed mechanical ventilation at the intensive care unit and had kidney failure. The further evolvement was favourable in the end but needed intensive treatment for over 4 weeks. Tuberculosis cases with such severe evolution are rather known with immunodeficient patients. Extrapulmonary tuberculosis, especially skeletal tuberculosis is seen more frequent in young immunocompetent migrants. The migrating persons seem to be more at risk to get sick than the ones staying in their origin country. We suppose the course of our patient's disease is miliary or septic, of which both are rather rare entities. PMID:24654236

  17. "Miliary" actinomycosis.

    Science.gov (United States)

    Fisher, M S

    1980-06-01

    Disseminated actinomycosis with hematogenous spread to the lungs is rare. A fatal case is reported, with the primary site of infection in the pelvis, in a woman with an intrauterine contraceptive device. PMID:7380879

  18. 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

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

    Directory of Open Access Journals (Sweden)

    Swaminathan S

    2007-01-01

    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.

  20. Diurnal observations on the behavioral ecology of Gymnothorax moringa (Cuvier) and Muraena miliaris (Kaup) on a Caribbean coral reef

    Science.gov (United States)

    Abrams, R. W.; Abrams, M. D.; Schein, M. W.

    1983-09-01

    Activities of muraenids, primarily Gymnothorax moringa and Muraena miliaris, were observed on a Caribbean coral reef with a view to further understanding their role in the reef ecosystem. Other muraenid species included in the total of 198 sightings were Echidna catenata, Enchelycore nigricans, and an unidentified brown moray. The five species were unequally distributed among three basic habitats (sand, coral head, reef rock) available on the reef. Nine particular holes accounted for 52.5% of the total sightings, although hundreds of other seemingly appropriate sites were available. The eels (except M. miliaris) were transient with respect to given holes and particular sections of the reef. While some G. moringa were sighted in the same holes for several consecutive days, M. miliaris individuals remained in the same coral heads throughout the 6-week study period. Muraenids observed in this study showed high tolerances for and were tolerated by other fishes (including other morays) and invertebrates on the reef. They appeared to be opportunistic, roving predators and were not strictly nocturnal. Distinct behavioral interactions and displays between muraenids and reef fish were observed.

  1. Miliary tuberculosis occurred after immunosuppressive drug in PNH patient with completely cured tuberculosis; a case report.

    Science.gov (United States)

    Lee, Jihyun; Gong, Soojung; Lee, Byounghoon; Lee, Soyoung; Lee, Jungae; Kim, Naeyu

    2012-01-01

    Paroxysmal nocturnal hemoglobinuria (PNH) is a clonal disorder that presents with hemolytic anemia, marrow failure and thrombophilia. During acute attacks, corticosteroid can alleviate the hemolytic paroxysm, but the prolonged administration induces serious toxicity including immunosuppression. So American thoracic society (ATS) for tuberculosis (TB) recommends prophylactic anti-TB medication in patients with a long-term steroid therapy. However, in the patient who was treated for active TB in the past, there are no guidelines of the test for determining patients who have latent TB infection (LTBI) and no recommendations of TB prophylaxis if there is no evidence of reactivation at present. A 40-year-old male patient presented with fever and aggravated weakness for a week. He was diagnosed with PNH a month ago and took corticosteroid for 3 weeks. In the past, he was diagnosed with pulmonary TB and completely cured after treatment. According to guideline, he was not indicated with TB prophylaxis. However, he caught miliary TB, progressed to acute respiratory distress syndrome. We experience this embarrassing case, and emphasize the need to investigate multicentral TB prevalence and to make the guidelines of anti-TB medication in subgroups of hematologic diseases including PNH. PMID:22554314

  2. Miliary tuberculosis occurred after immunosuppressive drug in PNH patient with completely cured tuberculosis; a case report

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    Lee Jihyun

    2012-05-01

    Full Text Available Abstract Paroxysmal nocturnal hemoglobinuria (PNH is a clonal disorder that presents with hemolytic anemia, marrow failure and thrombophilia. During acute attacks, corticosteroid can alleviate the hemolytic paroxysm, but the prolonged administration induces serious toxicity including immunosuppression. So American thoracic society (ATS for tuberculosis (TB recommends prophylactic anti-TB medication in patients with a long-term steroid therapy. However, in the patient who was treated for active TB in the past, there are no guidelines of the test for determining patients who have latent TB infection (LTBI and no recommendations of TB prophylaxis if there is no evidence of reactivation at present. A 40-year-old male patient presented with fever and aggravated weakness for a week. He was diagnosed with PNH a month ago and took corticosteroid for 3 weeks. In the past, he was diagnosed with pulmonary TB and completely cured after treatment. According to guideline, he was not indicated with TB prophylaxis. However, he caught miliary TB, progressed to acute respiratory distress syndrome. We experience this embarrassing case, and emphasize the need to investigate multicentral TB prevalence and to make the guidelines of anti-TB medication in subgroups of hematologic diseases including PNH.

  3. Unusual blooms of Noctiluca miliaris in the Arabian Sea during the Northeast Monsoon

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    Gomes, H. D.; Goes, J. I.; Matondkar, P.; Parab, S.; Al-Azri, A. R.; Thoppil, P. G.

    2007-05-01

    Until the late 1990's Noctiluca miliaris Suriray (synonym Noctiluca scintillans Macartney), a large heterotrophic dinoflagellate was a minor component of phytoplankton populations in the Arabian Sea, appearing in bloom form only sporadically in coastal regions predisposed to upwelling and deep slope water intrusions during the Southwest monsoon. Since then however, N. miralis blooms have increased in frequency and intensity, but with the majority of blooms being observed following the Northeast monsoon (NEM) and at times, in association with the well known blooms of the diazotroph Trichodesmium sp. Microscopy and chemotaxonomy from HPLC analysis of phytoplankton pigments undertaken in 2003-2004. as well as satellite ocean color data suggest that N. miralis blooms are becoming more intense and widespread in the Arabian Sea. Large blooms of these organisms have started appearing in the Gulf of Oman and off the coast of Oman. This study uses recent, merged SeaWiFS and MODIS-Aqua ocean color datasets to investigate the temporal evolution and spatial extent of these taxonomically validated blooms. Aqua-MODIS SST and altimetry data suggest that mesoscale eddies that populate the Western Arabian Sea during the NEM may be playing a significant role in the production and dispersal of these blooms from the Gulf of Oman into the Central Arabian Sea.

  4. Correlation between membrane potential responses and tentacle movement in the dinoflagellate Noctiluca miliaris.

    Science.gov (United States)

    Oami, Kazunori

    2004-02-01

    Membrane potential responses and tentacle movement of the marine dinoflagellate Noctiluca miliaris were recorded simultaneously and their time relationships were examined. The food-gathering tentacle of Noctiluca exhibited slow extension-flexion movements in association with the spontaneously recurring membrane potential responses termed the tentacle regulating potentials (TRPs). The flexion of the tentacle began during the slow depolarization of the TRPs. The rate of the flexion increased after the hyperpolarizing (negative) spike following the slow depolarization. The tentacle then extended slowly during the hyperpolarized level of the TRPs. A TRPs-associated flexion did not occur when the external Ca(2+) ions were removed. On the contrary, the tentacle showed conspicuous flexion (coiling) when the external Ca(2+) concentration was raised. In association with the stimulus-evoked action potential, which triggers bioluminescent flash (flash-triggering action potential; FTP), the tentacle coiled quickly. The FTP-associated coiling took place even in the Ca(2+)-deprived condition. The coupling mechanisms of the TRPs-associated and FTP-associated tentacle movements were compared, and their biological significance was discussed. PMID:14993823

  5. Retreived bacteria from Noctiluca miliaris (green) bloom of the northeastern Arabian Sea

    Science.gov (United States)

    Basu, Subhajit; Matondkar, S. G. Prabhu; Furtado, Irene

    2013-01-01

    In recent years, seasonal blooms of the dinoflagellate Noctiluca miliaris have appeared in the open-waters of the northern Arabian Sea (NAS). This study provides the first characterization of bacteria from a seasonal bloom of green Noctiluca of NAS (20°N-17°N and 64°E-70°E), during the spring-inter-monsoon cruise of Sagar Sampada 253, in March 2007. Bacterial growth as assessed by most-probable number (MPN) and plate counts, revealed `variable-physiotypes' over a wide range of salinities (0%-25% w/v NaCl), pH levels (5-8.5), and organic nutrient strengths, in comparison to non-bloom waters. MPN indices of bacteria in surface waters of bloom stations *DWK and *PRB, corresponded to (3.08-4.41)×103 cells/mL at 3.5% NaCl (w/v), and (2.82-9.49)×102 cells/mL at 25% (w/v) NaCl in tryptone-yeast extract broth (TYE). Plate counts were (1.12-4)×106 CFU/mL at 0% (w/v) NaCl, (1.28-3.9)×106 CFU/mL at 3.5% (w/v) NaCl, and (0.4-7)×104 CFU/mL at 25% NaCl (w/v) on TYE. One-tenth-strength Zobell's gave (0.6-3.74)×105 CFU/mL at pH 5 to (3.58-7.5)×105 CFU/mL at pH 8.5. These bacteria were identified to the genera Bacillus, Cellulomonas, Staphylococcus, Planococcus, Dietzia, Virgibacillus, Micrococcus, Sporosarcinae, Leucobacter, and Halomonas. The identity of three strains (GUFBSS253N2, GUFBSS253N30, and GUFBSS253N84) was confirmed through 16S rDNA sequence homology as Bacillus cohnii, Bacillus flexus, and Bacillus cereus. The ˜2-3-fold higher plate counts of culturable bacteria from the open-waters of the NAS indicate that these bacteria could critically determine the biogeochemical dynamics of the bloom and its milieu. The role of these bacteria in sustaining/terminating the bloom is under evaluation.

  6. Diffuse calcification of the urinary system and miliary tuberculosis due to delayed diagnosis of genitourinary tuberculosis: a case report.

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    Hairong Chen

    2015-02-01

    Full Text Available Genitourinary tuberculosis (GUTB is difficult to diagnose in the earlier stage owing to the non-specific symptoms. Usually, renal tuberculous involvement is unilateral and the imaging finding is renal calcification, but associated calcifications of bilateral ureter and bladder are rare. We report a 66-year-old man who presented with diffuse calcification of the urinary system (including bilateral pelvicalyceal system, both ureters and bladder and disseminated miliary tuberculosis due to GUTB. He had been misdiagnosed with urinary tract infection and urinary lithiasis for two years before the diagnosis of GUTB was confirmed by microbiological examination of the urine. This case highlights the importance of maintaining a high index of clinical suspicion for GUTB.

  7. Miliary tuberculosis with no pulmonary involvement in myelodysplastic syndromes: a curable, yet rarely diagnosed, disease: case report and review of the literature

    OpenAIRE

    Krambovitis Elias; Tsirakis George; Gitti Zoe; Alexandrakis Michael G; Neonakis Ioannis K; Spandidos Demetrios A

    2008-01-01

    Abstract Background Although tuberculosis is not uncommon among patients with myelodysplastic syndrome (MDS), only a few reports of such patients suffering from miliary tuberculosis (MT) exist. MT often presents as a fever of unknown origin and it is a curable disease, yet fatal if left untreated. Case presentation We report a case of MT with no clinical or laboratory indications of pulmonary involvement in a patient with MDS, and review the relevant literature. Mycobacterium tuberculosis was...

  8. Zelleriella ubatubensis, sp. n. (Protozoa: Opalinatea: entozoário de Thoropa miliaris (Spix, 1824 (Anura, Leptodactylidae de Ubatuba, São Paulo, Brasil

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    I. Gióia

    1983-01-01

    Full Text Available Zelleriella ubatubensis, sp. n. is described. This species was found in the caecal region of the leptodactylid Thoropa miliaris from Ubatuba, SP, Brasil. The cell body has an irregular ellipsoid outline (145.9 µm ± 3.0 x 93.9 µm ± 24. The nucleus (16.7 µm ±0.3 has a fragmented nucleolar mass (more than nine nucleoli. Z. ubatubensis seems to be morphologically similar to Z. caryosoma and Z. foliacea but it differs from them by dimension, chromatin and host. A great number of the observed specimens contained Endamoeba paulista in their cytoplasm.

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

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    Julio César Mantilla

    2007-12-01

    Full Text Available 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 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.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-specificity 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.

  10. Macrofaunal involvement in the sublittoral decay of kelp debris: The sea urchin Psammechinus miliaris (Gmelin) (Echinodermata: Echinoidea)

    Science.gov (United States)

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

    1985-01-01

    Psammechinus miliaris occurs in the Clyde Sea area in large numbers (urchins grew faster than older individuals on a diet of rotting weed but not on fresh weed. Large seasonal variation existed, however, with fast growth occurring in June-August and little, or no, growth in December-February, irrespective of diet. Starved controls did not grow. Correcting for seasonality, rotting kelp still promoted faster growth of young urchins than did fresh weed. Larger (older) individuals showed no difference. Urchins fed fresh weed had significantly longer gut retention times. Protein absorption efficiency was higher on fresh than rotting weed, varying with weed protein content and size of urchin. Very young individuals can only digest high protein weed efficiently, eg. material derived from near the frond meristem. Organic carbon content of rotting weed was significantly lower than fresh weed. Carbon absorption efficiencies were significantly higher on fresh weed which related to organic carbon content. Standard-sized urchins fed rotting weed produced larger dry weights of faeces per day, reflecting increased ingestion rate. In closed-system choice experiments urchins preferred rotting weed kinetically. Size-frequency analysis of field populations suggested that weed beds are principally colonized by larval settlement from the plankton. Mature Psammechinus have evolved different 'strategies' for exploiting fresh and rotting weed. Fresh weed is relatively difficult to digest and long gut retention times allow high protein absorption efficiencies to be attained. Rotting weed has microbial protein in quantities and a lower organic carbon fraction. Some bacterial protein is seemingly unavailable though and lower protein absorption efficiencies result. Thus gut retention time is shortened and more food passed through the gut. Growth remains equivalent. Substratum digestion is of paramount importance for Psammechinus feeding on either fresh or rotting weed, cf. the 'classical' microbe-stripping detritivore of Fenchel.

  11. Observações anatômicas sôbre a larva de Thoropa miliaris (Amphibia, Leptodactylidae

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    Rudolf Barth

    1956-12-01

    Full Text Available Die kaulquappe von Thoropa miliaris lebt in mittleren Lagen des Itatiáia-Gebirges (Staat Rio de Janeiro, in etwa 1650 m Hoebe, auf fast senkracht stehenden Felsplatten, ueber die staendig eine sehr duenne Schicht Wasser herablaeuft. Die Tiere haben keinen Flossensaum; der zwei- bis dreimal koerperlange Schwanz ist fast drehrund und besitzt an Stelle eines Flossensaumes nur einen ventralen Kiel, der die Schlaengelbewegung gegen den Wasserstrom unterstuetzt. Auch die juengsten Stadien haben keine aeusseren kiemen, sondern innere in einer Atemhoehle, deren Ausgang sich auf der linken Seite in der Mitte des Koerpers befindet. Die Tiere heften sich an den Steinen vermittels ihres sehr grossen Mundapparates fest. Die Lippen tragen zwei oder drei Reihen starker Keratin-Haken, die durch laufende Neubildung ersetzt werden. Die arbeitenden Spitzenzaehne des Hornschnabels in der Mundhoehle werden ebenfalls durch fortgesetztes Wachstum erneuert. Die Saugscheibenwirkung des Mundes wird durch ein Muskelpaar bedingt, das einerseits am Parasphenoid- und am Sphenethmoidknorpel, andererseits mit seinen unteren Buendeln am Prodentale (Spitze des Meckel'schen Knorpels, mit seinem oberen vermittels je zweier Sehnen am Promaxillare ansetzt. Durch die kontraktion dieser Muskeln wird das Prodentale nach oben und dann nach hinten, das Promaxillare (mit Gelenkstellen am Prointermaxillare und Pronasale nach oben und dann nach vorne gedreht. Hierdurch treten die beiden Kegel des Hornschnabels in die Mundhoehle, da sie den beiden Knorpeln fest aufsitzen. Bei starker Kontraktion werden die Knorpel auseinander gedrueckt und vergroessern die Mundhoehle. Wenn die Lippen, unterstuetzt von den Hakenreihen, fest dem Stein aufliegen, ergibt sich ein Unterdruck in der Mundhoehle, der genuegt, um die Larven auf der Unterlage festzuhalten. Das Loesen des Saugnapfes erfolgt durch die kontraktion einer Gruppe kleiner Muskelbuendel, die einerseits am Unterrand des Prodentale, andererseits an den falten der Unterlippe ansetzen.

  12. Miliary tuberculosis with no pulmonary involvement in myelodysplastic syndromes: a curable, yet rarely diagnosed, disease: case report and review of the literature

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    Krambovitis Elias

    2008-03-01

    Full Text Available Abstract Background Although tuberculosis is not uncommon among patients with myelodysplastic syndrome (MDS, only a few reports of such patients suffering from miliary tuberculosis (MT exist. MT often presents as a fever of unknown origin and it is a curable disease, yet fatal if left untreated. Case presentation We report a case of MT with no clinical or laboratory indications of pulmonary involvement in a patient with MDS, and review the relevant literature. Mycobacterium tuberculosis was isolated from the liquid culture of a bone marrow aspirate. Conclusion Even if the initial diagnostic investigation for a fever of obscure etiology is negative, MT should not be excluded from the differential diagnosis list. Since it is a curable disease, persistent and vigorous diagnostic efforts are warranted. In suspected cases, mycobacterial blood cultures should be collected as soon as possible after hospital admission and early bone marrow aspirate with mycobacterial cultures is advocated.

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

    Science.gov (United States)

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

    2013-05-01

    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 γ-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

  14. Hepatitis granulomatosa en paciente con tuberculosis miliar: presentación de un caso / Granulomatous hepatitis in a patient with Miliary Tuberculosis: presentation of a case

    Scientific Electronic Library Online (English)

    Dalia, García Cuervo; Yanet, Acosta Piedra; Omara, Bandera Rodríguez; Janet, Testar de Armas; Adianez, Jiménez Álvarez.

    2014-02-01

    Full Text Available La hepatitis granulomatosa como elemento inicial de una enfermedad tuberculosa es muy poco frecuente. El rendimiento de las pruebas para el diagnóstico de tuberculosis hepática resulta baja, siendo las principales causas de granulomatosis hepática las infecciones (tuberculosis, brucelosis, hongos, p [...] arásitos, etc.). En la tuberculosis miliar, durante la diseminación hemática, que ocurre en el desarrollo de la primoinfección, el hígado es capaz de recibir y albergar una carga considerable de bacilos por sus características anatomofuncionales que se agrupan en forma de granuloma, que es un patrón de reacción inflamatoria crónica en el que predomina un tipo especial de célula denominada macrófago. Esto es causa frecuente de síndrome febril prolongado de causa sistémica, puede debutar con manifestaciones clínicas poco precisas. Se presentó un caso del sexo masculino que ingresa en el servicio de Medicina del Hospital Militar Docente Dr. Mario Muñoz Monroy, de Matanzas, que ingresa por cuadro de fiebre de origen desconocido, que resultó ser por esta causa. Abstract in english Granulomatous hepatitis as initial element of a tubercular disease is few frequent; the efficacy of the tests for diagnosing hepatic tuberculosis is low, being infections (tuberculosis, brucellosis, fungi, parasites, etc.). The main cause of hepatic granulomatosis. during the hematic dissemination i [...] n the miliary tuberculosis, occurring in the development of primo-infection, liver is able of receiving and dwelling a considerable charge of bacilli due to its anatomic functional characteristics; they group in the form of granulomas, a pattern of chronic inflammatory reaction, in which there is a predomination of an special kind of cells called macrophages; it frequently causes a prolonged febrile syndrome and may start with little precise clinical manifestations. We present the case of a male patient entering the Medicine Service of the Military Hospital Dr. Mario Muñoz Monroy of Matanzas, with a picture of unknown origin fever, resulting being originated by this cause.

  15. 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

    Energy Technology Data Exchange (ETDEWEB)

    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

    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)

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

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    A. Modjtabai

    1969-01-01

    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,

  17. 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

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    Vitor Emer Egypto Rosa

    2011-12-01

    Full Text Available 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 tratamento. 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.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.

  18. Percutaneous breast implant herniation: a rare complication of miliary TB.

    Science.gov (United States)

    Dale, Adam P; Dedicoat, Martin J; Saleem, Tausif; Moran, Ed

    2015-01-01

    We describe the case of a 46-year-old female patient treated for disseminated tuberculosis (TB) infection involving the lungs, urinary tract and skin. Following initiation of antituberculous therapy, the patient's right breast implant eroded through the overlying skin and was seen to be herniating through the resulting defect. The breast implant was removed under local anaesthetic and histological analysis of the resected tissue demonstrated granuloma formation consistent with periprosthetic TB. Wound healing following implant removal was poor and future breast augmentation surgery was only considered following completion of 12?months anti-TB treatment. This case constitutes the first report in the literature of percutaneous breast implant herniation resulting from periprosthetic infection with TB. A high index of suspicion is required to ensure early detection and timely management of TB and, in cases where periprosthetic pus aspirate is sterile, mycobacterial infection must be actively excluded. PMID:25568276

  19. Intravesical BCG therapy as cause of miliary pulmonary tuberculosis.

    Science.gov (United States)

    Rosati, Yuri; Fabiani, Andrea; Taccari, Tommaso; Ranaldi, Renzo; Mammana, Gabriele; Tubaldi, Alberto

    2016-03-01

    Immunotherapy with intravesical bacillus Calmette-Guérin (BCG) is considered the most effective adjuvant to endoscopic resection of bladder urothelial carcinoma in the therapeutic management of non-muscle invasive (NMIBC) at intermediate and high risk of recurrence and progression (pTa - pT1 and high-grade carcinoma in situ, CIS). Despite its proven efficacy, this type of treatment can determine local and systemic side effects of moderate or severe gravity, with the histological diagnosis of epithelioid granulomas in different organs, even in the absence of microbiological positivity of BCG. The immunotherapy with BCG is usually well tolerated and the virulence of the attenuated BCG is very low in immuno-competent patients, although only 16% of patients are able to receive all the instillations of the maintenance period (3 years) of treatment provided by the protocols, precisely because of side effects. Minor side effects usually resolve within a few hours or days. They develop in 3-5% of patients and usually consist of local infectious complications. Manifestations of BCG dissemination, such as vascular and ocular complications, are much less common, while BCG-disseminated infections, with granulomatous pneumonia or hepatitis present, are quite rare, representing 0.5-2% of the complications recorded. We present the clinical case of granulomatous lung and possibly liver infection caused by BCG in a patient aged 56 years being treated for several weeks with intravesical BCG for NIMBC pT1 high grade associated with CIS. PMID:26616461

  20. Remotely Searching for Noctiluca Miliaris in the Arabian Sea

    Science.gov (United States)

    Werdell, P. Jeremy; Roesler, Collin S.; Goes, Joaquim I.

    2014-01-01

    Reversing monsoonal winds in the Arabian Sea result in two seasons with elevated biological activity, namely the annual summer Southwest Monsoon (SWM; June to September) and winter Northeast Monsoon (NEM; November to March) [Wiggert et al., 2005]. Generally speaking, the SWM and NEM create two geographically distinct blooms [Banse and English, 2000; Levy et al., 2007]. In the summer, winds from the southwest drive offshore Ekman transport and coastal upwelling along the northwestern coast of Africa, which brings nutrient-rich water to the surface from below the permanent thermocline [Bauer et al., 1991]. In the winter, cooling of the northern Arabian Sea causes surface waters to sink, which generates convective mixing that injects nutrients throughout the upper mixed layer [Madhupratap et al., 1996]. This fertilization of otherwise nutrient-deplete surface waters produces one of the most substantial seasonal extremes of phytoplankton biomass and carbon flux anywhere in the world [Smith, 2005].

  1. The subcellular origin of bioluminescence in Noctiluca miliaris.

    Science.gov (United States)

    Eckert, R; Reynolds, G T

    1967-05-01

    The light emitted by Noctiluca has its origin in 1 to 5 x 10(4) organelles ("microsources") which are scattered throughout the perivacuolar cytoplasm, and which appear to be the elementary functional units of bioluminescence. Microscopical techniques, image intensification, and microphotometry were employed in their investigation. Microsources are fluorescent, strongly phase-retarding, and range widely in diameter below 1.5 microns. The number of quanta emitted in a flash from a microsource ("microflash") is of the order of 10(5) photons. However, microflashes show a wide range of intensities, which are correlated with the size of the organelles from which they arise. Each organelle responds repetitively and with reproducible time course to a succession of invading triggering potentials. Reversible changes in the intensity of the flash emitted by the whole cell ("macroflash") occur because of graduations in intensity of microflashes rather than as a result of changes in the number of responsive organelles. The shape of the flash emitted by individual microsources resembles that of the macroflash except for slightly shorter rise and decay times. It is concluded that the macroflash results from somewhat asynchronous, but otherwise parallel summation of microflashes. PMID:5340466

  2. A case of emphysematous cystitis complicated with miliary tuberculosis

    OpenAIRE

    SOGA, Hideo; Imanishi, Osamu

    2012-01-01

    Summary Background: Emphysematous cystitis occurs mostly in diabetics with poor glycemic control or in immunocompromised patients. In most cases, diabetes mellitus correlates with the occurrence of emphysematous cystitis. The risk of relapse after tuberculosis cure or treatment completion is high among patients with diabetes mellitus. Case Report: A 64-year-old diabetic man suffering from high fever and lower abdominal pain was admitted to the emergency ward. Due to the results of radiographi...

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

    Directory of Open Access Journals (Sweden)

    Brzezińska-Wcisło Ligia

    2009-07-01

    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.

  4. Delay in diagnosis of generalized miliary tuberculosis with osseo-articular involvement: a case report

    Directory of Open Access Journals (Sweden)

    Atukorala Inoshi

    2011-10-01

    Full Text Available Abstract Introduction Diagnosis of atypical tuberculosis is difficult. Therefore, it is important that physicians are aware of rare presentations of tuberculosis to avoid diagnostic delays. Case presentation We present the case of a 17-year-old Sri Lankan man who presented to our facility with an ill-defined large induration over the skin of his left buttock and thigh. A cause could not be found despite extensive investigations. He also complained of chronic knee pain, but this was not investigated further at the time due to spontaneous resolution. Three years later his knee disease flared up again, with pain, swelling and restriction of movement. A synovial biopsy was suggestive of tuberculosis. He was started on antituberculosis therapy, to which he responded well. Our patient was asymptomatic two months after completion of therapy without any subsequent flare-ups. A chest roentgenogram taken on his second presentation showed evidence of tuberculosis sequelae in his lungs. The most likely diagnosis for the buttock and thigh swelling, when considering the entire clinical picture, is a tuberculous abscess. The constellation of skin and skeletal symptoms and pulmonary tuberculosis is a rare occurrence in an immunocompetent individual, but cases have been reported. Conclusions This case demonstrates the different presentations and the diagnostic difficulties posed by atypical manifestations of tuberculosis. It also demonstrates the value of maintaining a high degree of suspicion in endemic areas, even in the absence of microbiological evidence.

  5. Blooms of Noctiluca miliaris in the Arabian Sea - An in situ and satellite study

    Digital Repository Service at National Institute of Oceanography (India)

    Gomes, H.R.; Goes, J.I.; Matondkar, S.G.P.; Parab, S.G.; Al-Azri, A.R.N.; Thoppil, P.G.

    Phytoplankton cell density, chlorophyll a (chl a) concentration and pigment data collected during a series of five cruises in the northern Arabian Sea in the Northeast Monsoon (NEM, Nov-Jan) and the Spring Intermonsoon (SIM, Mar-May) since 2003...

  6. Locating Noctiluca miliaris in the Arabian Sea: An optical proxy approach

    Digital Repository Service at National Institute of Oceanography (India)

    Thibodeau, P.S.; Roesler, C.S.; Drapeau, S.L.; Matondkar, S.G.P.; Goes, J.I.; Werdell, P.J.

    -power light-emitting diodes (LEDs) with full-width, half-maximum (FWHM) ranges of 24 nm for the 440 nm and 470 nm LEDs and 32 nm for the 532 nm LED. The detector optical filter has a FWHM of 70 nm and is made of RG645 Schott glass. As the sensor is a special... for cultures grown under high and low light and collected at different growth phases (data modified from Proctor and Roesler 2010). (C) Fluorescence pigment ratio (F532 :F440) for each species after transfer function applied (see text). The bars for each...

  7. LCH DIAGNOSED BY FNAC: GROWTH RETARDATION OF CHILD AND CLINICALLY MISDIAGNOSED AS MILIARY TUBERCULOSIS

    Directory of Open Access Journals (Sweden)

    Ajay Kr.

    2013-05-01

    Full Text Available ABSTRACT- Langerhans cell histiocytosis (LCH is a rare disor der with multisystem involvement. Hear we report a case of LCH in a five year old chi ld with growth retardation and scalp swelling where FNAC was helpful in achieving a rapid and acc urate diagnosis despite of misdiagnosis at the clinician level. The cytological features are chara cteristic of LCH ie nuclear grooving, nuclear pseud o inclusion in background of eosinophils and plasma c ells. This can also avoid unnecessary biopsy and guide the management. ABBREVIATIONS: LCH- Langerhans cell histiocytosis, FNAC- Fine need le aspiration cytology, LC- Langerhans cell, IHC-Immun ohistochemistry

  8. Retrieved bacteria from Noctiluca miliaris (green) bloom of the northeastern Arabian Sea

    Digital Repository Service at National Institute of Oceanography (India)

    Basu, S.; Matondkar, S.G.P.; Furtado, I.

    Bloom stations: D: *DWK; P: *PRB ● Non-bloom stations: Cs: CAS; K: KTW; S: SMN; C: CHD; M: MGR; Dp: DPL C C C M M MC M C M Dp Dp Dp Dp Dp Dp Cs Cs ● Fig.2 Hydrographic characteristics of northeastern Arabian Sea surface waters during March 2007 a...

  9. Study of ecological consequence of the bloom (Noctiluca miliaris) in off shore waters of the Northern Arabian Sea

    Digital Repository Service at National Institute of Oceanography (India)

    Dwivedi, R.M.; Chauhan, R.; Solanki, H.U.; Raman, M.; Matondkar, S.G.P.; Madhu, V.R.; Meenakumari, B.

    catch data (percent hooking rates of tuna) were obtained from Fishery Survey of India and were used to study response of fish to prevailing high productivity in the bloom waters. Fishing in oceanic waters within Indian EEZ indicated no adverse effect...

  10. Primer registro de Kalicephalus costatus (Nematoda, Diaphanocephalidae, parásito de Liophis miliaris semiaureus (Serpientes, Colubridae de la provincia de Entre Ríos

    Directory of Open Access Journals (Sweden)

    Ramallo, Geraldine

    2005-08-01

    Full Text Available El objetivo de la presente nota es dar a conocer el primer registro del género Kalicephalus Molin, 1861 en Argentina y el sexto a nivel sudamericano, ampliándose de este modo su distribución geográfica.

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

    Digital Repository Service at National Institute of Oceanography (India)

    Basu, S.; Deobagkar, D.D; Matondkar, S.G; Furtado, I.

    bloom were approx. 2-3-fold higher in comparison to non-bloom waters and ranged from 3.20×10 sup(5) to 6.84×10 sup(5) cfu ml sup(-1). An analysis of the dominant heterotrophs associated with Noctiluca bloom resulted in phylogenetic and a detailed...

  12. Red tide of Noctiluca miliaris off south of Thiruvananthapuram subsequent to the ‘stench event’ at the southern Kerala coast

    Digital Repository Service at National Institute of Oceanography (India)

    Sahayak, S.; Jyothibabu, R.; Jayalakshmi, K.J.; Habeebrehman, H.; Sabu, P.; Prabhakaran, M.P.; Jasmine, P.; Shaiju, P.; Rejomon, G.; Threslamma, J.; Nair, K.K.C.

    kill was noticed on 17 September 2004 along the Trivandrum coast, with foul smell coming from the sea. Many people, especially children, who got exposed the stench, were hospitalized due to vomiting and nausea. Initial reports indicated...

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

    Directory of Open Access Journals (Sweden)

    Romero Maroto, Martín

    1997-06-01

    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.

  14. A checklist of gilled mushrooms (Basidiomycota: Agaricomycetes) with diversity analysis in Hollongapar Gibbon Wildlife Sanctuary, Assam, India

    OpenAIRE

    Girish Gogoi; Vipin Parkash

    2015-01-01

    Hollongapar Gibbon Wildlife Sanctuary is comprised of five distinct compartments.  A total of 138 species of gilled mushrooms belonging to 48 genera, 23 families, five orders of the class Agaricomycetes, division Basidiomycota, have been collected and analyzed. The order Agaricales was was found with the highest number of species (113), followed by Russulales (14), Polyporales (5), Cantharellales (4) and Boletales (2). The species Coprinellus disseminatus and Megacollybia rodmani have shown t...

  15. Diagnóstico genotípico y fenotípico de tuberculosis ósea y miliar en un paciente positivo para HIV en Bogotá, Colombia / Phenotypic and genotypic diagnosis of bone and miliary tuberculosis in an HIV+ patient in Bogotá, Colombia

    Scientific Electronic Library Online (English)

    Leonardo F., Jurado; Martha I., Murcia; Patricia, Hidalgo; John E., Leguizamón; Lorena R., González.

    2015-03-01

    Full Text Available La tuberculosis se considera la causa más frecuente de muerte producida por un solo agente infeccioso. El diagnóstico de la tuberculosis extrapulmonar no siempre es posible mediante los métodos convencionales debido al lento crecimiento del bacilo y a la naturaleza paucibacilar de las muestras, por [...] lo que es necesario recurrir a las técnicas moleculares. El riesgo de tuberculosis, así como la mortalidad, aumenta en los pacientes con infección por HIV, en quienes el compromiso extrapulmonar es más frecuente. Se describe el caso de un hombre mestizo de 56 años de edad con sospecha de padecer tuberculosis, que asistió a consulta en el Hospital San Ignacio de Bogotá y relató haber tenido dolor en una lesión ulcerada localizada en el tercio distal del antebrazo derecho durante los dos meses anteriores y en quien se confirmó la infección por HIV. El examen histológico de los tejidos óseo y pulmonar demostró la presencia de granulomas múltiples, células gigantes y fibrosis. Tanto los cultivos como la reacción en cadena de la polimerasa en la secuencia de inserción 6110 ( insertion sequence , IS6110) fueron positivos. Los aislamientos de Mycobacterium tuberculosis recuperados fueron sensibles a los medicamentos antituberculosos de primera línea. Abstract in english Tuberculosis is the single most frequent cause of death by an infectious agent worldwide. Diagnosis of extra-pulmonary tuberculosis is not always possible through conventional methods, due to the long time required for cultures and the paucibacillary nature of samples; hence the need of rapid molecu [...] lar methods. HIV infection increases the risk of tuberculosis, and HIV/tuberculosis coinfection is associated with higher mortality. We describe the case of a 56-year old mestizo male patient suspected of having tuberculosis who consulted the San Ignacio Hospital in Bogotá with a two-month history of a painful ulcerated lesion over the distal third area of the right forearm and in whom HIV coinfection was confirmed. Bone and pulmonary histological examination evidenced multiple granulomas, giant cells and fibrosis. Cultures and IS6110-PCR from lung and bone tissues were positive for Mycobacterium tuberculosis complex. Mycobacterium tuberculosis isolates were sensitive to first line drugs.

  16. A Case of Dermatophytic Blepharitis

    Directory of Open Access Journals (Sweden)

    Mustafa Kulaç

    2008-07-01

    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.

  17. The nodular form of hepatic tuberculosis: a review with five additional new cases

    OpenAIRE

    Huang, W-T; Wang, C-c; Chen, W-J; Cheng, Y-F; Eng, H-L

    2003-01-01

    Background: Tuberculosis presenting as an isolated liver tumour, without active pulmonary or miliary tuberculosis, or other clinical evidence of tuberculosis, is distinctly rare. A greater awareness of this rare clinical entity may prevent needless surgical intervention.

  18. Clinical and radiological deterioration in a patient with AIDS

    International Nuclear Information System (INIS)

    Paradoxical clinical deterioration of miliary tuberculosis, characterized by pulmonary and abdominal manifestations, is reported in a patient with the acquired immunodeficiency syndrome, after initiation of treatment with highly active antiretroviral therapy. Paradoxical reaction was attributed to partial restoration of cell-mediated immunity related to highly effective antiretroviral therapy. Because tuberculosis has a high prevalence in HIV patients and tuberculosis is often characterized by miliary spreading of disease in these patients, it is important to recognize this phenomenon. (orig.)

  19. Clinical and radiological deterioration in a patient with AIDS

    Energy Technology Data Exchange (ETDEWEB)

    Backer, A.I. de [General Hospital Sint-Lucas, Department of Radiology, Ghent (Belgium); Mortele, K.J. [Brigham and Women' s Hospital, Harvard Medical School, Department of Radiology, Division of Abdominal Imaging and Intervention, Boston, MA (United States); Bomans, P.; Vanschoubroeck, I.J. [Ziekenhuisnetwerk Antwerpen, Stuivenberg, Department of Internal Medicine, Antwerp (Belgium); Keulenaer, B.L. de [Royal Darwin Hospital, Intensive Care Unit, Tiwi, NT (Australia); Kockx, M.M. [Ziekenhuisnetwerk Antwerpen, Stuivenberg, Department of Pathology, Antwerp (Belgium)

    2005-11-01

    Paradoxical clinical deterioration of miliary tuberculosis, characterized by pulmonary and abdominal manifestations, is reported in a patient with the acquired immunodeficiency syndrome, after initiation of treatment with highly active antiretroviral therapy. Paradoxical reaction was attributed to partial restoration of cell-mediated immunity related to highly effective antiretroviral therapy. Because tuberculosis has a high prevalence in HIV patients and tuberculosis is often characterized by miliary spreading of disease in these patients, it is important to recognize this phenomenon. (orig.)

  20. Findings in computerized axial tomography of tuberculous encephalopathy.

    Science.gov (United States)

    Estañol, B; Lombardo, L; Pérez-Ortega, R; Flores-Barroeta, F

    1981-01-01

    A 24 year-old woman with miliary tuberculosis of the lungs, developed a diffuse encephalopathy with signs of increased intracraneal pressure and without meningitis. A CAT scanner disclosed decreased density of the white matter and multiple nodular lesions enhanced with the infusion of contrast media. To our knowledge, this is the first description of the findings in computerized axial tomography of a patient with miliary tuberculosis and hematogenous dissemination associated to diffuse encephalopathy without meningitis. PMID:7247611

  1. A checklist of gilled mushrooms (Basidiomycota: Agaricomycetes with diversity analysis in Hollongapar Gibbon Wildlife Sanctuary, Assam, India

    Directory of Open Access Journals (Sweden)

    Girish Gogoi

    2015-12-01

    Full Text Available Hollongapar Gibbon Wildlife Sanctuary is comprised of five distinct compartments.  A total of 138 species of gilled mushrooms belonging to 48 genera, 23 families, five orders of the class Agaricomycetes, division Basidiomycota, have been collected and analyzed. The order Agaricales was was found with the highest number of species (113, followed by Russulales (14, Polyporales (5, Cantharellales (4 and Boletales (2. The species Coprinellus disseminatus and Megacollybia rodmani have shown the highest (8.26 and the lowest density (0.05, respectively.  A total of 24 species, e.g., Termitomyces albuminosus, Marasmius curreyi, Marasmiellus candidus, Leucocoprinus medioflavus, Mycena leaiana, Hygrocybe miniata, Collybia chrysoropha, Gymnopus confluens were common with frequency percentage of 11.9, whereas Megacollybia rodmani with less frequency percentage (2.4 was found only in few quadrates of the sanctuary.  The highly abundant species were Termitomyces medius (91.7 and Coprinellus disseminatus (86.8, and less abundant species were Psilocybe wayanadensis (1.0 and Lepiota sp. (1.0 in the study site.  The order of the species richness index (R compartment wise was 2>3>4>5>1. Both the Shannon diversity index and Simpson diversity index of agarics was maximum (1.88, 0.98 in compartment 2, whereas minimum (1.72, 0.95 in compartment 1 and 5, respectively.  Moreover, the compartment 2 was found very much similar with compartment 3 and very less similar with compartment 1. 

  2. GenBank blastx search result: AK058913 [KOME

    Lifescience Database Archive (English)

    Full Text Available AK058913 001-009-A01 V01144.1 Sea urchin (P. miliaris) gene for histones H1, H4, H2B, H3 and H2A ... (in that order, with many gaps). (see ... also for allelic sequence.).|INV INV 1e-1 ...

  3. GenBank blastx search result: AK058913 [KOME

    Lifescience Database Archive (English)

    Full Text Available AK058913 001-009-A01 V01143.1 Sea urchin (P. miliaris) gene for histones H4, H2B, H3, H2A and H1 ... (in that order, containing many sequence gaps). (see ... also for allelic sequence.).|INV INV 7e-2 ...

  4. GenBank blastn search result: AK240854 [KOME

    Lifescience Database Archive (English)

    Full Text Available AK240854 J065021E17 V01143.1 PMHIS7 Sea urchin (P. miliaris) gene for histones H4, H2B, H3, H2A ... 1 (in that order, containing many sequence gaps). (see ... also for allelic sequence.). INV 5e-42 1 ...

  5. Distribution and ecology of the Trichodesmium spp. in the Arabian Sea: Ship and satellite studies

    Digital Repository Service at National Institute of Oceanography (India)

    Parab, S.G.; Matondkar, S.G.P.; Raman, M.; Dwivedi, R.M.

    of Trichodesmium with Noctiluca miliaris was also observed. We have generated a series of OCM imageries from January to March in order to locate the appearance of these blooms in different regions of the Arabian Sea. . However in a typical Trichodesmium bloom...

  6. Taxonomy Icon Data: dog [Taxonomy Icon

    Lifescience Database Archive (English)

    Full Text Available dog Canis lupus ... familiaris Chordata/Vertebrata/Mammalia/Theria/Eutheria/Carnivora Canis_lupus _fa ... miliaris_L.png Canis_lupus _familiaris_NL.png Canis_lupus _familiaris_S.png Can ... is_lupus _familiaris_NS.png http://biosciencedbc.jp/taxonomy ...

  7. HRTC in military lung disease

    Energy Technology Data Exchange (ETDEWEB)

    Voloudaki, A.E.; Tritou, I.N.; Magkanas, E.G.; Gourtsoyiannis, N.C. [Crete Univ., Iraklion (Greece). Dept. of Radiology; Chalkiadakis, G.E. [Crete Univ., Iraklion (Greece). Dept. of Thoracic Surgary; Siafakas, N.M. [Crete Univ., Iraklion (Greece). Dept. Medicine

    1999-07-01

    Purpose: To analyze high resolution CT (HRCT) features of a miliary pattern in different diseases. Material and methods: Eight HRCT studies with a miliary lung pattern were retrospectively reviewed with the diagnoses tuberculosis (n=3), Candida albicans (n=1), sarcoidosis (n=3), and metastatic adenocarcinoma (n=1). Results: In all cases, HRCT showed diffusely disseminated nodules up to 3 mm. In 2 cases of tuberculosis and 1 of sarcoidosis, the lesions predominated in the upper/middle lung zones. In the case of metastatic adenocarcinoma the nodules were more sparse in the lung periphery while in 1 case of sarcoidosis, HRCT revealed a predominance of the lesions in the outer third of the lungs. Cyst-like lesions of 1-2 mm were observed in 2/3 cases of tuberculosis and in metastatic adenocarcinoma. Notably thickened interlobular septa and interlobar fissures were each seen in 2/3 cases of sarcoidosis. In general, a random relationship of miliary nodules to secondary lobular structures and bronchovascular bundles was observed, despite the co-existence of centrilobular, subpleural and paraseptal nodules. Conclusion: HRCT features that potentially contribute in making a differential diagnosis are: (a) A peripheral distribution of nodules, an increased number of thickened interlobular septae, and a notable thickening of interlobar fissures, all of which are indicative of sarcoidosis; and (b) multiple cyst-like lesions which should direct attention to tuberculous or metastatic origin. The predominance of miliary nodules in relation to cephalocaudal axis, their margin and size are not helpful features to the differential diagnosis of diseases presenting a miliary pattern. (orig.)

  8. HRTC in military lung disease

    International Nuclear Information System (INIS)

    Purpose: To analyze high resolution CT (HRCT) features of a miliary pattern in different diseases. Material and methods: Eight HRCT studies with a miliary lung pattern were retrospectively reviewed with the diagnoses tuberculosis (n=3), Candida albicans (n=1), sarcoidosis (n=3), and metastatic adenocarcinoma (n=1). Results: In all cases, HRCT showed diffusely disseminated nodules up to 3 mm. In 2 cases of tuberculosis and 1 of sarcoidosis, the lesions predominated in the upper/middle lung zones. In the case of metastatic adenocarcinoma the nodules were more sparse in the lung periphery while in 1 case of sarcoidosis, HRCT revealed a predominance of the lesions in the outer third of the lungs. Cyst-like lesions of 1-2 mm were observed in 2/3 cases of tuberculosis and in metastatic adenocarcinoma. Notably thickened interlobular septa and interlobar fissures were each seen in 2/3 cases of sarcoidosis. In general, a random relationship of miliary nodules to secondary lobular structures and bronchovascular bundles was observed, despite the co-existence of centrilobular, subpleural and paraseptal nodules. Conclusion: HRCT features that potentially contribute in making a differential diagnosis are: (a) A peripheral distribution of nodules, an increased number of thickened interlobular septae, and a notable thickening of interlobar fissures, all of which are indicative of sarcoidosis; and (b) multiple cyst-like lesions which should direct attention to tuberculous or metastatic origin. The predominance of miliary nodules in relation to cephalocaudal axis, their margin and size are not helpful features to the differential diagnosis of diseases presenting a miliary pattern. (orig.)

  9. Disseminated Mycobacterium avium complex infection in an immunocompetent pregnant woman

    Directory of Open Access Journals (Sweden)

    Kim Woo

    2006-10-01

    Full Text Available 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 in the sputum and placenta. The patient was treated successfully with clarithromycin-based combination regimen. Conclusion This appears to be the first case of disseminated MAC in an otherwise healthy pregnant woman. Clinicians should be alert for the diagnosis of MAC infection in diverse clinical conditions.

  10. 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

  11. Pulmonary Strongyloides stercoralis infection

    Science.gov (United States)

    Dogan, Canan; Gayaf, Mine; Ozsoz, Ayse; Sahin, Birsen; Aksel, Nimet; Karasu, Isil; Aydogdu, Zekiye; Turgay, Nevin

    2014-01-01

    The 17-year-old male patient presented with fever, weakness, dyspnea and weight loss. His chest radiography demonstrated diffuse reticulonodular density, and high-resolution lung tomography indicated diffuse micronodules and prevalent ground-glass pattern. The findings were consistent with miliary involvement. The patient underwent examinations for rheumatology, immunology, cytology and infectious conditions. His immune system was normal and had no comorbidities or any history of immunosuppressive treatment. Strongyloides stercoralis larvae were noted upon direct inspection of the feces. Clinical and radiological improvement was achieved with albendazole 400 mg/day. This case is being presented since miliary involvement in the lungs caused by S. stercoralis infection in an individual with intact immune system is rare and difficult to diagnosis. PMID:26029521

  12. Pulmonary Strongyloides stercoralis infection

    Directory of Open Access Journals (Sweden)

    Canan Dogan

    2014-01-01

    Full Text Available The 17-year-old male patient presented with fever, weakness, dyspnea and weight loss. His chest radiography demonstrated diffuse reticulonodular density, and high-resolution lung tomography indicated diffuse micronodules and prevalent ground-glass pattern. The findings were consistent with miliary involvement. The patient underwent examinations for rheumatology, immunology, cytology and infectious conditions. His immune system was normal and had no comorbidities or any history of immunosuppressive treatment. Strongyloides stercoralis larvae were noted upon direct inspection of the feces. Clinical and radiological improvement was achieved with albendazole 400 mg/day. This case is being presented since miliary involvement in the lungs caused by S. stercoralis infection in an individual with intact immune system is rare and difficult to diagnosis.

  13. Imaging Features of Pediatric Pentastomiasis Infection: a Case Report

    Energy Technology Data Exchange (ETDEWEB)

    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

    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

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

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, Dong Kyun; Cho, June Sik; Shin, Kyung Sook; Kang, Dae Young [College of Medicine, Chungnam National Univ., Taejon (Korea, Republic of)

    2002-06-01

    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.

  15. COMPARISON OF DIET AND USE OF BROMELIADS BETWEEN A BROMELICOLOUS AND A BROMELIGENOUS ANURAN AT AN INSELBERG IN THE SOUTHEASTERN OF BRAZIL

    Directory of Open Access Journals (Sweden)

    PERTEL WESLEI

    2010-06-01

    Full Text Available Anurans from an inselberg in southeastern Brazil were studied using a sample ofsixty tank of bromeliads Alcantharea sp. We found 153 tadpoles of S. arduous, 21adults of S. arduous, 30 adults of T. miliaris, and two adults of Scinax x-signatus,which were not considered in our analyses. Tadpoles of S. arduous were present in35% 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 allow them to occupy the centerportion of bromeliads, while T. miliaris, which lack pads on their toes, were foundon the base of the plant axils. The number of anuran species and the abundance ofindividuals found were low. This may be a result of the high altitude of our studiedsite or a restriction imposed by the saxicolous environment, such as high temperaturesand low humidity during the day. Both species can be considered generalist feedersdue to their wide variety of ingested prey. Formicidae was their main prey but wasabsent segregation in the bromeliads. Blattodea was very common inside the bromeliadaxils and represented the most signifi cant prey by weight in both frog species. Weconclude that both anurans forage inside and outside of bromeliads. Trophic nichebreadth in S. arduous was larger than in T. miliaris. Even both species being commoninhabitants of the same environment, they demonstrated a marked spatial segregationin the bromeliads. Based on their diet, however, there may be disputes for territoryoutside of the bromeliads.

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

    Directory of Open Access Journals (Sweden)

    Amir Hossein Sarrami

    2010-12-01

    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.

  17. Coexistence of pulmonary tuberculosis and sarcoidosis: a diagnostic dilemma.

    Science.gov (United States)

    Mandal, Sanjay Kumar; Ghosh, Sudip; Mondal, Soumya Sarathi; Chatterjee, Sumanta

    2014-01-01

    Tuberculosis and sarcoidosis are multisystem diseases having different aetiology and management; however, they have similar clinical and histological characteristics. Very rarely they may coexist. We report a rare case of a 38-year-old woman who presented with chronic cough, low-grade fever and respiratory distress that was initially diagnosed as miliary tuberculosis. Diagnosis was supported by positive mycobacterial culture and initially responded to antitubercular treatment, but later recurrences led to further investigations and the diagnosis of coexisting sarcoidosis. PMID:25527682

  18. A Case of Disseminated Tuberculosis with Adrenal Insufficiency

    Science.gov (United States)

    Al-Mamari, Ali; Balkhair, Abdullah; Gujjar, Arunodaya; Ben Abid, Fatma; Al-Farqani, Ahmed; Al-Hamadani, Aisha; Jain, Rajeev

    2009-01-01

    We present the case of a 37 year-old female who had disseminated tuberculosis (TB) with bilateral adrenal involvement resulting in primary adrenal failure (Addison’s disease) with refractory hyponatraemia and possible extrapontine ‘myelinolysis’. Laboratory results were remarkable for adrenal insufficiency. A Mantoux reaction was positive with evidence of pulmonary miliary TB. The magnetic resonance imaging scan showed all the characteristic changes of adrenal TB. PMID:21509318

  19. A Case of Disseminated Tuberculosis with Adrenal Insufficiency

    OpenAIRE

    Al-Mamari, Ali; Balkhair, Abdullah; Gujjar, Arunodaya; Ben Abid, Fatma; Al-Farqani, Ahmed; Al-Hamadani, Aisha; Jain, Rajeev

    2009-01-01

    We present the case of a 37 year-old female who had disseminated tuberculosis (TB) with bilateral adrenal involvement resulting in primary adrenal failure (Addison’s disease) with refractory hyponatraemia and possible extrapontine ‘myelinolysis’. Laboratory results were remarkable for adrenal insufficiency. A Mantoux reaction was positive with evidence of pulmonary miliary TB. The magnetic resonance imaging scan showed all the characteristic changes of adrenal TB.

  20. I. Specific Nature of Triggering Events.

    Science.gov (United States)

    Eckert, R

    1965-03-01

    The flash of Noctiluca miliaris occurs only in response to a characteristic all-or-none action potential, the polarity of which is opposite to that of metazoan action potentials, whether recorded internally or externally. Mechanical stimulation evokes a slow, generator-like graded potential which can give rise to the flash-triggering action potential. The flash is all-or-none; it facilitates, summates, and exhibits fatigue, each independently of changes in the amplitude of the action potential. PMID:17790656

  1. II. Asynchronous Flash Initiation by a Propagated Triggering Potential.

    Science.gov (United States)

    Eckert, R

    1965-03-01

    The action potential of Noctiluca miliaris is conducted over the cell, triggering luminescent cytoplasmic organelles as it propagates away from the stimulus site. Local light emission follows local active current with a latency of 1 to 3 milliseconds. Whereas bioluminescence normally occurs over this cell with an advancing front of emission, it can be initiated synchronously by electrical stimulation of the entire cell. PMID:17790657

  2. Multicentric Histiocytosis Related to Avian Leukosis Virus Subgroup J (ALV-J)-Infection in Meat-Type Local Chickens

    OpenAIRE

    FURUKAWA, Seiko; TSUKAMOTO, Kenji; MAEDA, Minoru

    2013-01-01

    ABSTRACT Gross lesions characterized by swollen livers and spleens accompanied by diffuse white miliary spots, which resembled those of Marek’s disease, were detected in two flocks of local meat-type chickens at a Japanese poultry processing plant in June and August 2010. The microscopic examinations revealed proliferative foci consisting of spindle or polymorphic cells in the interstitium of livers, splenic follicles and the interstitium of kidneys. These cells were positive immunohistochemi...

  3. 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.)

  4. October 2014 imaging case of the month

    Directory of Open Access Journals (Sweden)

    Sakla S

    2014-10-01

    Full Text Available No abstract available. Article truncated after first page. A 53-year-old man presents with fatigue and dyspnea on exertion. An admission chest radiograph (Figure 1 was obtained. What is the best term or phrase used to describe the salient radiographic abnormality? 1. Diffuse thick-walled cavitary lesions; 2. Interstitial and alveolar pulmonary edema with effusions; 3. Miliary nodules; 4. Patchy consolidation; 5. Tension pneumothorax.

  5. Diagnostic value of CT on hepatic tuberculosis

    International Nuclear Information System (INIS)

    Objective: To assess CT manifestations and diagnostic value in patients with hepatic tuberculosis. Methods: Ten cases of hepatic tuberculosis proved by hepatic biopsy or surgical specimens were analyzed retrospectively. Results: This group of hepatic tuberculosis included three types. (1) Five cases of miliary hepatic tuberculosis demonstrated that the liver swelled diffusely associated with multiple miliary low attenuations, and showed no enhancement after contrast agents administration. (2) Three cases of tubercle hepatic tuberculosis depicted multiple hypodensity areas or mixed density regions in the liver. The extension of lesions reduced in arterial phase, and a ring-like enhancement was displayed in the portal phase. (3) One case of hepatic tuberculoma illustrated solitary space occupying lesion accompanied with central necrosis. The envelope was thin and smooth which enhanced slightly after injecting Gd-DTPA. Another one was hepatic abscess and depicted fluid-fluid level inside the lesion. Conclusions: The CT manifestations of miliary hepatic tuberculosis lack of characteristics, it is hard to make the diagnosis clear-cut unless integrating the medical history and lab test. The 'powder calcification' findings of tubercle hepatic tuberculosis is propitious to draw a qualitative diagnosis. And the feature of hepatic tuberculomas with fluid- fluid level is in favor of making a differential diagnosis against parallel tumors. (authors)

  6. Discrimination of Phytoplankton Functional Groups Using an Ocean Reflectance Inversion Model

    Science.gov (United States)

    Werdell, Paul J.; Roesler, Collin S.; Goes, Joaquim I.

    2014-01-01

    Ocean reflectance inversion models (ORMs) provide a mechanism for inverting the color of the water observed by a satellite into marine inherent optical properties (IOPs), which can then be used to study phytoplankton community structure. Most ORMs effectively separate the total signal of the collective phytoplankton community from other water column constituents; however, few have been shown to effectively identify individual contributions by multiple phytoplankton groups over a large range of environmental conditions. We evaluated the ability of an ORM to discriminate between Noctiluca miliaris and diatoms under conditions typical of the northern Arabian Sea. We: (1) synthesized profiles of IOPs that represent bio-optical conditions for the Arabian Sea; (2) generated 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. By comparing the estimates from the inversion model with those from synthesized vertical profiles, we identified those conditions under which the ORM performs both well and poorly. Even under perfectly controlled conditions, the absolute accuracy of ORM retrievals degraded when further deconstructing the derived total phytoplankton signal into subcomponents. Although the absolute magnitudes maintained biases, the ORM successfully detected whether or not Noctiluca miliaris appeared in the simulated water column. This quantitatively calls for caution when interpreting the absolute magnitudes of the retrievals, but qualitatively suggests that the ORM provides a robust mechanism for identifying the presence or absence of species.

  7. 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)

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

    2010-06-30

    Full Text Available 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.

  8. BIODIVERSIDAD DE MACROHONGOS DE LA RESERVA NACIONAL MAGALLANES BIODIVERSITY OF MACROFUNGI OF THE MAGALLANES NATIONAL RESERVE

    Directory of Open Access Journals (Sweden)

    Verónica Mancilla

    2008-01-01

    Full Text Available El presente estudio entrega antecedentes cuantitativos sobre la riqueza y abundancia de macrohongos existentes en comunidades vegetales de la Reserva Nacional Magallanes. Se realizó entre los meses de enero a mayo de 2005 sobre cuatro comunidades vegetales (bosque de lenga, bosque de coigüe, murtillar y pastizal húmedo. En cada una se delimitaron parcelas permanentes, en las cuales mediante cuadrantes aleatorios se evaluó la riqueza y abundancia de macrohongos periódicamente cada 14 días. Paralelamente se realizaron muéstreos intensivos, lo que permitió complementar la lista de especies. En total se identificó un total de 40 especies considerando ambos muéstreos. El estudio de diversidad demostró que la mayor riqueza y abundancia de macrohongos se presenta en comunidades boscosas, siendo superior en las parcelas relevadas en coigüe. En el matorral no se registraron individuos. La especie más abundante fue Russula nothofaginea. Por otro lado, Coprinus disseminatus fue la especie presente en mayor cantidad de ambientes. Un análisis de la variación estacional de las fructificaciones permite concluir que la mayor diversidad de macromicetes se presenta en el mes de mayo. Los resultados validan la hipótesis que los bosques de coigüe presentan la mayor abundancia de macrohongos comparados con otras comunidades vegetales. Sin embargo, en los muéstreos intensivos, considerando bosques mixtos y diversos ambientes, aumenta la riqueza de especies en las cuencas de árboles caducifolios. Por otro lado, se estima que las condiciones climáticas extremas presentadas en este estudio (nevazones tempranas y temperaturas congelantes pudieron afectar la diversidad de macrohongos en las distintas comunidades.The present study delivers qualitative precedents on the richness and abundance of macro- fungi existing in plant communities of the National Reserve Magallanes. It was realized between January to May 2005 on four plant communities (forest of lenga, forest of coigüe, murtillar and humid grassland. In every community there were delimited permanent plots, in which by means of random quadrants the richness and abundance of macrofungi were evaluated from time to time every 14 days. Parallel intensive sampling realized what allowed to complement the list of species. In whole there was identified a whole of 40 species considering both samplings. The study demonstrated that la major richness and abundance of macrofungi appears in forest communities, being superior in the plots relieved in coigüe. In the bushes did not register individuáis. The most abundant species was Russula nothofaginea. On the other hand, Coprinus disseminatus was the present species in major quantity of environments. An analysis of the seasonal variation of the fructifications allows to conclude that the major diversity of macromicetes appears in May. The results valídate the hypothesis that the forests the forests of coigüe present the major abundance of macro fungicompared with other plant communities. Nevertheless, the intensive samplings, considering mixed forests and diverse environments, the richness of species increases in the trees caducifolios basins. On the other hand, it estimates that the climatic extreme conditions presented in this study (snow early and temperatures cool could affect the diversity of macro fungi in the different communities.

  9. Diagnostic Usefulness of IFN-Gamma Releasing Assays Compared With Conventional Tests in Patients With Disseminated Tuberculosis.

    Science.gov (United States)

    Yu, Shi Nae; Jung, Jiwon; Kim, Yong-Kyun; Lee, Ju Young; Kim, Sun-Mi; Park, Su Jin; Lee, Sang-Oh; Choi, Sang-Ho; Kim, Yang Soo; Woo, Jun Hee; Kim, Sung-Han

    2015-07-01

    IFN-gamma releasing assays (IGRAs) such as T-SPOT.TB assay and QuantiFERON-TB In-Tube (QFT-GIT) have yielded promising results for the diagnosis of tuberculosis (TB). However, little is known about the usefulness of these assays for diagnosing disseminated TB. We therefore compared their usefulness with traditional tests in patients with disseminated TB. All adult patients with suspected disseminated TB were prospectively enrolled at a tertiary hospital in an intermediate TB-burden country during a 6-year period. Disseminated TB was defined as involvement of the bone marrow or ?2 noncontiguous organs, or presence of miliary lung lesions. A total of 101 patients with confirmed and probable disseminated TB were finally analyzed. Of these 101 patients, 52 (52%) had miliary TB and the remaining 49 (48%) had nonmiliary disseminated TB. In addition, 63 (62%) had no underlying disease. Chronic granuloma with/without necrosis, acid-fast bacillus staining, Mycobacterium tuberculosis PCR, and culture for M tuberculosis were positive in 77% (41/53), 43% (43/101), 70% (67/96), and 72% (73/101), of the patients, respectively. The T-SPOT.TB assay was positive in 90% (91/101) of them. The sensitivity of the T-SPOT.TB assay in patients with miliary TB (90%) was similar to that in patients with nonmiliary TB (90%) (P?>?0.99). In a subgroup analysis of the 58 patients in whom both QFT-GIT and the T-SPOT.TB results were available, the sensitivity of QFT-GIT (67%) was lower than that of T-SPOT.TB (95%) (P?

  10. 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.)

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

    Science.gov (United States)

    Werdell, P. Jeremy; Ooesler, Collin S.

    2012-01-01

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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

    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.)

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

    Energy Technology Data Exchange (ETDEWEB)

    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

    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.

  14. Individual movements and population density estimates for moray eels on a Caribbean coral reef

    Science.gov (United States)

    Abrams, R. W.; Schein, M. W.

    1986-12-01

    Observations of moray eel (Muraenidae) distribution made on a Caribbean coral reef are discussed in the context of long term population trends. Observations of eel distribution made using SCUBA during 1978, 1979 1980, and 1984 are compared and related to the occurrence of a hurricane in 1979. An estimate of the mean standing stock of moray eels is presented. The degree of site attachment is discussed for spotted morays ( Gymnothorax moringa) and goldentail morays ( Muraena miliaris). The repeated non-aggressive association of moray eels with large aggregations of potential prey fishes is detailed.

  15. Tuberculosis Can Mimic Lung Cancer: A Case Series

    Directory of Open Access Journals (Sweden)

    Levent Dalar

    2013-03-01

    Full Text Available Tuberculosis can mimic all pathological considerations of the lung and can present in many various forms and appearances. Most common radiographic appearances are cavitary, fibroproductive, exudative, acinary, micro and macronodular and miliary types. Six patients (5 men; ages ranging from 38 to 74 years who presented at our clinic during previous years were evaluated. In this case series report we discussed the consideration that, very rarely, post- primary lung tuberculosis presenting with large nodular and mass-like forms in a chest X-ray or tomography scan, can be considered as having a neoplastic pattern.

  16. Concurrent occurrence of both intracranial and intramedullary tuberculomas

    Directory of Open Access Journals (Sweden)

    Sreeramulu Diguvinti

    2015-06-01

    Full Text Available Tuberculosis involving spinal cord in the form of intramedullary tuberculoma is uncommon, and the concurrent occurrence of cranial and intramedullary tuberculomas is extremely rare. We report a case of disseminated tuberculoma involving brain and spinal cord with miliary tuberculosis in a 32-year-old male presenting with fever, cerebellar signs and motor weakness of both upper and lower extremities. Based on magnetic resonance imaging and polymerase chain reaction, we diagnosed as tuberculoma. He completely recovered with conventional antituberculous treatment and steroids. The follow-up of the patient showed disappearance of signs and symptoms.

  17. 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.

  18. Primary hepatic tuberculosis mimicking intrahepatic cholangiocarcinoma: report of two cases

    Science.gov (United States)

    2015-01-01

    Hepatic tuberculosis (TB) is usually associated with pulmonary or miliary TB, but primary hepatic TB is very uncommon even in countries with high prevalence of TB. The clinical manifestation of primary hepatic TB is atypical and imaging modalities are unhelpful for differential diagnosis of the liver mass. Image-guided needle biopsy is the best diagnostic method for primary hepatic TB. In the cases presented here, we did not perform liver biopsy because we believed the liver masses were cholangiocarcinoma, but primary hepatic TB was ultimately confirmed by postoperative pathology. Here we report two cases of patients who were diagnosed with primary hepatic TB mimicking mass-forming intrahepatic cholangiocarcinoma. PMID:26236700

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

    International Nuclear Information System (INIS)

    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.)

  20. The myoneme of the Acantharia (Protozoa): A new model of cellular motility.

    Science.gov (United States)

    Febvre, J

    1981-01-01

    The myonemes of Acantharia are made of bundles of microfilaments twisted up in elementary microstrands of two. Myonemes exhibit three kinds of movements: slow contraction accompanied by undulations of the organelle, quick contraction and subsequent relaxation. In vivo, contraction-relaxation cycles were studied with normal, time-lapse and high speed film-recordings (1000 frames/s). Kinetic parameters of these movements are given. All the movements are actively produced by the organelle itself and are dependant on calcium concentration. An hypothesis about the way myoneme microfilaments might interact to generate motile forces is given. The most closely related system might be the myoneme of the dinoflagellate Noctiluca miliaris. PMID:7199949

  1. CT appearances of abdominal tuberculosis

    Energy Technology Data Exchange (ETDEWEB)

    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

    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.

  2. CT appearances of abdominal tuberculosis

    International Nuclear Information System (INIS)

    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.

  3. Aerospace Technologies and Applications for Dual Use

    DEFF Research Database (Denmark)

    Events which occurred over the past years have shown how the threat related to both intentional and natural disasters could bring the civil and the miliary worlds closer in the conception and deployment of countermeasures, as well as in the identification of effective strategies for enhancing the...... aims at the global protection of the mankind. Aeropsace is also a natural environment for dual use: many of the related enabling technologies have been first developed for the military world and then applied to civil - including commercial - purposes....

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

    Directory of Open Access Journals (Sweden)

    Bassiri-Jahromi Shahindokht

    2009-01-01

    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.

  5. 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)

  6. [A case of alveolar microlithiasis which developed spontaneous pneumothorax due to progression of emphysematous bullae during 34 years after established diagnosis].

    Science.gov (United States)

    Shishido, S; Toritani, T; Nakano, H; Tokushima, T

    1993-07-01

    The patient was a 46-year-old man who was taxi driver. He had received therapy for miliary tuberculosis from nine years old, and the diagnosis of alveolar microlithiasis was made by open lung biopsy at twelve years of age in 1956. At that time, there were no emphysematous bullae, and slight alveolar wall thickening was observed histopathologically. After a 34 year interval, he developed spontaneous pneumothorax with sudden dyspnea. Multiple emphysematous bullae were found at thoracoscopy performed to treat the pneumothorax. Arterial blood gas analysis after resolution of the pneumothorax showed hypoxia with a PO2 of 65.4 torr, and lung function tests revealed restrictive disorder. Thus, in this patient, emphysematous bullae progressed resulting in a pneumothorax, and lung fibrosis also developed 34 years after the diagnosis of alveolar microlithiasis. Alveolar microlithiasis is occasionally misdiagnosed as miliary tuberculosis. The authors stress that the chest roentgenographic finding of ari-bronchogram demonstrating intra-alveolar foci is an important sign in the differential diagnosis. PMID:8366628

  7. Imaging diagnosis of pulmonary tuberculosis in immunocompromised patients

    International Nuclear Information System (INIS)

    Objective: To evaluate CT and X-ray features of pulmonary tuberculosis in diabetic patients, patients post kidney transplantation, and patients with acquired immunodeficiency syndrome (AIDS). Methods: The authors reviewed CT scans in 20 patients with diabetic patients, X-ray films in 10 cases after kidney transplantation, and CT scans in 2 patients with AIDS. Results: CT features of pulmonary tuberculosis in diabetic diseases included larger confluent consolidation (10 cases ), multiple small cavities within any given lesion (9 cases ) and non-segmental distribution (2 cases). Satellite lesions were found in most films. The X-ray appearances of pulmonary tuberculosis post kidney transplantation included patch and larger confluent consolidation (6 cases), and miliary tuberculosis(4 cases). The CT findings of pulmonary tuberculosis with AIDS were enlarged mediastinal lymph nodes (1 case), pulmonary infiltration (1 case), and extra chest lesions(2 cases) such as enlarged neck lymph nodes and post-peritoneal lymph nodes. Conclusion: The Main radiological findings of pulmonary tuberculosis in immunocompromised patients appear larger confluent consolidation, multiple small cavities within a given lesion, miliary tuberculosis, enlarged mediastinal lymph nodes, and extra chest enlarged lymph nodes

  8. Tuberculosis in patients with end-stage renal disease

    International Nuclear Information System (INIS)

    The purpose of our study was to describe the clinical and radiological manifestations of tuberculosis in patients with end-stage renal disease. The medical records, chest radiographs, and CT scans of 42 patients with tuberculosis among 871 consecutive patients with end-stage renal disease were reviewed. Patterns of initial chest radiographs were categorized as primary, postprimary, miliary, or atypical, according to the predominant radiologic findings. Chest radiographs and CT scans revealed pulmonary tuberculosis in 28 patients and extrapulmonary tuberculosis in 15. The pattern of chest radiographs indicative of pulmonary tuberculosis was primary in 12 cases, postprimary in 11, miliary in one, demonstrated atypical infiltrates in three, and was normal in one. Tuberculosis involved the extrathoracic lymph nodes in six cases, the peritoneum in four, the spine in three, and the bone marrow in two. The primary pattern, seen in 12 patients, manifested as pleural effusion or segmental consolidation, and in ten of the twelve the former was dominant. The radiological pattern of pulmonary tuberculosis in end-stage renal disease is often primary, and extrapulmonary involvement is frequent

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

    Energy Technology Data Exchange (ETDEWEB)

    Park, Tae Won; Kim, Young Girl; Lee, Sam Sun [Dept. of Oral and Maxillofacial Radiology, College of Dentistry, Seoul National University, Seoul (Korea, Republic of)

    1995-02-15

    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.

  10. 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.

  11. Study of MRI features of intracranial tuberculosis and its dynamic evolution during antituberculous treatment

    International Nuclear Information System (INIS)

    Objective: To explore MRI features of intracranial tuberculosis, and the dynamic evolution of intracranial tuberculosis during antituberculous treatment. Methods: From September 2009 to February 2012, seventy-two patients with intracranial tuberculosis were reviewed retrospectively. Intracranial tuberculosis lesions were divided into 3 categories: pure parenchymal tuberculosis, tuberculous meningitis and hybrid type with both parenchymal tuberculosis and tuberculous meningitis. The MRI characteristics of these lesions were analysed. According to the lesion size, pure parenchymal tuberculosis was divided into 3 subtypes: 0.3 cm or less was defined as miliary, >0.3 cm and <1.0 cm as nodule, greater than or equal to 1.0 cm as tuberculoma. Serial follow-up scans were performed in 36 patients, and dynamic MRI changes in the process of anti-tuberculosis treatment during 3 to 6 months were observed. The disappearance rate of the lesions was calculated and statistically analysed by using Chi-square test. Results: There were 883 lesions in 38 cases with parenchymal tuberculosis. Multiple lesions distributed widely, 423 lesions (47.9%) ≤0.3 cm, 330 lesions (37.4%) between 0.3-1.0 cm, and 130 lesions (14.7%) ≥ 1.0 cm. Twenty-four cases with tuberculous meningitis showed meningeal enhancement at basilar cistern. Ten cases with hybrid type presented both parenchymal tuberculosis and meningitis. Among 36 patients with serial MRI follow-up scans, 22 cases were pure parenchymal tuberculosis. The disappearance rates of military, nodules and tuberculomas were 52.2% (59/113), 33.3% (33/99) and 0, respectively, after 3 months treatment. The disappearance rates were 87.6% (99/113), 50.5% (50/99) and 18.2% (2/11), respectively, after 6 months treatment. Disappearance rate of miliary lesions was obviously higher than that of nodules at both 3 and 6 months, and the difference was statistically significant,(χ2=7.657, 34.786, P<0.01). Nine lesions of parenchymal tuberculosis enlarged with paradoxical response to antituberculous chemotherapy at 3 months, and 8 of them disappeared after 6 months of therapy. The outcome of tuberculous meningitis was relatively poor. Conclusions: It is objective to classify parenchymal tuberculosis into three types: miliary, nodules and tuberculoma. Dynamic MRI changes of intracranial tuberculosis is helpful for understanding the disease better. (authors)

  12. Disseminated tuberculosis in a patient with recurrent transitional cell carcinoma of renal pelvis and bladder following intravesical BCG therapy: A report of a rare case

    Directory of Open Access Journals (Sweden)

    Mukta Pujani

    2015-01-01

    Full Text Available Bacillus Calmette-Guerin (BCG has been used as an intravesical instillation for nonmuscle invasive (superficial bladder cancer for the last 3 decades. Although intravesical BCG therapy is well-tolerated by most of the patients, adverse reactions have also been reported which are usually local, benign, and self-limited. Systemic complications such as miliary tuberculosis (TB are very rare with few documented reports in literature. We hereby report a rare case of disseminated TB in bilateral lungs, adrenal, cervical, mediastinal, and para-aortic lymph nodesin a patient with recurrent transitional cell carcinoma (TCC of renal pelvis and urinary bladder. Peculiar feature of this case was the development of TB 2 years following last BCG instillation, which is unlike most of the cases in the literature where TB developed within few weeks of last dose of BCG.

  13. Dicty_cDB: Contig-U16270-1 [Dicty_cDB

    Lifescience Database Archive (English)

    Full Text Available 2A(his12) and H2B(hi... 48 0.48 1 ( AC216169 ) Procavia capensis clone CH280-416L...20 AF378198_5( AF378198 |pid:none) Rhynchosciara americana histone H1... 102 1e-20 ( P02283 ) RecName: Full=...AP006162 |pid:none) Oryza sativa Japonica Group genomi... 71 4e-11 EU008881_1( EU008881 |pid:none) Giardia i...id:none) Sea urchin (P.miliaris) late histone H... 56 1e-06 U82927_1( U82927 |pid:none) Drosophila virilis h...FE846070 ) CAFI535.rev CAFI Pichia stipitis aerobic dextrose... 60 1e-04 1 ( CR382131 ) Yarrowia lipolytica

  14. Recognition of Pneumocystis carinii in foals with respiratory distress

    International Nuclear Information System (INIS)

    Five 3-month-old foals presenting with fever and respiratory disease were found to have pulmonary abscesses with patchy to diffuse alveolar and interstitial pneumonia on post-mortem examination. All affected foals had evidence of Rhodococcus equi infection and had few to abundant Pneumocystis carinii cysts in the sections of affected lung. Of the 5 foals examined radiographically, 3 had a distinct reticulonodular (miliary) pattern which may aid in the ante-mortem diagnosis of P. carinii pneumonia (PCP). Leukocyte counts of foals with PCP were significantly greater than in the control group of foals with uncomplicated bacterial pneumonia. Foals with PCP tended to be more tachypnoeic than the control foals and 4 of the 5 PCP+ foals appeared dyspnoeic before death. The ante-mortem recognition of PCP may be expedited by bronchoalveolar lavage and successful treatment of foals with PCP may require the administration of adequate levels of potentiated sulphonamides

  15. Rare presentation of gall bladder tuberculosis in a non immuno-compromised patient

    Directory of Open Access Journals (Sweden)

    Pawan Kumar

    2015-06-01

    Full Text Available The gall bladder is least common intraabdominal organ to be involved by tuberculosis. It is either part of systemic miliary tuberculosis or abdominal tuberculosis. Isolated gall bladder tuberculosis is even rarer, can presents either as calculus or acalculus cholecystitis. Gall bladder tuberculosis presenting as a localized perforation with a sinus formation into anterior abdominal wall is unreported complication in a non immuno-compromised person. A 48-year old female presented with a gradually increasing swelling in right hypochondrium. Abdominal ultrasound showed superficial collection over right hypochondrium with intraperitoneal extension. Computed tomography showed localized gall bladder perforation with extension to the abdominal wall. Patient underwent emergency exploration and cholecystectomy with excision of sinus tract and drainage of abdominal wall abscess. Histopathological examination showed granulomatous cholecystitis suggestive of tuberculosis of gall bladder with extension into the sinus tract. She had an uneventful recovery and was treated with 6-month antitubercular therapy after surgery.

  16. The radiographic findings in diagnosis of pulmonary lymphoma

    International Nuclear Information System (INIS)

    Objective: To study the radiographic findings in the diagnosis of pulmonary lymphoma and pseudo lymphoma. Methods: Eight patients with pulmonary lymphoma and 2 with pseudo lymphoma were examined by X-ray film, tomography, and CT. Results: Single or multiple nodules or masses were observed in 8 patients with pulmonary lymphoma, shaggy borders or halo of ground-glass attenuation in 7 patients, 2 patients had multiple patchy infiltrates bilaterally, 2 had diffuse interstitial infiltrates and 1 had miliary nodules. Multiple consolidations with air bronchogram and without hilar and mediastinal lymphadenopathy were observed in 2 patients with pulmonary pseudo lymphoma. Conclusion: Radiographic findings of pulmonary lymphoma were varied, the most common findings were the nodules or masses with shaggy borders or halo of ground-glass attenuation. The specific findings of pulmonary pseudo lymphoma were multiple consolidations with air bronchogram and without hilar and mediastinal lymphadenopathy. The final diagnosis relied on pathology

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

    Directory of Open Access Journals (Sweden)

    K.H. Erlwanger

    2009-05-01

    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.

  18. Pulmonary and extrapulmonary tuberculosis.

    Science.gov (United States)

    Ortona, L; Federico, G

    1998-01-01

    Pulmonary tuberculosis: primary tuberculosis, usually asymptomatic, represents the first infection and is shown by a parenchymal mostly mid-pulmonary focus and satellite lymphadenopathy. Postprimary pulmonary tuberculosis, mostly located in the upper fields may be caused by endogenous reinfection for reactivation of a hematogenous focus formed during primary infection or from exogenous reinfection. Extrapulmonary tuberculosis: it includes numerous forms mostly from hematogenous spread. Miliary tuberculosis may involve a number of organs and apparatus besides the lung. Tuberculous meningitis predominantly involves the base of the skull, the fluid is clear with hypoglycorrhachia and lymphocyte pleocytosis. Lymph node tuberculosis is generally unilateral and cervical. Tuberculous pleuritis is exudative or dry. Other forms of tuberculous serositis are pericarditis and peritonitis. Renal tuberculosis involves the medullaris and intestinal tuberculosis the ileocecum; tuberculous spondilitis (Pott's disease) involves the last dorsal vertebrae. Other forms are osteoarthritis, genital tract tuberculosis, pancreatitis, laryngitis, otitis. PMID:9673136

  19. Histologic diagnoses of tissues from two nineteenth century Habsburgs.

    Science.gov (United States)

    Józsa, László G

    2008-03-01

    This study describes the histological alterations of the internal organs of Prince Joseph Habsburg (1776-1847) and his first wife, Alexandra Pavlovna Romanova (1783-1801). Both corpses were mummified and the internal organs were stored separately in rosemary oil, in metal vessels. Royal Prince Joseph Habsburg died on 13 January 1847. The microscopic study confirms focal subacute glomerulonephritis (type Berg) with IgA precipitate on the glomerular mesangium and Bowmann's capsule. To the best of this author's knowledge, this is the first case in the paleopathological literature in which the subacute IgA glomerulonephritis could be confirmed immunohistochemically. Gout (urate nephropathy), severe arteriosclerosis, prostate adenoma and purulent prostatitis could also be diagnosed. The Prince's first wife, Alexandra Pavlovna Romanova, died in childbirth at age 18 years, along with her newborn daughter. Histological examination of Alexandra's organs revealed severe fibrocaseous and miliary tuberculosis, with dissemination to the lymph nodes, liver and spleen. PMID:18831390

  20. 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

  1. Recommendations Concerning the First-Line Treatment of Children with Tuberculosis.

    Science.gov (United States)

    Principi, Nicola; Galli, Luisa; Lancella, Laura; Tadolini, Marina; Migliori, Giovanni Battista; Villani, Alberto; Esposito, Susanna

    2016-02-01

    This document describes the recommendations of a group of scientific societies concerning the first-line therapeutic approach to paediatric tuberculosis (TB). The treatment of pulmonary TB should be based on the existence of parenchymal involvement and the risk of antibiotic resistance. The treatment of extra-pulmonary TB is based on the regimens used for severe pulmonary TB. The administration of corticosteroids is recommended only in cases of miliary TB, tuberculous meningitis and tuberculous pericarditis. Vitamin B6 may be indicated in the case of isoniazid-treated TB in breastfeeding infants, severely malnourished subjects, or patients with other diseases at high risk of vitamin deficiency. Once having started treatment, children with TB should be carefully followed up in order to evaluate compliance, the response to treatment, the need for treatment changes, and the presence of drug-related adverse events. Primary care paediatricians can support reference centres in providing family healthcare education and encouraging treatment compliance. PMID:26612773

  2. Post-kala-azar dermal leishmaniasis associated with AIDS

    Directory of Open Access Journals (Sweden)

    Bittencourt Achiléa

    2003-01-01

    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.

  3. Tuberculous meningoencephalitis with severe neurological sequel in an immigrant child

    Science.gov (United States)

    Yasar, Kadriye Kart; Pehlivanoglu, Filiz; Sengoz, Gonul; Ince, E Rahsan; Sandikci, Semra

    2011-01-01

    Central nervous system tuberculosis (TB) is the most devastating manifestation of TB. It is a challenge for clinicians because of the difficulty in making an early diagnosis and the severe consequences of delayed treatment. The aim of this report is to point out the relation between migration and TB based on a 14-year-old child with tuberculous meningoencephalitis (TBM) of an immigrant family. Migration, crowded living conditions and positive family history contribute to the severe course of TB as TBM and miliary TB forms. TB control may prevent these severe manifestations of the disease among immigrants. Prompt diagnosis with helpful early diagnostic tools like polymerase chain reaction in TBM is crucial due to the high mortality and morbidity. PMID:21716875

  4. Tuberculous meningoencephalitis with severe neurological sequel in an immigrant child

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    Kadriye Kart Yasar

    2011-01-01

    Full Text Available Central nervous system tuberculosis (TB is the most devastating manifestation of TB. It is a challenge for clinicians because of the difficulty in making an early diagnosis and the severe consequences of delayed treatment. The aim of this report is to point out the relation between migration and TB based on a 14-year-old child with tuberculous meningoencephalitis (TBM of an immigrant family. Migration, crowded living conditions and positive family history contribute to the severe course of TB as TBM and miliary TB forms. TB control may prevent these severe manifestations of the disease among immigrants. Prompt diagnosis with helpful early diagnostic tools like polymerase chain reaction in TBM is crucial due to the high mortality and morbidity.

  5. A case of calcified intracranial tuberculoma presenting unique MRI findings

    International Nuclear Information System (INIS)

    A 41-year-old male patient was admitted in our Ryukyu University Hospital complaining of parosmia. He had a history of miliary tuberculosis 21 years ago. Neurologically he showed left anosmia and hyperreflexia of the right upper extremity. Plain skull X-P and CT scan revealed a calcified mass, 25 mm in diameter, at the left frontal base. In MRI, the mass showed isointensity using the T1 weighted inversion recovery sequence and heterogenously low intensity using the T2 weighted spin echo sequence. Surgery was performed by bifrontal craniotomy. Then the tumor was removed totally including two coexisting small tumors. Histologically, they consisted of calcified caseous tissue and thick collagen capsule, suggesting old calcified tuberculomas. Postoperative course was uneventful and did not result in meningitis. Antituberculous therapy of streptmycin, isoniazid and rifapicin was given for 2 weeks, started on the operative day. MRI findings were presented in detail and the guideline of antituberculous therapy to the tuberculoma was discussed. (author)

  6. Post-kala-azar dermal leishmaniasis associated with AIDS

    Directory of Open Access Journals (Sweden)

    Bittencourt Achiléa

    2002-01-01

    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.

  7. Chylous effusions

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    Tomić Ilija

    2003-01-01

    Full Text Available This paper presents 4 patients with chylothorax, and one patient with bilateral chylothorax and chyloperitoneum. The chylous effusions were of benign etiology, developed as a complication of miliary tuberculosis (1 patient, after L-2 vertebral body fracture (1 patient, and idiopathic (2 patients. The diagnosis was confirmed by the presence of chylomicrons and high content of triglycerides in the effusion, ranged 11,9-29,1 mmol/l. Lymphangiography showed multiple abnormalites of lymphatic system, the obstruction of ductus thoracicus, dilatation and convulsion of lymphatic channels, but the site of lymphatic leak was not detected. The treatment included an extended period of pleural and peritoneal drainage with total parenteral nutrition (1 patient, pleurodesis using Corynebacterium parvum (2 patients, and surgical partial parietal pleurectomy with continous drainage (1 patient. The treatment was successful in all patients.

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

    International Nuclear Information System (INIS)

    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.)

  9. Applications of bacillus Calmette-Guerin and recombinant bacillus Calmette-Guerin in vaccine development and tumor immunotherapy.

    Science.gov (United States)

    Zheng, Yuan-qiang; Naguib, Youssef W; Dong, Yixuan; Shi, Yan-chun; Bou, Shorgan; Cui, Zhengrong

    2015-01-01

    Bacillus Calmette-Guerin (BCG) vaccines are attenuated live strains of Mycobacterium bovis and are among the most widely used vaccines in the world. BCG is proven to be effective in preventing severe infant meningitis and miliary tuberculosis. Intravesical instillation of BCG is also a standard treatment for non-muscle invasive bladder cancer. In the past few decades, recombinant BCG (rBCG) technology had been extensively applied to develop vaccine candidates for a variety of infectious diseases, including bacterial, viral, and parasite infections, and to improve the efficacy of BCG in bladder cancer therapy. This review is intended to show the vast applications of BCG and recombinant BCG (rBCG) in the prevention of infectious diseases and cancer immunotherapy, with a special emphasis on recent approaches and trends on both pre-clinical and clinical levels. PMID:26268434

  10. [Association between severe tuberculosis in children and previous BCG immunization in a national referral hospital, Peru 1990-2000].

    Science.gov (United States)

    Llanos-Tejada, Félix; del Castillo, Hernán

    2012-03-01

    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 total 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. PMID:22510912

  11. Radiological profile of pulmonary tuberculosis in HIV: concerning 171 observations in Kinshasa

    International Nuclear Information System (INIS)

    This prospective descriptive study was conducted in Depistage center of the Tuberculosis treatment of Kabinda during a period of three months, had as objectives to study the radiological profile of pulmonary tuberculosis in HIV and HIV- patients, then to compare the frequency of different radiological abnormalities between the two groups to determine some characteristics of co-infection HIV/TP+. Among 171 patients with contagious pulmonary tuberculosis, 50 patients had positive serology for HIV, a prevalence of 29,2%. The intrathoracic lymph nodes, localized lesions only in the lower field were more observed in HIV, as well as pleurisy and the absence of radiological abnormality. The only one case of miliary was HIV positive. By contrast, excavations and localized lesions in the upper field were predominant in HIV-. Atypical radiological manifestations of pulmonary tuberculosis were more common in patients with HIV infection.

  12. Choroidal Tuberculoma in Two Cases With Multiple Intracranial Tuberculomas

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    Baki ARPACI

    2011-12-01

    Full Text Available We report two cases of concurrent choroidal and multiple intracranial tuberculomas which is rare. A 45-year-old man presented to the hospital with a history of miliary tuberculosis, headache, and blurred vision on his left eye. The other case, a 25-year-old woman complained of coughing, back pain, night sweats, headache, nausea and vomiting. Their neurological examination were unremarkable except the presence of a choroidal lesion in one of their eyes, and brain MRIs revealed peripheral ring enhancing nodules. They were diagnosed as concurrent intracranial and choroidal tuberculomas and four-drug antituberculous regimen was started. After these treatments, the choroidal and brain tuberculomas revealed significant regression. Early diagnosis, adequate treatment and follow-up for the response to the treatment of choroidal tuberculoma can prevent serious complications. Detailed ocular examinations should be performed in all cases with tuberculosis, for possible presence of early asymptomatic choroidal tuberculoma.

  13. Calorific and carbon values of marine and freshwater Protozoa

    Science.gov (United States)

    Finlay, B. J.; Uhlig, G.

    1981-12-01

    Calorific and carbon values were determined for a variety of marine and freshwater Protozoa ( Noctiluca miliaris, Euplotes sp., Eufolliculina sp. respectively Tetrahymena pyriformis, Paramecium caudatum), their food sources (Bacteria, Dunaliella primolecta, Ceratium hirundinella), and for Protozoa-dominated plankton samples. Most calorific values lie close to the centre of the range covering organisms in general. Low values in some marine samples probably resulted from the retention of bound water in the dried material. When all results were combined with data selected from the literature, the dependence of calorific value on carbon content was highly significant. This relationship is probably also adequately described by an energy-carbon regression through the variety of organic compounds commonly found in organisms. Calorific value expressed per unit carbon is shown to vary little in Protozoa (mean conversion factor 46 J [mg C]-1) or throughout the range of biological materials considered in this study (45 J [mg C]-1).

  14. Subcellular sources of luminescence in Noctiluca.

    Science.gov (United States)

    Eckert, R

    1966-01-21

    The perivacuolar cytoplasm of Noctiluca miliaris contains approximately 10(4) microsources of luminescence, with dimensions of 0.5 to 1.5 microns, which exhibit marked fluorescence with ultraviolet excitation. Local invasion by an action potential elicits light emission (microflashes) from these sources with a coupling latency of about 2 milliseconds. Magnitudes of the microflash vary directly with the dimensions of the source. Time courses of the microflash resemble that of the macroflash emitted by the whole cell but have somewhat shorter time constants. The small discrepancy induration between micro- and macroflash can be explained by the 5- to 10-millisecond asynchrony of microsource triggering that results from the conduction time of the action potential. Reversible gradations in amplitude of the macroflash, as from potentiation or fatigue, result from parallel summation of graded changes in microflash intensity. Thus the macroflash gives a reasonably true picture of the subcellular kinetics of luminescence. PMID:5903345

  15. Climate Change Impacts on Biological Production in the Arabian Sea

    Science.gov (United States)

    Goes, J. I.; Thoppil, P. G.; Gomes, H. D.; Matondkar, P.; Al-Azri, A. R.; Dwivedi, R. N.

    2007-05-01

    For the past eight years, the western half of the Arabian Sea has witnessed an almost 350 percent increase in summer-time phytoplankton blooms due to strengthening of the southwest monsoon winds and intensification of coastal upwelling linked to the warming trend over Eurasia. We have also observed that the warming trend is undermining convective mixing responsible for nutrient enrichment during the boreal winter component of the monsoon cycle, causing a decline in winter-time phytoplankton biomass in the eastern Arabian Sea. On the other hand, the western Arabian Sea has been witnessing an increase in chlorophyll due to unprecedented blooms of Noctiluca miliaris Suriray tied to mesoscale eddy activity and the uplift of subsurface, cooler, nutrient-rich and oxygen poor waters seen early during the season off the coast of Oman.

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

    Energy Technology Data Exchange (ETDEWEB)

    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

    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.)

  17. Multicentric histiocytosis related to avian leukosis virus subgroup J (ALV-J)-infection in meat-type local chickens.

    Science.gov (United States)

    Furukawa, Seiko; Tsukamoto, Kenji; Maeda, Minoru

    2014-01-01

    Gross lesions characterized by swollen livers and spleens accompanied by diffuse white miliary spots, which resembled those of Marek's disease, were detected in two flocks of local meat-type chickens at a Japanese poultry processing plant in June and August 2010. The microscopic examinations revealed proliferative foci consisting of spindle or polymorphic cells in the interstitium of livers, splenic follicles and the interstitium of kidneys. These cells were positive immunohistochemically with Iba1 antibody, indicating they were histiocytic cells. Some of them contained antigens of avian leukosis virus (ALV) by immunohistochemistry,and the env gene of ALV subgroup J was detected from the spleens by polymerase chain reaction (PCR). Phylogenetic analysis of the PCR product indicated that the env gene might be descended from the American ADOL-7501 strain of ALV-J. These results suggest that the swollen livers and spleens of the meat-type chickens may come from histiocytic proliferation caused by ALV-J infection. PMID:23978900

  18. 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)

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

    2006-06-01

    Full Text Available [...] 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

  19. Current status of new tuberculosis vaccine in children.

    Science.gov (United States)

    Pang, Yu; Zhao, Aihua; Cohen, Chad; Kang, Wanli; Lu, Jie; Wang, Guozhi; Zhao, Yanlin; Zheng, Suhua

    2016-04-01

    Pediatric tuberculosis contributes significantly to the burden of TB disease worldwide. In order to achieve the goal of eliminating TB by 2050, an effective TB vaccine is urgently needed to prevent TB transmission in children. BCG vaccination can protect children from the severe types of TB such as TB meningitis and miliary TB, while its efficacy against pediatric pulmonary TB ranged from no protection to very high protection. In recent decades, multiple new vaccine candidates have been developed, and shown encouraging safety and immunogenicity in the preclinical experiments. However, the limited data on protective efficacy in infants evaluated by clinical trials has been disappointing, an example being MVA85A. To date, no vaccine has been shown to be clinically safer and more effective than the presently licensed BCG vaccine. Hence, before a new vaccine is developed with more promising efficacy, we must reconsider how to better use the current BCG vaccine to maximize its effectiveness in children. PMID:27002369

  20. Comparative radiological features of disseminated disease due to Mycobacterium tuberculosis vs non-tuberculosis mycobacteria among AIDS patients in Brazil

    Directory of Open Access Journals (Sweden)

    Willers Denise MC

    2008-02-01

    Full Text Available Abstract Background Disseminated mycobacterial disease is an important cause of morbidity and mortality in patients with HIV-infection. Nonspecific clinical presentation makes the diagnosis difficult and sometimes neglected. Methods We conducted a retrospective cohort study to compare the presentation of disseminated Mycobacterial tuberculosis (MTB and non-tuberculous Mycobacterial (NTM disease in HIV-positive patients from 1996 to 2006 in Brazil. Results Tuberculosis (TB was diagnosed in 65 patients (67.7% and NTM in 31 (32.3% patients. Patients with NTM had lower CD4 T cells counts (median 13.0 cells/mm3 versus 42.0 cells/mm3, P = 0.002. Patients with tuberculosis had significantly more positive acid-fast smears (48.0% vs 13.6%, P = 0.01. On chest X-ray, miliary infiltrate was only seen in patients with MTB (28.1% vs. 0.0%, P = 0.01. Pleural effusion was more common in patients with MTB (45.6% vs. 13.0%, P = 0.01. Abdominal adenopathy (73.1% vs. 33.3%, P = 0.003 and splenic hypoechoic nodules (38.5% vs. 0.0%, P = 0.002 were more common in patients with TB. Conclusion Miliary pulmonary pattern on X-ray, pleural effusion, abdominal adenopathy, and splenic hypoechoic nodules were imaging findings associated with the diagnosis of tuberculosis in HIV-infected patients. Recognition of these imaging features will help to distinguish TB from NTM in AIDS patients with fever of unknown origin due to disseminated mycobacterial disease.

  1. Ultrasonographic and CT findings of hepatosplenic tuberculosis

    Energy Technology Data Exchange (ETDEWEB)

    Moon, Un Hyeon; Lee, Jeong Seok; Ko, Kang Seok; Park, Byung Ran; Yang, Dong Cheol; Im, Ju Hyeon [Kwangju Christian Hospital, Kwangju (Korea, Republic of); Kang, In Young [Kwangju Green Cross Hospital, Kwangju (Korea, Republic of)

    1998-08-01

    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.

  2. Ultrasonographic and CT findings of hepatosplenic tuberculosis

    International Nuclear Information System (INIS)

    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

  3. Cavitary Lesions and Nodular Infiltration Patterns in Multi-Drug Resistant TB and Non-Tuberculosis Mycobacterium: Comparison of Chest CT

    Directory of Open Access Journals (Sweden)

    Shahram Kahkouee

    2010-05-01

    Full Text Available Background/Objective: By increasing of HIV frequency, MDRTB has also increased. Clinical and laboratory findings of multi-drug resistant TB (MDRTB and non-tuberculosis mycobacterium (NTM are very similar. Maybe imaging findings help early differentiation before culture result. This study has compared cavitary lesions and nodular infiltration patterns in the chest CT of MDRTB and NTM."nPatients and Methods: A retrospective study was performed on 66 hospitalized patients (43 MDRTB and 23 NTM in Masih Daneshvari Hospital (from 2006-2009. Lung CT scans were evaluated by a radiologist and two radiology residents without any information about the culture result. Nodular infiltrations were classified into 6 patterns (tree in bud, scattered nodule, lobar nodular infiltration, cavitary nodule, macronodule, miliary pattern and cavitary lesions to thick and thin, single and multiple with lobar distribution and satellite nodule adjacent to cavity. Chi-square statistics analysis was performed."nResult: Respectively in NTM and MDRTB: Mean age (51.5%-44.8%, sex (34.8% M and 65.2 F, 58.1% M and 41.9% F, treatment history (56.5%,83.7%, scattered nodular infiltration (47.8%, 60.5%, lobar nodular infiltration (13%, 9.3%, TIB (47.8%, 46.5%, miliary pattern (0%, 0%, cavitary nodule (21.7%, 27.9%, macro nodule (nodule?10mm (43.5%, 25.6%, cavity (69.6%, 76.7%, thin wall cavity (65.2%, 46.5%, thick wall cavity (26.1%, 58.1%, satellite nodule adjacent to cavity (39.1%, 9.3%, single cavity (13%, 14%, lobar distribution of single cavity: RUL (8.7%, 4.7%, RML (0%, 0%, RLL (0%, 0%, LUL (4.3%, 4.7%, lingual (0%, 0%, LLL (0%, 4.7%, multiple cavity (56.5%, 60.5%, lobar distribution of multiple cavity: RUL (26.1%, 51.2%, RML (21.7%, 9.3%, RLL (26.1%, 23.3%, LUL (47.8%, 44.2%, lingual (26.1%, 18.6%, LLL (30.4%, 16.3%."nConclusion: Treatment history (p=0.016, satellite nodule adjacent to cavity (p=0.004, thick wall cavity (p=0.013 and multiple cavity in RUL (p=0.05 are more common in NTM with significant difference. Frequency difference in other variables was not significant (p>0.05.

  4. Tuberkulosis Perinatal Bermanifestasi sebagai Tuberkulosis Milier dan Meningitis

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    Heda Melinda D. Nataprawira

    2014-10-01

    Full Text Available Perinatal tuberculosis (TB is rarely reported, because the clinical manifestations are not specific and there is a problem in its laboratory and radiology examination which caused undiagnosed. Perinatal TB is the preferred description that encompasses TB acquired either intra uterine, during or post delivery in early newborn period. A-3- month old baby was transferred to Pediatric Emergency Hasan Sadikin Hospital because of prolong fever and unable to breastfeed. There was no problem with delivery. Lethargic, fever, tachypnea, and hepatosphlenomegali were found on physical examination. Ziehl Neelsen smear of gastric lavage yielded positive acid fast bacilli. Tuberculine test was non reactive, chest x-ray showed a miliary pattern, and cerebral spinal fluid analysis gave tuberculous meningitis interpretation. By active finding, his father and grandfather were detected as a source of TB transmission. In additon to oral antituberculosis regimen, antibiotics and prednison were also given. Septic shock and disseminated intravascular coagulation were occurred during his illness and the baby died. Staphylococcus haemolyticus was identified from blood culture. In conclusion, although there were no problems during labor, active investigation of perinatal TB possibility is required on the family with a source of TB. Caution on TB in pregnant women is necessary at developing country with high rates of TB.

  5. Disseminated tuberculosis after extracorporeal shock-wave lithotripsy in an AIDS patient presenting with urosepsis.

    Science.gov (United States)

    Tourchi, Ali; Ebadi, Maryam; Hosseinzadeh, Alireza; Shabaninia, Mahsa

    2014-03-01

    Haematogenous dissemination of undiagnosed urinary tuberculosis after performing extracorporeal shock-wave lithotripsy (ESWL) is extremely rare. Herein, we report a 41-year-old male who presented with urosepsis to the emergency room; catheterization was performed and retention resolved. He had a tattoo on his left arm and a five-year history of intravenous drug use. Blood tests indicated anaemia, leukocytosis, elevated CRP and ESR and mild hyponatraemia; haematuria, moderate bacteriuria and 2+ proteinuria on urinanalysis were observed. Chest X-ray revealed lesions suggestive of miliary tuberculosis, which was confirmed by chest CT scan. Brain CT and MRI suggested brain involvement in the setting of tuberculosis. On further investigations, HIV infection and hepatitis C seropositivity were detected and the patient remained in a coma for five days with a Glasgow Coma Scale of 6/15. Finally, the diagnosis of haematogenous dissemination of tuberculosis following lithotripsy was established. Anti-tuberculosis and anti-retroviral therapy were prescribed and monthly follow-up visits were scheduled. In conclusion, in a patient diagnosed with ureterolithiasis, a thorough history and physical examination, with specific attention to HIV and tuberculosis predisposing factors, should be carried out and preoperative screening tests considering the possibility of urinary tuberculosis are required. Finally, if urinary tuberculosis is detected, ESWL must be postponed until after appropriate treatment of tuberculosis. PMID:23970650

  6. Effectiveness of BCG Vaccination in Prevention of Childhood Tuberculosis: A Prospective Study from Kishanganj, Bihar

    Directory of Open Access Journals (Sweden)

    Kashif Shahnawaz, Goutam Sarkar, Palash Das, Mausumi Basu, Biman Roy

    2013-01-01

    Full Text Available Introduction: BCG vaccine has shown consistently high efficacy against childhood tubercular meningitis and miliary tuberculosis and other mycobacterial diseases. It is considered to be a safe vaccine with a low incidence of adverse effects. Efficacy of BCG vaccine found in different clinical trials is variable in different geography. Objectives: Study was done to assess the efficacy of BCG vac-cine. Materials and Methods: All the children who were less than three years of age and were previously BCG vaccinated and not-vaccinated, were included in this study. A total of sixty (60 vaccinated children and sixty non-vaccinated children were selected. These children were followed up prospectively for 24 months, at the end of which, it was seen whether they developed tuberculosis or not. Results: Out of these 60 children in both the cases and control groups, total number of BCG vaccinated children who developed TB were 4 (i.e. 6.6% and total number of Non-BCG vaccinated children who developed TB were 12 (i.e. 20%. Thus, the efficacy of BCG vaccine calculated in our study was 67%. Conclusion: Most studies in different parts of the world have shown that the efficacy of BCG vaccine varies from zero to eigh-ty percent. This study favors the efficacy of BCG vaccine. This vaccination strategy will be favorable for our children. Creation of awareness among the parents and family members for an early administration of BCG vaccine after child birth can be recom-mended.

  7. Prime-boost bacillus Calmette-Guérin vaccination with lentivirus-vectored and DNA-based vaccines expressing antigens Ag85B and Rv3425 improves protective efficacy against Mycobacterium tuberculosis in mice.

    Science.gov (United States)

    Xu, Ying; Yang, Enzhuo; Wang, Jianguang; Li, Rui; Li, Guanghua; Liu, Guoyuan; Song, Na; Huang, Qi; Kong, Cong; Wang, Honghai

    2014-10-01

    To prevent the global spread of tuberculosis (TB), more effective vaccines and vaccination strategies are urgently needed. As a result of the success of bacillus Calmette-Guérin (BCG) in protecting children against miliary and meningeal TB, the majority of individuals will have been vaccinated with BCG; hence, boosting BCG-primed immunity will probably be a key component of future vaccine strategies. In this study, we compared the ability of DNA-, protein- and lentiviral vector-based vaccines that express the antigens Ag85B and Rv3425 to boost the effects of BCG in the context of immunity and protection against Mycobacterium tuberculosis in C57BL/6 mice. Our results demonstrated that prime-boost BCG vaccination with a lentiviral vector expressing the antigens Ag85B and Rv3425 significantly enhanced immune responses, including T helper type 1 and CD8(+) cytotoxic T lymphocyte responses, compared with DNA- and protein-based vaccines. However, lentivirus-vectored and DNA-based vaccines greatly improved the protective efficacy of BCG against M. tuberculosis, as indicated by a lack of weight loss and significantly reduced bacterial loads and histological damage in the lung. Our study suggests that the use of lentiviral or DNA vaccines containing the antigens Ag85B and Rv3425 to boost BCG is a good choice for the rational design of an efficient vaccination strategy against TB. PMID:24773322

  8. Abnormal chest shadow on CT in immunosuppressed patients

    International Nuclear Information System (INIS)

    An abnormal chest shadow was observed on CT scans in 25 cases of 23 immunosuppressed patients. Pulmonary disease was pathologically confirmed to be pneumocystis carinii pneumonia (PC pneumonia) in four patients, cytomegalovirus pneumonia (CMV pneumonia) in one, bacterial pneumonia in seven, fungal infection in three, miliary tuberculosis in one, leukemic infiltration in two, lymphangitis carcinomatosa in three, drug-induced pneumonitis in three, and ARDS in one. In almost all patients, especially those with infectious diseases such as PC pneumonia, CMV pneumonia, and bacterial pneumonia, the abnormal shadow was wide and visible in the bilateral lung fields. We presumed that such findings as lobular shadow, centrilobular shadow, and mosaic pattern reflected the extension of disease via the respiratory tract, and that those findings are typical of infectious diseases. Because such findings as abnormal linear shadow and swelling of a broncho-vascular bundle were very frequently recognized in patients with lymphangitis carcinomatosa and frequently recognized in those with drug-induced pneumonitis, these diseases may be distinguished from other diseases. An area of slightly increased density was frequently recognized in patients with PC pneumonia, bacterial pneumonia, and drug-induced pneumonitis. Such lesions were pathologically confirmed to be located in the interstitium and/or alveolus. CT was extremely useful in comprehending the character and extension of particular diseases among various diseases. As the number of patients studied was small, the utility of CT in immunosuppressed patients requires further investigation in a larger number of patients. (author)

  9. Study of tuberculous meningitis by CT

    International Nuclear Information System (INIS)

    Computed tomography is a very valuable method by which the pathogenic evolution of tuberculous meningitis may be followed, thereby facilitating its differential diagnosis and controlling the efficiency of therapy. The initial miliary tuberculosis in the brain, very often unaccompanied by neurological symptoms, may offer very evident CT images. CT may also demonstrate the fibrogelatinous exudate which fills the basal cisterns and surrounds the arterial vessels which cross this region. Because of this, secondary arteritis is frequent and may be indirectly detected by CT in the form of foci of ischemic infarcts. Tuberculomas may be multiple, and are found equally in the cerebral and the cerebellar parenchyma. These tuberculomas present different images on CT, depending on the evolution of the disease at that moment. Hydrocephalus is a common complication of TM and is caused by a lack of reabsorption of the cerebrospinal fluid, or by an obstructive lesion in the ventricular drainage pathways due to a tuberculoma. This complication is usually easily identified by CT, which, moreover, permits the control of its evolution. (orig.)

  10. [Does emergency tropical medicine exist? The physician's point of view].

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    Hovette, P; Bâ, K; Kraemer, P; Chaudier, B; Bahrouch, L; Fourcade, L

    2002-01-01

    The existence of tropical medical emergencies is a recurrent issue that joins the debate over the definition of tropical medicine. Is it medicine practiced in warmer climates, medicine practiced with poor diagnostic and therapeutic facilities or medicine involving only tropical diseases? Presentation of a few case reports provides a better response to this question than a long speech. The first case involves a 57-year-old man presenting a complicated attack of Plasmodium falciparum malaria and severe respiratory distress. The second case involves a pregnant AIDS patient presenting multifocal miliary tuberculosis associated with renal abscess and bacteremia. The third case involves a 34-year-old soldier hospitalized for right hilar pneumonia in whom work-up demonstrated co-infection by HIV 1 and 2, thick drop tests revealed uncomplicated Plasmodium falciparum malaria, and cytobacterial examination of sputum samples identified Salmonella enteritidis and acid-alcohol resistant germs. The fourth case involves a 60-year man hospitalized for febrile collapse in whom work-up revealed amebic pericarditis. These four case reports illustrate the main features of tropical medical emergencies: adult patients (frequently young), associated deficiencies or immunocompromise (HIV infection/AIDS), severe or complicated tropical disease, severe advanced stage disease because of inability to pay for care, multiple pathology, poor diagnostic/therapeutic facilities, and high mortality. PMID:12244920

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

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    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

    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

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

    International Nuclear Information System (INIS)

    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

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

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    G. Kalema-Zikusoka

    2005-09-01

    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.

  14. Pancreatite esclero-gomosa simulando sindrome cancerosa da cabeça do pâncreas

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    A. Penna de Azevedo

    1944-06-01

    Full Text Available Em um homem de 49 anos de idade, observou-se um sindrome de tumor da cabeça do pâncreas. Realizada a intervenççao cirúrgica foi verificada a presença de uma formaão dura de aspecto fibroso, medindo 9 x 7,5 x 6,5 cm. O exame microscópico mostrou tratar-se de uma pancreatite indurativa associada à presença de gomas miliares, infiltração de eosinófilos e lesões produtivas dos vasos sanguíneos, correspondendo ao aspecto dos processo esclerogomosos sifilíticos do pâncreas.A tumor of the head of the pancreas is reported ina a male, 49 years old, which corresponded to a nodule of fibrous tissue measuring 9 x 7,5 x 6,5 cm. Microscopically, a chronic interstitial pancreatitis associated to miliary gummata, eosinophilic infiltration and proliferation of blood vessels was found and the diagnosis of siphilitic pancreatitis was done.

  15. The chest radiological manifestation in psittacosis

    International Nuclear Information System (INIS)

    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)

  16. Computed tomography of intracranial tuberculosis

    International Nuclear Information System (INIS)

    CT is a valuable method in determining number, location and extent of lesions, although a definite diagnosis is often not possible on CT. In intracranial tuberculosis, CT was helpful in the diagnosis, assessing the degree of hydrocephalus and evaluating the effectiveness of antituberculous therapy. Twenty-one cases of clinically proven intracranial tuberculosis were studied by CT in our hospital during last 3 years. Of them, eighteen cases were tuberculous meningitis and the rests were tuberculoma. The results were as follows: 1. Tuberculous meningitis presented the following three patterns of CT findings according to its disease process. a. In early stage of the disease, suspicious multiple isodense small nodules in the cerebral and cerebellar hemispheres showed dense enhancement in postcontrast scan representing miliary tubercles. b. In later stage of the disease, precontrast scan showed partial or total obliteration of the basal and sylvian cisterns with mild dilatation of ventricular system. Postcontrast scan showed dense enhancement of basal and sylvian cisterns. This type of finding was the most common in our series. c. Moderate to marked dilatation of ventricle with or without a cluster of calcifications in suprsella area on precontrast scan was seen in far later stage of as a sequellae of the disease. No enhancement was noted in postcontrast study. 2. Tuberculoma showed an isodense or slightly hyperdense area in the cerebral or cerebellar hemisphere with associated minimal edema in precontrast study. Postcontrast scan showed a small ring enhancement with central lucent area

  17. Scrotal inflammation: characteristic US patterns

    International Nuclear Information System (INIS)

    During the last 3 years (1987-1990) the authors have performed 562 ultrasound studies of the scrotum in patients ranging 6 months to 76 years of age. All patients were referred with a non-specific clinical suspicion of scrotal pathologies. Only 214/562 patients presenting with signs and symptoms of scrotal inflammation were considered for this study. Among this group of 214 patients, 34 cases of tubercolous epididymo-orchitis were identified. The remaining 180 patients were classified as follows: non specific inflammation 141, other non inflammatory pathology 39. In the group with findings of tubercolosis, all stages of disease were identified, including miliary forms as well as nodular forms. The patients were closely followed during medical terapy or until surgery was performed to study the course of the disease. For each form of disease specific US findings and differential diagnostic criteria were recognized and will be illustrated in this paper. All diagnosis of tubercolosis were confirmed either at surgery or on the basis of successful response to specific chemoterapy. US diagnosis based on the morphologic and echo texture criteria allowed high diagnostic accuracy: in fact in the whole group of 214 patients with inflammatory disease there were only 1 false positive and 1 false negative diagnosis with a sensitivity of 96.9%, a specificity of 89.9% and a diagnostic accuracy of 98.85%. The paper also stresses the importance of US in the short- and long-term follow-up of the patients undergoing medical therapy

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

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    Mukhopadhyay Chiranjoy

    2004-12-01

    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.

  19. Neonatal BCG vaccination is associated with enhanced T-helper 1 immune responses to heterologous infant vaccines

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    Daniel H. Libraty

    2014-01-01

    Full Text Available Neonatal Bacille Calmette Guérin (BCG vaccination has been reported to have beneficial effects beyond preventing infantile tuberculous meningitis and miliary disease. We hypothesized that BCG vaccine given at birth would enhance T-helper 1 (Th1 immune responses to the first vaccines given later in infancy. We conducted a nested case-control study of neonatal BCG vaccination and its heterologous Th1 immune effects in 2–3 months old infants. BCG vaccination at birth was associated with an increased frequency of interferon-γ (IFN-γ producing spot-forming cells (SFC to tetanus toxoid 2–3 months later. The frequency of IFN-γ producing SFC to polioviruses 1–3 also trended higher among infants who received BCG vaccination at birth. The frequency of IFN-γ+/tumor necrosis factor-α (TNF-α+CD45RO+CD4+ T-cells upon stimulation with phorbol myristate acetate (PMA/Ionomycin was higher in 2–3 months old infants who received BCG vaccination at birth compared to those who did not. The circulating frequency of forkhead box P3 (FoxP3+ CD45RO+ regulatory CD4+ T-cells also trended lower in these infants. Neonatal BCG vaccination is associated with heterologous Th1 immune effects 2–3 months later.

  20. Vitamin D intoxication caused by ingestion of commercial cat food in three kittens.

    Science.gov (United States)

    Wehner, Astrid; Katzenberger, Julia; Groth, Anna; Dorsch, Roswitha; Koelle, Petra; Hartmann, Katrin; Weber, Karin

    2013-08-01

    Two siblings, a 6-month-old sexually intact male weighing 2.5 kg (cat 1) and a sexually intact female (cat 2) British Shorthair cat weighing 2.3 kg, were examined because of a 3-week history of polyuria, lethargy and laboured breathing. One year previously, another sibling (cat 3) had been presented because of similar, yet more severe, clinical signs at the age of 5 months. Physical examination revealed lethargy, dehydration and polypnoea with slightly increased inspiratory effort. Diagnostic investigation revealed severe hypercalcaemia (cats 1-3), renal azotaemia (cats 1 and 3) and a radiologically generalised miliary interstitial pattern of the lungs (cats 1-3) attributable to hypervitaminosis D caused by ingestion of commercial cat food. Cat 3 was euthanased. Cats 1 and 2 were treated with isotonic saline solution (180 ml/kg IV daily), sucralfate (30 mg/kg PO q12h), terbutaline (only cat 1: 0.1 mg/kg SC q4h), furosemide (1.5 mg/kg IV q8h) and tapering doses of prednisolone. Cat 2 was normal on day 14. Cat 1 had stable renal disease and was followed up to day 672. The radiological generalised military interstitial pattern of the lungs had improved markedly. Excessive cholecalciferol-containing commercially available cat food poses a great hazard to cats. Supportive treatment may result in long-term survival and improvement of radiological pulmonary abnormalities. PMID:23295272

  1. Two cases of papillary thyroid carcinoma with solitary lung metastasis

    International Nuclear Information System (INIS)

    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)

  2. [The Great Imitator; Clavicular Tuberculosis Mimics a Metastatic Neoplasm].

    Science.gov (United States)

    Mikawa, Takahiro; Miyoshi, Kazuyasu; Fujita, Koji; Hase, Ryota; Hosokawa, Naoto

    2015-09-01

    In the same manner as syphilis, tuberculosis (TB) was often called "The Great Imitator". We have to consider not only malignancies but also TB as a differential diagnosis when we find any tumorous regions. We report herein on a rare case, clavicular osteomyelitis due to TB. A 72-year-old female, with diabetic nephropathy, was on maintenance hemodialysis. She had a fall 2 months prior to admission followed by pain around her right clavicle. Ulceration occurred in that region a month prior to admission, and CT scan revealed a fracture of the right clavicle with a tumor surrounding that area. Seven days prior to admission, she went to a neurologist because of dizziness. MRI of the brain revealed a tumor in her pons. The physician suspected the tumor was metastasis. Needle biopsies revealed only necrotic tissue so the medical oncologist consulted us because they suspected it was caused by infection of some kind. From the patient's history and the physical examination, we suspected TB osteomyelitis and grew some more cultures, but only MRSA and E. coli were detected. We administered vancomycin and cefmetazole for the secondary bacterial osteomyelitis. After a month of hospitalization, we found miliary regions on her chest CT and Mycobacterium tuberculosis was grown from the needle biopsy specimen. We started multi-antituberculosis therapy and the patient had a good prognosis. We report herein on a rare case of clavicular osteomyelitis due to TB, together with a review of the literature. PMID:26630791

  3. Tuberculose hepática pseudotumoral Pseudotumoral hepatic tuberculosis

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    Antonio Nocchi Kalil

    1999-06-01

    Full Text Available Tuberculous involvement of the liver is usually a diffuse process, associated with miliary tuberculosis. However localized tuberculosis of the liver producing a macronodular tuberculoma or an abscess is rare. The authors present a case of pseudotumoral hepatic tuberculosis in a 34-year old woman. This patient presented a 2 month history of fever weight loss of 4Kg and right upper quadrant abdominal pain. She denied jaundice, choluria, or acholia. Laboratory investigation, including renal and liver function tests. revealed normal levels. Chest X-ray was normal. Abdominal ultrasonography demonstrated a hypoechoic nodule in the right hepatic lobe. CT scan showed hypodense areas in the same place and no retroperitoneal lymphadenopathy. Due to the inespecificity of the signs, symptoms and image findings, a diagnostic laparoscopy was performed, it was however inconclusive. Then, the patient was submitted to a laparotomy with ressection of the lesion. Histological examination revealed a tuberculoid granulomatous lesion with caseous necrosis. Postoperatively, the patient was placed on antituberculous chemotherapy with rifampin, isoniazid and pyrazinamide. Eight months later the patient is asymptomatic.

  4. Paradoxical response during antituberculous therapy in a patient discontinuing infliximab: a case report

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    Yoon Young Kyung

    2009-04-01

    Full Text Available Abstract Introduction The use of the drug infliximab for the treatment of patients with Crohn's disease can be complicated by tuberculosis. A paradoxical reaction during antituberculosis chemotherapy and immunologic reconstitution after discontinuation of infliximab can result in severe disseminated tuberculosis. Case presentation A 38-year-old Korean man with severe Crohn's disease presented with fever and diffuse abdominal pain. Infliximab had been started 2 months before admission. A chest X-ray and abdominal computed tomography scan revealed numerous miliary nodules in both lung fields and microabscesses in the spleen. Given the diagnosis of disseminated tuberculosis, the infliximab therapy was discontinued and antituberculosis therapy was promptly started. Over the next 3 months, the patient was diagnosed with tuberculosis lymphadenitis on a right supraclavicular lymph node and surgical excision of the lesion was performed. With the diagnosis of a paradoxical response, anti-tuberculous therapy was continued for 12 months. Conclusion Our case suggests that patients who develop tuberculosis after infliximab exposure are at an increased risk of developing a paradoxical reaction. The current recommendation of discontinuing infliximab during tuberculosis treatment should be re-evaluated.

  5. Mycobacterial antigen detection by immunohistochemistry in pulmonary tuberculosis.

    Science.gov (United States)

    Humphrey, D M; Weiner, M H

    1987-07-01

    A preliminary diagnosis of tuberculosis can be established by the detection of acid-fast bacilli (AFB) and confirmed by culture of the microorganism. To evaluate an alternative method of diagnosis, the distribution of mycobacterial antigens in lung tissue specimens was characterized by an indirect peroxidase-antiperoxidase method and was compared to the detection of AFB by Ziehl-Neelsen stain. Histologic specimens were obtained from 59 hospital patients. Of nine patients with mycobacterial disease, seven had antigen detected in tissue. In two patients with tuberculous pneumonia, the distribution of mycobacterial antigens was approximately the same as that of AFB. In contrast, in four patients with caseating pulmonary granulomas, clumps of mycobacterial antigens were demonstrated in necrotic areas of the granulomas where there were few or no AFB. In one patient with Mycobacterium intracellulare infection, cross-reactive antigens stained weakly. Antigen was not found in tissue from two patients; one had miliary lung granulomas, and the second had mediastinal lymph node granulomas. Mycobacterial antigens were not detected in specimens from 50 control patients with nonmycobacterial diseases. On the basis of this study of 59 cases, immunohistochemical detection of microbial antigens appears to be useful for establishing the mycobacterial etiology of caseating pulmonary granulomas. PMID:3297995

  6. Stroke in a patient with tuberculous meningitis and HIV infection

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    Maria Bruna Pasticci

    2013-02-01

    Full Text Available Abstract. Tuberculous meningitis (TBM is a devastating disease. TBM occurs more commonly in HIV infected patients. The influence of HIV co-infection on clinical manifestations and outcome of TBM is not well defined. Yet, some differences have been observed and stroke has been recorded to occur more frequently. This study reports on an HIV infected Caucasian female with lung, meningeal tuberculosis and stroke due to a cortical sub-cortical ischemic lesion.TBM was documented in the absence of neurologic symptoms. At the same time, miliary lung TB caused by multi-susceptible Mycobacterium tuberculosis was diagnosed. Anti-TB therapy consisting of a combination of four drugs was administered. The patient improved and was discharged five weeks later. In conclusion, TBM and multiple underling pathologies including HIV infection, as well as other risk factors can lead to a greater risk of stroke. Moreover, drug interactions and their side effects add levels of complexity. TBM must be included in the differential diagnosis of HIV infected patients with stroke and TBM treatment needs be started as soon as possible before the onset of vasculopathy.

  7. Histopathology of Disseminated Mycobacterium bovis Infection Complicating Intravesical BCG Immunotherapy for Urothelial Carcinoma.

    Science.gov (United States)

    Larsen, Brandon T; Smith, Maxwell L; Grys, Thomas E; Vikram, Holenarasipur R; Colby, Thomas V

    2015-05-01

    Intravesical instillation of Bacillus Calmette-Guérin (BCG) is a mainstay of adjunctive therapy for superficial bladder cancer. Disseminated BCG infection ("BCG-osis") after this therapy is rare and potentially life-threatening; only isolated case reports detail the histopathologic findings thereof, few of which had a diagnosis confirmed by molecular testing. We report 3 additional cases of BCG-osis complicating BCG therapy, all confirmed by cultures and molecular assays, including the first cases of wedge biopsy-confirmed BCG pneumonia and BCG olecranon bursitis. When suggested by a relevant clinical history, recognition of randomly distributed granulomas in any organ should prompt consideration of BCG-osis and liberal performance of AFB stains, aided by targeted molecular assays. Physicians should maintain a high index of suspicion when miliary infiltrates arise after intravesical BCG instillation, and close multidisciplinary communication is essential. Pathologist awareness of this rare cause of granulomatous inflammation aids recognition of BCG-osis and facilitates prompt initiation of antimycobacterial therapy. PMID:25614462

  8. Studies on dinoflagellate chromosomal basic protein.

    Science.gov (United States)

    Li, J Y

    Routine cytochemical methods proved useless in demonstrating basic protein in dinoflagellate chromosomes because when the DNA was removed, these chromosomes dissolved away just as eubacterial nucleoids. However, with ammoniacal silver technique or alkaline Biebrich scarlet, DNA could be kept intact, all the dinoflagellate chromosomes examined gave positive reaction. The acid-soluble proteins were extracted from methanol-fixed Amphidinium carterae and methanol-fixed isolated nuclei of Noctiluca miliaris, and subjected to urea polyacrylamide gel electrophoresis. Only one band of basic protein co-migrating with histone H4 was found. The chromosomes of Oxyrrhis marina can retain their original forms after the removal of DNA. Their chromosomal basic protein can be demonstrated by various cytochemical methods. This protein co-migrates with histone H4 in urea gel too. Its amino acid composition has been determined. This protein can combine with DNA fibril to form a nucleosome-like structure which seems to be corresponding to two of the archaebacterial nucleosome-like structures and may represent the primitive nucleosome. PMID:6424736

  9. Species identification of mixed algal bloom in the Northern Arabian Sea using remote sensing techniques.

    Science.gov (United States)

    Dwivedi, R; Rafeeq, M; Smitha, B R; Padmakumar, K B; Thomas, Lathika Cicily; Sanjeevan, V N; Prakash, Prince; Raman, Mini

    2015-02-01

    Oceanic waters of the Northern Arabian Sea experience massive algal blooms during winter-spring (mid Feb-end Mar), which prevail for at least for 3 months covering the entire northern half of the basin from east to west. Ship cruises were conducted during winter-spring of 2001-2012 covering different stages of the bloom to study the biogeochemistry of the region. Phytoplankton analysis indicated the presence of green tides of dinoflagellate, Noctiluca scintillans (=N. miliaris), in the oceanic waters. Our observations indicated that diatoms are coupled and often co-exist with N. scintillans, making it a mixed-species ecosystem. In this paper, we describe an approach for detection of bloom-forming algae N. scintillans and its discrimination from diatoms using Moderate Resolution Imaging Spectroradiometer (MODIS)-Aqua data in a mixed-species environment. In situ remote sensing reflectance spectra were generated using Satlantic™ hyperspectral radiometer for the bloom and non-bloom waters. Spectral shapes of the reflectance spectra for different water types were distinct, and the same were used for species identification. Scatter of points representing different phytoplankton classes on a derivative plot revealed four diverse clusters, viz. N. scintillans, diatoms, non-bloom oceanic, and non-bloom coastal waters. The criteria developed for species discrimination were implemented on MODIS data and validated using inputs from a recent ship cruise conducted in March 2013. PMID:25638059

  10. SPECTRUM OF EXTRA PULMONARY TUBERCULAR PATIENTS ATTENDING A TERTIARY CARE HOSPITAL

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    Seema Dayal

    2013-01-01

    Full Text Available Background: Extra pulmonary tuberculosis is increasing day by day. Even it has reversed the epidemiological trend of pulmonary tuberculosis. Over the last several years reported EPTB was increasing in absolute numbers and in proportion of all reported cases of tuberculosis, however similar studies from high burden Etawah district with high prevalence of HIV are lacking .Therefore, we have conducted this study to investigate clinical and pathological features of EPTB. Material & Method: The study was conducted on 925 clinically suspective tubercular patients who attended pathology department. They were compared in terms of age, sex, and site. Result: Out of the 925 clinically suspective extra pulmonary tubercular patients, 900 was diagnosed as EPTB patients. Females had higher proportion (51.77% of EPTB than males (48.22%. EPTB was more common in young age (20-29 years in males, where as in females common in (40-49 years age group. Most common site was lymph node (58% followed by Abdominal (13% urogenital (13%osteoarticular (12%, miliary (2%, CNS (1% and skin(1%. Conclusion: Out data suggest that EPTB was relatively common in young age in males and in latter group in females gender. Lymph node tuberculosis was most common site in both males and females. Tuberculosis control programmed may targets these population for EPTB case finding.

  11. Tc-99m erythromycin lactobionate inhalation scintigraphy in parenchymal lung diseases

    Energy Technology Data Exchange (ETDEWEB)

    Durak, Hatice E-mail: hdurak@kordon.deu.edu.tr; Aktogu, Serir; Degirmenci, Berna; Sayit, Elvan; Ertay, Tuerkan; Dereli, Sevket

    1999-08-01

    We have investigated Technetium 99m erythromycin lactobionate (Tc 99m EL) clearance from the lungs after inhalation, in the presence of an alveolitis. Eighteen patients (6 sarcoidosis, 7 idiopathic fibrosis, and 5 miliary tuberculosis) were imaged after the patients inhaled 1,110 MBq of Tc 99m EL. Clearance half time for the first 45 min, for 24 h, and retention at 24 h correlated with percentage of lymphocytes in bronchoalveolar lavage fluid (BAL) (r=.729, r=.883, and r=.826, respectively). There was a positive correlation between peripheral penetration (PP) and forced expiratory volume in 1 s (FEV{sub 1}) (r=.806) and forced vital capacity (FVC) (r=.781). Retention was more marked in sarcoidosis compared with tuberculosis (0.025

  12. Radiological patterns of childhood pulmonary tuberculosis in Khartoum state

    International Nuclear Information System (INIS)

    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)

  13. Tc-99m erythromycin lactobionate inhalation scintigraphy in parenchymal lung diseases

    International Nuclear Information System (INIS)

    We have investigated Technetium 99m erythromycin lactobionate (Tc 99m EL) clearance from the lungs after inhalation, in the presence of an alveolitis. Eighteen patients (6 sarcoidosis, 7 idiopathic fibrosis, and 5 miliary tuberculosis) were imaged after the patients inhaled 1,110 MBq of Tc 99m EL. Clearance half time for the first 45 min, for 24 h, and retention at 24 h correlated with percentage of lymphocytes in bronchoalveolar lavage fluid (BAL) (r=.729, r=.883, and r=.826, respectively). There was a positive correlation between peripheral penetration (PP) and forced expiratory volume in 1 s (FEV1) (r=.806) and forced vital capacity (FVC) (r=.781). Retention was more marked in sarcoidosis compared with tuberculosis (0.025< p≤0.05). Radioaerosol lung imaging may reflect the pulmonary function impairment in parenchymal lung diseases. Retention of Tc 99m EL may be related to number of BAL cells or presence of a lymphocytic alveolitis. Long residency time of Tc 99m EL in the lungs implies that erythromycin can also be administered by inhalation for therapeutic purposes

  14. Tuberculous endocarditis.

    Science.gov (United States)

    Liu, Alexander; Nicol, Edward; Hu, Yanmin; Coates, Anthony

    2013-08-10

    Mycobacterium tuberculosis (TB) is a major cause of death globally. TB is capable of infecting every organ in the body, and the heart is no exception. Tuberculous endocarditis (TBE) was first reported in 1892 and subsequently many other cases have been described, highlighting the significant morbidity and mortality associated with this manifestation of TB. TBE usually presents with miliary tuberculosis and most early cases were diagnosed on autopsy. With increasing application of prosthetic valve replacements in the treatment of infective endocarditis (IE), TB infections have begun to affect these as well as native valves. With the introduction of TB culture methods and drug therapy, the prognosis has improved. HIV and drug resistance are likely to make the management of TBE more difficult in the future. Large scale studies, both prospective and retrospective, are required to ascertain the true incidence of TBE whilst development of novel anti-TB therapy is also required to combat resistance. We present the first extensive literature review on TBE in over 75 years. PMID:23021600

  15. Demographic And Risk Factors Related To Military Tuberculosis

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    M. Rasolinejad

    2006-05-01

    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.

  16. Case of calcified intracranial tuberculoma presenting unique MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Kinjo, Toshihiko; Mukawa, Jiro; Miyagi, Kouichi; Takara, Eiichi; Mekaru, Susumu; Ishikawa, Yasunari

    1988-05-01

    A 41-year-old male patient was admitted in our Ryukyu University Hospital complaining of parosmia. He had a history of miliary tuberculosis 21 years ago. Neurologically he showed left anosmia and hyperreflexia of the right upper extremity. Plain skull X-P and CT scan revealed a calcified mass, 25 mm in diameter, at the left frontal base. In MRI, the mass showed isointensity using the T/sub 1/ weighted inversion recovery sequence and heterogenously low intensity using the T/sub 2/ weighted spin echo sequence. Surgery was performed by bifrontal craniotomy. Then the tumor was removed totally including two coexisting small tumors. Histologically, they consisted of calcified caseous tissue and thick collagen capsule, suggesting old calcified tuberculomas. Postoperative course was uneventful and did not result in meningitis. Antituberculous therapy of streptmycin, isoniazid and rifapicin was given for 2 weeks, started on the operative day. MRI findings were presented in detail and the guideline of antituberculous therapy to the tuberculoma was discussed.

  17. Successful Treatment of Demodex gatoi with 10% Imidacloprid/1% Moxidectin.

    Science.gov (United States)

    Short, Jeanmarie; Gram, Dunbar

    2016-01-01

    Demodex gatoi is a transmissible, short-bodied mite found in the stratum corneum of cats. It is known to cause moderate to intense pruritus, often manifested as self-induced alopecia and excoriations. 10% imidacloprid/1% moxidectin (a) is a monthly, topical solution indicated for the treatment and/or prevention of fleas, heartworms, intestinal parasites, and ear mites. A household of cats was presented for pruritus that ranged from mild to severe in 8 of the 13 felines. The most common clinical signs included miliary-type papular dermatitis and focal areas of erythema associated with alopecia. Multiple skin scrapings of each animal revealed Demodex gatoi mites in only two cats. Weekly topical administration of 10% imidacloprid/1% moxidectin was used on all cats in the household for a total of ten doses. Skin scrapings following treatment were negative, and all cats in the house improved. Based on the successful treatment of this small number of cats, weekly application of 10% imidacloprid/1% moxidectin should be considered for the clinical resolution of cats affected by D. gatoi. PMID:26606209

  18. Parameters from the community of leaf-litter frogs from Estação Ecológica Estadual Paraíso, Guapimirim, Rio de Janeiro State, southeastern Brazil

    Scientific Electronic Library Online (English)

    Carlos F.D., Rocha; Davor, Vrcibradic; Mara C., Kiefer; Carla C., Siqueira; Mauricio, Almeida-Gomes; Vitor N.T., Borges Júnior; Fábio H., Hatano; Angélica F., Fontes; Jorge A.L., Pontes; Thais, Klaion; Lívia O., Gil; Monique Van, Sluys.

    2011-12-01

    Full Text Available Estudamos a comunidade de anuros de folhiço da EstaçãoEcológica Estadual Paraíso, em Guapimirim, estado do Rio de Janeiro, no sudeste do Brasil. Combinamos três métodosde amostragem (plots, transectos e armadilhas de queda) para apresentar dados sobre a composição de espécies, riqueza,abundância rel [...] ativa e densidade. A assembleia local foi composta por 14 espécies de anuros, pertencentes a nove famílias. Haddadus binotatus, espécie de desenvolvimento direto, foi a mais abundante durante o estudo. A densidade de anuros de folhiço estimada com base na amostragem por plots foi de4,3 ind/100m². Haddadus binotatus apresentou a maior densidade (1,1 ind/100m²). Os anuros foram registrados predominantemente durante a noite. Thoropa miliaris apresentou os maiores valores de CRC (39,0 ± 10,3 mm). As menores espécies foram Euparkerella brasiliensis (16,7 ± 2,2 mm) e E. cochranae (16,0 ± 2,7mm). Rhinella ornata apresentou a maior massa corporal média (12,1 ± 7,5 g) e E. cochranae (0,4 ± 0,2 g) a menor. A massa média total foi de 938,6 g/ha. Nossos resultados corroboram com a tendência de maiores densidades de anuros de folhiço na região Neotropical quando comparado com áreas Tropicais do Velho Mundo, tendendo a serem maiores na América Central do que na América do Sul. Abstract in english We studied the leaf-litter frog community of Estação Ecológica Estadual Paraíso, in Guapimirim, Rio de Janeiro State, southeastern Brazil. Herein we combined three sampling methods (large plots, visual encounter surveys and pit-fall traps) to present data on species composition, richness, relative a [...] bundance and densities. The local assemblage of frogs associated to the leaf-litter was composed by 14 species, belonging to nine families. Haddadus binotatus, a direct-developing frog, was the most abundant species in the community. The estimated density of the local leaf-litter frog assemblage based on plot sampling was 4.3 frogs/100 m². Haddadus binotatus had the highest density (1.1 ind/100 m²). Frogs were predominantly found at night. Thoropa miliaris had the largest values of SVL (39.0 ± 10.3 mm), whereas the smallest species were Euparkerella brasiliensis (16.7 ± 2.2 mm) and E. cochranae (16.0 ± 2.7 mm). Rhinella ornata had the highest mean body mass (12.1 ± 7.5 g), and E. cochranae the lowest (0.4 ± 0.2 g). The overall frog mass was 938.6 g/ha. Our data support that higher densities of leaf-litter frogs tend to occur in the Neotropical region compared to the OldWorld tropics, tending to be higher in Central America than in South America.

  19. Parameters from the community of leaf-litter frogs from Estação Ecológica Estadual Paraíso, Guapimirim, Rio de Janeiro State, southeastern Brazil

    Directory of Open Access Journals (Sweden)

    Carlos F.D. Rocha

    2011-12-01

    Full Text Available We studied the leaf-litter frog community of Estação Ecológica Estadual Paraíso, in Guapimirim, Rio de Janeiro State, southeastern Brazil. Herein we combined three sampling methods (large plots, visual encounter surveys and pit-fall traps to present data on species composition, richness, relative abundance and densities. The local assemblage of frogs associated to the leaf-litter was composed by 14 species, belonging to nine families. Haddadus binotatus, a direct-developing frog, was the most abundant species in the community. The estimated density of the local leaf-litter frog assemblage based on plot sampling was 4.3 frogs/100 m². Haddadus binotatus had the highest density (1.1 ind/100 m². Frogs were predominantly found at night. Thoropa miliaris had the largest values of SVL (39.0 ± 10.3 mm, whereas the smallest species were Euparkerella brasiliensis (16.7 ± 2.2 mm and E. cochranae (16.0 ± 2.7 mm. Rhinella ornata had the highest mean body mass (12.1 ± 7.5 g, and E. cochranae the lowest (0.4 ± 0.2 g. The overall frog mass was 938.6 g/ha. Our data support that higher densities of leaf-litter frogs tend to occur in the Neotropical region compared to the OldWorld tropics, tending to be higher in Central America than in South America.Estudamos a comunidade de anuros de folhiço da EstaçãoEcológica Estadual Paraíso, em Guapimirim, estado do Rio de Janeiro, no sudeste do Brasil. Combinamos três métodosde amostragem (plots, transectos e armadilhas de queda para apresentar dados sobre a composição de espécies, riqueza,abundância relativa e densidade. A assembleia local foi composta por 14 espécies de anuros, pertencentes a nove famílias. Haddadus binotatus, espécie de desenvolvimento direto, foi a mais abundante durante o estudo. A densidade de anuros de folhiço estimada com base na amostragem por plots foi de4,3 ind/100m². Haddadus binotatus apresentou a maior densidade (1,1 ind/100m². Os anuros foram registrados predominantemente durante a noite. Thoropa miliaris apresentou os maiores valores de CRC (39,0 ± 10,3 mm. As menores espécies foram Euparkerella brasiliensis (16,7 ± 2,2 mm e E. cochranae (16,0 ± 2,7mm. Rhinella ornata apresentou a maior massa corporal média (12,1 ± 7,5 g e E. cochranae (0,4 ± 0,2 g a menor. A massa média total foi de 938,6 g/ha. Nossos resultados corroboram com a tendência de maiores densidades de anuros de folhiço na região Neotropical quando comparado com áreas Tropicais do Velho Mundo, tendendo a serem maiores na América Central do que na América do Sul.

  20. 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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    J.I. Aláez

    2007-08-01

    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.

  1. Unusual radiological findings of adult-onset pulmonary tuberculosis

    International Nuclear Information System (INIS)

    Usual chest radiographic findings in pulmonary tuberculosis are well described in radiologic literatures for both primary and postprimary phases of disease. During the last decade, many authors have enumerated the unusual manifestations of pulmonary tuberculosis in adult population. These unusual findings usually have been involved in the frequent failure of both radiologist and clinician to recognize that tuberculosis could be the cause of a abnormal chest radiograph in patients who are finally and surprisingly proven to have tuberculosis. Authors have evaluated 249 patients who were admitted and newly proven to have adult-onset pulmonary tuberculosis at Chung-Ang University Hospital from January, 1985 to December, 1986. Unusual findings were noted in 76 (30.5%) of the 249 patients with adult-onset pulmonary tuberculosis. These unusual findings most frequently could be seen in 3rd decades and showed no sex difference in incidence. A broad spectrum of abnormal findings including usual and unusual abnormalities were procedure by adult-onset pulmonary tuberculosis. The unusual radiographic findings were arbitrarily classified. Pleural effusion without parenchymal disease (10.0%), unusual location of infiltrate (5.6%) and atelectasis (3.2%) were relatively common. Hilar and / or mediastinal lymphnode enlargement (1.6%), cavity without parenchymal infiltrates (1.6%), septic lung-like infiltrates (1.6%), completely clear lungs (1.2%), miliary infiltrates (1.2%), fibrocalcific scar-like infiltrates (1.2%), masslike density (1.2%) and rheumatoid lung-like infiltrates (1.2%) were occasionally noted. Pneumothorax without parenchymal disease (0.4%) and bron chocutaneous fistula (0.4%) are. The recognition of these unusual findings could further improve the detection and diagnosis of adult-onset pulmonary tuberculosis

  2. Lung nodule detected by F-18 fluorodeoxyglucose positron emission tomography-computed tomography in patients with papillary thyroid cancer, negative 131I whole body scan, and undetectable serum-stimulated thyroglobulin levels: two case reports

    Science.gov (United States)

    2012-01-01

    Introduction When a pulmonary nodular lesion is detected by F-18 fluorodeoxyglucose positron emission tomography-computed tomography in a patient with post-surgical papillary thyroid carcinoma with undetectable serum-stimulated thyroglobulin levels and negative 131I whole body scan, diagnosis and management of the nodule may be confusing. Case presentation We describe two post-surgical patients with papillary thyroid carcinoma who showed pulmonary nodular lesions detected by F-18 fluorodeoxyglucose positron emission tomography-computed tomography. In both cases serum-stimulated thyroglobulin levels were undetectable and nodular lesions were not detected by 131I whole body scan. In the first case, a 64-year-old Asian woman showed one focal increased fluorodeoxyglucose uptake lesion in the right lower lobe of one of her lungs. Based on the histologic study, the pulmonary nodular lesion was diagnosed as a solitary pulmonary metastasis from papillary thyroid carcinoma. In the second case, a 59-year-old Asian woman showed a new pulmonary nodule in the right lower lobe. The computed tomography scan of her chest revealed a 9mm nodule in the anterior basal segment and another tiny nodule in the posterior basal segment of the right lower lobe. Six months later, both nodules had increased in size and miliary disseminated nodules were also seen in both lungs. Based on their histology, the pulmonary nodular lesions were considered to be primary lung adenocarcinoma. Conclusions The present cases emphasize that physicians should be cautious and make efforts for an accurate diagnosis of pulmonary nodules detected on F-18 fluorodeoxyglucose positron emission tomography-computed tomography in patients with papillary thyroid carcinoma with no evidence of metastasis such as negative 131I whole body scan and undetectable stimulated serum thyroglobulin levels. PMID:23114422

  3. Uptake of iodine-123-a-methyl-l-tyrosine (IMT) in primary bone and soft-tissue tumours

    International Nuclear Information System (INIS)

    Full text: The aim f this study was to determine the suitability of 123I-IMT for (i) visualising primary bone and soft tissue tumours, (ii) distinguishing between benign and malignant tumours and (iii) grading primary bone and soft tissue tumours. The measurement of the regional uptake of IMT provides information on the rate of amino acid transport, in rapidly growing tissues. It has been mainly studied in brain tumours. 8 patients (5 males and 3 females) and aged between 33-88yrs were recruited into the pilot study. 4 with benign bony lesions, 2 with low grade chondrosarcomas and 2 with high-grade neoplasms (one bone and one soft tissue). All underwent planar +/- SPECT imaging commencing 15 minutes post-injection of IMT and the results were compared with standard imaging studies and the histological findings. No abnormal uptake was seen in any of the 4 benign tumours, while intense uptake was seen in the 2 high-grade tumours. Presumed miliary lung metastases in one of these patients were not visualised with IMT. One of the low-grade chondrosarcomas had subtle uptake while the other was normal. Of the seven patients who had Thallium imaging, the IMT results were concordant in 6 and discordant in one with low-grade chondrosarcoma that was mildly positive on IMT and negative on thallium. IMT allows confident differentiation between high grade and low grade or benign bone or soft tissue tumours but does not appear to differentiate between benign and low-grade lesions or offer any significant advantage over conventional thallium imaging for bone and soft tissue tumours in this pilot study. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  4. Hepatobiliary tuberculosis in western India

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    Amarapurkar Deepak

    2008-04-01

    Full Text Available 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, biochemical and imaging findings and histology/microbiology were noted. Of 242 included cases, 38 patients (15.7%; age 38.1 ± 12.5 years; sex ratio 2.5:1 had HBTB, whereas 20 patients (9%; age 39.3 ± 16.3 years; sex ratio 2.1:1 had other liver diseases. Diagnosis of HBTB was based on caseating granuloma on histology (18/23 procedures, positive smear/culture for acid-fast bacilli (21/39 procedures and positive polymerase chain reaction for Mycobacterium tuberculosis (28/29 procedures when diagnostic procedures were guided by imaging results. Thirty-eight cases with HBTB were classified as follows [patients (n, (%]: (A hepatic TB [20 (52.6%]: (1 granulomatous hepatitis - 10 (26.3%, (2 liver abscesses or pseudotumors - 10 (26.3% and (3 calcified hepatic granuloma - 0 (0%; (B biliary TB [15 (39.4%]: (1 biliary strictures - 2 (5.2%, (2 gall bladder involvement - 1 (2.6% and (3 biliary obstruction due to lymph node masses - 12 (31.5%; (C mixed variety [3 (7.8%]: (1 simultaneous granulomatous hepatitis and biliary stricture - 1 (2.6% and (2 simultaneous lymph node involvement and calcified hepatic granuloma - 2 (5.2%. All the cases responded well to standard anti-tuberculosis therapy. HBTB forms an important subgroup in TB cases. It requires a combination of imaging, histological and microbiological procedures to define the diagnosis. HBTB responds well to treatment.

  5. Thoracic radiographic features of silicosis in 19 horses

    International Nuclear Information System (INIS)

    Clinical records and thoracic radiographs of 19 horses with a confirmed pathologic diagnosis of silicosis were reviewed. These horses had histories of varying degrees of chronic weight loss, exercise intolerance, and respiratory distress. At the time of presentation, two horses were asymptomatic. Ten horses were geldings and nine were female. The mean age of the 19 horses was 10.7 +/- 5.5 years. Fourteen horses were identified as being from the Monterey-Carmel Peninsula of midcoastal California. An abnormal, structured interstitial pulmonary pattern was identified on thoracic radiographs in each horse. The interstitial pulmonary changes were classified as miliary (13 horses), reticulonodular (4), or linear interstitial (2), and were best visualized dorsally and caudodorsally. In addition to the abnormal interstitial pulmonary pattern, areas of pulmonary consolidation were evident caudodorsally in seven horses. Other thoracic radiographic features included: hilar lymphadenopathy (4 horses), pleural effusion/thickening (4), cranial mediastinal lymphadenopathy (2), hyperinflation (1), and a discrete pulmonary mass (1). Necropsy findings in eight horses and results of lung biopsies in an additional five horses showed a diffuse, multifocal, granulomatous pneumonia with areas of pulmonary fibrosis. Cellular infiltrates included predominantly macrophages with intracellular and/or extracellular crystalline material, occasional lymphocytes, and giant cells. Similar cellular changes were also identified, during necropsy, in the hilar and tracheobronchial lymph nodes in each of the eight horses, although gross enlargement of the lymph nodes was present in only six horses. The radiographic and pathologic findings of these 19 horses are consistent with chronic or the accelerated forms of silicosis that are recognized in humans

  6. Tuberculous Meningitis in Children and Adults: A 10-Year Retrospective Comparative Analysis

    Science.gov (United States)

    Leca, Daniela A.; Juganariu, Gabriela; Teodor, Andra; Hurmuzache, Mihnea; Nastase, Eduard V.; Anton-Paduraru, Dana T.

    2015-01-01

    Background Tuberculous meningitis (TBM) is the most lethal form of Mycobacterium tuberculosis infection, which has a high rate of neurological complications and sequelae. Objectives Our study offers a real-world infectious disease clinic perspective, being thus representative for the clinical environment of developing countries. Methods We performed a retrospective analysis of the 127 adult and 77 pediatric cases diagnosed with TBM in the Infectious Disease Hospital of the School of Medicine of Iasi, Romania between 2004–2013. Results Definite diagnosis of TBM was established in 31% of children but in only 20% of adults (p = 0.043). A contact with an individual with pulmonary tuberculosis was documented in 30% of children vs. 13% of adults (p = 0.0007). Coma occurred in 19% of patients (similar in children and adults); other consciousness abnormalities were seen in 27% of children and in 72% of adults (p = 0.000001). Cranial nerve palsies occurred prior to therapy in 9% of cases (12% vs 7% of children and adults, respectively, p>0.05), and developed 2–7 days after treatment initiation in 10% (12 vs 9%). CSF cultures were positive for M. tuberculosis in 24% of patients (31% vs. 20%, p>0.05). Overall mortality was 7.35%, similar for children and adults. Yet, permanent neurological sequelae, which were seen in 23% of patients occurred significantly more frequent in children vs. adults (36% vs. 14%, respectively, p = 0.0121). In conclusion, our retrospective analysis on a significant number of cases of TBM identified striking differences between children and adults: while children were in an earlier stage at the admission, they associated a higher frequency of neurological sequelae and miliary pattern, and they were more likely to have normal CSF protein levels and positive cultures of CSF. PMID:26186004

  7. The clinical utility of camera-based FDG PET in patients with papillary thyroid cancers

    International Nuclear Information System (INIS)

    We evaluated the usefulness of F-18 FDG gamma camera based PET (CoDe-PET) in patients papillary thyroid cancers (PTC). Twenty patients with PTC (7 males, 13 females and mean age of 44 ranging 19-71) underwent CoDe-PET of the neck and chest using a dual-head gamma camera equipped with coincidence detection circuitry. There were two groups of patients studied. First group, 17 athyrotic patients with PTC underwent CoDe-PET for elevated thyroglobulin and negative I-131 whole body diagnostic scan after total thyroidectomy. Second group, 3 patients with PTC performed CoDe-PET preoperatively. Neck and chest images were obtained and attenuation correction was not made. CoDe-PET images were evaluated visually and compared with the anatomical images or posttherapy I-131 scans if performed. The results of CoDe-PET was positive in 10 of 17. In 3 cases, abnormal FDG uptake were histologically confirmed. One patient underwent radical neck dissection and the other two patients received I-131 ablation therapy. Of the remaining 14 patients, seven were CoDe-PET positive and the other seven were negative. A total of 11 patients received subsequent I-131 ablation therapy, in whom only three have concordant CoDe-PET results with post-therapy I-131 scans. Two with military pulmonary metastases failed to concentrate FDG but neck diseases were detected. In the 2nd group consisting of patients before total thyroidectomy, CoDe-PET detected thyroid cancers in two patients but failed in one in which the size of cancer was 0.5 cm in diameter. In the follow-up of patients with papillary thyroid cancer, CoDe-PET appears useful in detecting residual or recurrent lesions in the neck of patients with elevated serum thyroglobulin levels but negative diagnostic iodine scans. However, CoDe-PET was insensitive in detecting miliary pulmonary metastases and small lesions in the neck

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

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    Yatin N. Dholakia

    2012-01-01

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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

    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.)

  10. 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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    Félix Llanos-Tejada

    2012-03-01

    Full Text Available 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 revisaron 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.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 total 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.

  11. Pulmonary coccidioidomycosis: pictorial review of chest radiographic and CT findings.

    Science.gov (United States)

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

    2014-01-01

    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. PMID:25019431

  12. Application of photosensitive devices to bioluminescence studies

    Energy Technology Data Exchange (ETDEWEB)

    Reynolds, G.T.

    1978-01-01

    A brief review is given of some results obtained by the application of image intensification to studies of bioluminescence. The system consists of an image intensifier placed at the output of a suitable microscope, so that the image from the microscope falls on the intensifier cathode. The photon gain of the intensifier can be varied from a few thousand to one million. The output of the intensifier is recorded either on film or, in most applications to date, by means of a TV vidicon. The TV system permits display on a monitor in real time and simultaneous recording on magnetic tape for subsequent playback and analysis. It also provides time resolution for dynamic studies. Results are summarized for in vivo observations on Noctiluca miliaris, Obelia, Renilla, and Mnemiopsis leidyi. Utilization of the luminescence of aequorin in the presence of Ca/sup 2 +/ has been directed to observations on amoebae and the egg of the Medaka fish. Studies at the molecular level have been made by means of the spectral distribution of the output light. In these, the output of a fast input lens grating spectrometer is focused on the image intensifier cathode. Thus the entire visible spectrum of an in vivo bioluminescent flash can be intensified and recorded on film by photographing the output. The film is then analyzed by means of a digitized densitometer, and a computer program corrects the observed spectrum for system non-linearities and non-uniformities. In this way, the in vivo spectra of 15 bioluminescent species have been recorded.

  13. Detection of Pulmonary tuberculosis: comparing MR imaging with HRCT

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    Lauria Francesco N

    2011-09-01

    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.

  14. Múltiplos tuberculomas intracerebrais na vigência de terapia específica para tuberculose pulmonar: a propósito de um caso Intracranial tuberculomas developing during treatment of pulmonary tuberculosis: case report

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    MARIA LÚCIA VELLUTINI PIMENTEL

    2000-06-01

    Full Text Available A forma clássica de apresentação da neurotuberculose é a meningite. Os tuberculomas cerebrais são formas raras de neurotuberculose e resultam da disseminação hematogênica de focos distantes de infecção pelo Mycobacterium tuberculosis. Aproximadamente 1% dos pacientes com tuberculose do sistema nervoso central desenvolve tuberculomas intracranianos, poucas semanas ou meses após o início da quimioterapia tuberculostática. A involução das lesões é lenta e não necessariamente significa resistência medicamentosa ou falta de aderência ao tratamento. Descrevemos o caso, diagnosticado e tratado na 25ª Enfermaria da Santa Casa da Misericórdia do Rio de Janeiro, de um paciente imunocompetente que apresentou meningite e tuberculomas múltiplos do sistema nervoso central, durante o tratamento específico de tuberculose miliar. A literatura é revisada e o diagnóstico, terapêutica e possíveis mecanismos imunológicos são discutidos.The classical presentation of neurotuberculosis is meningitis. Intracranial tuberculomas are a rare manifestation of neurotuberculosis and are due to hematogenous dissemination of distant focuses of Mycobacterium tuberculosis infection. Around 1% of patients with central nervous system tuberculosis develop intracranial tuberculomas some weeks or months after the beginning of the specific treatment with tuberculostatic chemotherapy. The involution of the lesions is slow and does not mean drug resistance nor lack of adequate treatment. We describe the case, diagnosed and treated at the 25th Infirmary of Santa Casa da Misericórdia do Rio de Janeiro, of an immunocompetent male patient who developed meningitis and multiple intracranial tuberculomas during the specific treatment of miliary tuberculosis. The literature is revised and the diagnosis, treatment and possible immunological mechanisms are discussed.

  15. 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

  16. Transcriptional profiling of Mycobacterium tuberculosis replicating ex vivo in blood from HIV- and HIV+ subjects.

    Science.gov (United States)

    Ryndak, Michelle B; Singh, Krishna K; Peng, Zhengyu; Zolla-Pazner, Susan; Li, Hualin; Meng, Lu; Laal, Suman

    2014-01-01

    Hematogenous dissemination of Mycobacterium tuberculosis (M. tb) occurs during both primary and reactivated tuberculosis (TB). Although hematogenous dissemination occurs in non-HIV TB patients, in ?80% of these patients, TB manifests exclusively as pulmonary disease. In contrast, extrapulmonary, disseminated, and/or miliary TB is seen in 60-70% of HIV-infected TB patients, suggesting that hematogenous dissemination is likely more common in HIV+ patients. To understand M. tb adaptation to the blood environment during bacteremia, we have studied the transcriptome of M. tb replicating in human whole blood. To investigate if M. tb discriminates between the hematogenous environments of immunocompetent and immunodeficient individuals, we compared the M. tb transcriptional profiles during replication in blood from HIV- and HIV+ donors. Our results demonstrate that M. tb survives and replicates in blood from both HIV- and HIV+ donors and enhances its virulence/pathogenic potential in the hematogenous environment. The M. tb blood-specific transcriptome reflects suppression of dormancy, induction of cell-wall remodeling, alteration in mode of iron acquisition, potential evasion of immune surveillance, and enhanced expression of important virulence factors that drive active M. tb infection and dissemination. These changes are accentuated during bacterial replication in blood from HIV+ patients. Furthermore, the expression of ESAT-6, which participates in dissemination of M. tb from the lungs, is upregulated in M. tb growing in blood, especially during growth in blood from HIV+ patients. Preliminary experiments also demonstrate that ESAT-6 promotes HIV replication in U1 cells. These studies provide evidence, for the first time, that during bacteremia, M. tb can adapt to the blood environment by modifying its transcriptome in a manner indicative of an enhanced-virulence phenotype that favors active infection. Additionally, transcriptional modifications in HIV+ blood may further accentuate M. tb virulence and drive both M. tb and HIV infection. PMID:24755630

  17. Tuberculosis: From an incurable scourge to a curable disease - journey over a millennium

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    Surendra K Sharma

    2013-01-01

    Full Text Available Globally, tuberculosis (TB still remains a major public health problem. India is a high TB burden country contributing to 26 per cent of global TB burden. During 1944-1980, TB became treatable and short-course chemotherapy emerged as the standard of care. When TB elimination seemed possible in the early 1980s, global human immunodeficiency virus (HIV infection/acquired immunodeficiency syndrome (AIDS pandemic resulted in a resurgence of TB. Widespread occurrence of multidrug-resistant and extensively drug-resistant TB (M/XDR-TB is threatening to destabilize TB control globally. Atypical clinical presentation still poses a challenge. Disseminated, miliary and cryptic TB are being increasingly recognized. Availability of newer imaging modalities has allowed more efficient localization of lesions and use of image guided procedures has facilitated definitive diagnosis of extrapulmonary TB. Introduction of liquid culture, rapid drug-susceptibility testing (DST, molecular diagnostic methods has helped in rapid detection, speciation and DST profiling of Mycobacterium tuberculosis isolates. While treatment of TB and HIV-TB co-infection has become simpler, efforts are on to shorten the treatment duration. However, drug toxicities and drug-drug interactions still constitute a significant challenge. Recently, there has been better understanding of anti-TB drug-induced hepatotoxicity and its frequent confounding by viral hepatitis, especially, in resource-constrained settings; and immune reconstitution inflammatory syndrome (IRIS in HIV-TB. Quest for newer biomarkers for predicting a durable cure, relapse, discovery/repurposing of newer anti-TB drugs, development of newer vaccines continues to achieve the goal of eliminating TB altogether by 2050.

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

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    Susan M Pereira

    2007-09-01

    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.

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

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    Fujii, Tadashige [Shinshu Univ., Matsumoto, Nagano (Japan). School of Allied Medical Sciences; Tanaka, Masao; Koizumi, Tomonori; Kubo, Keishi

    2000-02-01

    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 PaO{sub 2} (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)

  20. Tuberculosis Frequency in Patients Taking TNF-alpha Blokers

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    Coşkun Doğan

    2012-08-01

    Full Text Available Objective: To evaluate tuberculosis frequency in patients who take tumor necrosis factor alpha (TNF-α inhibitors for Collagen Vascular Disease (CVD.Materials and Methods: Patients who actively use or were planned to use TNF-α 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-α 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-α inhibitor therapy was begun in the study although 38 were taking TNF-α 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.

  1. Radiographic findings in adult pulmonary tuberculosis

    International Nuclear Information System (INIS)

    During the period from March, 1980 to February, 1981 in the Department of Radiology, Jeonbug National University Hospital, we reviewed the radiologic findings of 879 cases newly diagnosed pulmonary tuberculosis and 56 cases diagnosed tuberculous pleural effusion without lung parenchymal lesion on initial chest P-A film in the adult (older than 16 years). The results were as follows. 1. Sex distribution of pulmonary tuberculosis was 668 cases (76%) in male, 211 cases (24%) in female, the average age 44.6, and the highest incidence in the third and sixth decade with similarity. 2. The incidence of pulmonary tuberculosis was highest in the springtime (29.5%) and its peak particularly in May. 3. Classifying the extent of pulmonary tuberculosis into minimal, moderately advanced and far advanced pulmonary tuberculosis, their ratio was 6 : 1.5 : 1 with the concrete date of 553 cases (70.8%), 136 cases (17.4%) and 92 cases (11.8%) respectively. 4. In the case of minimal pulmonary tuberculosis the location of TB-lesion incidence were right upper, left upper and both upper lobes in the ratio of 45 : 27 :28 (%) 5. The radiological findings of pulmonary tuberculosis appeared various, but the ill-defined patchy density of exudative reaction signifying an initial lesion were than the most (35%). 6. As an unusual type of tuberculosis, cavitary TB was 38 cases (4.3%), among them, in 3 cases (7.9%) there appeared air-fluid level. Miliary TB was 8 cases (0.9%), mostly abundant in the youngsters (esp. in the third decade), and female immensely outnumbered male. Tuberculoma was 10 cases (1.4%), female preceded male in the ratio of 7 : 3, and in right upper lobe in the incidence was highest (50%). 7. Without lung parenchymal lesion, the cases to have caused an tuberculous pleural effusion were 56 (6.0%), and in the years of 16 to 29 it was the most frequent with 26 cases (46.4%). 8. With complicated pulmonary tuberculosis, 78 cases (9.5%) showed to combine with other diseases. Among them pleural effusion was 14 cases (1.7%) and pneumothorax 14 cases (1.7%), which were the most frequent. 9. Spread of tuberculosis beyond the lung to other organ was 28 cases (3.1%) and frequent in female characteristically. Among them, bone and joint TB was 16 cases and the most abundant in number, in particular, spine TB was the most frequent with 10 cases (36%)

  2. Tuberculosis in children undergoing hemodialysis

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    Gargah Tahar

    2010-04-01

    Full Text Available Gargah Tahar1, Goucha-Louzir Rim2, Lakhoua Mohamed Rachid11Department of Pediatric Nephrology, 2Department of Nephrology, Charles Nicolle Hospital, Tunis, TunisiaAbstract: Tuberculosis (TB remains a public health problem in Tunisia. Its incidence is higher in immunocompromised hosts than in the general population. In children and during hemodialysis, TB is characterized by the frequency of extrapulmonary localizations and diagnostic difficulties. The aim of this retrospective study is to evaluate the incidence of TB in Tunisian children undergoing hemodialysis and to determine its clinical features as well as the results of chemotherapy.Method: This retrospective study includes seven TB children among 112 children on hemodialysis at the pediatric nephrology department in Charles Nicolle Hospital from 2002 to 2008. The diagnosis of TB was established by a combination of clinical, radiological, biochemical, microbiological, and histological examinations. Treatment with anti-TB drugs, the results of therapy, and the outcome of patients were noted.Results: There were four girls and three boys aged 10 to 16 years (mean, 13 years. They had been on hemodialysis for 2 to 5 years (mean, 3 years. Noted clinical features were weight loss and fever in five cases, chest pain in one case, cervical lymph node in one case, and spinal pain in one case. The organ systems involved were pleural in two cases, pulmonary in one case, peritoneal in one case, cervical lymphatic in one case, and spinal in one case. One patient was treated empirically with a good response. Diagnosis was made by isolation of mycobacterium TB in three cases, by specific histological signs observed in a lymph node biopsy in one case, in peritoneal biopsy in one case, and in discovertebral biopsy in one case. In the remaining patient, the clinical and radiological presentations were compatible with pulmonary TB. All patients received four anti-TB drugs: isoniazid, rifampicin, pyrazinamide, and ethambutol. One patient died with miliary TB. The other patients had favorable outcomes.Conclusions: TB in hemodialysis children has a nonspecific clinical presentation. Extrapulmonary locations are most common. Diagnosis is often difficult, but successful outcomes are possible when made at an early stage.Keywords: child, hemodialysis, tuberculosis

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

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    Herdiman T. Pohan

    2004-12-01

    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

  4. Bacillus Calmette-Guérin (BCG) infection following intravesical BCG administration as adjunctive therapy for bladder cancer: incidence, risk factors, and outcome in a single-institution series and review of the literature.

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    Pérez-Jacoiste Asín, María Asunción; Fernández-Ruiz, Mario; López-Medrano, Francisco; Lumbreras, Carlos; Tejido, Angel; San Juan, Rafael; Arrebola-Pajares, Ana; Lizasoain, Manuel; Prieto, Santiago; Aguado, José María

    2014-10-01

    Bacillus Calmette-Guérin (BCG) is the most effective intravesical immunotherapy for superficial bladder cancer. Although generally well tolerated, BCG-related infectious complications may occur following instillation. Much of the current knowledge about this complication comes from single case reports, with heterogeneous diagnostic and therapeutic approaches and no investigation on risk factors for its occurrence. We retrospectively analyzed 256 patients treated with intravesical BCG in our institution during a 6-year period, with a minimum follow-up of 6 months after the last instillation. We also conducted a comprehensive review and pooled analysis of additional cases reported in the literature since 1975. Eleven patients (4.3%) developed systemic BCG infection in our institution, with miliary tuberculosis as the most common form (6 cases). A 3-drug antituberculosis regimen was initiated in all but 1 patient, with a favorable outcome in 9/10 cases. There were no significant differences in the mean number of transurethral resections prior to the first instillation, the time interval between both procedures, the overall mean number of instillations, or the presence of underlying immunosuppression between patients with or without BCG infection. We included 282 patients in the pooled analysis (271 from the literature and 11 from our institution). Disseminated (34.4%), genitourinary (23.4%), and osteomuscular (19.9%) infections were the most common presentations of disease. Specimens for microbiologic diagnosis were obtained in 87.2% of cases, and the diagnostic performances for acid-fast staining, conventional culture, and polymerase chain reaction (PCR)-based assays were 25.3%, 40.9%, and 41.8%, respectively. Most patients (82.5%) received antituberculosis therapy for a median of 6.0 (interquartile range: 4.0-9.0) months. Patients with disseminated infection more commonly received antituberculosis therapy and adjuvant corticosteroids, whereas those with reactive arthritis were frequently treated only with nonsteroidal antiinflammatory drugs (p BCG regimen was resumed in only 2 of 36 patients with available data (5.6%), with an uneventful outcome. In the absence of an apparent predictor of the development of disseminated BCG infection after intravesical therapy, and considering the protean variety of clinical manifestations, it is essential to keep a high index of suspicion to initiate adequate therapy promptly and to evaluate carefully the risk-benefit balance of resuming intravesical BCG immunotherapy. PMID:25398060

  5. Postmortem Investigations Following Human Immunodeficiency Virus Infection

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    Andrey V. Bychkov

    2009-04-01

    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.

  6. Monsoon driven changes in phytoplankton populations in the eastern Arabian Sea as revealed by microscopy and HPLC pigment analysis

    Science.gov (United States)

    Parab, Sushma G.; Prabhu Matondkar, S. G.; Gomes, H. do R.; Goes, J. I.

    2006-12-01

    Like the rest of the Arabian Sea, the west coast of India is subject to semi-annual wind reversals associated with the monsoon cycle that result in two periods of elevated phytoplankton productivity, one during the northeast (NE) monsoon (November-February) and the other during the southwest (SW) monsoon (June-September). Although the seasonality of phytoplankton biomass in these coastal waters is well known, the abundance and composition of phytoplankton populations associated with this distinct and predictable seasonal cycle is poorly known. Here we present for the first time, the results of a study on the community structure of phytoplankton for this region, derived from HPLC pigment analysis and microscopic cell counts. Our sampling strategy allowed for large spatial and temporal coverage over regions representative of the coastal and offshore waters, and over seasons that included the NE and the SW monsoon. Monthly observations at a fixed coastal station in particular, allowed us to follow changes in phytoplankton community structure associated with the development of anoxia. Together these measurements helped establish a pattern of seasonal change of three major groups of phytoplankton: diatoms, dinoflagellates and cyanobacteria that appeared to be tightly coupled with hydrographic and chemical changes associated with the monsoonal cycle. During the SW monsoon when nitrate concentrations were high, diatoms were dominant but prymnesiophytes were present as well. By October, as nitrate fell to below detection levels and anoxic conditions began to develop on the shelf below the shallow pycnocline, both diatom and prymensiophytes declined sharply giving way to dinoflagellates. In the well oxygenated surface waters, where both nitrate and ammonium were below detection limits, pico-cyanobacterial populations became dominant. During the NE monsoon, a mixed diatom-dinoflagellate population was quickly replaced by blooms of Trichodesmium erythraeum and Noctiluca miliaris with higher amounts of zeaxanthin, β-carotene, Chl b and prasinoxanthin. Trichodesmium trichomes were noticed in the water column as early as December when nitrate concentrations became limiting. The low phytoplankton biomass and high ammonium concentrations argue that active grazing populations may be responsible for preventing diatom-dinoflagellate populations from establishing themselves to bloom proportions in the eastern Arabian Sea during the early NE monsoon. Trichodesmium continued its dominance well into May, when nutrient enrichment associated with its death and decay helped simulate the growth of both diatoms and dinoflagellates. Given that anoxic conditions are becoming more pervasive in the eastern Arabian Sea, our observations in particular, those of a shift towards dinoflagellate dominance during the development of anoxia assume particular importance.

  7. Satellite and ship studies of phytoplankton in the Northeastern Arabian during 2000—2006 period

    Science.gov (United States)

    Matondkar, S. G. P.; Dwivedi, R. M.; Parab, Sushma; Pednekar, Suraksha; Desa, E. S.; Mascarenhas, A.; Raman, Mini; Singh, S. K.

    2006-12-01

    Sequence of the images from IRS P4 / OCM satellite and extensive shipboard sampling programme are used to understand the seasonal variation of phytoplankton abundance and types in the Northeastern (NE) Arabian Sea and Lakshadweep Sea. An appreciable degree of spatial and temporal variability is observed in chlorophyll a distribution from November to April months, as well as coastal and offshore stations, indicating marked seasonality in phytoplankton distribution in NE Arabian Sea. During November month (fall intermonsoon) average chlorophyll a (Chl a) by fluorometer was (0.799 mgm^-3) and by OCM it was 0.584 mgm^-3. The higher chlorophyll a observed was due to Trichodesmium (cyanobacteria) blooms. During December the average chlorophyll a was 0.34 mgm^-3 also due to Trichodesmium filaments in water column. During January onwards winter cooling led to increase in nutrients which enhanced chlorophyll a value to 0.64 mgm^-3 due to growth of flagellates (as seen by high chlorophyll b besides chlorophyll a) in water column. February, March and April supported moderately high chlorophyll value (0. 3 to 0.5 mgm^-3) due to growth of prasinophytes (as seen by pigment prasinoxanthin) and blooms of the Noctiluca miliaris. Time series monitoring of Noctiluca bloom was also conducted using OCM based chlorophyll images in NE Arabian Sea. During February chlorophyll a retrieved by OCM was 0.3 to 0.9 mgm^-3. Pigment analysis of water samples indicated the equal important of accessory pigment like zeaxanthin, prasinoxanthin, beta-carotene. The relevance of these pigments estimated by HPLC like zeaxanthin (cyanobacteria), fucoxanthin (diatoms), peridinin (dinoflagellates) is presented and discussed. Similarly, exercise is conducted in Lakshadweep waters where Trichodesmium related peak in chlorophyll a was observed during March onwards in OCM data. The average chlorophyll a in NE Arabian Sea at surface during November was (0.726 mgm^-3), December (0.34 mgm^-3), January (0.723 mgm^-3), February (0.344 mgm^-3), March (0.963 mgm^-3) and April 0.665 mgm^-3. Similar trend was observed in primary productivity estimates. The attempt is made to work out seasonality in the productivity of the Arabian Sea using OCM derived chlorophyll and relation of enhancement in productivity due to development of winter blooms in the Arabian Sea. The environmental conditions (temperature, wind, nutrients and mixed layer depth) affecting these blooms responsible for year to year variation in bloom biomass and productivity is also presented in detail.

  8. 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)

  9. Adiaspiromicose humana. Relato de um caso tratado com cetoconazol

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    Ricardo Luiz M. Martins

    1997-12-01

    Full Text Available É descrito um caso de adiaspiromicose humana, da forma pulmonar disseminada, no qual se empregou o cetoconazol. O paciente, oriundo de Goianésia, GO, referia tosse produtiva, dispnéia e emagrecimento. Doente há dois meses, já fizera uso do esquema tríplice tuberculostático, devido a um radiograma do tórax ter acusado lesões sugestivas de tuberculose miliar. Esse tratamento não surtiu o efeito esperado, pelo que foi ele submetido a uma biópsia pulmonar a céu aberto. A medida permitiu o reconhecimento da natureza fúngica da doença. Passou-se, então, ao emprego do cetoconazol, quando o processo já completara três meses de evolução. Dois meses depois, foi o paciente novamente visto, para controle do tratamento: todas as manifestações respiratórias haviam cessado e um novo radiograma mostrou regressão completa das alterações pulmonares. Apesar disso, é discutida a eficácia do cetoconazol contra C. parvum var crescens, tendo-se em conta o fato de o microrganismo não se reproduzir no hospedeiro.A case of human disseminated pulmonary adiaspiromycosis is reported. The patient, from Goianesia, GO, was admitted to the Brasilia University Hospital, in November 1992, with wet cough, dyspnea and weight loss3/4manifestations that had appeared two months before. Prior to admission, he had been treated for a suspected miliary tuberculosis, because a chest roentgenogram had shown a diffuse reticulonodular infiltrate in both lungs. This therapy brought no improvement to the patient status. An open chest biopsy was then performed, and the microscopic examination of the lung tissue revealed the fungal nature of the disease. Ketoconazole, 400mg/day, was started and the patient discharged from the hospital. He was seen again two months later: the respiratory manifestations had disappeared and a new chest roentgenogram showed complete resolution of the pulmonary lesions. The usefulness of ketoconazole is, however, questioned, since, as there is no multiplication of the fungus in the host organism3/4adiaspiromycosis. is believed to be, usually, a self-healing disease -, the efficacy of this imidazole derivative against the agent in animal tissues remains to be confirmed.

  10. 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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    Elizabete Abrantes Nunes

    2008-10-01

    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.

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

    Scientific Electronic Library Online (English)

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

    2012-06-01

    Full Text Available 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.

  12. 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)

  13. Development of Pacing, Electrophysiology and Defibrillation in India

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    Mohan Nair

    2002-04-01

    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.

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

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    Murilo Gimenes Rodrigues

    2010-10-01

    Full Text Available 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 retrospectively. 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 neurotuberculosisOBJETIVO: 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 prognósticos 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

  15. Neurotuberculosis: Hallazgos intracraneanos en RM Neurotuberculosis: Intracranial MRI findings

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    Jorge Docampo

    2012-06-01

    Full Text Available 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 retrospectiva, 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.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 positive 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.

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

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    Mauricio L. Barreto

    2006-07-01

    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.

  17. Diagnostic Challenge: Hepatic Granulomas Associated With Portal Hypertension

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    Bita Behnava

    2006-12-01

    Full Text Available A 53-year-old man was referred to our clinic due to markedly elevated serum alkaline phosphatase (Alk-Phos and mildly elevated aspartate aminotransferase (AST and alanine aminotransferase (ALT for the past 3 years. He had no drug history. There was no pruritus, fever, fatigue, icterus, rash, weight loss, respiratory symptoms, arthropathy, diarrhea, or peripheral lymphadenopathy. Physical examination was normal. Laboratory tests showed WBC 8000/ mm3, PMN 70%, lymphocyte 25%, Hgb 13.8 g/dl, ESR in first hour 25, ALT 65 IU/Lit, AST 59 IU/Lit, Alk- Phos 780 IU/Lit, gamma glutamyltranspeptidase (GGT 800 IU/Lit, HBsAg negative, anti HBC negative, anti HCV negative, serum Albumin 4.2, g/dl serum gamma globulin 2 g/dl, antinuclear antibody (ANA negative, anti-smooth muscle (anti-sm Ab negative, anti liver kidney microsomal (anti LKM Ab negative, and anti mitochondrial (AMA Ab negative. Abdominal sonography revealed only mild splenomegaly. Magnetic resonance cholangiopancreatography (MRCP study was normal. The patient underwent liver biopsy. Examination of the specimens revealed moderate periportal interface hepatitis, moderate portal inflammation, focal necrosis, marked bridging fibrosis, lobular non-caseating granulomatousinflammation and bile ductule proliferation. Acid fast staining for TB bacilli was negative. Other laboratory results were as follows: modified histopathologic activity index (HAI grading 9, modified HAI staging 4, and combined HAI 13. Computerized topography (CT scan of thorax was performed and showed enlarged nodes of anterior and middle (pretracheal and subcarinal, mediastinal and bilateral hilar nodes. There were multiple small sized centrilobular micronodules with formation of large lobular macronodules in the upper lobes and peribronchovascular nodular thickening. Then, a high resolution CT (HRCT of the lungs, a PPD test and angiotensine converting enzyme (ACE test were performed. HRCT study showed peribronchovascular nodular thickening of interestitium and centrilobular micronodules and nodularity of the interlobular fissures. ACE level was 79 (higher than normal and induration of PPD test was 5mm.DiscussionInitially, he was referred to our clinic only due to elevation in Alk-Phos and liver aminotransferases from which he had been suffering for more than 3 years. Liver smears showed hepatic granulomas with significant fibrosis. In this case, we will discuss the causes of hepatic granulomas that are associated with significant liver fibrosis and portal hypertension.Differential Diagnosis:Primary Biliary Cirrhosis (PBC: PBC is characterized by a T-lymphocytemediated attack on small intralobular bile ducts(1. PBC typically presents in middle life and women are about ten times as commonly affected as men(2. Some of the patients are asymptomatic at the time of diagnosis; however, symptoms will appear with progression of hepatic disease over time (3. Fatigue and pruritis are the most common presenting symptoms of PBC. Jaundice is usually a lateCorrespondence:Bita Behnava MD, Infectious Disease SpecialistTel: +98 21 8898 0786Fax: +98 21 8895 8048E-mail: bita_behnava@yahoo.comHep Mon 2006; 6 (1: 37-39symptom that heralds the onset of the advanced disease (4. Physical examination may show hyperpigmentation, hepatosplenomegaly and osteopenia (5, 6. The most typical biochemical abnormality in PBC is an elevated AlkPhos. The finding of AMA seropositivity is highly sensitive (98% as a diagnostic test (2. The diagnosis of PBC should be confirmed by percutaneous liver biopsy. Also, liver biopsy is needed to determine the stage of the disease. The early stages of PBC are characterized by portal hepatitis, granulomas and bile-duct lesions. Hepatic granulomas tend to be located in portal tracts. The progressive stage of PBC is dominated by fibrosis spanning between portal tracts and also ductopenia. In addition, the inflammatory features described with early stages are often seen (7, 8, 9. The histological findings of present case can suggest PBC, but pulmonary involvement and mediastinal lymph node enlargement are not seen in PBC. Furthermore, patients with progressive lesions of PBC are usually symptomatic, but our patient was asymptomatic. Also, AMA test for this case was negative. Thus, it seems that PBC is an unlikely diagnosis.Tuberculosis:Hepatic granulomas have been described in about 90 percent of patients with miliary tuberculosis, 75 percent of cases with extra pulmonary tuberculosisand 25 percent of patients with pulmonary tuberculosis (10. Also, liver may be primarily involved (11. Most of the patients are symptomaticfor one to two years prior to time of diagnosis. Symptoms include fever, night sweats, fatigue, anorexia and weight loss(11. Rarely, may splenomegaly, ascites and symptoms of liver failure be seen (12. In miliary tuberculosis, hepatic granulomas are distributed throughout the liver parenchyma, but in other forms of hepatic tuberculosis, granulomas are characteristically located in periportal and portal areas (13, 14. Hepatic granulomas may or may not caseate and acid-fast organisms can occasionally be found within the granulomas (14. The presence of hepatic granulomas in a patient would suggest tuberculosis. In the current case; however, tuberculosis is an unlikely diagnosis for many reasons. First, there was no fever, fatigue, weight loss or respiratory symptoms in spite of severe liver damage and pulmonary involvement. Hepatic granulomas and significant liver fibrosis may be found in the end stage of tuberculous hepatitis, but bilateral hilar and mediastinal lymphadenopathy are not consistent with post primary tuberculosis. Furthermore, there were no caseation or acid bacilli in liver smears and PPD test was negative.Drugs:Many drugs have been associated with noncaseating hepatic granulomas (15. These granulomas are usually located in periportal and portal areas. Some of these drugs can be associated with progressive liver injury and subsequent cirrhosis (16. However, this patient had not received any drugs for the past 10 months.Sarcoidosis:Sarcoidosis is a multisystem granulomatous disorder of unknown etiology and is characterized by the presence of noncaseating granulomas in involved organs (17. Sarcoidosis most frequently involves lungs- in over 90 percent of patients with Sarcoidosis (18. The classic chest roentgenogram reveals bilateral hilar adenopathy. This finding may occur in combination with parenchymal infiltrates, depending upon the stage of the disease. The serum angiotensine converting enzyme level is elevated in 75 percent of untreated patients with Sarcoidosis(19. Hepatic involvement is usually silent. The clinical consequences of the liver involvement are variable ranging from asymptomatic biochemical abnormalities (usually a mildly elevated Alk-Phos and GGT to cholestatic liver disease and cirrhosis(15. These patients may present with FUO. Hepatic granulomas are characteristically well-formed and non-caseating(15. They tend to be in portal and periportal regions. Some of them heal, but leave fibrosis and scarring. A component of lobular hepatitis and portal triaditismay be present. Cirrhosis may develop because of scarring of granulomas. Similar to PBC, destruction of intralobular bile ducts may be seen (20, 21, 22.In the present case, hepatic noncaseating granulomas and significant fibrosis would suggest sarcoidosis. Granulomas of sarcoidosis are predominantly located in portal area but can be seen in lobular region. Our patient had lobular granulomas proliferation of bile ducts that was seen in this case, is not specific for PBC and can be found in sarcoidosis. In addition to this histologic feature, elevated ACE and CT scan findings (bilateral hilar and mediastinal lymph node enlargement and also pulmonary involvement can confirm the diagnosisof sarcoidosis. Although, hepatic granulomas with bile duct lesions are most often seen in PBC extrahepatic findings exclude this diagnosis. It is surprising that this case of sarcoidosis was presented to the clinician exclusively with liver enzyme abnormalities, but extensive investigation revealed a severe liver disease with pulmonary and mediastinal lymph node involvement.