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1

Lupus miliaris disseminatus faciei report of 4 cases  

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Full Text Available Lupus miliaris disseminatus faciei is an uncommon disease affecting face. Previously lupus miliaris disseminatus faciei was thought to be a tuberculid; but now it is considered as a granulomatuous variant fo acne rosacea. We report 4 cases; each having lesions on face but in 1 also on body. The cases had erythematous tiny popular lesions of varying chronicity of 4 months to 1 year. Investigations for tuberculosis were negative. Histopathology revealed tuberculoid granuloma. All patients responded to Erythromycin; except 1 required Chloroquine.

Sule R; Athavale N; Gharpuray M

1992-01-01

2

Granulomatous rosacea : is it a variant of lupus miliaris disseminatus faciei?  

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Full Text Available Granulomatous rosacea, a subtype of rosacea showing non-caseating epithelioid cell granulomas is difficult to differentiate form lupus miliaris disseminatus faciei. Although appearently similar, the clinical and pathologic features, and the natural course of both are different. The similarities and differentiation of rosacea from lupus miliaris disseminatus faciei is discussed.

Kaur S; Kanwar A; Thami G; Mohan H; Arya S

2003-01-01

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[Lupus miliaris disseminatus faciei associated with epidermal cysts].  

UK PubMed Central (United Kingdom)

Lupus miliaris disseminatus faciei (LMDF) is a chronic granulomatous disease, which tends to be located on the central part of the face. Its typical histological image is one of epithelioid granulomas with caseous necrosis. Its association with epidermal cysts has been described on few occasions in literature. We present a case of LMDF associated with epidermal cysts in a female Caucasian patient. This association suggests that the rupture of the epidermal cysts may be related to the appearance of LMDF. However, there are probably other factors that may also contribute to its pathogenesis.

Sanz-Sánchez T; Daudén E; Moreno de Vega MJ; Fraga J; García-Díez A

2005-06-01

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Lupus miliaris disseminatus faciei successfully treated with tranilast: report of two cases.  

UK PubMed Central (United Kingdom)

We report two cases of lupus miliaris disseminatus faciei (LMDF) in which oral tranilast was effective. In case 1, the patient was a 33-year-old woman who had developed pale red papules on her face, especially around her eyes and lower jaw, approximately 7 months previously. Examination of a skin biopsy specimen revealed epithelioid cell granulomas accompanied by caseous necrosis, and a diagnosis of LMDF was made. The patient was treated successively with azithromycin, roxithromycin and minocycline hydrochloride, but there was no improvement. When we tried oral tranilast therapy, flattening of the papules was observed 2 weeks after the start of treatment, and by 1 month the papules had almost disappeared. In case 2, the patient was a 39-year-old man who had broken out in erythematous papules on both upper and lower eyelids, with some accompanied by scaling, 2 years before the initial examination. Pathological specimen revealed epithelioid cell granulomas accompanied by caseous necrosis, and a diagnosis of LMDF was made. There was no improvement when treated orally with minocycline hydrochloride or doxycycline hydrochloride, and treatment was switched to oral tranilast therapy. After 1 month of treatment, the papules had almost disappeared. We concluded that oral tranilast therapy should be tried as a treatment for intractable LMDF.

Koike Y; Hatamochi A; Koyano S; Namikawa H; Hamasaki Y; Yamazaki S

2011-06-01

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Lupus miliaris disseminatus faciei successfully treated with tranilast: report of two cases.  

Science.gov (United States)

We report two cases of lupus miliaris disseminatus faciei (LMDF) in which oral tranilast was effective. In case 1, the patient was a 33-year-old woman who had developed pale red papules on her face, especially around her eyes and lower jaw, approximately 7 months previously. Examination of a skin biopsy specimen revealed epithelioid cell granulomas accompanied by caseous necrosis, and a diagnosis of LMDF was made. The patient was treated successively with azithromycin, roxithromycin and minocycline hydrochloride, but there was no improvement. When we tried oral tranilast therapy, flattening of the papules was observed 2 weeks after the start of treatment, and by 1 month the papules had almost disappeared. In case 2, the patient was a 39-year-old man who had broken out in erythematous papules on both upper and lower eyelids, with some accompanied by scaling, 2 years before the initial examination. Pathological specimen revealed epithelioid cell granulomas accompanied by caseous necrosis, and a diagnosis of LMDF was made. There was no improvement when treated orally with minocycline hydrochloride or doxycycline hydrochloride, and treatment was switched to oral tranilast therapy. After 1 month of treatment, the papules had almost disappeared. We concluded that oral tranilast therapy should be tried as a treatment for intractable LMDF. PMID:21623898

Koike, Yumi; Hatamochi, Atsushi; Koyano, Satomi; Namikawa, Hiromi; Hamasaki, Yoichiro; Yamazaki, Soji

2010-11-26

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Atypical manifestations of tinea faciei  

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

Mittal R; Jain Chanchal; Gill S; Jindal Ramesh

1996-01-01

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Tinea faciei in a newborn due to Trichophyton tonsurans.  

UK PubMed Central (United Kingdom)

We report here the first case of neonatal tinea faciei caused by Trichophyton tonsurans in mainland China. The mother of the infant had tinea corpris and tinea capitis while the father had tinea incongnito. The infections in the parents were mycologically confirmed to be due to Trichophyton tonsurans. Ttinea faciei in the infant was cured after two-week topical use of amorolfine cream. The mother ceased breastfeeding and took oral terbinafine for 4 weeks. No recurrence was observed in the infant during 12 months of follow-up.

Fu M; Ge Y; Chen W; Feng S; She X; Li X; Liu W

2013-01-01

8

Leber's miliary aneurysms.  

UK PubMed Central (United Kingdom)

Leber's disease is a form of primary retinal telangiectasia characterized by the presence of abnormalities in the retinal vasculature. It is an idiopathic, unilateral condition with male predilection. It is not associated with any other systemic or ocular disease. The disease has a very slow progression and can be complicated by vascular dilatations, neovascularizations, thromboses, retrovitreal hemorrhages, and macular changes. We present a case of Leber's miliary aneurysms in an asymptomatic 22-year-old male patient. His fundus examination showed aneurysmal dilatations with lipid exudation. Intravenous fluorescein angiography showed early and late leakage as well as capillary dropout with late hypofluorescence. In this case, the patient was treated with laser photocoagulation of the retina.

Alturkistany W; Waheeb S

2013-05-01

9

Miliary pattern in neonatal pneumonia  

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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.

Flores, J.A.M.

1988-05-01

10

Concomitant acromioclavicular and miliary tuberculosis.  

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A 48-year-old man was being treated unsuccessfully for miliary tuberculosis for 5 months until he presented with acromioclavicular joint swelling. Imaging of the shoulder revealed destruction of the acromioclavicular joint and the patient was brought to the operating theatre and underwent the excision of the distal end of the clavicle, synovectomy and drainage of the abscess. Surgery was followed by prompt clinical, functional and radiological improvement. Histopathology confirmed the diagnosis of acromioclavicular tuberculosis. Resistance to appropriate antituberculous treatment in patients with miliary tuberculosis can sometimes be a result of undiagnosed extrapulmonary site of infection. PMID:23813516

Agathangelidis, Filon; Boutsiadis, Achilleas; Fouka, Evangelia; Karataglis, Dimitrios

2013-06-21

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Recurrent pneumothoraces in miliary tuberculosis.  

Science.gov (United States)

An 18-year-old female patient with miliary tuberculosis presented with bilateral, simultaneous pneumothoraces, which were recurrent with a bronchopleural fistula. The recurrent pneumothoraces were managed with tube thoracostomy and pleurodesis. Various possible pathogenetic mechanisms of this rare complication are discussed. PMID:3227556

Chandra, K S; Prasad, A S; Prasad, C E; Murthy, K J; Srinivasulu, T

1988-10-01

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Recurrent pneumothoraces in miliary tuberculosis.  

UK PubMed Central (United Kingdom)

An 18-year-old female patient with miliary tuberculosis presented with bilateral, simultaneous pneumothoraces, which were recurrent with a bronchopleural fistula. The recurrent pneumothoraces were managed with tube thoracostomy and pleurodesis. Various possible pathogenetic mechanisms of this rare complication are discussed.

Chandra KS; Prasad AS; Prasad CE; Murthy KJ; Srinivasulu T

1988-10-01

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Erythromelanosis follicularis faciei et colli: Relationship with keratosis pilaris  

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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.

Augustine M; Jayaseelan E

2008-01-01

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Bilateral spontaneous pneumothorax in miliary tuberculosis.  

UK PubMed Central (United Kingdom)

Pneumothorax is a common complication in pulmonary tuberculosis that is usually seen with underlying cavitary lesion. However, it is uncommonly seen in patients with miliary tuberculosis. This communication describes bilateral spontaneous pneumothorax in an 18 years' old female patient having miliary tuberculosis.

Arya M; George J; Dixit R; Gupta RC; Gupta N

2011-07-01

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CLINICAL MANIFESTATIONS AND OUTCOME OF MILIARY TUBERCULOSIS  

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Full Text Available Miliary tuberculosis (TB) is due to hematogenous spread of Mycobacterium tuberculosis. Clinical manifestations are nonspecific and protean, depending on the predominant site of involvement.We evaluated the clinical manifestations of 15 patients with miliary TB. The diagnosis of miliary tuberculosis was based on the identification of miliary nodules on chest radiography and one of the three following criteria: 1) positive acid-fast bacilli smear and/or culture (14/15), 2) histopathological identification of TB histopathological granuloma (4/15), or 3) radiological and clinical improvement after anti-tuberculosis treatment (14/15). The median age (±SD) of the patients was 52.6±19.1 years. Only one patient had underlying diseases, diabetes mellitus. Three patients developed acute respiratory distress syndrome (ARDS), one of whom died during intensive care. ARDS caused by miliary TB is associated with a high fatality rate, scope remains for improvement in its management.

J. Ayatollahi

2004-01-01

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Tinea faciei caused by Trichophyton rubrum var. raubitschekii in Germany  

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

Jochen Brasch; Jens Michael Jensen

2008-01-01

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Miliary Tuberculosis: A Case Report  

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

Zhinous B. Makoo; Roshanak B. Makoo; Omid Mashrabi

2010-01-01

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[Pancytopenia: a severe complication of miliary tuberculosis].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To analyze the epidemiology, clinical features and outcome of patients with hematologic abnormalities in miliary tuberculosis. METHODS: This was a retrospective study in the pneumology department of the University hospital in Abidjan (RCI), between January 2000 and December 2009. We analyzed the medical records of patients with pancytopenia occurring in the context of miliary tuberculosis. We compared the clinical characteristics and the outcome in patients with pancytopenia versus patients without pancytopenia. RESULTS: Pancytopenia occurred in 12% of patients with miliary tuberculosis; 11 men (61%) and seven women (39%). The average age of patients was 33 years, [17-67 years]. Pancytopenia with miliary tuberculosis was frequently associated with HIV: 92.8% (P=0.0009). The clinical characteristics were: fever (88.9%), severe weight loss: 100% vs. 78.8% MT without pancytopenia (P=0.025), respiratory distress: 100% vs. 52.3% MT without pancytopenia (P=0.00032), splenomegaly: 77.8% vs. 5.30% MT without pancytopenia (P=0.0000), multiple lymph nodes: 66.7% vs. 29.5% MT without pancytopenia (P=0.0043). The occurrence of pancytopenia in military TB is associated with a bad prognosis and the outcome was unfavorable in 8.33% (P=0.00001). CONCLUSION: Patients with pancytopenia in miliary tuberculosis have a high mortality despite tuberculosis treatment.

Achi HV; Ahui BJ; Anon JC; Kouassi BA; Dje-Bi H; Kininlman H

2013-01-01

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Frequency and predictors of miliary tuberculosis in patients with miliary pulmonary nodules in South Korea: A retrospective cohort study  

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Full Text Available Abstract Background Miliary pulmonary nodules are commonly caused by various infections and cancers. We sought to identify the relative frequencies of various aetiologies and the clinical and radiographic predictors of miliary tuberculosis (TB) in patients with miliary pulmonary nodules. Methods We performed a retrospective cohort study of patients who presented with micronodules occupying more than two-thirds of the lung volume, based on computed tomography (CT) of the chest, between November 2001 and April 2007, in a tertiary referral hospital in South Korea. Results We analyzed 76 patients with miliary pulmonary nodules. Their median age was 52 years and 38 (50%) were males; 18 patients (24%) had a previous or current malignancy and five (7%) had a history of TB. The most common diagnoses of miliary nodules were miliary TB (41 patients, 54%) and miliary metastasis of malignancies (20 patients, 26%). Multivariate analysis revealed that age ?30 years, HIV infection, corticosteroid use, bronchogenic spread of lesions, and ground-glass opacities occupying >25% of total lung volume increased the probability of miliary TB. However, a history of malignancy decreased the probability of miliary TB. Conclusion Miliary TB accounted for approximately half of all causes of miliary pulmonary nodules. Young age, an immune-compromised state, and several clinical and radiographic characteristics increased the probability of miliary TB.

Jin Sang-Man; Lee Hyun; Park Eun-Ah; Lee Ho; Lee Sang-Min; Yang Seok-Chul; Yoo Chul-Gyu; Kim Young Whan; Han Sung Koo; Shim Young-Soo; Yim Jae-Joon

2008-01-01

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Case for diagnosis  

Science.gov (United States)

Childhood Granulomatous Periorificial Dermatitis is an acneiform facial rash that affects the periorificial area in children. The clinical aspectare asymptomatic 1-3 mm papules of, monomorphic, erythematous or hypopigmented in periorificial areas - mouth, nose and eyes. It's a benign and self-limited disease that heals spontaneously without scarring and specific therapy. Differential diagnoses include perioral dermatitis, granulomatous-rosacea, sarcoidosis, and lupus miliaris disseminatus faciei. We present the case of a 4-year-old boy, presenting papules in periorificials areas. Due to its low incidence and low number of publications we report the present case.

Tiengo, Adriana; Barros, Hugo Rocha; Carvalho, Daniele Bueno; de Oliveira, Gabriela Mantovanelli; Romiti, Ney

2013-01-01

 
 
 
 
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Tinea faciei and tinea capitis in a 15-day-old infant  

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A case of tinea faciei and tinea capitis in a 15-day-old male infant caused by Trichophyton tonsurans is being reported because of its rarity. This may be the youngest infant from India where source of infection was his elder brother who had black dot type of tinea capitis and incubation peri...

Mittal R; Shivali

22

Tinea faciei and tinea capitis in a 15-day-old infant  

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Full Text Available A case of tinea faciei and tinea capitis in a 15-day-old male infant caused by Trichophyton tonsurans is being reported because of its rarity. This may be the youngest infant from India where source of infection was his elder brother who had black dot type of tinea capitis and incubation period in the present case was 7 days.

Mittal R; Shivali

1996-01-01

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Gujjar lung: a disease mimicking miliary tuberculosis.  

UK PubMed Central (United Kingdom)

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

Hassan G; Qureshi W; Kadri SM; Khan GQ; Sona-Ul-Lah; Rather RA; Omer MS

2008-01-01

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Recurrent pneumothorax developing during chemotherapy in a patient with miliary tuberculosis  

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

Gupta Prem; Mehta Dinesh; Agarwal Dipti; Chand Trilok

2007-01-01

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Disseminated histoplasmosis simulating miliary tuberculosis: a case report  

International Nuclear Information System (INIS)

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

2007-04-13

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Tinea faciei due to microsporum canis in children: a survey of 46 cases in the District of Cagliari (Italy).  

UK PubMed Central (United Kingdom)

Dermatophytoses are frequent in children, but involvement of the facial skin has peculiar aspects that should be considered a separate entity: tinea faciei. Microsporum canis infection in tinea faciei has not been widely documented. To review cases of tinea faciei due to M. canis in children diagnosed at the Dermatology Clinic, University of Cagliari. Between 1990 and 2009, all children with dermatophyte infections of the facial skin were recruited for the study after parental consent. Diagnosis was made through direct microscopic and cultural examination. Age, sex, clinical form, illness duration, identified dermatophyte, source of infection, and treatment were recorded. Forty-six cases of tinea faciei due to M. canis in children aged 11 months to 15 years (29 male/17 female) were diagnosed. In 42 (91.3%) children, the illness was the result of contact with pets, and 4 (8.7%) cases resulted from contact with children affected by tinea capitis due to M. canis. Clinical manifestations were typical ringworm in 34 (74%) patients, whereas in 12 (26%) cases, atypical forms mimicking atopic dermatitis, impetigo, lupus erythematosus, and periorificial dermatitis were observed. In 18 (39%) cases, involvement of the vellus hair follicle was documented as ectothrix invasion. Topical or systemic antifungal therapy was effective in all patients. Tinea faciei shows a complex spectrum of differential diagnosis and age-related variations with respect to other superficial dermatophytosis. M. canis is the main organism responsible in children residing in Cagliari, capitol city of Sardinia, Italy. Close collaboration with veterinary and educational programs within infant communities are required for adequate prevention.

Atzori L; Aste N; Aste N; Pau M

2012-07-01

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Tinea faciei due to microsporum canis in children: a survey of 46 cases in the District of Cagliari (Italy).  

Science.gov (United States)

Dermatophytoses are frequent in children, but involvement of the facial skin has peculiar aspects that should be considered a separate entity: tinea faciei. Microsporum canis infection in tinea faciei has not been widely documented. To review cases of tinea faciei due to M. canis in children diagnosed at the Dermatology Clinic, University of Cagliari. Between 1990 and 2009, all children with dermatophyte infections of the facial skin were recruited for the study after parental consent. Diagnosis was made through direct microscopic and cultural examination. Age, sex, clinical form, illness duration, identified dermatophyte, source of infection, and treatment were recorded. Forty-six cases of tinea faciei due to M. canis in children aged 11 months to 15 years (29 male/17 female) were diagnosed. In 42 (91.3%) children, the illness was the result of contact with pets, and 4 (8.7%) cases resulted from contact with children affected by tinea capitis due to M. canis. Clinical manifestations were typical ringworm in 34 (74%) patients, whereas in 12 (26%) cases, atypical forms mimicking atopic dermatitis, impetigo, lupus erythematosus, and periorificial dermatitis were observed. In 18 (39%) cases, involvement of the vellus hair follicle was documented as ectothrix invasion. Topical or systemic antifungal therapy was effective in all patients. Tinea faciei shows a complex spectrum of differential diagnosis and age-related variations with respect to other superficial dermatophytosis. M. canis is the main organism responsible in children residing in Cagliari, capitol city of Sardinia, Italy. Close collaboration with veterinary and educational programs within infant communities are required for adequate prevention. PMID:22011084

Atzori, Laura; Aste, Natalia; Aste, Nicola; Pau, Monica

2011-10-20

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Miliary tuberculosis in Qatar : a review of 32 adult cases.  

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Full Text Available BACKGROUND: This study was conducted to define the demographic, clinical and laboratory features, methods of diagnosis and outcome, in patients with miliary tuberculosis (TB) in Qatar, and compare the findings with other reported studies. PATIENTS AND METHODS: A retrospective review of 32 cases of miliary TB treated at the Hamad Medical Corporation during a seven-year period (1992 to 1998) was undertaken. The 32 patients comprised 24 males and 8 females, and their mean age was 33.3 years. The majority (90%) were expatriates. The clinical features of the patients were similar to those of previously reported series. The most common presenting symptoms were fever, cough, night sweats, weight loss and sputum production. Fever, rales, lymphadenopathy, altered mental status and hepatomegaly were the most common signs. Chest radiograph was abnormal in 94% of patients, and showed a miliary pattern in 69%. Sputum, cerebrospinal fluid, bronchial washings, and urine smears for acid-fast bacilli were rarely positive, however, cultures for Mycobacterium tuberculosis were positive in 54.8%, 37.5%, 33%, and 25%, respectively. The diagnoses in the majority of patients were made on the basis of the clinical presentation and supported by a miliary pattern on chest radiograph. In those whom chest radiograph did not show the classic miliary pattern, transbronchial biopsy was diagnostic in 1 of 2 patients (50%), bone marrow biopsy in 5 of 11 (45%), liver biopsy in 1 of 2 (50%), and lymph node biopsy in all 7 patients (100%). Thirty patients were treated with a four-drug regimen consisting of isoniazid, rifampin, pyrazinamide, and streptomycin or ethambutol. Mortality due to miliary TB was 3%. CONCLUSION: Miliary TB is common in Qatar, especially among expatriates. Because the clinical features of the disease are nonspecific, a high index of suspicion is essential for early diagnosis in order avoid delays in therapy and poor outcome.

Alsoub H; Al Alousi F

2001-01-01

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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)

2005-01-01

30

Bronchoscopic lung biopsy for diagnosis of miliary tuberculosis  

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Full Text Available Background: Miliary tuberculosis is often treated empirically in India in the absence of a positive diagnosis based on sputum examination. We investigated the role of fiberoptic bronchoscopy for diagnosis of this disease. Methods : Records of patients undergoing fiberoptic bronchoscopy and bronchoscopic lung biopsy, and diagnosed to have miliary tuberculosis, over a four year period were evaluated. Two to four lung biopsy specimens were obtained from each patient and examined microscopically after Hematoxylin-eosin and Zeihl-Neelson staining. Results : Thirty one patients of miliary tuberculosis (19 men and 12 women) underwent fiberoptic bronchoscopy during the study period. No endobronchial abnormality was noted in any patient. Bronchoscopic lung biopsy yielded adeqaute specimen in all but one patient. Granulomatous inflammation was noted in 21 (67.7%) patients on histopathological evaluation of biopsy specimens; of them, acid-fast bacilli were demonstrated in one patient. One patient (3.2%) had normal alveolar architecture. In the other 8 patients (25.8%), nonspecific pulmonary interstitial inflammation and/or mild fibrosis were seen. Bronchial wash specimens showed acid-fast bacilli in only one patient; this patient also had granulomatous inflammation on lung biopsy. All patients tolerated bronchoscopy well and there were no procedure-related complications. Conclusion: Bronchoscopic lung biopsy is a safe procedure and an effective method of establishing diagnosis of miliary tuberculosis in a majority of patients with this disease. Bronchial washings do not provide significant additional information in this regard.

Aggarwal A; Gupta D; Joshi K; Jindal S

2005-01-01

31

[Multiple miliary osteomata cutis. Excision with "front lift" approach  

UK PubMed Central (United Kingdom)

Multiple miliary osteomata of the skin commonly occur on the face and the upper trunk of young healthy women. The mechanism of bone formation is unknown. There is no adequate therapy, which reduces or reverses the growth of osteomatas. Those tumours which are cosmetically disturbing may be excised by a small incision through the skin. For the first time we report their removal via the subcutaneous "front-lift" approach.

Senti G; Schmid MH; Burg G

2001-06-01

32

[Multiple miliary osteomata cutis. Excision with "front lift" approach].  

Science.gov (United States)

Multiple miliary osteomata of the skin commonly occur on the face and the upper trunk of young healthy women. The mechanism of bone formation is unknown. There is no adequate therapy, which reduces or reverses the growth of osteomatas. Those tumours which are cosmetically disturbing may be excised by a small incision through the skin. For the first time we report their removal via the subcutaneous "front-lift" approach. PMID:11428082

Senti, G; Schmid, M H; Burg, G

2001-06-01

33

Multidrug resistant miliary tuberculosis during infliximab therapy despite tuberculosis screening.  

UK PubMed Central (United Kingdom)

We describe an unusual case of multidrug-resistant miliary tuberculosis diagnosed 9 months after the commencement of infliximab treatment for psoriasis despite negative pretreatment tuberculosis screening, including chest X-ray and interferon-gamma release assay. After 4 months' treatment with amikacin, ethambutol, pyrazinamide and moxifloxacin, infliximab was restarted with concomitant anti-TB medications. No recurrence of tuberculosis has been detected 12 months after recommencing infliximab.

Gin A; Dolianitis C

2013-05-01

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The first case of tinea faciei caused by Trichophyton mentagrophytes var. erinacei isolated in Chile.  

UK PubMed Central (United Kingdom)

BACKGROUND: Trichophyton mentagrophytes var. erinacei is a zoophilic dermatophyte transmitted by hedgehogs which human infections manifest as highly inflammatory and pruritic eruptions. METHODS: We report a 21-year-old woman who presented with a two-week history of a pruritic scaly erythematous plaque on the nose. The patient had kept hedgehogs as pets, and one had bitten her on the tip of the nose two months prior to the appearance of the nasal lesion. RESULTS: Fungal culture from the scales on the tip of the patient's nose was compatible with T. mentagrophytes var. erinacei. The strains isolated from cultures made from samples taken from the noses and ears of the pet hedgehogs were morphologically similar to the strain isolated from the patient. Morphological identification was confirmed by sequencing the internal transcribed spacer. The lesion was diagnosed as tinea faciei, and therapy was initiated with topical and systemic terbinafine 250mg/day for eight weeks, which resulted in complete improvement. ConcLUSIONS: Trichophyton mentagrophytes var. erinacei is the most common dermatophyte isolated in hedgehogs. Usually T. mentagrophytes var. erinacei infection manifests as an extremely inflammatory and pruritic eruption that is confined to the site of contact with the hedgehog. Although the identification of T. mentagrophytes by traditional methods is possible, identification by ITS region analysis is a fast, simple, and increasingly available method. The increasing frequency of the practice of keeping exotic animals as pets has resulted in the emergence of several zoonotic diseases that can potentially be transmitted to humans.

Concha M; Nicklas C; Balcells E; Guzmán AM; Poggi H; León E; Fich F

2012-03-01

35

Sequential radiographic changes of nodules in patients with miliary pulmonary tuberculosis  

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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.

Yeon, Jae Woo; Park, Chan Sup; Bae, In Young; Kwak, Seung Min; Cho, Chul Ho; Kwon, Min Joong; Joo, Ji Soen; Chung, Won Kyun [Inha University, Songnam (Korea, Republic of). Coll. of Medicine

1998-06-01

36

Sequential radiographic changes of nodules in patients with miliary pulmonary tuberculosis  

International Nuclear Information System (INIS)

[en] 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

1998-01-01

37

High-resolution CT findings of miliary pulmonary tuberculosis  

International Nuclear Information System (INIS)

[en] This study was performed to identify the characteristic findings of miliary pulmonary tuberculosis on HRCT and to evaluated the usefulness of HRCT by comparison with chest radiographs. High resolution CT, chest radiographs and medical records were retrospectively reviewed in 10 patients with miliary pulmonary tuberculosis. We analysed the size, distribution and margin of nodules, reticular or ground-glass density, parenchymal lesion, mediastinal lymphadenopathy and pleural effusion on HRCT which were compared with chest radiographic findings. On HRCT, characteristic 1-2 mm sized sharp or ill-defined nodular densities were randomly distributed throughout both lungs in all cases. In seven cases, the nodules were evenly scattered, but slightly more in upper lung zone in two cases, and in lower in one case. Only three cases revealed somewhat large and abundant nodules in posterior lung zone. There were findings of ill-defined margin of nodules in three cases, reticular densities in three cases and ground-glass opacity in two cases, all of which were observed within 4 weeks after onset of symptom. In one case, HRCT scan revealed a micronodular pattern in the lung parenchyma, even though chest radiographs of 2 days before were not obviously abnormal. HRCT was better to evaluate the margin of nodule and distribution than chest radiographs in four cases. Focal parenchymal lesion (n = 5), pleural effusion (n = 4), mediastinal lymphadenopathy (n = 6) and ARDS (n = 1) were also associated. HRCT could suggest a more specific diagnosis of miliary pulmonary tuberculosis with the above characteristic findings in appropriate clinical setting and normal or interstitial pattern of chest radiographs

1995-01-01

38

High-resolution CT findings of miliary pulmonary tuberculosis  

Energy Technology Data Exchange (ETDEWEB)

This study was performed to identify the characteristic findings of miliary pulmonary tuberculosis on HRCT and to evaluated the usefulness of HRCT by comparison with chest radiographs. High resolution CT, chest radiographs and medical records were retrospectively reviewed in 10 patients with miliary pulmonary tuberculosis. We analysed the size, distribution and margin of nodules, reticular or ground-glass density, parenchymal lesion, mediastinal lymphadenopathy and pleural effusion on HRCT which were compared with chest radiographic findings. On HRCT, characteristic 1-2 mm sized sharp or ill-defined nodular densities were randomly distributed throughout both lungs in all cases. In seven cases, the nodules were evenly scattered, but slightly more in upper lung zone in two cases, and in lower in one case. Only three cases revealed somewhat large and abundant nodules in posterior lung zone. There were findings of ill-defined margin of nodules in three cases, reticular densities in three cases and ground-glass opacity in two cases, all of which were observed within 4 weeks after onset of symptom. In one case, HRCT scan revealed a micronodular pattern in the lung parenchyma, even though chest radiographs of 2 days before were not obviously abnormal. HRCT was better to evaluate the margin of nodule and distribution than chest radiographs in four cases. Focal parenchymal lesion (n = 5), pleural effusion (n = 4), mediastinal lymphadenopathy (n = 6) and ARDS (n = 1) were also associated. HRCT could suggest a more specific diagnosis of miliary pulmonary tuberculosis with the above characteristic findings in appropriate clinical setting and normal or interstitial pattern of chest radiographs.

Lee, Seung Hee; Kook, Shin Ho; Noh, In Gye; Jung, Kyung Jae [Kangbuk Samsung General Hospital, Seoul (Korea, Republic of)

1995-10-15

39

Study on biological characteristic of Bambusaspis miliaris (Boisduval)  

UK PubMed Central (United Kingdom)

Bambusaspis miliaris (Boisduval) is a new pest damaging the basal culm of Phyllostachys pubescens in Fujian, it has two generations per year in Sanmingzhong, Youxi region of Fujian Province. The peak period of egg-laying and incubation of the first generation is in late July, middelate August, and, those of the second generation in middle November, early-middle May of next year. Egg-laying number by a female was 7 to 165. The peak period of infestion each year occurs in early-middle may and middlelate August.

Wei Kaiju; Zhan Zuren; Wu Wangmin; Hu Yongzhen

1999-01-01

40

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

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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.

Kim, Min Jeong; Lee, Jin Seong; Ko, Yoon Seok; Lee, In Sun; Seo, Joon Beom; Song, Koun Sick; Lim, Tae Hwan [University of Ulsan College of Medicine, Seoul (Korea, Republic of)

2002-10-01

 
 
 
 
41

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

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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.)

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

42

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

International Nuclear Information System (INIS)

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

2008-01-01

43

Miliary osteoma cutis of the face: A case report  

Directory of Open Access Journals (Sweden)

Full Text Available Introduction: Miliary osteoma cutis (OC) of the face is a rare benign extra skeletal bone formation. For our knowledge, only 23 cases have been reported in the English literature. These lesions may be primary or secondary. They cause diagnostic, therapeutic and cosmetic concern especially in women who are usually concerned. Our purpose is to present a case which is completely documented with the clinical, histological and radiological findings. We also report a possible pathogenic theory according to our histologic findings.Case Report: We report a case of a multiple miliary OC of the face in a 45-year-old woman which suffered from gravidarum acne. These lesions were treated by focal surgical treatment. Conclusions: Based on our histological findings, an osteoblastic metaplasia seems to be a possible pathogenic theory. This metaplasia seems to be secondary to a chronic inflammation. Concerning therapeutic procedures, they are non consensual and debated and are based on surgical or medical treatment. More reports are needed in order to assess the therapeutic management of this disease and its inducing factors.

Saadia Bouraoui; Mona Mlika; Rim Kort; Fayka Cherif; Ahlem Lahmar; Sabeh Mzabi-Regaya

2012-01-01

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

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

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

2005-04-15

45

Skeletal scintigraphy in miliary tuberculosis: photopenia after treatment  

Energy Technology Data Exchange (ETDEWEB)

A case of miliary tuberculosis mimicking metastatic disease on bone scan is presented. The patient, a 35-year-old man, was hospitalized with fever, chills, hemoptysis, and a 23 kg weight loss over the previous 7 months. Chest radiographs revealed an apical infiltrate. Technetium-99m methylene diphosphonate bone scan revealed increased uptake not only in the lumbar spine but also in the ribs, thoracic spine and shoulder girdle, areas of which were asymptomatic. The bone scan was found to be useful in the evaluation of therapy in osseous tuberculosis. With antituberculosis therapy the bone scan abnormality generally returns to normal in 3 to 6 months, and it seems that bone scanning may play an important role in detection of unsuspected bone involvement and follow-up of patients with osseous tuberculosis.

Rust, R.J.; Park, H.M.; Robb, J.A.

1981-10-01

46

[Leber's miliary aneurysms associated with vitreomacular traction syndrome: case report].  

Science.gov (United States)

Retinal telangiectasias are idiopathic vascular abnormalities of the retina characterized by irregular dilatation of the retinal vessels, intraretinal and subretinal exudation. The aim of this article is to describe the uncommon association of Leber's miliary aneurysms and vitreomacular traction syndrome in a female patient. The diagnosis was established with angiofluoresceinography and optic coherence tomography. The patient was treated with focal photocoagulation with argon green laser directed to the perimacular aneurysms and pars plana posterior vitrectomy. The visual acuity showed great improvement after a four-month follow-up. The present report supports the importance of optic coherence tomography in cases where the vitreoretinal interface must be evaluated, including vascular pathologies, which allowed us to offer a better treatment to this patient. PMID:18157318

Násser, Luciano Sólia; Almeida, Herbert Paulo de; Zacarias, Leandro Cabral; Abujamra, Suel; Gomes, André Marcelo Vieira

47

[Leber's miliary aneurysms associated with vitreomacular traction syndrome: case report].  

UK PubMed Central (United Kingdom)

Retinal telangiectasias are idiopathic vascular abnormalities of the retina characterized by irregular dilatation of the retinal vessels, intraretinal and subretinal exudation. The aim of this article is to describe the uncommon association of Leber's miliary aneurysms and vitreomacular traction syndrome in a female patient. The diagnosis was established with angiofluoresceinography and optic coherence tomography. The patient was treated with focal photocoagulation with argon green laser directed to the perimacular aneurysms and pars plana posterior vitrectomy. The visual acuity showed great improvement after a four-month follow-up. The present report supports the importance of optic coherence tomography in cases where the vitreoretinal interface must be evaluated, including vascular pathologies, which allowed us to offer a better treatment to this patient.

Násser LS; Almeida HP; Zacarias LC; Abujamra S; Gomes AM

2007-09-01

48

Miliary tuberculosis in Qatar: A review of 32 adult cases  

International Nuclear Information System (INIS)

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

2001-01-01

49

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

UK PubMed Central (United Kingdom)

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.

Ray S; Talukdar A; Kundu S; Khanra D; Sonthalia N

2013-01-01

50

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

Directory of Open Access Journals (Sweden)

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

Ray S; Talukdar A; Kundu S; Khanra D; Sonthalia N

2013-01-01

51

Miliary nodules due to secondary pulmonary hemosiderosis in rheumatic heart disease.  

Science.gov (United States)

Pulmonary hemosiderosis is defined as the clinical and functional consequence of iron overload of the lungs, which usually occurs due to recurrent intra-alveolar bleeding. It can manifest as miliary mottling and should be entertained in the differential diagnosis of patients presenting with miliary nodules on chest radiography, especially those with mitral stenosis. The management of secondary pulmonary hemosiderosis secondary to valvular heart disease includes valvuloplasty and/or valve replacement. The radiological opacities may disappear with successful treatment of the underlying valvular disease in many patients. However, they may persist with no physiological impairment to the patient. Here, we present a 32-year-old man with mitral stenosis who presented with fever and miliary shadows on chest radiography, which was ultimately diagnosed as secondary pulmonary hemosiderosis. PMID:21390194

Agrawal, Gyanendra; Agarwal, Ritesh; Rohit, Manoj Kumar; Mahesh, Venkat; Vasishta, Rakesh Kumar

2011-02-28

52

Miliary nodules due to secondary pulmonary hemosiderosis in rheumatic heart disease  

Directory of Open Access Journals (Sweden)

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

Gyanendra Agrawal; Ritesh Agarwal; Manoj Kumar Rohit; Venkat Mahesh; Rakesh Kumar Vasishta

2011-01-01

53

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

Energy Technology Data Exchange (ETDEWEB)

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.

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

54

Coexistence of acute miliary pulmonary tuberculosis and metastatic lung adenocarcinoma: a case report.  

UK PubMed Central (United Kingdom)

A 36-year-old man complained of cough, expectoration and progressive anhelation for more than 3 months. Thoracic computed tomography (CT) showed miliary nodules diffusely distributed throughout both lungs. Acute miliary pulmonary tuberculosis (AMPT) was confirmed by sputum culture; meanwhile lung adenocarcinoma was found by sputum cytology. Subsequently, adenocarcinoma of colon was diagnosed according to PET/CT images and histopathology. Herein we report this case of coexistence of AMPT and metastatic lung adenocarcinoma, and suggest that diagnosis of pulmonary tuberculosis should be made cautiously for patients with diffusely military nodules, especially for those without symptoms alleviated after anti-tuberculous treatment.

Wang Y; Tu L; Li Z; Wang X; Luo Y; Huang C; Sun L

2013-06-01

55

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

A new 16-day echinoid early life stage (ELS) bioassay was developed to allow for prolonged observation of possible adverse effects during embryogenesis and larval development of the sea urchin Psammechinus miliaris. Subsequently, the newly developed bioassay was applied to study the effects of key m...

Anselmo, H.M.R., Drs; Koerting, L.; Devito, S.; Berg, J.H.J., van den; Dubbeldam, M.; Kwadijk, C.; Murk, A.J.

56

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

International Nuclear Information System (INIS)

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

1985-01-01

57

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

Energy Technology Data Exchange (ETDEWEB)

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

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

1985-03-01

58

Miliary brain metastasis presenting with calcification in a patient with lung cancer: a case report  

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Full Text Available Abstract Introduction Miliary brain metastasis is an extremely rare form of brain metastasis which can present with atypical imaging findings. We report the case of a patient with miliary brain metastasis of lung cancer showing calcification in metastatic lesions. Case presentation A 68-year-old Japanese woman was diagnosed with lung adenocarcinoma. Brain computed tomography revealed multiple small calcified lesions in both cerebral hemispheres. Mutation of the epidermal growth factor receptor gene (exon 21, L858R) in lung cancer cells was detected, and treatment with gefitinib was initiated. A partial response was observed; however, the patient was readmitted to our hospital because of regrowth of the primary lesion and complaints of nausea, headache, and difficulty walking. Brain magnetic resonance imaging revealed scattered tiny nodules enhanced by gadolinium. A diagnosis of leptomeningeal carcinomatosis was made on the basis of cerebrospinal fluid cytology. The patient’s general status worsened, and she died 356?days after the day of first medical examination. Upon autopsy, the brain was found to be edematous and swollen. Lung carcinoma cells were diffusely disseminated on the meningeal surface. Metastatic foci of small nodular form, accompanied by calcifications, were also found in the brain parenchyma. We diagnosed miliary metastasis of lung carcinoma. Conclusions To the best of our knowledge, this is the third report of calcified miliary brain metastasis confirmed by autopsy. We describe calcified lesions that increased in size during the clinical course of nine months. Brain computed tomography findings that reveal multiple small calcified lesions in patients with malignancy should raise suspicion of miliary brain metastasis.

Inomata Minehiko; Hayashi Ryuji; Kambara Kenta; Okazawa Seisuke; Imanishi Shingo; Ichikawa Tomomi; Suzuki Kensuke; Yamada Toru; Miwa Toshiro; Kashii Tatsuhiko; Matsui Shoko; Tobe Kazuyuki; Sasahara Masakiyo

2012-01-01

59

Miliary Pulmonary Tuberculosis That Can Be Confused with Pump-Lung Syndrome After Heart Surgery  

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Full Text Available Miliary pulmonary tuberculosis is a rare condition following open heart surgery. Tuberculosis is a more common entity in Asia and Africa. Following an increase in international travels globalizing world, the possibility of the occurrence of this entity has increased worldwide. The patient, without a history of previous tuberculosis was admitted to our department with a clinical condition that mimics heart failure. After routine laboratory tests, cardiologists and cardiovascular surgeons easily established the diagnosis of pump lung disease. The condition of patient did not respond to the treatments, untill the right diagnosis established with consultations. The patient responded to treatment following the diagnosis of miliary pulmonary tuberculosis 35 days after coronary bypass surgery, and is still on maintenance therapy.

Mehmet Be?ir Akp?nar; Ebru ?pek Türko?lu; Sevinç Sannav; Fidan Sever

2012-01-01

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Tropical pulmonary eosinophilia misdiagnosed as miliary tuberculosis: a case report and literature review.  

UK PubMed Central (United Kingdom)

Tropical pulmonary eosinophilia is prevalent in the tropical and subtropical regions of the world. It is an occult form of human filariasis and results from an exaggerated immune response to filarial parasites Wuchereria bancrofti and Brugia malayi. Tuberculosis is prevalent in our country and may mimic almost any pulmonary disease on chest skiagram. Here we describe a patient with acute chest symptoms and micro-nodular opacity over chest roentogenogram, diagnosed as miliary tuberculosis and treated accordingly. Actually he was suffering from tropical pulmonary eosinophilia and showed response to combined diethylcarbamazine and corticosteroid therapy. This case serves as a reminder that tropical pulmonary eosinophilia may be wrongly diagnosed as miliary tuberculosis if one rely solely on a chest X-ray with micronodular opacities. We also stress on early diagnosis and treatment of this condition to avoid unfavorable outcomes.

Ray S; Kundu S; Goswami M; Maitra S

2012-06-01

 
 
 
 
61

Tropical pulmonary eosinophilia misdiagnosed as miliary tuberculosis: a case report and literature review.  

Science.gov (United States)

Tropical pulmonary eosinophilia is prevalent in the tropical and subtropical regions of the world. It is an occult form of human filariasis and results from an exaggerated immune response to filarial parasites Wuchereria bancrofti and Brugia malayi. Tuberculosis is prevalent in our country and may mimic almost any pulmonary disease on chest skiagram. Here we describe a patient with acute chest symptoms and micro-nodular opacity over chest roentogenogram, diagnosed as miliary tuberculosis and treated accordingly. Actually he was suffering from tropical pulmonary eosinophilia and showed response to combined diethylcarbamazine and corticosteroid therapy. This case serves as a reminder that tropical pulmonary eosinophilia may be wrongly diagnosed as miliary tuberculosis if one rely solely on a chest X-ray with micronodular opacities. We also stress on early diagnosis and treatment of this condition to avoid unfavorable outcomes. PMID:22172479

Ray, Sayantan; Kundu, Supratip; Goswami, Manas; Maitra, Subhasis

2011-12-08

62

The form of the globiferous pedicellarial ossicles of the regular echinoid, Psammechinus miliaris Gmelin.  

UK PubMed Central (United Kingdom)

The form of the globiferous pedicellariae from Psammechinus miliaris is described. The valve ossicle resembles that of Parechinus in its triangular valve shape and open blade form, contrasting with Echinus in these features. The present study indicates that the relationship of the valve nerve pathway to the skeletal ossicle is related to the form of the distal blade. It is proposed that subterminal teeth or a tubular blade may be alternative structural devices for strengthening the venom tooth during venom injection.

Oldfield SC

1976-01-01

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Amyloid angiopathy causing widespread miliary haemorrhages within the brain evident on MRI  

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The case of a 70-year-old woman with cerebral amyloid angiopathy (CAA) is presented. MRI of the head showed widespread miliary foci of haemorrhage within the cerebrum and cerebellum, with some additional linear lesions within the cerebral cortex and patchy lesions in the white matter. This is in contrast to the more usual pattern of intracranial haemorrhage in CAA, i. e., a lobar haematoma. (orig.) With 4 figs., 17 refs.

Good, C.D.; Ng, V.W.K.; Clifton, A.; Britton, J.A. [Atkinson Morley`s Hospital, London (United Kingdom). Dept. of Neuroradiology; Hart, Y. [Department of Neurology, Atkinson Morley`s Hospital, London (United Kingdom); Wilkins, P. [Department of Neuropathology, Atkinson Morley`s Hospital, London (United Kingdom)

1998-05-01

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Amyloid angiopathy causing widespread miliary haemorrhages within the brain evident on MRI  

International Nuclear Information System (INIS)

The case of a 70-year-old woman with cerebral amyloid angiopathy (CAA) is presented. MRI of the head showed widespread miliary foci of haemorrhage within the cerebrum and cerebellum, with some additional linear lesions within the cerebral cortex and patchy lesions in the white matter. This is in contrast to the more usual pattern of intracranial haemorrhage in CAA, i. e., a lobar haematoma. (orig.).

1998-01-01

65

[A case of miliary tuberculosis and esophageal perforation secondary to tuberculous mediastinal lymphadenitis].  

UK PubMed Central (United Kingdom)

An 80-year-old woman was admitted to a local hospital following transient disturbance of consciousness after a fall. High intermittent fever developed after hospitalization and she was diagnosed as having mediastinal abscess with esophageal perforation. She underwent mediastinal drainage and surgical repair of the esophagus. Acid-fast bacilli were detected in her sputum. Chest CT scanning showed a diffuse granular shadow. Then she was diagnosed as having miliary tuberculosis and treated with combination of INH, RFP, EB, and PZA. However, five days after treatment was initiated, fever and skin eruption appeared and treatment has to be stopped after one month. Then she was referred to our hospital. We gradually increased the dosages of INH and RFP, which resulted in pyrexia. Therefore, we changed EB to SM. Fever subsided and we were able to administer the full dose of drugs from the beginning of January 2007. Thereafter, the patient improved gradually. However, she died in February 2007. At autopsy, we identified tuberculous mediastinal lymphadenitis, inflammatory granuloma under the esophageal mucosa and miliary tuberculosis. We report this case as a rare case of miliary tuberculosis and esophageal perforation secondary to tuberculous mediastinal lymphadenitis.

Ishikawa S; Yano S; Wakabayashi K; Kadowaki T; Kimura M; Kobayashi K; Ikeda T; Takeyama H

2009-04-01

66

Predictors and outcome of patients with acute respiratory distress syndrome caused by miliary tuberculosis: a retrospective study in Chongqing, China  

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Full Text Available Abstract Background Miliary tuberculosis (TB) is an uncommon cause of acute respiratory distress syndrome (ARDS) with a high mortality. The aim of the present study was to evaluate the clinical characteristics, predictors and outcome of patients with ARDS caused by miliary TB. Methods A retrospective study was conducted among patients with a diagnosis of ARDS with miliary TB in four hospitals from 2006 to 2010. Medical records and laboratory examinations of these patients were taken during the first 24 h of admission. Results Eighty-five patients with miliary TB developed ARDS, 45 of whom survived (52.9%). The median age was 36.6?±?12.5 years with 38 males (44.7%). Diabetes mellitus (DM) was the most common underlying disease (18.8%).ICU mortality was 47.1%. The time from admission to anti-tuberculosis therapy was 4.5?±?2.0 days. Mean duration of mechanical ventilation was 8.5?±?3.0 days in all patients. Duration of time to diagnosis, time from diagnosis to mechanical ventilation, and time to anti-tuberculosis therapy were significantly shorter in survivors than those in non-survivors. Diabetes mellitus (OR 5.431, 95%CI 1.471-20.049; P?=?0.005), ALT (70-100U/L, OR 10.029, 95%CI 2.764-36.389; P?=?0.001), AST (>94U/L,OR 8.034, 95%CI 2.200-29.341; P?=?0.002), D-dimer (>1.6mg/L, OR 3.167, 95%CI 0.896-11.187; P?=?0.042), hemoglobin ( Conclusions Accurate diagnosis, early initiation of anti-tuberculosis therapy and mechanical ventilation are important for the outcome of patients with ARDS caused by miliary TB. DM, ALT, AST, D-dimer, hemoglobin, and albumin are independent predictors of ARDS development in patients with miliary TB.

Deng Wang; Yu Min; Ma Hilary; Hu Liang; Chen Gang; Wang Yong; Deng Jia; Li ChangYi; Tong Jin; Wang Dao

2012-01-01

67

BCG pneumonitis with a miliary radiological pattern complicating intravesical BCG immunotherapy  

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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.

Evangelia Fouka; Nikolaos Angelis; Penelope Stefanopoulou; Nikolaos Galanis

2010-01-01

68

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

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A new 16-day echinoid early life stage (ELS) bioassay was developed to allow for prolonged observation of possible adverse effects during embryogenesis and larval development of the sea urchin Psammechinus miliaris. Subsequently, the newly developed bioassay was applied to study the effects of key marine persistent organic pollutants (POPs). Mortality, morphological abnormalities and larval development stages were quantified at specific time points during the 16-day experimental period. In contrast to amphibians and fish, P. miliaris early life development was not sensitive to dioxin-like toxicity in the prolonged early life stage test. Triclosan (TCS) levels higher than 500 nM were acutely toxic during embryo development. Morphological abnormalities were induced at concentrations higher than 50 nM hexabromocyclododecane (HBCD) and 1000 nM tetrabromobisphenol A (TBBPA). Larval development was delayed above 25 nM HBCD and 500 nM TBBPA. Heptadecafluorooctane sulfonic acid (PFOS) exposure slightly accelerated larval development at 9 days post-fertilization (dpf). However, the accelerated development was no longer observed at the end of the test period (16 dpf). The newly developed 16-day echinoid ELS bioassay proved to be sensitive to toxic effects of POPs that can be monitored for individual echinoid larvae. The most sensitive and dose related endpoint was the number of developmental penalty points. By manipulation of the housing conditions, the reproductive season could be extended from 3 to 9 months per year and the ELS experiments could be performed in artificial sea water as well. PMID:21871664

Anselmo, Henrique M R; Koerting, Lina; Devito, Sarah; van den Berg, Johannes H J; Dubbeldam, Marco; Kwadijk, Christiaan; Murk, Albertinka J

2011-08-25

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

UK PubMed Central (United Kingdom)

A new 16-day echinoid early life stage (ELS) bioassay was developed to allow for prolonged observation of possible adverse effects during embryogenesis and larval development of the sea urchin Psammechinus miliaris. Subsequently, the newly developed bioassay was applied to study the effects of key marine persistent organic pollutants (POPs). Mortality, morphological abnormalities and larval development stages were quantified at specific time points during the 16-day experimental period. In contrast to amphibians and fish, P. miliaris early life development was not sensitive to dioxin-like toxicity in the prolonged early life stage test. Triclosan (TCS) levels higher than 500 nM were acutely toxic during embryo development. Morphological abnormalities were induced at concentrations higher than 50 nM hexabromocyclododecane (HBCD) and 1000 nM tetrabromobisphenol A (TBBPA). Larval development was delayed above 25 nM HBCD and 500 nM TBBPA. Heptadecafluorooctane sulfonic acid (PFOS) exposure slightly accelerated larval development at 9 days post-fertilization (dpf). However, the accelerated development was no longer observed at the end of the test period (16 dpf). The newly developed 16-day echinoid ELS bioassay proved to be sensitive to toxic effects of POPs that can be monitored for individual echinoid larvae. The most sensitive and dose related endpoint was the number of developmental penalty points. By manipulation of the housing conditions, the reproductive season could be extended from 3 to 9 months per year and the ELS experiments could be performed in artificial sea water as well.

Anselmo HM; Koerting L; Devito S; van den Berg JH; Dubbeldam M; Kwadijk C; Murk AJ

2011-11-01

70

Development of Miliary Tuberculosis under Infliximab in a Patient with Spondyloarthritis and Suspected Crohn's Disease.  

UK PubMed Central (United Kingdom)

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

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

2013-10-01

71

Lichen amyloidosis in an unusual location.  

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We report lichen amyloidosis occurring on the upper lip and nasolabial folds of a 61-year-old woman from Singapore. She had a past history of systemic lupus erythematosus, which was in remission for three years. There had been no lesions of lupus erythematosus in this area. Clinically, the lesions were skin-coloured, firm papules and our differential diagnoses included trichoepithelioma, papular sarcoid or lupus miliaris disseminatus faciei. Skin biopsy from one of the lesions showed amyloid deposits in the dermis which were Congo red stain positive. These deposits also showed apple green birefringence. Immunohistochemical staining of the amyloid deposits stained positive for cytokeratins (CK) 5 and 6, and negative for CK 14. The kappa and lambda stains were equivocal. Further investigations, including multiple myeloma screen and rectal biopsy, ruled out systemic amyloidosis. There was no other evidence of cutaneous amyloidosis on her limbs or trunk. She refused treatment for her lesions. This case highlights the commonly-seen form of primary localised cutaneous amyloidosis in an unusual location. PMID:17538738

Jhingan, A; Lee, J S S; Kumarasinghe, S P W

2007-06-01

72

Tuberculous Otitis Media and Staphylococcus aureus Coinfection in a Five-Year-Old Boy with Miliary Tuberculosis.  

UK PubMed Central (United Kingdom)

A five-year-old boy with acute on chronic ear discharge and fever was diagnosed to have tubercular otitis media (TOM) with Staphylococcus aureus co-infection. His chest X-ray was suggestive of miliary tuberculosis. The clinical presentation of the child with a brief review of the literature pertaining to the case is being discussed in this report.

Manigandan G; Venkatesh C; Gunasekaran D; Soundararajan P

2013-01-01

73

Tuberculous Otitis Media and Staphylococcus aureus Coinfection in a Five-Year-Old Boy with Miliary Tuberculosis  

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A five-year-old boy with acute on chronic ear discharge and fever was diagnosed to have tubercular otitis media (TOM) with Staphylococcus aureus co-infection. His chest X-ray was suggestive of miliary tuberculosis. The clinical presentation of the child with a brief review of the literature pertaining to the case is being discussed in this report.

Manigandan, Gopalakrishnan; Venkatesh, Chandrasekaran; Gunasekaran, Dhandapani; Soundararajan, Palanisamy

2013-01-01

74

Tuberculosis miliar en paciente inmunocompetente como causa rara de fiebre nosocomial MILIARY TUBERCULOSIS AN UNCOMMON CAUSE OF NOSOCOMIAL FEVER IN AN IMMUNOCOMPETENT PATIENT  

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Full Text Available La tuberculosis ha disminuido su incidencia en los últimos años en Chile, siendo considerado actualmente como un país con baja incidencia de tuberculosis (A progresive decrease of tuberculosis incidence has been shown in the last years in Chile. Presently Chile is considered as a country with a low incidence of tuberculosis (< 20 cases per 10(5) inhabitants). Miliary tuberculosis is an uncommon form of tuberculosis in immunocompetent patients. Miliary tuberculosis is tipically observed in immunocompromised patients. It is an infrequent cause of nosocomial fever. We report a case of miliary tuberculosis in an immunocompetent patient, that caused intrahospitalary fever, in the course of a long term hospitalization.

Alcides Zambrano F.; Carlos Salazar P.; Christian Fontecilla M.; Eugenio Miranda M.

2004-01-01

75

Reproductive ecology and behavior of Thoropa miliaris (Spix, 1824) (Anura, Leptodactylidae, Telmatobiinae)/ Ecologia e Comportamento Reprodutivo de Thoropa miliaris (Spix, 1824) (Anura, Leptodactylidae, Telmatobiinae)  

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Full Text Available Abstract in portuguese Ecologia e Comportamento Reprodutivo de Thoropa miliaris (Spix, 1824) (Anura, Leptodactylidae, Telmatobiinae). As espécies de Thoropa estão distribuídas no sul e sudeste do Brasil e têm girinos semiterrestres em ambientes rochosos. Aqui apresentamos dados complementares sobre reprodução, cuidado paternal e canibalismo por girinos em T. miliaris. Machos guardiões foram testados quanto a perturbações às suas desovas. As desovas foram postas em faixas de umidade na (more) rocha; os ovos foram postos em camada única e estavam aderidos à superfície da rocha, raízes e uns aos outros. Os girinos eclodiram entre quatro e seis dias após a oviposição. O número de ovos em duas desovas foi 750 e 1190; os ovos eram cinza e a porção vitelínica mediu cerca de 1,7 mm em diâmetro; 2,3 mm com a cápsula gelatinosa. Foram observadas interações agressivas entre os machos. Os machos permaneceram com suas desovas durante a noite e reagiram agressivamente às perturbações experimentais. Girinos em estágios tardios foram vistos canibalizando ovos. Uma desova em uma faixa de umidade recém formada morreu por desidratação. As faixas de umidade na rocha são os únicos locais onde os ovos e os girinos podem se desenvolver e representam um fator limitante para a reprodução porque são raras. Para as fêmeas, a seleção de faixas úmidas recém formadas deve representar um balanço entre as vantagens em ocupar lugares livres de girinos canibais e/ou competidores e os riscos de perda de prole por desidratação. Nossos resultados não apóiam Cycloramphinae como um táxon válido, indicando que as similaridades morfológicas e comportamentais entre as espécies de Thoropa e Cycloramphus devem ser interpretadas como convergência. Abstract in english Thoropa species are distributed in southern and southeastern Brazil and have semiterrestrial tadpoles on rocky environments. Herein, we provide further data on reproduction, paternal care and tadpole cannibalism in T. miliaris. Guarding males were tested for disturbances in their egg masses. Egg masses were laid in stripes of wet rock; eggs were in a single layer and were adhered to the rock surface, roots, and to one another. The tadpoles hatched between four and six day (more) s. The egg number in two egg masses was 750 and 1190; eggs were gray and the yolk were about 1.7 mm in diameter; 2.3 mm with the jelly capsule. Aggressive interactions were observed between males. Males remained with their egg masses during the night and reacted aggressively to the experimental disturbances. Late stage tadpoles were found cannibalizing eggs. An egg mass in a recently formed wet stripe died from drought. The strips of wet rock are the only places where eggs and tadpoles can develop and represent a limiting factor for reproduction because they occur in short supply. For the females, the selection of newly formed wet strips may represent a trade-off between the advantages of using places free of cannibalistic and/or competitive tadpoles and the risks of losing offspring by drought. Our results do not support Cycloramphinae as a valid taxon, indicating that the morphological and behavioral similarities between Thoropa and Cycloramphus species should be interpreted as convergence.

Giaretta, Ariovaldo Antonio; Facure, Kátia Gomes

2004-01-01

76

Specific synovitis of a knee as the first manifestation of miliary tuberculosis.  

UK PubMed Central (United Kingdom)

Tuberculosis (TB) is declared global emergency. Miliary TB is a treatable, potentially lethal form of TB resulting from massive lympho-hematogenous dissemination of Mycobacterium tuberculosis. Impaired cell-mediated immunity underlies the disease's development. We present a case of specific synovitis in a 21-year-old Caucasian HIV-seronegative woman. She presented with high fever and swelling of the right knee. Chest radiograph revealed bilateral nodular opacities in upper pulmonary lobes and signs of pleural effusions. Sputum samples were negative for Acid Fast Bacilli (AFB) and Löwenstein-Jensen (L-J) culture negative. Diagnosis was confirmed histologically by pleural biopsy and positive L-J cultures of knee puncture, also documented by MRI. Treatment outcome was successful with anti-tuberculous drugs following standardized treatment regimen.

Adzic T; Pesu D; Stojsic J; Nagorni-Obradovi L; Stevi R

2008-07-01

77

Specific synovitis of a knee as the first manifestation of miliary tuberculosis.  

Science.gov (United States)

Tuberculosis (TB) is declared global emergency. Miliary TB is a treatable, potentially lethal form of TB resulting from massive lympho-hematogenous dissemination of Mycobacterium tuberculosis. Impaired cell-mediated immunity underlies the disease's development. We present a case of specific synovitis in a 21-year-old Caucasian HIV-seronegative woman. She presented with high fever and swelling of the right knee. Chest radiograph revealed bilateral nodular opacities in upper pulmonary lobes and signs of pleural effusions. Sputum samples were negative for Acid Fast Bacilli (AFB) and Löwenstein-Jensen (L-J) culture negative. Diagnosis was confirmed histologically by pleural biopsy and positive L-J cultures of knee puncture, also documented by MRI. Treatment outcome was successful with anti-tuberculous drugs following standardized treatment regimen. PMID:18998328

Adzic, Tatjana; Pesu, Dragica; Stojsic, Jelena; Nagorni-Obradovi, Ljudmila; Stevi, Ruza

78

Miliary pattern due to occupational lung disease in a patient with laryngeal cancer.  

UK PubMed Central (United Kingdom)

Inhalation of metal dusts and fumes can induce a wide range of respiratory disorders, including granulomatosis, chemical pneumonitis and pulmonary interstitial disease. Laryngeal cancer is the most common cancer of the upper aerodigestive tract. We present a patient with occupational lung disease whose chest CT showed miliary nodular pattern, with concurrent laryngeal cancer who had been engaged in type printing for 22 years. Histology of the laryngeal lession showed squamous cell laryngeal cancer. Histology of the nodules showed a foreign body granulomatous response with several foreign body cells, most probably due to exposure to numerous inorganic (lanthanides, elements such us La, Ce, Nd, Sm, EU, Tb, Lu) and organic particles (such us acrylates, epoxy- and urethane-acrylates).

Sampsonas E; Kaparianos A; Tzelepi V; Zolota V; Karkoulias K; Tsiamita M; Mastronikolis N; Spiropoulos K

2010-01-01

79

[Miliary tuberculosis of the liver as a cause of septic shock with multi-organ failure  

UK PubMed Central (United Kingdom)

A woman aged 63 presented with septic fever, followed by hepatocellular jaundice. Viral hepatitis was ruled out by serologic tests, but no definite diagnosis could be made. Due to severe disturbance of the plasmatic coagulatory system and a serum bilirubin level above 4 mg/dl, a liver biopsy was not performed. The patient had a persistent septicemia refractory to Imipenem. In spite of intensive care measures, the patient died of disseminated intravascular coagulation and multiorgan failure caused by septic shock. The correct diagnosis of miliary tuberculosis was made only post mortem by histopathological examination of liver specimens and confirmed by detection of Mycobacterium tuberculosis DNA in the patient's liver by polymerase chain reaction.

Mandak M; Kerbl U; Kleinert R; Höfler G; Zeichen R; Denk H

1994-01-01

80

[Miliary tuberculosis of the liver as a cause of septic shock with multi-organ failure].  

Science.gov (United States)

A woman aged 63 presented with septic fever, followed by hepatocellular jaundice. Viral hepatitis was ruled out by serologic tests, but no definite diagnosis could be made. Due to severe disturbance of the plasmatic coagulatory system and a serum bilirubin level above 4 mg/dl, a liver biopsy was not performed. The patient had a persistent septicemia refractory to Imipenem. In spite of intensive care measures, the patient died of disseminated intravascular coagulation and multiorgan failure caused by septic shock. The correct diagnosis of miliary tuberculosis was made only post mortem by histopathological examination of liver specimens and confirmed by detection of Mycobacterium tuberculosis DNA in the patient's liver by polymerase chain reaction. PMID:8165813

Mandak, M; Kerbl, U; Kleinert, R; Höfler, G; Zeichen, R; Denk, H

1994-01-01

 
 
 
 
81

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.  

UK PubMed Central (United Kingdom)

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.

Lal M; Dutt D; Tyagi CH

2012-04-01

82

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

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

Milenkovi? Branislava; Dudvarski-Ili? Aleksandra; Jankovi? Goran; Martinovi? Lena; Mija? Dragana

2011-01-01

83

Loss of vision and renal function in a patient with miliary tuberculosis.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Visual loss is a rare complication of tuberculosis; it can be related to anti-tuberculous drugs or to the infection itself. For the treatment of visual loss, differential diagnosis is important between infection and adverse effect of anti-tuberculous drugs. CASE: A 48-year-old male patient with a history of tuberculosis and visual loss during anti-tuberculous drug therapy was admitted to our hospital. Anti-tuberculous drugs had been stopped on the 2nd day of therapy due to development of optic neuritis secondary to ethambutol administration at another hospital. He had miliary tuberculosis, renal failure requiring dialysis and visual disturbances. Anti-tuberculous drugs, including ethambutol, were initiated at our clinic because the period between the ethambutol therapy and visual loss was too short and the dose of ethambutol was not very high. Computed brain tomography was normal. Fundoscopic examination revealed only hypertensive retinopathy. Our diagnosis was tuberculosis-related visual loss, which could be due to neuroretinitis, intraocular tuberculosis or chiasmal tuberculoma. In addition, ethambutol rarely causes visual loss during the early period or when given at lower doses. In our case no complications developed from the treatment and the patient's visual loss and renal function improved. At his last visit, 12 months later, his vision had improved and his serum creatinine was lower, at 2.2 mg/dL. CONCLUSION: With anti-tuberculous treatment, renal functions and visual disturbances were improved in a patient with miliary tuberculosis. During the anti-tuberculous therapy, visual loss can be related to ethambutol toxicity or the tuberculosis infection itself. Differential diagnosis is very important and anti-tuberculous drugs must be continued if the diagnosis is tuberculosis.

Balal M; Paydas S; Seyrek N; Karayaylali I

2005-03-01

84

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

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

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

1997-10-01

85

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

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

Swaminathan S; Padmapriyadarsini C; Ponnuraja C; Sumathi C; Rajasekaran S; Amerandran V; Reddy MVK; Deivanayagam C

2007-01-01

86

Isoniazid- and streptomycin-resistant miliary tuberculosis complicated by intracranial tuberculoma in a Japanese infant.  

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In Japan, the incidence of severe pediatric tuberculosis (TB) has decreased dramatically in recent years. However, children in Japan can still have considerable opportunities to contract TB infection from adult TB patients living nearby, and infants infected with TB may develop severe disseminated disease. A 3-month-old girl was admitted to our hospital with dyspnea and poor feeding. After admission, miliary TB and multiple brain tuberculomas were diagnosed. Anti-tuberculous therapy was initiated with streptomycin (SM), isoniazid (INH), rifampicin and pyrazinamide. Symptoms persisted after starting the initial treatment and mycobacterial cultures of gastric fluid remained positive. Drug sensitivity testing revealed the TB strain isolated on admission as completely resistant to INH and SM. Treatments with INH and SM were therefore stopped, and treatment with ethambutol and ethionamide was started in addition to rifampicin and pyrazinamide. After this change to the treatment regimen, symptoms and laboratory data gradually improved. The patient was treated with these four drugs for 18 months, and then pyrazinamide was stopped. After another 2 months, ethambutol was stopped. Treatment of tuberculosis was completed in 24 months. No adverse effects of these anti-TB drugs were observed. The patient achieved a full recovery without any sequelae. On the other hand, the infectious source for this patient remained unidentified, despite the extensive contact investigations. The incidence of drug-resistant TB is increasing in many areas of the world. Continuous monitoring for pediatric patients with drug-resistant TB is therefore needed. PMID:23470647

Ishiwada, Naruhiko; Tokunaga, Osamu; Nagasawa, Koo; Ichimoto, Keiko; Kinoshita, Kaori; Hishiki, Haruka; Kohno, Yoichi

2013-01-01

87

Isoniazid- and streptomycin-resistant miliary tuberculosis complicated by intracranial tuberculoma in a Japanese infant.  

UK PubMed Central (United Kingdom)

In Japan, the incidence of severe pediatric tuberculosis (TB) has decreased dramatically in recent years. However, children in Japan can still have considerable opportunities to contract TB infection from adult TB patients living nearby, and infants infected with TB may develop severe disseminated disease. A 3-month-old girl was admitted to our hospital with dyspnea and poor feeding. After admission, miliary TB and multiple brain tuberculomas were diagnosed. Anti-tuberculous therapy was initiated with streptomycin (SM), isoniazid (INH), rifampicin and pyrazinamide. Symptoms persisted after starting the initial treatment and mycobacterial cultures of gastric fluid remained positive. Drug sensitivity testing revealed the TB strain isolated on admission as completely resistant to INH and SM. Treatments with INH and SM were therefore stopped, and treatment with ethambutol and ethionamide was started in addition to rifampicin and pyrazinamide. After this change to the treatment regimen, symptoms and laboratory data gradually improved. The patient was treated with these four drugs for 18 months, and then pyrazinamide was stopped. After another 2 months, ethambutol was stopped. Treatment of tuberculosis was completed in 24 months. No adverse effects of these anti-TB drugs were observed. The patient achieved a full recovery without any sequelae. On the other hand, the infectious source for this patient remained unidentified, despite the extensive contact investigations. The incidence of drug-resistant TB is increasing in many areas of the world. Continuous monitoring for pediatric patients with drug-resistant TB is therefore needed.

Ishiwada N; Tokunaga O; Nagasawa K; Ichimoto K; Kinoshita K; Hishiki H; Kohno Y

2013-01-01

88

Frequent EGFR mutations in nonsmall cell lung cancer presenting with miliary intrapulmonary carcinomatosis.  

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Nonsmall cell lung cancer (NSCLC) presenting with miliary intrapulmonary carcinomatosis (MIPC) is rare. We investigated the clinical characteristics and epidermal growth factor receptor (EGFR) mutation rate of NSCLC patients with MIPC at initial diagnosis. From June 2004 to December 2008, we screened newly diagnosed NSCLC patients for MIPC using image-based criteria. We recorded clinical data and analysed EGFR mutation status. For comparison, we collected specimens from stage IV NSCLC patients without MIPC tested for EGFR mutations from April 2001 to November 2008. From 3,612 NSCLC patients, 85 patients with MIPC at initial diagnosis were identified; 81 had adenocarcinoma. Of the 85 patients, 60 had specimen sequencing to detect EGFR mutation; 42 (70%) were positive. Compared with 673 stage IV patients without MIPC, patients with MIPC had higher EGFR mutation rate (p=0.036); even male smokers had a high EGFR mutation rate (91%). Multivariate analysis of prognostic factors for overall survival of the 85 patients with MIPC revealed that adenocarcinoma, absence of extrapulmonary metastasis and having EGFR mutation were associated with longer overall survival. NSCLC patients with MIPC at initial diagnosis had higher rates of adenocarcinoma and EGFR mutation. EGFR tyrosine kinase inhibition may be the treatment of choice for NSCLC patients with MIPC at initial diagnosis among Asians.

Wu SG; Hu FC; Chang YL; Lee YC; Yu CJ; Chang YC; Wu JY; Shih JY; Yang PC

2013-02-01

89

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

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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.

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

2012-01-01

90

Diagnostic usefulness of a T-cell-based assay in patients with miliary tuberculosis compared with those with lymph node tuberculosis.  

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Forty-three patients with miliary tuberculosis were evaluated for diagnostic usefulness of enzyme-linked immunospot (ELISPOT) assay. Among noninvasive rapid tests available within 3-5 days, ELISPOT had the highest sensitivity (93%), compared with acid-fast bacilli stain (sputum, 32% and bronchoalveolar lavage, 7%), Mycobacterium tuberculosis polymerase chain reaction (sputum, 53% and bronchoalveolar lavage, 36%), and tuberculin skin test (22%). In comparison with 44 patients with lymph node tuberculosis, the sensitivity of the ELISPOT assay in patients with miliary tuberculosis (93%) was as high as in those with lymph node tuberculosis (95%, P = .63), whereas the sensitivity of the tuberculin skin test was substantially lower in patients with miliary tuberculosis (22%) than in those with lymph node tuberculosis (73%, P < .001).

Lee YM; Park KH; Kim SM; Park SJ; Lee SO; Choi SH; Kim YS; Woo JH; Kim SH

2013-01-01

91

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

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Full Text Available Abstract in english 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.

Gióia, I.; Lima, R. S.

1983-01-01

92

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

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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.

I. Gióia; R. S. Lima

1983-01-01

93

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

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Full Text Available Abstract in spanish La tuberculosis sin tratamiento en mujeres gestantes es un riesgo definido para la transmisión de la enfermedad al recién nacido y para resultados adversos, obstétricos y perinatales. La tuberculosis en mujeres gestantes y la tuberculosis congénita son afecciones infrecuentes y de difícil 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 man (more) ifestaciones en el puerperio inmediato, diagnóstico en el segundo mes del puerperio y desenlace fatal. Además, se presenta el caso de su hijo prematuro con manifestaciones desde el nacimiento, evidencia de complejo pulmonar primario, atelectasia persistente por obstrucción bronquial por las adenopatías e infección por citomegalovirus; recibió tratamiento estándar con mejoría. Abstract in english Untreated tuberculosis during pregnancy presents a serious risk for transmission of disease to the newborn and can result in adverse perinatal and obstetrical outcomes. Tuberculosis during pregnancy and congenital tuberculosis are infrequent conditions and are difficult to diagnose due the non-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 (more) 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.

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

2007-12-01

94

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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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 ...

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

95

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

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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.

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

2013-01-01

96

[Lupus erythematosus disseminatus and Pneumocystis carinii pneumonia  

UK PubMed Central (United Kingdom)

We report a 49 years old woman with systemic lupus erythematosus and a WHO type IV nephropathy, treated with prednisone 1 mg/kg/day po and cyclophosphamide 1 g/month iv. After two months in this treatment schedule, she presented with an acute pneumonia; broncoalveolar lavage and lung biopsy disclosed the presence of Pneumocystis carinii. She was treated with trimethoprim-sulfamethoxazole 960 mg tid with a favorable response. Opportunistic infections are frequent in lupus erythematosus and Pneumocystis carinii pneumonia has been recently reported in this disease. The changes in immune response and the adverse effects of drugs used in its treatment may explain the increased susceptibility of these patients to infections by Pneumocystis carinii.

Wainstein E; Neira O; Guzmán L

1993-12-01

97

Sex-specific biochemical and histological differences in gonads of sea urchins (Psammechinus miliaris) and their response to phenanthrene exposure.  

UK PubMed Central (United Kingdom)

Female and male individuals of the same species often differ with respect to their susceptibility to toxicant stress. In the present study, sea urchins (Psammechinus miliaris) of both sexes were exposed to high (150 ?g L?¹) and environmentally relevant (5 ?g L?¹) concentrations of phenanthrene over 10 days. While food intake was significantly decreased following exposure to 150 ?g L?¹ phenanthrene, histological indices (lipofuscin accumulation, fibrosis, oocyte atresia), energetic status (energy charge, sum adenylates, AMP/ATP ratio) as well as ascorbate levels in the gonads showed either little or no effect upon phenanthrene exposure. However, most parameters (vitamin C, energy charge, sum adenylates, AMP/ATP ratio, ATP and ADP concentrations, lipofuscin content, fibrosis) significantly differed between male and female animals. This study illustrates the difficulties to identify toxic injury in reproductive tissue as it may be superimposed by gametogenesis and spawning of gametes.

Schäfer S; Abele D; Weihe E; Köhler A

2011-02-01

98

[A case of miliary tuberculosis complicated by disseminated intravascular coagulation and acute respiratory distress syndrome successfully treated with recombinant human soluble thrombomodulin].  

Science.gov (United States)

A 67-year-old woman was referred to our hospital for persistent fever and dyspnea. Chest X-ray revealed diffuse reticulonodular shadows and high-resolution computed tomography showed randomly distributed small nodules. Examination of sputum and urine revealed acid-fast bacilli, which were later confirmed as Mycobacterium tuberculosis sensitive to all drugs. Laboratory tests revealed thrombocytopenia, an elevated concentration of fibrin degradation products, and severe hypoxemia. We therefore diagnosed her with miliary tuberculosis complicated by acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulation (DIC). After admission, her status rapidly worsened and she required mechanical ventilation. Treatment with recombinant human soluble thrombomodulin (rTM) and high-dose methylprednisolone was started in addition to the antituberculosis chemotherapy. The patient's condition gradually improved and she was weaned from ventilation on day 30. She was discharged on day 92. It is generally thought that prognosis of miliary tuberculosis complicated by DIC and ARDS is very poor. A recent report suggested that rTM is effective for DIC and ARDS secondary to sepsis. This is the first report of miliary tuberculosis complicated by DIC and ARDS successfully treated with rTM. PMID:23350518

Shiraishi, Sachiko; Futami, Shinji; Kurahara, Yu; Tsuyuguchi, Kazunari; Hayashi, Seiji; Suzuki, Katsuhiro

2012-12-01

99

[A case of miliary tuberculosis complicated by disseminated intravascular coagulation and acute respiratory distress syndrome successfully treated with recombinant human soluble thrombomodulin].  

UK PubMed Central (United Kingdom)

A 67-year-old woman was referred to our hospital for persistent fever and dyspnea. Chest X-ray revealed diffuse reticulonodular shadows and high-resolution computed tomography showed randomly distributed small nodules. Examination of sputum and urine revealed acid-fast bacilli, which were later confirmed as Mycobacterium tuberculosis sensitive to all drugs. Laboratory tests revealed thrombocytopenia, an elevated concentration of fibrin degradation products, and severe hypoxemia. We therefore diagnosed her with miliary tuberculosis complicated by acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulation (DIC). After admission, her status rapidly worsened and she required mechanical ventilation. Treatment with recombinant human soluble thrombomodulin (rTM) and high-dose methylprednisolone was started in addition to the antituberculosis chemotherapy. The patient's condition gradually improved and she was weaned from ventilation on day 30. She was discharged on day 92. It is generally thought that prognosis of miliary tuberculosis complicated by DIC and ARDS is very poor. A recent report suggested that rTM is effective for DIC and ARDS secondary to sepsis. This is the first report of miliary tuberculosis complicated by DIC and ARDS successfully treated with rTM.

Shiraishi S; Futami S; Kurahara Y; Tsuyuguchi K; Hayashi S; Suzuki K

2012-12-01

100

High resolution CT of the lungs in acute disseminated tuberculosis and a pediatric radiology perspectice of the term 'miliary'  

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High resolution CT (HRCT) of the lungs in six children with acute disseminated tuberculosis was evaluated. There was a wide variation in the HRCT appearances. This covered differences in size, distribution and concentration of nodular opacities. Coalescence of nodules and the presence of intestitial thickening was variable. The recognition of acute disseminated tuberculosis is important for diagnosis and has prognostic implications. The use of the term 'acute disseminated tuberculosis' rather than 'miliary tuberculosis' is advocated. (orig.)

Jamieson, D.H. (Dept. of Radiology, Red Cross War Memorial Children' s Hospital, Univ. of Cape Town, Rondebosch (South Africa)); Cremin, B.J. (Dept. of Radiology, Red Cross War Memorial Children' s Hospital, Univ. of Cape Town, Rondebosch (South Africa))

1993-09-01

 
 
 
 
101

[Serious course of a miliary tuberculosis in a 34-year-old patient with ulcerative colitis and HIV infection under concomitant therapy with infliximab].  

UK PubMed Central (United Kingdom)

A 34-year-old HIV-positive patient with ulcerative colitis was transferred to the authors' hospital because of progressive worsening of his general condition with intermittent fever, increasing lymphopenia, anemia, thrombopenia and neutropenia under anti-tumor necrosis factor-(TNF-)alpha therapy with infliximab. In spite of negative screening tests before initiation of infliximab therapy and intermittent tests during treatment, miliary tuberculosis was finally diagnosed and a tuberculostatic therapy was started. The patient's clinical condition worsened due to the development of a serious exudative necrotizing pancreatitis which was likely to be caused by the tuberculostatic treatment. Due to severe pulmonary infiltrates and pleural effusions with respiratory failure the patient finally passed away.

Zeitz J; Huber M; Rogler G

2010-04-01

102

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

UK PubMed Central (United Kingdom)

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.

Neonakis IK; Alexandrakis MG; Gitti Z; Tsirakis G; Krambovitis E; Spandidos DA

2008-01-01

103

Aneurisma miliar de Leber associado à síndrome de tração vítreomacular: relato de caso/ Leber's miliary aneurysms associated with vitreomacular traction syndrome: case report  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese Telangiectasias retinianas são anormalidades vasculares primárias e idiopáticas caracterizadas por dilatações irregulares e incompetência dos vasos retinianos com variados graus de exsudação intra e sub-retiniana. O objetivo desse relato é documentar uma rara associação entre aneurisma miliar de Leber e síndrome de tração vítreomacular bem caracterizada à angiofluoresceinografia e tomografia de coerência óptica. O tratamento realizado foi fotocoagulaçã (more) o com laser de argônio nos aneurismas perimaculares e cirurgia de vitrectomia posterior via pars plana, o que resultou em melhora consistente da acuidade visual. O caso relatado confirma a importância da tomografia de coerência óptica em estudar a interface vítreorretiniana e suas alterações, o que permitiu abordagem completa da doença em questão. Abstract in english Retinal telangiectasias are idiopatic vascular abnormalities of the retina characterizad by irregular dilatation of the retinal vessels, intraretinal and subretinal exsudation. The aim of this article is to describe the uncommon association of Leber's miliary aneurysms and vitreomacular traction syndrome in a female patient. The diagnosis was established with angiofluoresceinography and optic coherence tomography. The patient was treated with focal photocoagulation with a (more) rgon green laser directed to the perimacular aneurysms and pars plana posterior vitrectomy. The visual acuity showed great improvement after a four-month follow-up. The present report supports the importance of optic coherence tomography in cases where the vitreoretinal interface must be evaluated, including vascular pathologies, which allowed us to offer a better treatment to this patient.

Násser, Luciano Sólia; Almeida, Herbert Paulo de; Zacarias, Leandro Cabral; Abujamra, Suel; Gomes, André Marcelo Vieira

2007-10-01

104

Aneurisma miliar de Leber associado à síndrome de tração vítreomacular: relato de caso Leber's miliary aneurysms associated with vitreomacular traction syndrome: case report  

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Full Text Available Telangiectasias retinianas são anormalidades vasculares primárias e idiopáticas caracterizadas por dilatações irregulares e incompetência dos vasos retinianos com variados graus de exsudação intra e sub-retiniana. O objetivo desse relato é documentar uma rara associação entre aneurisma miliar de Leber e síndrome de tração vítreomacular bem caracterizada à angiofluoresceinografia e tomografia de coerência óptica. O tratamento realizado foi fotocoagulação com laser de argônio nos aneurismas perimaculares e cirurgia de vitrectomia posterior via pars plana, o que resultou em melhora consistente da acuidade visual. O caso relatado confirma a importância da tomografia de coerência óptica em estudar a interface vítreorretiniana e suas alterações, o que permitiu abordagem completa da doença em questão.Retinal telangiectasias are idiopatic vascular abnormalities of the retina characterizad by irregular dilatation of the retinal vessels, intraretinal and subretinal exsudation. The aim of this article is to describe the uncommon association of Leber's miliary aneurysms and vitreomacular traction syndrome in a female patient. The diagnosis was established with angiofluoresceinography and optic coherence tomography. The patient was treated with focal photocoagulation with argon green laser directed to the perimacular aneurysms and pars plana posterior vitrectomy. The visual acuity showed great improvement after a four-month follow-up. The present report supports the importance of optic coherence tomography in cases where the vitreoretinal interface must be evaluated, including vascular pathologies, which allowed us to offer a better treatment to this patient.

Luciano Sólia Násser; Herbert Paulo de Almeida; Leandro Cabral Zacarias; Suel Abujamra; André Marcelo Vieira Gomes

2007-01-01

105

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

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

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

2007-03-15

106

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

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese O lúpus eritematoso sistêmico (LES) é uma doença autoimune multissistêmica na qual há grande prevalência e manifestações incomuns de doenças infecciosas oportunistas, principalmente pelas múltiplas anormalidades no sistema imunológico e pelo efeito imunossupressor das medicações utilizadas em seu tratamento. Pacientes com LES têm incidência aumentada de tuberculose, e o acometimento osteoarticular ocorre em 1%-3% desses casos. Manifesta-se com dor, diminui (more) ção da mobilidade e aumento do volume osteoarticular, e os achados radiográficos costumam ser inespecíficos. A ressonância magnética nuclear (RMN) é exame útil para definir o grau de acometimento ósseo; entretanto, o diagnóstico etiológico é dado apenas pela cultura de líquido sinovial, pela cultura óssea ou pela histologia dessas regiões. Devido à inespecificidade dos achados, geralmente há atraso diagnóstico, em média de 11 meses. Relata-se o caso de uma paciente do gênero feminino com LES apresentando fatores predisponentes para a infecção/reativação da tuberculose. A RMN foi importante para definir o acometimento ósseo, e o diagnóstico etiológico foi dado pela biópsia óssea. A paciente também apresentava acometimento pulmonar devido à tuberculose, em sua forma miliar, demonstrado pela radiografia simples de tórax e pela tomografia computadorizada e confirmado pela cultura do bacilo de Koch no escarro. Houve demora de 1,5 mês para o início da terapêutica, tempo considerado curto em relação à literatura. Conclui-se dessa maneira que a tuberculose óssea, apesar de rara, deve sempre ser lembrada como diagnóstico diferencial nos pacientes lúpicos com osteomielite, principalmente naqueles com antecedente de tuberculose pulmonar. Abstract in english Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease, which has great prevalence and uncommon manifestations of opportunistic infectious diseases, mainly due to the multiple abnormalities of the immune system and the immunosuppressive effect of the medications used in its treatment. Patients whit SLE have an increased incidence of tuberculosis, and osteoarticular involvement occurs in 1%-3% of the cases, manifesting as pain, reduction in mobility, and in (more) creased 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.

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

2011-12-01

107

Gujjar Lung: A Disease Mimicking Miliary Tuberculosis  

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Gujjar lung is a chronic lung disease caused due to the long-term exposure to pinewood smoke inhalation in Gujjar community and the people residing at the hilly regions of the Indian sub-continent. This is characterized clinically by progressive cough and dyspnea, distinct radiological patterns and ...

Hassan, G.; Qureshi, Waseem; Kadri, S.M.; Khan, G.Q.; Sona-ul-lah,; Rather, Rashid A.; Omer, Mir Suhail

108

Aneurismas miliares de Leber Leber's miliary aneurysm  

Directory of Open Access Journals (Sweden)

Full Text Available Caso clínico: Varón de 45 años con sensación de escotoma en campo visual derecho. En la imagen del fondo de ojo aparecen dilataciones aneurismáticas con exudación lipídica en arcada temporal superior e inferior. La angiofluoresceingrafía muestra dilatación vascular y extravasación tardía de colorante. Discusión: La enfermedad de Leber es una vasculopatía retiniana primaria caracterizada por múltiples aneurismas asociados a exudados lipídicos intrarretinianos. El compromiso visual depende de la afectación macular por exudados. El diagnóstico diferencial comprende al resto de vasculopatías retinianas primarias y aneurismas secundarios a otras patologías. El tratamiento es la fotocoagulación con láser argon de los aneurismas.Case report: A 45-year-old man was referred to us with a scotoma sensation in his right visual field. Funduscopic examination showed aneurysmal dilatations with lipid exudation in the superior and inferior temporal retinal arcades in his right eye. Angiofluorography showed vascular dilatations and late dye leakage. Discussion: Leber’s disease is a primary retinal vasculopathy characterized by several aneurysms associated with intraretinal lipid exudates. Visual compromise depends on macular involvement by the exudates. Differential diagnosis must be established with other primary retinal vasculopathies and secondary aneurysms. Treatment consists of argon laser photocoagulation of the aneurysms.

L. Berástegui; J. Andonegui

2008-01-01

109

Aneurismas miliares de Leber/ Leber's miliary aneurysm  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish Caso clínico: Varón de 45 años con sensación de escotoma en campo visual derecho. En la imagen del fondo de ojo aparecen dilataciones aneurismáticas con exudación lipídica en arcada temporal superior e inferior. La angiofluoresceingrafía muestra dilatación vascular y extravasación tardía de colorante. Discusión: La enfermedad de Leber es una vasculopatía retiniana primaria caracterizada por múltiples aneurismas asociados a exudados lipídicos intrarretiniano (more) s. El compromiso visual depende de la afectación macular por exudados. El diagnóstico diferencial comprende al resto de vasculopatías retinianas primarias y aneurismas secundarios a otras patologías. El tratamiento es la fotocoagulación con láser argon de los aneurismas. Abstract in english Case report: A 45-year-old man was referred to us with a scotoma sensation in his right visual field. Funduscopic examination showed aneurysmal dilatations with lipid exudation in the superior and inferior temporal retinal arcades in his right eye. Angiofluorography showed vascular dilatations and late dye leakage. Discussion: Leber?s disease is a primary retinal vasculopathy characterized by several aneurysms associated with intraretinal lipid exudates. Visual compromis (more) e depends on macular involvement by the exudates. Differential diagnosis must be established with other primary retinal vasculopathies and secondary aneurysms. Treatment consists of argon laser photocoagulation of the aneurysms.

Berástegui, L.; Andonegui, J.

2008-11-01

110

Case for diagnosis/ Caso para diagnostico  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese A Dermatite Periorificial Granulomatosa da Infância é erupção facial acneiforme que afeta área periorificial do segmento cefálico de pré-puberes. Consiste em pápulas assintomáticas de 1 a 3 mm, monomorfas, eritematosas ou hipopigmentadas em áreas periorificiais - boca, nariz e olhos. A doença é benigna e auto-limitada, curando sem deixar cicatriz e por regra sem terapia específica. Diagnósticos diferenc (more) iais incluem a dermatite perioral, rosácea granulomatosa, sarcoidose e lúpus miliar da face. Relata-se paciente de 4 anos, masculino, com erupção papulosa há 2 anos em áreas periorificais. Devido à sua baixa incidência e o reduzido número de publicações relata-se o presente caso. Abstract in english Childhood Granulomatous Periorificial Dermatitis is an acneiform facial rash that affects the periorificial area in children. The clinical aspectare asymptomatic 1-3 mm papules of, monomorphic, erythematous or hypopigmented in periorificial areas - mouth, nose and eyes. It's a benign and self-limited disease that heals spontaneously without scarring and specific therapy. Differential diagnoses include perioral dermatitis, granulomatous-rosacea, sarcoidosis, and lupus mili (more) aris disseminatus faciei. We present the case of a 4-year-old boy, presenting papules in periorificials areas. Due to its low incidence and low number of publications we report the present case.

Tiengo, Adriana; Barros, Hugo Rocha; Carvalho, Daniele Bueno; Oliveira, Gabriela Mantovanelli de; Romiti, Ney

2013-08-01

111

Unusual cutaneous ulcers in a case of miliary tuberculosis  

Directory of Open Access Journals (Sweden)

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

Amladi Sangeeta; Jerajani Hemangi; Rupani Sadhana

1993-01-01

112

[A case of "miliary" Crohn's disease (author's transl)  

UK PubMed Central (United Kingdom)

A case of "milary" Crohn's disease in a 53-year-old woman is described. There were numerous epithlioid-cell, non-caseous serosal granulomas in the jejunal and terminal ileal regions. There were, furthermore, immediately adjoining the epithelioid-cell granulomas, granuloma-like collections of brown fat tissue, a previously undescribed coexistence.

Otto HF; Gebbers JO; Kügler S

1975-03-01

113

[Keratodermic genodermatosis with hydrocystomas, miliary cysts, xanthelasmas, nail and dental dystrophies, and basal cell epitheliomas  

UK PubMed Central (United Kingdom)

Two cases of a condition including palms and soles keratoderma, ectodermal dysplasias and basal cell epitheliomas are reported by the authors, with clinical, genetical and pathological data. The condition is called Keratodermal Genodermatose with hydrocystomas, milium cysts, xanthelasma, dental and nail dysplasias and basal cell epitheliomata (Borda's syndrome).

de Kaminsky AR; Kaminsky CA; Shaw M; Formentini E; Abulafia J

1978-01-01

114

[A case of miliary tuberculosis complicated by a tuberculous aneurysm of the thoracic aorta].  

Science.gov (United States)

An 85-year-old woman was admitted to our hospital with the chief complaint of fever. Antibiotics were not effective and a chest computed tomography scan revealed a diffuse micronodular shadow and thoracic aortic aneurysm. Subsequently, a bronchoscopy sputum culture was positive for Mycobacterium tuberculosis. Two months after the initiation of chemotherapy, the thoracic aortic aneurysm enlarged despite the improvement in lung findings. Tuberculous aneurysms are quite rare, but can be critical and acute. Therefore, caution should be exercised when treating such patients. PMID:24044167

Uchida, Yasuki; Tsukino, Mitsuhiro; Watanabe, Isao

2013-08-01

115

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 infrecue...

Luis Miguel Sosa; Luz Libia Cala; Julio César Mantilla

116

[A case of miliary tuberculosis complicated by a tuberculous aneurysm of the thoracic aorta].  

UK PubMed Central (United Kingdom)

An 85-year-old woman was admitted to our hospital with the chief complaint of fever. Antibiotics were not effective and a chest computed tomography scan revealed a diffuse micronodular shadow and thoracic aortic aneurysm. Subsequently, a bronchoscopy sputum culture was positive for Mycobacterium tuberculosis. Two months after the initiation of chemotherapy, the thoracic aortic aneurysm enlarged despite the improvement in lung findings. Tuberculous aneurysms are quite rare, but can be critical and acute. Therefore, caution should be exercised when treating such patients.

Uchida Y; Tsukino M; Watanabe I

2013-08-01

117

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

Directory of Open Access Journals (Sweden)

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

Raut W .K; Sawaitu V. K; Bobhate S . K; Fule R .P; Salodkar A . D

2002-01-01

118

Le pietre miliari dell'OA 2002-2012 Open Access Milestones 2002-2012  

Directory of Open Access Journals (Sweden)

Full Text Available L'articolo offre una panoramica sui passi fatti dal movimento per l'accesso aperto nel primo decennio di attività, con una rassegna delle dichiarazioni e dei documenti fondamentali.The present article aims at offering an overview on the milestones of the Open Access movement in its first decade. The main declarations, statements and documents are described.

Ilaria Fava

2012-01-01

119

Open Access Milestones 2002-2012 Le pietre miliari dell'OA 2002-2012  

Directory of Open Access Journals (Sweden)

Full Text Available The present article aims at offering an overview on the milestones of the Open Access movement in its first decade. The main declarations, statements and documents are described.L'articolo offre una panoramica sui passi fatti dal movimento per l'accesso aperto nel primo decennio di attività, con una rassegna delle dichiarazioni e dei documenti fondamentali.

Ilaria Fava

2012-01-01

120

Impetigo-Like Tinea Faciei Around the Nostrils Caused by Arthroderma vanbreuseghemii Identified Using Polymerase Chain Reaction-Based Sequencing of Crusts.  

UK PubMed Central (United Kingdom)

We report a case of Arthroderma vanbreuseghemii (a teleomorph of Trichophyton interdigitale) infection around the nostrils in a 3-year-old girl. The culture was negative, so the pathogenic agent was identified using polymerase chain reaction-based sequencing of the crusts taken from the lesion on the nostril. Treatment with oral itraconazole and topical 1% naftifine/0.25% ketoconazole cream after a topical wash with ketoconazole shampoo was effective.

Kang D; Ran Y; Li C; Dai Y; Lama J

2012-12-01

 
 
 
 
121

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

UK PubMed Central (United Kingdom)

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

Bergler-Czop B; Lis-Swiety A; Brzezi?ska-Wcis?o L

2009-01-01

122

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

Science.gov (United States)

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

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

2009-01-01

123

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

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Abstract Background Hemifacial atrophy (Parry-Romberg syndrome) is a relatively rare disease. The etiology of the disease is not clear. Some authors postulate its relation with limited scleroderma linearis. Linear scleroderma "en coup de sabre" is characterized by clinical presence ...

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

124

"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)

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.

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

2009-01-01

125

Impetigo-Like Tinea Faciei Around the Nostrils Caused by Arthroderma vanbreuseghemii Identified Using Polymerase Chain Reaction-Based Sequencing of Crusts.  

Science.gov (United States)

We report a case of Arthroderma vanbreuseghemii (a teleomorph of Trichophyton interdigitale) infection around the nostrils in a 3-year-old girl. The culture was negative, so the pathogenic agent was identified using polymerase chain reaction-based sequencing of the crusts taken from the lesion on the nostril. Treatment with oral itraconazole and topical 1% naftifine/0.25% ketoconazole cream after a topical wash with ketoconazole shampoo was effective. PMID:23278484

Kang, Daoxian; Ran, Yuping; Li, Conghui; Dai, Yaling; Lama, Jebina

2012-12-26

126

50 CFR Appendix A to Part 622 - Species Tables  

Science.gov (United States)

...Hemipteronotus novacula Green razorfish, Hemipteronotus splendens Bluehead wrasse, Thalassoma bifasciatum Chain moray, Echidna catenata Green moray, Gymnothorax funebris Goldentail moray, Gymnothorax miliaris Batfish, Ogcocepahalus...

2010-10-01

127

[New clinical aspects of dermatomycosis.].  

Science.gov (United States)

Usually the clinical diagnostic of tinea is easy for the dermatologist, but occasionally, mostly as a result of an unsuitable treatment, the cutaneous lesions can show up atypical forms. In this article tinea capitis in the elderly, tinea follicularis et granulomatosa of the legs, tinea faciei and tinea incognito are discussed. PMID:18473600

Moreno Giménez, J C

1999-10-01

128

[New clinical aspects of dermatomycosis.].  

UK PubMed Central (United Kingdom)

Usually the clinical diagnostic of tinea is easy for the dermatologist, but occasionally, mostly as a result of an unsuitable treatment, the cutaneous lesions can show up atypical forms. In this article tinea capitis in the elderly, tinea follicularis et granulomatosa of the legs, tinea faciei and tinea incognito are discussed.

Moreno Giménez JC

1999-10-01

129

Caso para diagnóstico Case for diagnosis  

Directory of Open Access Journals (Sweden)

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

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

2010-01-01

130

Caso para diagnóstico/ Case for diagnosis  

Scientific Electronic Library Online (English)

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

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

2010-12-01

131

Isolated tuberculous liver abscess in a 3-year-old immunocompetent child.  

UK PubMed Central (United Kingdom)

Tuberculous liver abscess without active pulmonary or miliary tuberculosis or other clinical evidence of tuberculosis, is very rare. A 3-year-old immunocompetent boy with isolated tuberculous liver abscess recovered completely on systemic anti-tuberculous drugs.

Nandan D; Bhatt GC; Dewan V; Yadav TP; Singh S

2013-01-01

132

Sperm concentration and fertilization rate in Bufo arenarum (Amphibia: Anura).  

UK PubMed Central (United Kingdom)

The influence of sperm concentration upon the fertilization rate of Bufo arenarum oocytes was determinated. The experimental results were analysed according to the theories of Rothschild and Swann, and Hultin and Hagström for Psammechinus miliaris. The experimental results agreed with the predictions of the latter theory. Since Bufo arenarum and Psammechinus miliaris oocytes differ in both size and disposition of jelly envelopes, the postulations of Hultin and Hagström's theory appear to have a general validity.

Cabada MO

1975-04-01

133

Long-term sequelae of Farmer's lung disease in HRCT: a 14-year follow-up study of 88 patients and 83 matched control farmers  

Energy Technology Data Exchange (ETDEWEB)

The aim of this study was to compare high-resolution computed tomography (HRCT) findings of long-term farmer's lung (FL) patients and control farmers. We studied 88 FL patients and 83 matched control farmers with a mean follow-up time of 14 years. Emphysematous, fibrotic, and miliary changes were recorded by HRCT. The pattern of emphysema and location and distribution of other findings were evaluated in detail. Emphysema was found in 20 (23%) FL patients and in 6 (7%) controls (p=0.005). Recurrences of FL attacks increased (p=0.021) the risk of emphysema. Prevalence of fibrosis (17 vs 10%, p=0.16) and miliary changes (11 vs 4%, p=0.06) did not differ significantly in patients and controls. Among FL patients, emphysematous, fibrous, and miliary changes were more pronounced at the base than in the upper parts of the lung (p<0.02). In slice analysis, the pattern of emphysema was more polymorphous (p=0.001) and the distribution of fibrotic and miliary changes was more variable among FL patients than controls. Emphysema in HRCT is more common in FL patients than matched control farmers, and the occurrence is increased by recurrences of FL. Emphysematous, fibrous, and miliary changes in FL patients HRCT are multiform and predominate in the lower parts of the lung. (orig.)

Malinen, A.P.; Partanen, P.L.K.; Rytkoenen, H.T.; Vanninen, R.L. [Department of Clinical Radiology, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio (Finland); Erkinjuntti-Pekkanen, R.A. [Department of Pulmonary Diseases, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio (Finland)

2003-09-01

134

Long-term sequelae of Farmer's lung disease in HRCT: a 14-year follow-up study of 88 patients and 83 matched control farmers.  

Science.gov (United States)

The aim of this study was to compare high-resolution computed tomography (HRCT) findings of long-term farmer's lung (FL) patients and control farmers. We studied 88 FL patients and 83 matched control farmers with a mean follow-up time of 14 years. Emphysematous, fibrotic, and miliary changes were recorded by HRCT. The pattern of emphysema and location and distribution of other findings were evaluated in detail. Emphysema was found in 20 (23%) FL patients and in 6 (7%) controls (p=0.005). Recurrences of FL attacks increased (p=0.021) the risk of emphysema. Prevalence of fibrosis (17 vs 10%, p=0.16) and miliary changes (11 vs 4%, p=0.06) did not differ significantly in patients and controls. Among FL patients, emphysematous, fibrous, and miliary changes were more pronounced at the base than in the upper parts of the lung (p<0.02). In slice analysis, the pattern of emphysema was more polymorphous (p=0.001) and the distribution of fibrotic and miliary changes was more variable among FL patients than controls. Emphysema in HRCT is more common in FL patients than matched control farmers, and the occurrence is increased by recurrences of FL. Emphysematous, fibrous, and miliary changes in FL patients HRCT are multiform and predominate in the lower parts of the lung. PMID:12928967

Malinen, A P; Erkinjuntti-Pekkanen, R A; Partanen, P L K; Rytkönen, H T; Vanninen, R L

2003-03-06

135

[The modern body image as ethical device for biomedical enhancement].  

UK PubMed Central (United Kingdom)

Ovid's "De medicamine faciei feminae" contains the astonishing sentence "Culta placent - all that is artificial is beautiful". In his "Éloge du maquillage" Baudelaire, buidling on Ovid's argument, states that first culture as picture and construction of beauty brings forth the truth of Nature and claims that cosmetics that allow errors of beauty to disappear artificially produce the true fulfillment of human nature. The present article looks into the historical roots of the body images that have emerged in modern times and attempts to derive structural devices for an ethical assessment of the potential we have to enhance human nature.

Breitsameter C

2013-01-01

136

A study of tubercular antigen and antibody in childhood tuberculosis.  

UK PubMed Central (United Kingdom)

A radioimmunoassay for the detection of tubercular (TB) antigen (Ag) and antitubercular antibody (Ab) was evaluated for the serodiagnosis of childhood tuberculosis. Children with primary complex, progressive primary complex, miliary tuberculosis, and calcified lung lesions without clinical evidence of active tuberculosis were studied. Significantly elevated levels of TB Ag and TB Ab isolated from the circulating immune complexes were obtained in primary, progressive primary, and miliary tuberculosis patients as compared to controls (P less than 0.01). The majority of patients with calcified lung lesions and without active tuberculosis demonstrated high levels of antibody. It was observed that elevated levels of TB Ag and/or antibodies were present in 54 per cent of patients with primary complex, 94 per cent of patients with progressive disease and 69 per cent of patients with miliary tuberculosis. It is possible that is suspected patients with the above mentioned diseases, a diagnosis can be established by using these techniques.

Ashtekar MD; Samuel AM; Kameswaran M; Kadival GV; Sakhalkar V; Rajadhyaksha S

1992-02-01

137

A study of tubercular antigen and antibody in childhood tuberculosis.  

Science.gov (United States)

A radioimmunoassay for the detection of tubercular (TB) antigen (Ag) and antitubercular antibody (Ab) was evaluated for the serodiagnosis of childhood tuberculosis. Children with primary complex, progressive primary complex, miliary tuberculosis, and calcified lung lesions without clinical evidence of active tuberculosis were studied. Significantly elevated levels of TB Ag and TB Ab isolated from the circulating immune complexes were obtained in primary, progressive primary, and miliary tuberculosis patients as compared to controls (P less than 0.01). The majority of patients with calcified lung lesions and without active tuberculosis demonstrated high levels of antibody. It was observed that elevated levels of TB Ag and/or antibodies were present in 54 per cent of patients with primary complex, 94 per cent of patients with progressive disease and 69 per cent of patients with miliary tuberculosis. It is possible that is suspected patients with the above mentioned diseases, a diagnosis can be established by using these techniques. PMID:1573688

Ashtekar, M D; Samuel, A M; Kameswaran, M; Kadival, G V; Sakhalkar, V; Rajadhyaksha, S

1992-02-01

138

Long-term sequelae of Farmer's lung disease in HRCT: a 14-year follow-up study of 88 patients and 83 matched control farmers  

International Nuclear Information System (INIS)

The aim of this study was to compare high-resolution computed tomography (HRCT) findings of long-term farmer's lung (FL) patients and control farmers. We studied 88 FL patients and 83 matched control farmers with a mean follow-up time of 14 years. Emphysematous, fibrotic, and miliary changes were recorded by HRCT. The pattern of emphysema and location and distribution of other findings were evaluated in detail. Emphysema was found in 20 (23%) FL patients and in 6 (7%) controls (p=0.005). Recurrences of FL attacks increased (p=0.021) the risk of emphysema. Prevalence of fibrosis (17 vs 10%, p=0.16) and miliary changes (11 vs 4%, p=0.06) did not differ significantly in patients and controls. Among FL patients, emphysematous, fibrous, and miliary changes were more pronounced at the base than in the upper parts of the lung (p

2003-01-01

139

Molecular epidemiology of dermatophytosis in Tehran, Iran, a clinical and microbial survey.  

Science.gov (United States)

In the framework of a survey on dermatophytoses, 14,619 clinical specimens taken from outpatients with symptoms suggestive of tinea and referred to a Medical Mycology laboratory in Tehran, Iran, were analyzed by direct microscopy and culture. In total, 777 dermatophyte strains recovered in culture were randomly identified by a formerly established RFLP analysis method based on the rDNA ITS regions. For confirmation of species identification, 160 isolates representing the likely entire species spectrum were subjected to ITS-sequencing. Infection was confirmed in 5,175 collected samples (35.4%) by direct microscopy and/or culture. Tinea pedis was the most prevalent type of infection (43.4%), followed by tinea unguium (21.3%), tinea cruris (20.7%), tinea corporis (9.4%), tinea manuum (4.2%), tinea capitis (0.8%) and tinea faciei (0.2%). Trichophyton interdigitale was the most common isolate (40.5%) followed by T. rubrum (34.75%), Epidermophyton floccosum (15.6%), Microsporum canis (3.9%), T. tonsurans (3.5 %) and M. gypseum (0.5%). Other species included M. ferrugineum, T. erinacei, T. violaceum, T. schoenleinii, and a very rare species T. eriotrephon (each one 0.25%). The two strains of T. eriotrephon isolated from tinea manuum and tinea faciei are the second and third reported cases worldwide. Application of DNA-based methods is an important aid in monitoring trends in dermatophytosis in the community. PMID:22587730

Rezaei-Matehkolaei, Ali; Makimura, Koichi; de Hoog, Sybren; Shidfar, Mohammad Reza; Zaini, Farideh; Eshraghian, Mohammadreza; Naghan, Parvaneh Adimi; Mirhendi, Hossein

2012-05-15

140

On the biosynthesis of 3?-sterols in some representatives of the echinoidea  

Digital Repository Infrastructure Vision for European Research (DRIVER)

1. The incorporation of sodium acetate-1-14C into some classes of lipids inParacentrotus lividus, Echinus acutus andPsammechinus miliaris is investigated. 2. It is demonstrated that these animals utilized the injected acetate for the biosynthesis of fatty acid and non-saponifiable lipids including ...

Voogt, P.A.

 
 
 
 
141

Topical application of ivermectin for the treatment of dermatological conditions/afflictions  

UK PubMed Central (United Kingdom)

Dermatological conditions/afflictions such as rosacea, common acne, seborrheic dermatitis, perioral dermatitis, acneform rashes, transient acantholytic dermatosis, and acne necrotica miliaris, most notably rosacea, are treated by topically applying onto the affected skin area of an individual in need of such treatment, a topical pharmaceutical composition which comprises a thus effective amount of ivermectin.

MANETTA VINCENT; WATKINS GARY R

142

TOPICAL APPLICATION OF IVERMECTIN FOR THE TREATMENT OF DERMATOLOGICAL CONDITIONS/AFFLICTIONS  

UK PubMed Central (United Kingdom)

Dermatological conditions/afflictions such as rosacea, common acne, seborrheic dermatitis, perioral dermatitis, acneform rashes, transient acantholytic dermatosis, and acne necrotica miliaris, most notably rosacea, are treated by topically applying onto the affected skin area of an individual in need of such treatment, a topical pharmaceutical composition which comprises a thus effective amount of ivermectin.

MANETTA VINCENT; WATKINS GARY R

143

Principles of order in the course of tuberculosis. Pathogenesis, morphology, and radiological findings of tuberculosis  

Energy Technology Data Exchange (ETDEWEB)

Presentation of different kinds in the course of tuberculosis of the lung. Comparison of pathologic-anatomical findings and radiology of an active, exudative, cavernous, cirrhotic, and miliary tuberculosis. Discussion of the concept of activity from different points of views: clinical, radioligical, and histological.

Wolfart, W.; Lesch, R.; Wenz, W.

1981-03-01

144

Multiple pulmonary nodules in tuberculosis  

Energy Technology Data Exchange (ETDEWEB)

Pulmonary infiltration with or without cavitation involving the upper lobes of the lung is the usual X-ray finding in patients with tuberculosis. Miliary nodules and tuberculomas are well known as another presentation of tuberculosis. Multiple bilateral large nodules in tuberculosis may give problems in the differential diagnosis to malignant neoplasmas. (orig.).

Heinrich, J.; Scheppach, W.; Schmidt, M.; Kulke, H.; Daemmrich, J.

1989-03-01

145

'Golden Kernels within the skin': disseminated cutaneous gout.  

UK PubMed Central (United Kingdom)

Presented in this paper is a case of a young Filipino man presenting with recurrent acute gouty flares leading to chronic tophaceous gout and unusual cutaneous manifestations (miliary gout, panniculitis, ulcerations). Unusual sites within the body (torso, shoulder, forearms, thigh) revealed multiple urate dermal deposition. Self-medication with steroids eventually led to secondary Cushing's syndrome and eventual emergence of metabolic complications.

Lo TE; Racaza GZ; Penserga EG

2013-01-01

146

Successful treatment of disseminated Acanthamoeba sp. infection with miltefosine.  

Science.gov (United States)

We report on an HIV-negative but immunocompromised patient with disseminated acanthamoebiasis, granulomatous, amoebic encephalitis and underlying miliary tuberculosis and tuberculous meningitis. The patient responded favorably to treatment with miltefosine, an alkylphosphocholine. The patient remained well with no signs of infection 2 years after treatment cessation. PMID:18976559

Aichelburg, Alexander C; Walochnik, Julia; Assadian, Ojan; Prosch, Helmut; Steuer, Andrea; Perneczky, Gedeon; Visvesvara, Govinda S; Aspöck, Horst; Vetter, Norbert

2008-11-01

147

Case of intracortical tuberculosis of the femur  

Energy Technology Data Exchange (ETDEWEB)

This is the report of an anatomical-radiological study of a case of femoral intracortical tuberculosis observed at the autopsy of an 83-year-old women presenting with diffuse miliary tuberculosis. Among the differential diagnoses, carcinoma metastasis is the main alternative to be discussed.

MacGee, W.; Lagier, R.

1988-05-01

148

THE HISTOLOGIGAL LESIONS OF ACUTE GLANDERS IN MAN AND OF EXPERIMENTAL GLANDERS IN THE GUINEA-PIG  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The glanders nodule in the class of cases studied by us is in no sense analogous to the miliary tubercle in its histogenesis, and our studies afford no support to Baumgarten's views. The primary effect of the bacillus of glanders on a tissue we found to be not a production of epithelioid cells, whi...

Wright, James Homer

149

Multiple pulmonary nodules in tuberculosis  

International Nuclear Information System (INIS)

Pulmonary infiltration with or without cavitation involving the upper lobes of the lung is the usual X-ray finding in patients with tuberculosis. Miliary nodules and tuberculomas are well known as another presentation of tuberculosis. Multiple bilateral large nodules in tuberculosis may give problems in the differential diagnosis to malignant neoplasmas. (orig.).

1989-01-01

150

Ulerythema ophryogenes, a rarely reported cutaneous manifestation of noonan syndrome: case report and review of the literature.  

UK PubMed Central (United Kingdom)

BACKGROUND: Ulerythema ophryogenes (also known as keratosis pilaris atrophicans faciei) is a rarely reported cutaneous manifestation of Noonan syndrome. OBJECTIVE: Recognizing ulerythema ophryogenes as a cutaneous association in Noonan syndrome may aid in the diagnosis of this relatively common genetic condition. METHODS: We present a case of a patient with Noonan syndrome and ulerythema ophryogenes associated with a SOS1 mutation and review the literature on this association. RESULTS: To the best of our knowledge, this is the second case of Noonan syndrome proven to be due to an SOS1 mutation in which ulerythema ophryogenes was clinically recognized and specifically diagnosed. CONCLUSIONS: The presence of ulerythema ophryogenes in a patient with Noonan syndrome increases the likelihood of a SOS1 mutation. Further reports by dermatologists and medical geneticists documenting ulerythema ophryogenes and not just descriptions of sparse or absent eyebrows will help support this genotype-phenotype correlation.

Li K; Ann Thomas M; Haber RM

2013-05-01

151

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

Energy Technology Data Exchange (ETDEWEB)

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.

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

152

Isolated hepatic tuberculosis  

Directory of Open Access Journals (Sweden)

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

Bangroo A; Malhotra Amit

2005-01-01

153

Tuberculous pseudotumor of the liver  

International Nuclear Information System (INIS)

Tuberculosis of the liver in association with generalized miliary tuberculosis is not an uncommon clinical entity. A solitary tuberculous liver abscess, however, is rare. Two such cases, in which there was no clinical evidence of extrahepatic tuberculosis, are reported. The similarities between this condition and other causes of hepatic lesions are discussed, with particular emphasis placed on the imaging patterns of various diagnostic imaging procedures

1987-01-01

154

Tuberculous pseudotumor of the liver  

Energy Technology Data Exchange (ETDEWEB)

Tuberculosis of the liver in association with generalized miliary tuberculosis is not an uncommon clinical entity. A solitary tuberculous liver abscess, however, is rare. Two such cases, in which there was no clinical evidence of extrahepatic tuberculosis, are reported. The similarities between this condition and other causes of hepatic lesions are discussed, with particular emphasis placed on the imaging patterns of various diagnostic imaging procedures.

Dhekne, R.D.; Moore, W.H.; Long, S.E.; Barron, B.J.

1987-10-01

155

Magnetic resonance imaging in acute intractional tuberculosis  

International Nuclear Information System (INIS)

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

1994-01-01

156

Acrodynia: exposure to mercury from fluorescent light bulbs  

Energy Technology Data Exchange (ETDEWEB)

Medical attention was sought for a 23-month-old toddler because of anorexia, weight loss, irritability, profuse sweating, peeling and redness of his fingers and toes, and a miliarial rash. The diagnosis was mercury poisoning, and an investigation of his environment disclosed that he had been exposed to mercury from broken fluorescent light bulbs. Acrodynia resulting from fluorescent bulbs has not been previously reported.

Tunnessen, W.W. Jr.; McMahon, K.J.; Baser, M.

1987-05-01

157

Biological control of fouling in suspended scallop cultivation.  

UK PubMed Central (United Kingdom)

Fouling of scallop shells and cultivation nets by living organisms is costly to remove and can reduce scallop growth. Here we investigate biological control of fouling in suspended scallop (Pecten maximus) cultivation. In preliminary trials in the Irish Sea, off the Isle of Man, sea urchins (Echinus esculentus and Psammechinus miliaris) and hermit crabs (Pagurus spp.) removed fouling from nets more efficiently than did a range of other invertebrates. Sea urchins and hermit crabs were subsequently deployed from August 2000 to January 2001 at various densities (hermit crabs and E. esculentus at 1, 2, or 3 per net and P. miliaris at 3, 5 or 7 per net) in pearl nets containing scallops. After 6 months, the survival of biological control organisms and their effect on scallop growth and mortality, and fouling of nets and scallop shells, were assessed. Only P. miliaris was associated with increased scallop shell growth, but no biological control organism reduced scallop growth or survival. All three biological control organisms significantly reduced the weight of fouling on nets (often by as much as 50%) and fouling of scallop shells; results were largely independent of biological control organism density. Sea urchins were most effective, removing hydroids and solitary tunicates efficiently; they could thus be commercially exploited alongside scallops in a form of polyculture. These results suggest that biological control could be an efficient and environmentally sound method of addressing the problem of fouling in scallop cultivation.

Ross KA; Thorpe JP; Brand AR

2004-01-01

158

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)

2006-01-01

159

Ecological release and venom evolution of a predatory marine snail at Easter Island.  

UK PubMed Central (United Kingdom)

BACKGROUND: Ecological release is coupled with adaptive radiation and ecological diversification yet little is known about the molecular basis of phenotypic changes associated with this phenomenon. The venomous, predatory marine gastropod Conus miliaris has undergone ecological release and exhibits increased dietary breadth at Easter Island. METHODOLOGY/PRINCIPAL FINDINGS: We examined the extent of genetic differentiation of two genes expressed in the venom of C. miliaris among samples from Easter Island, American Samoa and Guam. The population from Easter Island exhibits unique frequencies of alleles that encode distinct peptides at both loci. Levels of divergence at these loci exceed observed levels of divergence observed at a mitochondrial gene region at Easter Island. CONCLUSIONS/SIGNIFICANCE: Patterns of genetic variation at two genes expressed in the venom of this C. miliaris suggest that selection has operated at these genes and contributed to the divergence of venom composition at Easter Island. These results show that ecological release is associated with strong selection pressures that promote the evolution of new phenotypes.

Duda TF Jr; Lee T

2009-01-01

160

Teenagers as patients.  

UK PubMed Central (United Kingdom)

Adolescents tend to abandon the program of preventive and therapeutic medical care established for them in infancy by pediatrician and parents. Factors in this resistance were analyzed, and a teenage clinic was established. In review of experience over a four-year period, during which the number of appointments monthly rose from 20 to 300, it was noted that the needs of adolescents are related to their stage of development. In the teenage clinic the adolescent assumes an increasingly important role in communication between himself and the physician, with concurrent diminution of the parental role. Special goals of medical counseling of adolescents include strengthening of parent-adolescent relationships and adjustment of the teenager to school and community. The adolescent requests information about normal and abnormal growth and development (obesity, acne, sexual changes). Somatic abnormalities noted on physical examination were of three classes: (1) "Normal" deviations (male gynecomastia, adolescent striae, functional heart murmurs). (2) Medical problems usual to persons of any age. (3) Comparatively rare entities (lupus erythematosus disseminatus, Laurence-Moon-Biedel syndrome).

ROTH A

1958-12-01

 
 
 
 
161

The pathology of tuberculosis caused by Mycobacterium tuberculosis in a herd of semi-free-ranging springbok (Antidorcas marsupialis)  

Directory of Open Access Journals (Sweden)

Full Text Available The first detailed description of the pathology of tuberculosis, caused by Mycobacterium tuberculosis, in springbok is reported. The springbok were part of a semi-free-ranging herd kept on the grounds of iThemba Laboratory for Accelerator Based Science (LABS) in the Kuils River district of the Western Cape Province, South Africa. Mycobacterium tuberculosis was isolated from three animals out of a total of 33 sampled, with two animals showing tuberculosis lesions. The index case was an adult ewe that showed advanced miliary tuberculosis with marked macroscopic and microscopic lesions in the lungs, pleura and respiratory lymph nodes, and numerous acid-fast bacilli. Six healthy rams were sampled nine months later and a pilot study indicated miliary tuberculosis lesions in one ram, which again were macroscopically most prominent in the lungs, pleura and respiratory lymph nodes. Macroscopic lesions were also noted in the sternal, iliac, prefemoral and retropharyngeal lymph nodes. Microscopy in this animal revealed lesions in the macroscopically affected organs as well as numerous other lymph nodes, and suspected lesions occurred in the testicle and colon. Acid-fast bacilli were scarce to moderate in affected organs. Because of the miliary nature of the lesions in both affected animals, the route of infection could not be established conclusively. The lesions in most affected organs of both animals resembled classical tuberculous granulomas. A main study conducted on healthy animals 19 months after the pilot study failed to find any animal with tuberculosis lesions in the group of 25 sampled, and all were negative for mycobacteria via mycobacterial culture.

T.A. Gouws; M.C. Williams

2010-01-01

162

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

Directory of Open Access Journals (Sweden)

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.

Verónica Mancilla; Juan Marcos Henríquez; Jorge Vera

2008-01-01

163

Central pontine myelinolysis in advanced HIV infection with tuberculosis and multicentric Castleman's disease.  

UK PubMed Central (United Kingdom)

We present a case of central pontine myelinolysis (CPM) in a patient with advanced HIV infection and miliary tuberculosis. While hospitalized the patient developed an unusual ataxic variant of CPM with full clinical recovery. Follow-up imaging revealed resolution of pontine lesions. To our knowledge, this is the first report of a clinical and radiological recovery from CPM in advanced HIV disease. Our report extends our knowledge of neurological presentations in patients with advanced HIV infection. It highlights the importance of considering CPM in patients with advanced HIV disease presenting with an ataxic syndrome, even in the absence of an electrolyte derangement.

Katchanov J; Branding G; Stocker H

2013-07-01

164

Central pontine myelinolysis in advanced HIV infection with tuberculosis and multicentric Castleman's disease.  

Science.gov (United States)

We present a case of central pontine myelinolysis (CPM) in a patient with advanced HIV infection and miliary tuberculosis. While hospitalized the patient developed an unusual ataxic variant of CPM with full clinical recovery. Follow-up imaging revealed resolution of pontine lesions. To our knowledge, this is the first report of a clinical and radiological recovery from CPM in advanced HIV disease. Our report extends our knowledge of neurological presentations in patients with advanced HIV infection. It highlights the importance of considering CPM in patients with advanced HIV disease presenting with an ataxic syndrome, even in the absence of an electrolyte derangement. PMID:23970776

Katchanov, J; Branding, G; Stocker, H

2013-07-04

165

[Finding of the bacterial species Edwardsiella tarda in the aquarium fish Betta splendens  

UK PubMed Central (United Kingdom)

A case of the mass occurrence of a disease in the aquarium fish species Betta splendens is described; morphologically the disease was characterized by the finding of large dermal changes located mainly in the dorsal part and by miliary granulomata in liver, spleen and kidneys. The granulomata consisted of epitheloid light cells with centrally located necrosis. Gram-negative bacteria with morphological and biochemical characteristics corresponding to the bacterial species Edwardsiella tarda were isolated from the kidneys, liver and from the dermal lesion. The characteristics of the strains isolated by us were compared with the reference Edwardsiella strain (Bth 1/64) obtained from the Czechoslovak collection of type cultures, Prague.

Vladík P; Prouza A; Vítovec J

1983-01-01

166

[Pulmonary aspergillosis and chronic septic granulomatosis  

UK PubMed Central (United Kingdom)

Two children with chronic granulomatous disease who developed diffuse pulmonary aspergillosis are described. The outcome was satisfactory in one case with miliary disease because the diagnosis was made early by an open lung biopsy. In the other case the diagnosis was delayed and the child died after 7 months with disseminated haematogenous spread of the fungal infection. Although most of the infections of chronic granulomatous disease are bacterial, the abnormalities of phagocyte killing will also predispose to fungal infections. The prolonged survival of affected children because of antibiotic therapy will increase the risk of parasitic and fungal infections.

Olive D; Buriot D; Brocard O; Griscelli C

1979-03-01

167

Tuberculosis ganglionar con afectación cutánea (escrofulodermia) en paciente inmunocompetente. Reporte de un caso  

Directory of Open Access Journals (Sweden)

Full Text Available Tuberculosis (TB) infection is most prevalent in the world and its frequency continues to increase, being endemic in Paraguay. TB disease is defined by the presence of clinical symptoms and signs depending on the location of the disease. The most common primary site is the lung. But there are other less common locations such as pleural, pericardial, lymph nodes, miliary, meningeal, osteoarticular, gastrointestinal, renal, pancreatic, breast, skin, eye and genitourinary tract.We report the case of a 21 years old male patient, immunocompetent, with extrapulmonary tuberculosis (lymph node) with secondary skin involvement (scrofuloderma).

Martinez Braga Gabriela; Di Martino Ortiz Beatriz; Rodriguez Masi Mirtha; Knopfelmacher Oilda,; Bolla de Lezcano Lourdes

2011-01-01

168

CT findings of pulmonary tuberculosis in adult patients with no underlying disease  

Energy Technology Data Exchange (ETDEWEB)

To evaluate the CT spectrum of pulmonary tuberculosis, we reviewed CT of the chest in 80 adult patients with active pulmonary tuberculosis who had not been treated for tuberculosis. Main patterns seen in patients with active tuberculosis were: (1) nodular shadow (56%), (2) confluent consolidation (15%), and (3) round consolidation (16%). Other CT patterns were: (1) miliary tuberculosis (n=4), (2) pleural effusion only (n=4), and (3) normal chest (n=2). Major features seen at CT included segmental distribution (97%), satellite lesions (86%), single cavity in each cavitary lesion (95%), ectatic change of the bronchi, tendency of distortion or contraction. (author).

Ikezoe, Junpei; Takeuchi, Noriyuki; Johkoh, Tsuyoshi (Osaka Univ. (Japan). Faculty of Medicine) (and others)

1992-01-01

169

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.

2012-01-01

170

[Allergy caused by sodium fluoride glycerin: a case report].  

UK PubMed Central (United Kingdom)

In recent years, though more and more ulcerations of oral mucosa caused by allergy to drug occurred clinically, allergy to sodium fluoride glycerin is extremely rare. A case of allergy to sodium fluoride glycerin occurred in Qianfoshan Campus Hospital of Shandong University. After treatment by sodium fluoride glycerin, there was mucosal edema, a large number of red miliary granules in buccal and palatal mucosa. After 3 hours, there were swallowing difficulties, but no breathing difficulties. Next day large ulcers of oral mucosa developed. The patient was cured 7 days after treatment. Fluoride-sensitive test result was positive.

Ma J

2012-04-01

171

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

Directory of Open Access Journals (Sweden)

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

Melanie Cegielski; Bernard Vaudaux; Katia Jaton; David Bervini; Marie-Helene Perez

2012-01-01

172

Rosacea under the microscope: characteristic histological findings.  

UK PubMed Central (United Kingdom)

Rosacea is a common facial dermatosis that is seldom biopsied; thus, histological aspects have not been well described. Biopsies are generally performed in the presence of atypical symptoms (e.g. granulomas). Differential diagnosis with sarcoidosis, lupus miliaris or lupus erythematosus is another indication for biopsy. There are few published studies addressing the microscopic aspects of rosacea and describing the histological and immunohistochemical features of this disease. While some textbooks consider the microscopic signs of rosacea to be non-diagnostic, experienced dermatopathologists are generally able to make the diagnosis via histology. This article discusses the specific combinations of histological features that are highly suggestive of rosacea.

Cribier B

2013-03-01

173

Para-aminosalicylic acid-induced hypoglycaemia in a patient with diabetic nephropathy.  

Science.gov (United States)

A 62-year-old Indian with diabetic nephropathy controlled with metformin, developed miliary tuberculosis for which he was treated with rifampicin, isoniazid and ethambutol. Soon afterwards he developed cholestatic hepatitis and visual disturbance. Rifampicin and ethambutol were stopped. Streptomycin caused vertigo and had to be stopped. The introduction of para-aminosalicylic acid (PAS) led to hypoglycaemic coma. Metformin was stopped. Hypoglycaemic coma recurred. PAS was stopped and the patient's blood glucose concentrations became normal. Treatment with isoniazid and ethambutol led to total recovery from pulmonary tuberculosis. The induction of hypoglycaemia with PAS in this patient suggests a potential role for PAS in the treatment of diabetes mellitus. PMID:7393795

Dandona, P; Greenbury, E; Beckett, A G

1980-02-01

174

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

Energy Technology Data Exchange (ETDEWEB)

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

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

1993-03-01

175

Pulmonary alveolar microlithiasis.  

UK PubMed Central (United Kingdom)

This is a case report of 32 years old male, who presented in outdoor clinic of Pulmonology Department, Jinnah Hospital, Lahore, with progressively increasing shortness of breath over 2 years, multiple episodes of dry cough over 9 months, history of low-grade fever for 15 days and haemoptysis for the last one day. He was diagnosed as a case of miliary tuberculosis on the basis of his chest X-ray findings and was on anti-tuberculosis treatment by the GP of the locality. Diagnosis of pulmonary alveolar microlithiasis was made on the basis of clinical features and laboratory findings.

Saleem A; Chaudhary A; Iqbal ZH

2009-06-01

176

Fatal acute granulomatous pulmonary aspergillosis in a healthy subject after inhalation of vegetal dust.  

Science.gov (United States)

A previously healthy 28-year-old man presented a few hours after inhalation of vegetal dust with acute bilateral community-acquired pneumonia, which caused death in 10 days despite treatment with broad-spectrum antibiotics, intravenous amphotericin B, inotropic support, and mechanical ventilation. A postmortem lung biopsy indicated miliary granulomatous pulmonary aspergillosis. Six similar previously published cases of acute granulomatous pulmonary aspergillosis are reviewed. This entity in adulthood may reveal a defect in neutrophil or macrophage function, such as late-onset chronic granulomatous disease. PMID:12774197

Batard, E; Renaudin, K; Morin, O; Desjars, P; Germaud, P

2003-05-28

177

[Pulmonary fibrosis and arterial hypertension revealing a chronic pulmonary schistosomiasis. An unusual diagnosis in Europe].  

UK PubMed Central (United Kingdom)

We report on the case of a Senegalese woman who was hospitalised in Paris for dyspnea on exertion, revealing pulmonary fibrosis and arterial hypertension. With no evident etiology of this fibrosis, a surgical pulmonary biopsy was performed and revealed granulomatosis due to schistosomiasis. Diagnosis of chronic pulmonary schistosomiasis was obtained. The manifestations of the chronic pulmonary schistosomiasis include miliary and pulmonary arterial hypertension. Certain forms can lead to fibrosis as our case study illustrates and pose diagnostic problems outside parasitic endemic areas. Beside cases of acute schistosomiasis observed in tourists, the possibility of chronic forms of the disease in migrant originating from endemic areas should be recognised in industrialised countries.

Ngampolo I; Billhot M; Niang A; Epaud C; Riviere F; Le Floch H; Vaylet F; Milleron B; Margery J

2010-10-01

178

A case of constrictive pericarditis and thoracic aortic aneurysm: a hybrid therapeutic approach.  

Science.gov (United States)

The authors describe the case of a 59-year-old man, a former smoker, with hypertension, chronic renal failure undergoing hemodialysis, and a history of stent grafting for repair of an abdominal aortic aneurysm and miliary tuberculosis, who was diagnosed with constrictive pericarditis and a thoracic aortic aneurysm. In a patient with such a complex medical history, there were several etiologies to consider. The treatment consisted of pericardiectomy and a hybrid technique of supra-aortic debranching and subsequent endovascular stent-graft repair. PMID:23561832

Carvalho, Maria Salomé; Jerónimo de Sousa, Pedro; de Araújo Gonçalves, Pedro; Dores, Hélder; Abecasis, Miguel; Almeida, Manuel; Mendes, Miguel

2013-04-03

179

[Dermatophytosis: a summary of dermatomycosis as a proposal for future revision of the guidelines].  

UK PubMed Central (United Kingdom)

In preparing guidelines for dermatomycosis (tinea, trichophytia, dermatophytosis), we have primarily summarized the disease types and treatments as described in 4 textbooks used in Japan and abroad. We present our classification draft based on these following descriptions. In Japan, any dermatophytosis other than favus or tinea imbricata is considered to be tinea, while outside Japan, favus and tinea imbricata are also classified as tinea. Tinea capitis is classified together with trichophytia superficialis capillitii and kerion celsi, in a group that tends to include asymptomatic carriers. Most textbooks generally classify trichophytia profunda of the glabrous skin and granuloma trichophyticum as subtypes of tinea corporis. Tinea faciei can easily be misdiagnosed, but in many cases can be distinguished from tinea corporis by its specific clinical picture. Tinea unguium is regarded as one type of onychomycosis. We present a summary of dermatomycosis treatment as a proposal for future revision of the guidelines. One of the problems in the treatment of tinea capitis is that the safety of itraconazole (ITZ) and terbinafine hydrochloride (TBF) in children has not been established. Severity criteria for concomitant use of oral medications in the treatment of tinea pedis remains to should be established. Although many clinical studies concerning tinea unguium have been published, 3 of the 4 textbooks we consulted clearly stated that most of those studies were conducted by pharmaceutical companies. Further studies on the etiology and disease severity of tinea unguium are needed.

Ogawa Y; Hiruma M

2009-01-01

180

Epidemiology of dermatophytoses in Crete, Greece between 2004 and 2010.  

UK PubMed Central (United Kingdom)

AIM: The present work was undertaken in order to study the epidemiology of dermatophytoses in the island of Crete, Greece, over a 7-year period (2004-2010) and to compare the results with those reported earlier from this region and from other parts of the world. METHODS: A total of 3236 clinical specimens obtained from 2674 patients with signs of dermatomycoses were examined by direct micropscopy and culture. RESULTS: Overall, 392 specimens (12.1%) were proved mycologically positive for dermatophytes. The age of the patients ranged from 2 to 90 years (mean age, 41 years). Onychomycosis was the predominant clinical type of infection, followed by tinea pedis, tinea corporis, tinea capitis, tinea faciei, tinea manuum and tinea cruris. Among dermatophytes, nine species were isolated: Trichophyton rubrum (51%), Microsporum canis (18.9%), Trichophyton mentagrophytes var. interdigitale (18.4%), Trichophyton mentagrophytes var. mentagrophytes (5.1%), Epidermophyton floccosum (3.6%), Microsporum gypseum (1.5%), Trichophyton violaceum (0.8%), Trichophyton verrucosum (0.5%) and Trichophyton tonsurans (0.2%). CONCLUSION: In our area, the most common dermatophyte was T. rubrum followed by M. canis. Epidemiological studies regarding the current prevalence of dermatophytes in a certain region are needed for the appropriate management of these infections and implementation of effective prevention and control measures.

Maraki S

2012-06-01

 
 
 
 
181

Clinical variations in dermatophytosis in HIV infected patients  

Directory of Open Access Journals (Sweden)

Full Text Available Dermatophyte infections are common in HIV infected patients and can occur at some point during their illness. They may show clinical variations. The present study was to note the prevalence and clinical variations in dermatophytosis in HIV infected patients. Out of 185 HIV infected patients screened at our hospital, the diagnosis of dermatophytosis was made in 41 cases. The prevalence of dermatophytosis was 22.2% Male to female ratio was 3:1 The mean age of our patients was 30.7 years. The occupations of our patients in decreasing order of frequency were labourers (43.9%), drivers (29.3%) and rest were housewives, commercial sex workers etc. Heterosexual route was the most common mode of acquisition of HIV infection. Tinea corporis was the commonest dermatophyte infection and was seen in 22 (53.7%) cases, followed by tinea cruris in 18 (49.9%), tinea pedis in 7 (17.1), tinea faciei in 6 (14.7%) and one patient had tinea manum infection. Tinea unguium was recorded in 11 cases. Out of the 22 patients with tinea corporis, 19 were in the HIV Group IV. Ten of them presented with multiple, large sharply marginated areas of hyperkeratosis resembling dry scaly skin (anergic form of tinea corporis). Proximal white subungual onychomycosis (PWSO), thought to be pathognomonic of HIV was seen in 3 cases only. This study has brought into focus variations in presentations of dermatophytosis.

Kaviarasan P; Jaisankar T; Thappa Devinder Mohan; Sujatha S

2002-01-01

182

[Dermatomycosis caused by Trichophyton verrucosum in mother and child].  

Science.gov (United States)

In recent years, there has been an epidemiological renaissance of zoophilic dermatophytoses caused by a variety of factors. At present, the most important causative organisms are Microsporum canis, Trichophyton mentagrophytes var. granulosum and, as in the present case, Trichophyton verrucosum. These are formerly notifiable pathogens which are highly virulent and contagious. The example of an extensive, originally unrecognized tinea corporis et faciei in mother and child presented here shows the current importance of Trichophyton verrucosum, but also the diagnostic difficulties in dealing with a formerly rare infection disease. The inflammatory symptoms of deep trichophytosis with imminent danger of scar formation was the basis of synergistic combination therapy in the two patients. The source of infection for zoophilic dermatomycosis at the beginning of the epidemiological increase were looked for almost exclusively in Mediterranean countries. However, there are now increased indications of indigenous pools. In view of the neglect of consistent immunization of livestock and the lack of a requirement to notify the disease, a further rise in the number of cases in humans is to be expected. PMID:9715387

Czaika, V; Tietz, H J; Schulze, P; Sterry, W

1998-07-01

183

[Dermatomycosis caused by Trichophyton verrucosum in mother and child  

UK PubMed Central (United Kingdom)

In recent years, there has been an epidemiological renaissance of zoophilic dermatophytoses caused by a variety of factors. At present, the most important causative organisms are Microsporum canis, Trichophyton mentagrophytes var. granulosum and, as in the present case, Trichophyton verrucosum. These are formerly notifiable pathogens which are highly virulent and contagious. The example of an extensive, originally unrecognized tinea corporis et faciei in mother and child presented here shows the current importance of Trichophyton verrucosum, but also the diagnostic difficulties in dealing with a formerly rare infection disease. The inflammatory symptoms of deep trichophytosis with imminent danger of scar formation was the basis of synergistic combination therapy in the two patients. The source of infection for zoophilic dermatomycosis at the beginning of the epidemiological increase were looked for almost exclusively in Mediterranean countries. However, there are now increased indications of indigenous pools. In view of the neglect of consistent immunization of livestock and the lack of a requirement to notify the disease, a further rise in the number of cases in humans is to be expected.

Czaika V; Tietz HJ; Schulze P; Sterry W

1998-07-01

184

[Dermatophytosis: a summary of dermatomycosis as a proposal for future revision of the guidelines].  

Science.gov (United States)

In preparing guidelines for dermatomycosis (tinea, trichophytia, dermatophytosis), we have primarily summarized the disease types and treatments as described in 4 textbooks used in Japan and abroad. We present our classification draft based on these following descriptions. In Japan, any dermatophytosis other than favus or tinea imbricata is considered to be tinea, while outside Japan, favus and tinea imbricata are also classified as tinea. Tinea capitis is classified together with trichophytia superficialis capillitii and kerion celsi, in a group that tends to include asymptomatic carriers. Most textbooks generally classify trichophytia profunda of the glabrous skin and granuloma trichophyticum as subtypes of tinea corporis. Tinea faciei can easily be misdiagnosed, but in many cases can be distinguished from tinea corporis by its specific clinical picture. Tinea unguium is regarded as one type of onychomycosis. We present a summary of dermatomycosis treatment as a proposal for future revision of the guidelines. One of the problems in the treatment of tinea capitis is that the safety of itraconazole (ITZ) and terbinafine hydrochloride (TBF) in children has not been established. Severity criteria for concomitant use of oral medications in the treatment of tinea pedis remains to should be established. Although many clinical studies concerning tinea unguium have been published, 3 of the 4 textbooks we consulted clearly stated that most of those studies were conducted by pharmaceutical companies. Further studies on the etiology and disease severity of tinea unguium are needed. PMID:19942789

Ogawa, Yumi; Hiruma, Masataro

2009-01-01

185

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

International Nuclear Information System (INIS)

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

1998-01-01

186

Tuberculosis in patients with end-stage renal disease  

Energy Technology Data Exchange (ETDEWEB)

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.

Kim, Hyo Cheol; Goo, Jin Mo; Chung, Myung Jin; Moon, Min Hoan; Koh, Young Hwan; Im, Jung Gi [Seoul National Univ. College of Medicine and the Institute of Radiation Medicine, SNUMRC, Seoul (Korea, Republic of)

2001-03-01

187

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

Energy Technology Data Exchange (ETDEWEB)

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

Kim, Sang Jin; Lee, Jong Doo; Choi, Kyu Ok; Hwang, Hee Sung [College of Medicine, Yonsei Univ., Seoul (Korea, Republic of)

1990-10-15

188

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

International Nuclear Information System (INIS)

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

1978-01-01

189

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

Scientific Electronic Library Online (English)

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

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

2007-01-01

190

The chest image appearances of penicilliosis marneffei in patients with AIDS  

International Nuclear Information System (INIS)

Objective: To study the chest image appearances of penicilliosis marneffei (PSM) in patients with acquired immune deficiency syndrome (AIDS). Methods: Chest imaging features of PSM in 36 patients with AIDS were retrospectively analyzed. Results: Radiographic features of infiltrative lesions and focal lung consolidation were found in 14 cases (38.89%), in which 2 cases were with single lung disease (5.56%) and 12 cases with bilateral lung involvement (33.33%). Eight cases had diffuse lesions (22.22%), 10 cases had reticular image patterns (27.78%), 9 cases had nodular patterns (25.00%), 7 cases had ground-glass shadows (19.44%), 6 eases had diffuse miliary lesions (16.67% ), 4 cases had enlarged hilar and enlarged mediastinum lymph nodes (11.11). Cystic lesions was found in 5 cases (13.89%). Four cases had pleural effusion (11.11%), and 2 cases had nodular bump (5.56%). Pericardial effusion and pneumothorax each appeared in 1 case (2.78%). By HRCT, infiltrative lesion and focal lung consolidation were found in 32 patients (88.89%), in which 4 cases were with single lung lesions (11.11%) and 28 cases were with bilateral lung lesions (77.78%). Thirteen cases had diffuse lesions (36.11%), 10 cases had pulmonary interstitial hyperplasia (27.78%), 9 cases had nodular patterns (25.00%), 8 cases had ground-glass shadows(22.22%), 9 cases had diffuse miliary lesions (25.00%), 21 cases had enlarged lymph nodes in the mediastinum (58.33%). Cystic lesions were found in 8 cases (22.22%). Thirteen cases had pleural effusion (36.11%), and 2 cases had nodular bump (5.56%). Pericardial effusion and pneumothorax each appeared in 1 case (2.78%). Conclusion: The image appearances of PSM in patients with AIDS include infiltrative lesions or focal lung consolidation, ground-glass shadow, enlarged hilar and mediastinum lymph nodes, pleural effusion, interstitial involvement or reticular image pattern (pulmonary interstitial hyperplasia), diffuse miliary lesion, and cystic lesion. (authors)

2007-01-01

191

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

Directory of Open Access Journals (Sweden)

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

Bassiri-Jahromi Shahindokht; Khaksari Ali

2009-01-01

192

Clinico-epidemiological and mycological aspects of tinea incognito in Iran: A 16-year study.  

UK PubMed Central (United Kingdom)

BACKGROUND: Tinea incognito is a dermatophytic infection in which topical or systemic steroids have modified the clinical appearance of the mycosis and mimicking other skin diseases. OBJECTIVES: A large retrospective study was carried out to identify the clinical aspects and type of dermatophytes involved in tinea incognito cases in Iran during 1993-2008. Patients: Out of 6325 subjects suspected to have dermatophytoses, 56 patients (29 males, 27 females, mean age 32.6 years) were affected with tinea incognito. METHODS: The causative agents were identified macroscopically and microscopically after the clinical samples were subjected to potassium hydroxide examination and culture isolation. RESULTS: The most common type of infection was tinea corporis (32.1%), which significantly affected male patients. The prevalence of the other tineas in decreasing order was as follows: tinea faciei (26.8%), tinea cruris (14.3%), tinea manuum (12.5%), tinea pedis (8.9%), and tinea capitis (5.4%). The clinical features were to some extent diverse, ranging from eczema-like, seborrhoeic dermatitis-like, pyoderma-like and folliculitis to alopecia on scalp, trunk and limbs. Trichophyton verrucosum was the most frequently isolated species representing 33.9% of isolates, followed by T.mentagrophytes (28.6%), T. rubrum (12.5%), Epidermophyton floccosum (10.7%), Microsporum canis (8.9%), T. violaceum (3.6%), and T. schoenleinii (1.8%). CONCLUSION: To the best of our knowledge, this is the first broad investigation dealing with tinea incognito in Iran. The etiological agents of tinea incognito in Iran are consistent with those of the general population.

Ansar A; Farshchian M; Nazeri H; Ghiasian SA

2011-01-01

193

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

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

Mahdi Abastabar; Ali Rezaei -Matehkolaei; Mohammad Reza Shidfar; Parivash Kordbacheh; Rasoul Mohammadi; Tahereh Shokoohi; Mohammad Taghi Hedayati; Nilufar Jalalizand; Hossein Mirhendi

2013-01-01

194

Encefalitis carcinomatosa/ Carcinomatous encephalitis  

Scientific Electronic Library Online (English)

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

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

2004-12-01

195

Chest radiographic findings in patients with HIV/AIDS and pulmonary tuberculosis.  

UK PubMed Central (United Kingdom)

The study describes the main chest radiographic changes in people living with HIV/AIDS and pulmonary tuberculosis, confirmed by sputum culture. This was a descriptive study involving a total of 42 sputum tests from 42 people living with HIV/AIDS and a clinical suspicion of pulmonary tuberculosis. All patients attended two referral hospitals in Recife-PE, Brazil, between August 2009 and January 2012. The most common isolated radiological change was parenchymal consolidation, encountered in six (14.3%) patients, followed by patterns of interstitial infiltrate, diffuse micronodular (miliary), and an association between interstitial infiltrate and parenchymal consolidation, each being encountered in five (11.9%) patients. No statistically significant difference was observed between the radiological findings and CD4T-cell counts, p?=?0.680.

Albuquerque YM; Lima AL; Silva AC; Filho ES; Falbo AR; Magalhães V

2013-07-01

196

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

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

Tobias Saraiva Kunz; Ivo Rohling Ghizoni-Jr

2009-01-01

197

Is it toxoplasma encephalitis, HIV encephalopathy or brain tuberculoma?  

UK PubMed Central (United Kingdom)

A 31-year-old Malaysian man was presented with an episode of seizures by the roadside, after having been recently diagnosed as HIV positive accompanied with miliary tuberculosis. On physical examination, he was oriented to person, but not to time or place. There was no neck stiffness or papilloedema. The other systemic examination was unremarkable. Chest examination revealed crepitations at the upper zone of the right lung. After diagnosis suspicion, the case was confirmed as toxoplasma encephalitis by MRI and serological tests. Patient was treated with trimethoprim/sulfamethoxazole 480-2400 mg/day with folinic acid supplement for 60 days. Two months later, a repeat brain MRI showed resolution of the cerebral lesions.

Nimir AR; Osman E; Ibrahim IA; Saliem AM

2013-01-01

198

Computed tomographic scan evaluation of pulmonary blastomycosis.  

UK PubMed Central (United Kingdom)

BACKGROUND: Blastomycosis is an uncommon granulomatous pulmonary and extrapulmonary infectious disease caused by the thermally dimorphic fungus Blastomyces dermatitidis. Diagnosis may be delayed or difficult because of varied presentation. The characteristics of blastomycosis on computed tomographic (CT) scan of the chest are not well characterized. METHODS: The images from 34 chest CT scans from patients with confirmed pulmonary blastomycosis were retrospectively reviewed. RESULTS: The most common CT findings were air bronchograms in 22 patients (65%), consolidation in 21 patients (62%), nodules (smaller than 3 cm) in 21 patients (62%) and lymph node enlargement (mediastinal and hilar nodes combined) in 12 patients (35%). Only four patients (12%) had a miliary pattern. CONCLUSIONS: A specific abnormality characteristic of pulmonary blastomycosis was not identified on CT scanning. The diagnosis can only be made in the context of a high index of clinical suspicion with histological or culture confirmation.

Ronald S; Strzelczyk J; Moore S; Trepman E; Cheang M; Limerick B; Wiebe L; Sarsfield P; Macdonald K; Meyers M; Embil JM

2009-01-01

199

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

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

JAL. Pontes; RC. Pontes; CFD. Rocha

2009-01-01

200

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

UK PubMed Central (United Kingdom)

Gross lesions characterized by swollen livers and spleens accompanied with diffuse white miliary spots, which was resembling those of Marek's disease, were detected in two flocks of meat-type local 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 kidney. These cells were positive immunohistochemically with Iba1 antibody, indicating the histiocytic cells. Some of them contained antigens of avian leukosis virus (ALV) by immunohistochemistry, and env gene of ALV subgroup J was detected from the spleens by polymerase chain reaction (PCR). The phylogenetic analysis of 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.

Furukawa S; Tsukamoto K; Maeda M

2013-08-01

 
 
 
 
201

Calorific and carbon values of marine and freshwater Protozoa  

Science.gov (United States)

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).

Finlay, B. J.; Uhlig, G.

1981-12-01

202

STUDIES OF LUNG VOLUME : III. TUBERCULOUS WOMEN.  

UK PubMed Central (United Kingdom)

The total capacity, middle capacity, and residual air have been determined in twenty adult women suffering from pulmonary tuberculosis. The chest volumes have been determined in each case and the normal lung volumes calculated by means of the ratios worked out in Paper I and applied to thirty-one men in Paper II. The excursions of the diaphragm have been determined by fluoroscopy in all cases. Of eight patients with incipient tuberculosis, five had lung capacities like those of men in the same group; i.e., about normal total capacity, slightly increased residual air, and consequently somewhat decreased vital capacity. Three had considerably diminished total capacity. In these three patients, however, clinical abnormalities were found (extensive miliary tuberculosis, obstruction of bronchus, fixation of diaphragm in expiratory position). In twelve patients with moderately advanced and advanced tuberculosis, the results agreed with those found in men, the total capacity and vital capacity being decreased, while the residual air was practically normal.

Garvin A; Lundsgaard C; Van Slyke DD

1918-01-01

203

Hepatic tuberculosis mimicking Klatskin tumor: a diagnostic dilemma.  

Science.gov (United States)

Tubercular involvement of liver is rare and usually occurs in association with pulmonary or miliary tuberculosis, as diffuse involvement without recognizable pulmonary tuberculosis or rarely in a localized form, which presents as a tuberculoma or tubercular abscess. We report the case of a 22-year-old boy presenting with features of obstructive jaundice and a clinico-radiological picture highly suggestive of a perihilar cholangiocarcinoma (Klatskin tumor), but found to have tubercular involvement of porta hepatis. We review the literature on this unusual presentation, highlight the considerable diagnostic challenge such cases can pose, and also emphasize the need to consider tuberculosis in differential diagnosis of lesions involving the porta hepatis, particularly in areas endemic for the disease. PMID:18723964

Arora, Raman; Sharma, Alok; Bhowate, Prashant; Bansal, Vijender Kumar; Guleria, Sandeep; Dinda, Amit Kumar

204

Hepatic tuberculosis mimicking Klatskin tumor: A diagnostic dilemma  

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Full Text Available Tubercular involvement of liver is rare and usually occurs in association with pulmonary or miliary tuberculosis, as diffuse involvement without recognizable pulmonary tuberculosis or rarely in a localized form, which presents as a tuberculoma or tubercular abscess. We report the case of a 22-year-old boy presenting with features of obstructive jaundice and a clinico-radiological picture highly suggestive of a perihilar cholangiocarcinoma (Klatskin tumor), but found to have tubercular involvement of porta hepatis. We review the literature on this unusual presentation, highlight the considerable diagnostic challenge such cases can pose, and also emphasize the need to consider tuberculosis in differential diagnosis of lesions involving the porta hepatis, particularly in areas endemic for the disease.

Arora Raman; Sharma Alok; Bhowate Prashant; Bansal Vijender; Guleria Sandeep; Dinda Amit

2008-01-01

205

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

International Nuclear Information System (INIS)

[en] 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

1999-01-01

206

Pancreatite esclero-gomosa simulando sindrome cancerosa da cabeça do pâncreas  

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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.

A. Penna de Azevedo; Antero Junqueira

1944-01-01

207

Distant metastases in papillary thyroid cancer. A review of 91 patients  

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Of 731 patients with papillary thyroid cancer, 91 had metastases outside regional lymph nodes. The most common site was intrathoracic, occurring in 73 of the 91 patients. Miliary, micronodular pulmonary metastases, with iodine 131 (I-131) uptake and curable by I-131 treatment were encountered in seven patients. It has not been established whether this was a transient stage in additional patients. In 38 patients rounded, macronodular pulmonary metastases were found. Another 21 patients had unilateral pulmonary infiltration and mediastinal enlargement. Pulmonary infiltrations may be hematogenic, or may possibly occur via regional, mediastinal lymph nodes. Mortality within 1 year of the diagnosis of distant metastases exceeded 50%. Occurrence of distant metastases showed a slight but highly significant association with male sex, advanced age, and advanced local tumor stage. Better prognostic determinants are, however, required if adequate therapy of the individual patient with papillary thyroid cancer is to be achieved.

Hoie, J.; Stenwig, A.E.; Kullmann, G.; Lindegaard, M.

1988-01-01

208

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

Scientific Electronic Library Online (English)

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

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

2009-08-01

209

Pulmonary coccidioidomycosis.  

Science.gov (United States)

Coccidioidomycosis refers to the spectrum of disease caused by the dimorphic fungi Coccidioides immitis and Coccidioides posadasii. Clinical manifestations vary depending upon both the extent of infection and the immune status of the host. Coccidioidomycosis has been reported to involve almost all organ systems; however, pulmonary disease is the most common clinical manifestation. The incidence of coccidioidomycosis continues to rise, and primary coccidioidal pneumonia accounts for 17 to 29% of all cases of community-acquired pneumonia in endemic regions. The majority of patients with coccidioidomycosis resolve their initial infection without sequelae; however, several patients develop complications of disease ranging in severity from complicated pulmonary coccidioidomycosis to widely disseminated disease with immediately life-threatening manifestations. This review focuses on complications of pulmonary coccidioidomycosis with an emphasis on the management of primary coccidioidal infection, solitary pulmonary nodules, pleural effusions, cavitary disease, acute respiratory distress syndrome (ARDS), miliary disease, and sepsis. PMID:22167403

Thompson, George R

2011-12-13

210

Raised CA125 serum level in tubercular peritonitis.  

Science.gov (United States)

A 24-year old woman was admitted with a history of fever and pelvic pain. ESR and CA125 serum level were high and PPD test was negative. Ultra sound and CT evaluation detected free fluid in abdominopelvic cavity. Laparotomy showed fibrinous strands adhering to and fibrotic sac surrounding the components of abdominal cavity. Opening the sac, grey miliary nodules were spotted and pathologic examination revealed multiple granulomatous lesions. Diagnosed with TBP, patient underwent specific antibiotic therapy and her condition improved significantly following treatment. As laboratory findings and image analysis may be misleading in diagnosis of TBP, diagnostic approach of laparotomy and subsequent pathologic examination is of vital value--particularly in premenopausal female patients to preserve fertility. PMID:22360043

Atarod, Zohrerh; Geran-Ourimi, Taraneh; Yazdani, Fereshteh; Mahdavi, Mohammad Reza; Roshan, Payam

2011-09-01

211

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

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

K.H. Erlwanger; B.A. De Witt; L.G. Fick; R.S. Hetem; L.C.R. Meyer; D. Mitchell; W.A. Wilson; B. Mitchell

2012-01-01

212

Pyostomatitis vegetans: a review of the literature.  

Science.gov (United States)

Pyostomatitis vegetans (PV) is a rare condition characterized by pustules that affect the oral mucosa. It is a highly specific marker for inflammatory bowel disease and its correct recognition may lead to the diagnosis of ulcerative colitis or Crohn's disease. Thus, a presumptive diagnosis of PV should suggest a complete gastrointestinal investigation. PV pathogenesis is as yet unknown, although immunological and microbial factors have been suggested as possible aetiological factors. Pyostomatitis vegetans is characterized by erythematous, thickened oral mucosa with multiple pustules and superficial erosions. A peripheral eosinophilia has been observed in most cases reported. Histology shows epithelial acanthosis and superficial ulceration with intraepithelial and / or subepithelial abscesses containing large numbers of eosinophils. The underlying connective tissue exhibits neutrophil and eosinophil infiltration, with miliary abscesses in some cases. Treatment of PV focuses on control of the underlying disease. PMID:19242389

Femiano, Felice; Lanza, Alessandro; Buonaiuto, Curzio; Perillo, Letizia; Dell'Ermo, Antonio; Cirillo, Nicola

2009-03-01

213

Pyostomatitis vegetans: a review of the literature.  

UK PubMed Central (United Kingdom)

Pyostomatitis vegetans (PV) is a rare condition characterized by pustules that affect the oral mucosa. It is a highly specific marker for inflammatory bowel disease and its correct recognition may lead to the diagnosis of ulcerative colitis or Crohn's disease. Thus, a presumptive diagnosis of PV should suggest a complete gastrointestinal investigation. PV pathogenesis is as yet unknown, although immunological and microbial factors have been suggested as possible aetiological factors. Pyostomatitis vegetans is characterized by erythematous, thickened oral mucosa with multiple pustules and superficial erosions. A peripheral eosinophilia has been observed in most cases reported. Histology shows epithelial acanthosis and superficial ulceration with intraepithelial and / or subepithelial abscesses containing large numbers of eosinophils. The underlying connective tissue exhibits neutrophil and eosinophil infiltration, with miliary abscesses in some cases. Treatment of PV focuses on control of the underlying disease.

Femiano F; Lanza A; Buonaiuto C; Perillo L; Dell'Ermo A; Cirillo N

2009-03-01

214

[Intracranial tuberculomas developing during treatment of pulmonary tuberculosis: case report  

UK PubMed Central (United Kingdom)

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.

Pimentel ML; Alves SM; Novis SA; Brandão RZ; Belo Neto E

2000-06-01

215

An radiography study of pediatric pulmonary cryptococcosis  

International Nuclear Information System (INIS)

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

1981-01-01

216

An radiography study of pediatric pulmonary cryptococcosis  

Energy Technology Data Exchange (ETDEWEB)

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

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

1981-12-15

217

Advanced microlithiasis alveolaris pulmonum  

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

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

1987-09-01

218

Post-kala-azar dermal leishmaniasis associated with AIDS  

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

Bittencourt Achiléa; Silva Nancy; Straatmann Andréa; Nunes Victor Luiz Correia; Follador Ivonise; Badaró Roberto

2002-01-01

219

Post-kala-azar dermal leishmaniasis associated with AIDS  

Directory of Open Access Journals (Sweden)

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

Bittencourt Achiléa; Silva Nancy; Straatmann Andréa; Nunes Victor Luiz Correia; Follador Ivonise; Badaró Roberto

2003-01-01

220

Post-kala-azar dermal leishmaniasis associated with AIDS  

Scientific Electronic Library Online (English)

Full Text Available Abstract in english 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 manifestatio (more) ns of visceral leishmaniasis three years after the diagnosis of AIDS. During treatment for visceral leishmaniasis he developed disseminated miliary papules. Microscopically, the skin biopsy showed a "saw-tooth" pattern with a lichenoid mononuclear infiltrate simulating lichen planus. The histopathological diagnosis was achieved through the finding of amastigotes. The authors discuss the clinicopathological aspects of this case based on a review of the specific literature.

Bittencourt, Achiléa; Silva, Nancy; Straatmann, Andréa; Nunes, Victor Luiz Correia; Follador, Ivonise; Badaró, Roberto

2002-12-01

 
 
 
 
221

Post-kala-azar dermal leishmaniasis associated with AIDS  

Scientific Electronic Library Online (English)

Full Text Available Abstract in english 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 manifestatio (more) ns of visceral leishmaniasis three years after the diagnosis of AIDS. During treatment for visceral leishmaniasis he developed disseminated miliary papules. Microscopically, the skin biopsy showed a "saw-tooth" pattern with a lichenoid mononuclear infiltrate simulating lichen planus. The histopathological diagnosis was achieved through the finding of amastigotes. The authors discuss the clinicopathological aspects of this case based on a review of the specific literature.

Bittencourt, Achiléa; Silva, Nancy; Straatmann, Andréa; Nunes, Victor Luiz Correia; Follador, Ivonise; Badaró, Roberto

2003-06-01

222

Coexistence of Granulomatous Enteric Inflammation and Neoplasia in an Adult Sheep.  

Science.gov (United States)

A 7-year-old dairy sheep suffering from chronic loss of weight without diarrhea or anorexia was euthanized after failing to respond to any treatment (antibiotic and antiparasitic). The main findings at the necropsy of this animal were multifocal miliary nodules in several organs, mainly in the Peyer's patches of the small intestine, and a segmental thickening of the jejunal wall. Histologic examination of the samples taken at the necropsy showed a multifocal chronic granulomatous inflammation, with mineralization and caseous necrosis at the core of the larger granulomas and scarce intrahistiocytic acid-fast bacilli consistent with a disseminated digestive tuberculosis. Polymerase chain reaction and bacteriological culture from these samples confirmed Mycobacterium avium subsp avium to be the etiologic agent of this infection. Histologically, the cause of the segmental thickening of the jejunal wall was found to be a small intestine adenocarcinoma, which in some areas coexisted with the granulomatous lesion. PMID:23456963

Benavides, J; Garcia-Pariente, C; Garrido, J M; Sevilla, I A; García-Marín, J F; Pérez, V; Ferreras, M C

2013-03-01

223

Choroidal Tuberculoma in Two Cases With Multiple Intracranial Tuberculomas  

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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.

Aysu ?EN; Betül TU?CU; Aysun SOYSAL; Burcu YÜKSEL; Nihal KOCABIYIK; Baki ARPACI

2011-01-01

224

Pulmonary coccidioidomycosis.  

UK PubMed Central (United Kingdom)

Coccidioidomycosis refers to the spectrum of disease caused by the dimorphic fungi Coccidioides immitis and Coccidioides posadasii. Clinical manifestations vary depending upon both the extent of infection and the immune status of the host. Coccidioidomycosis has been reported to involve almost all organ systems; however, pulmonary disease is the most common clinical manifestation. The incidence of coccidioidomycosis continues to rise, and primary coccidioidal pneumonia accounts for 17 to 29% of all cases of community-acquired pneumonia in endemic regions. The majority of patients with coccidioidomycosis resolve their initial infection without sequelae; however, several patients develop complications of disease ranging in severity from complicated pulmonary coccidioidomycosis to widely disseminated disease with immediately life-threatening manifestations. This review focuses on complications of pulmonary coccidioidomycosis with an emphasis on the management of primary coccidioidal infection, solitary pulmonary nodules, pleural effusions, cavitary disease, acute respiratory distress syndrome (ARDS), miliary disease, and sepsis.

Thompson GR 3rd

2011-12-01

225

Two Polynomial-Time Algorithms for Dual Scheduling Problems  

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

PENG Hong-jie; TANG Guo-chun

2010-01-01

226

Magnetic resonance imaging in acute intractional tuberculosis; Magnetresonanztomographie bei akuter intrakranieller Tuberkulose  

Energy Technology Data Exchange (ETDEWEB)

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.) [Deutsch] Die Befunde von drei Patienten mit intrakranieller Tuberkulose (intrakranielle Miliartuberkulose, Meningitis tuberculosa, Neuritis und Tuberkulome) in der Magnetresonanztomographie (MRT) wurden mit der Computertomographie (CT) verglichen. Sowohl die MRT als auch die CT wurden nativ und nach Kontrastmittelgabe durchgefuehrt. Die MRT zeigte sich im Nachweis von Granulomen insbesondere im Bereich des Hirnstamms ueberlegen. Ebenso wurde ein hoeherer Bildkontrast bei der Darstellung der Meningitis beobachtet. Eine Neuritis der Hirnnerven war nur mit der MRT nachweisbar. Die kontrastmittelunterstuetzte MRT sollte in der bildgebenden Diagnostik einer intrakraniellen Turberkulose primaer zum Einsatz gelangen. (orig.)

Venz, S. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Sander, B. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Benndorf, G. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Terstegge, K. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Podrabsky, P. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Cordes, M. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Felix, R. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany)

1994-12-31

227

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  

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

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

2006-01-01

228

THE HISTOLOGIGAL LESIONS OF ACUTE GLANDERS IN MAN AND OF EXPERIMENTAL GLANDERS IN THE GUINEA-PIG.  

UK PubMed Central (United Kingdom)

The glanders nodule in the class of cases studied by us is in no sense analogous to the miliary tubercle in its histogenesis, and our studies afford no support to Baumgarten's views. The primary effect of the bacillus of glanders on a tissue we found to be not a production of epithelioid cells, which undergo necrosis and invasion by leucocytes, as happens in the cases in which the bacillus of tuberculosis is concerned, but to be the production of primary necrosis of the tissue, followed by inflammatory exudation, often of a suppurative character. Degenerative changes rapidly ensue in the inflammatory products. These conclusions are in harmony with the observations of Tedeschi, above referred to.

Wright JH

1896-11-01

229

[Evaluation of clinical presentation and prognosis of tuberculosis in patients undergoing hemodialysis].  

UK PubMed Central (United Kingdom)

INTRODUCTION: Patients with chronic renal failure treated with hemodialysis represent a high risk group for the development of tuberculosis (TB) in comparison to general population. AIM: The aim of the study was to evaluate clinical presentation, biochemical parameters and outcome of tuberculosis in patients attending the Center for Hemodialysis, Sarajevo University Clinical Center. PATIENTS AND METHODS: The study conducted during the 2000-2005 period included four patients with tuberculosis that were already treated with chronic hemodialysis. Three of these four patients had pulmonary type and one had extrapulmonary type (bone type) of tuberculosis diagnosed by bone biopsy. Miliary TB diagnosis was verified with radiographic lung imaging and appropriate bacteriologic and biochemistry tests. RESULTS: The mean age of the study patients was 66.5 +/- 59.6 years and mean hemodialysis duration 6.7 +/- 4.5 years. During the study period, we diagnosed four cases of active tuberculosis in 200 patients receiving hemodialysis therapy (2%). Tuberculin test was performed in all four patients and was negative. Clinical presentation was predominated by inappetence, feebleness and elevated body temperature. Biochemical tests revealed anemia (Htc 0.25 +/- 0.15), hypoalbuminemia (36.0 +/- 28.5) and extremely raised sedimentation raste (86 +/- 30). Increased transaminases were present in two of four patients; the culture of Mycobacterium tuberculosis was found in patients with pulmonary type of TB. Radiographic tests revealed miliary changes in two patients and pleural effusion in one patient. All patients were administered tuberculostatic drugs and six-month treatment resulted in full recovery. CONCLUSION: Negative PPD test does not exclude the occurrence of TB in hemodialysis patients and the existence of pulmonary infiltrate and pleural effusion on radiographic chest images suggests the presence of the TB.

Resi? H; Dizdarevi? Z; Cori? A; Avdi? E; Kukavica N; Mesi? E

2008-02-01

230

Inhibition of cellular efflux pumps involved in multi xenobiotic resistance (MXR) in echinoid larvae as a possible mode of action for increased ecotoxicological risk of mixtures.  

Science.gov (United States)

In marine organisms the multi xenobiotic resistance (MXR) mechanism via e.g. P-glycoprotein (P-gp) and multidrug resistance-associated protein (MRP) is an important first line of defense against contaminants by pumping contaminants out of the cells. If compounds would impair the MXR mechanism, this could result in increased intracellular levels of other compounds, thereby potentiating their toxicity. A calcein-AM based larval cellular efflux pump inhibition assay (CEPIA) was developed for echinoid (Psammechinus miliaris) larvae and applied for several contaminants. The larval CEPIA revealed that triclosan (TCS) and the nanoparticles P-85(®) (P-85) were 124 and 155× more potent inhibitors (IC(50) 0.5 ± 0.05 and 0.4 ± 0.1 ?M, respectively) of efflux pumps than the model inhibitor Verapamil (VER). PFOS (heptadecafluorooctane sulfonic acid) and pentachlorophenol also were more potent than VER, 24 and 5×, respectively. Bisphenol A and o,p'-dichlorodiphenyltrichloroethane (o,p'-DDT) inhibited efflux pumps with a potency 3× greater than VER. In a 48 h early life stage bioassay with P. miliaris, exposure to a non-lethal concentration of the inhibitors TCS, VER, the model MRP inhibitor MK-571, the nanoparticles P-85 and the model P-gp inhibitor PSC-833, increased the toxicity of the toxic model substrate for efflux pumps vinblastine by a factor of 2, 4, 4, 8 and 16, respectively. Our findings show that several contaminants accumulating in the marine environment inhibit cellular efflux pumps, which could potentiate toxic effects of efflux pumps substrates. PMID:22868905

Anselmo, Henrique M R; van den Berg, Johannes H J; Rietjens, Ivonne M C M; Murk, Albertinka J

2012-08-07

231

Inhibition of cellular efflux pumps involved in multi xenobiotic resistance (MXR) in echinoid larvae as a possible mode of action for increased ecotoxicological risk of mixtures.  

UK PubMed Central (United Kingdom)

In marine organisms the multi xenobiotic resistance (MXR) mechanism via e.g. P-glycoprotein (P-gp) and multidrug resistance-associated protein (MRP) is an important first line of defense against contaminants by pumping contaminants out of the cells. If compounds would impair the MXR mechanism, this could result in increased intracellular levels of other compounds, thereby potentiating their toxicity. A calcein-AM based larval cellular efflux pump inhibition assay (CEPIA) was developed for echinoid (Psammechinus miliaris) larvae and applied for several contaminants. The larval CEPIA revealed that triclosan (TCS) and the nanoparticles P-85(®) (P-85) were 124 and 155× more potent inhibitors (IC(50) 0.5 ± 0.05 and 0.4 ± 0.1 ?M, respectively) of efflux pumps than the model inhibitor Verapamil (VER). PFOS (heptadecafluorooctane sulfonic acid) and pentachlorophenol also were more potent than VER, 24 and 5×, respectively. Bisphenol A and o,p'-dichlorodiphenyltrichloroethane (o,p'-DDT) inhibited efflux pumps with a potency 3× greater than VER. In a 48 h early life stage bioassay with P. miliaris, exposure to a non-lethal concentration of the inhibitors TCS, VER, the model MRP inhibitor MK-571, the nanoparticles P-85 and the model P-gp inhibitor PSC-833, increased the toxicity of the toxic model substrate for efflux pumps vinblastine by a factor of 2, 4, 4, 8 and 16, respectively. Our findings show that several contaminants accumulating in the marine environment inhibit cellular efflux pumps, which could potentiate toxic effects of efflux pumps substrates.

Anselmo HM; van den Berg JH; Rietjens IM; Murk AJ

2012-11-01

232

Ultrasonographic and CT findings of hepatosplenic tuberculosis  

Energy Technology Data Exchange (ETDEWEB)

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.

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

233

Extrapulmonary tuberculosis: 7year-experience of a tertiary center in Istanbul.  

UK PubMed Central (United Kingdom)

BACKGROUND: Although a decreasing trend of tuberculosis (TB) was reported in Turkey, higher proportion of extrapulmonary tuberculosis (EPT) was revealed. MATERIAL AND METHODS: In this retrospective study, clinical and laboratory data of 141 EPT patients were evaluated for a seven-year period by using descriptive statistics, and parametric and non-parametric tests where appropriate. RESULTS: The most frequent types of EPT were meningeal TB (23%) and TB lymphadenitis (21%), respectively. Other types of EPT were skeletal, miliary, peritoneal, abscess, genitourinarial, cutaneous and gastrointestinal involvement which ranged between 18% and 1%. Mean age was 42 and female/male ratio was almost equal. All patients were born in Turkey. Although all of them were permanent residents of Istanbul, 73% of the patients came from East and Southeast Region of Turkey. For the patients, being older than 40years old (p<0.01), having miliary TB (p<0.05) and high CRP levels (p<0.05) were found to be associated with mortality. CONCLUSIONS: EPT still remains as a significant morbidity and mortality reason in lower income populations and developing countries. In our study, although all patients were residents of Istanbul approximately two thirds of them have migrated from East and Southeast parts of the country. The relatively high prevelance of tuberculosis cases in Istanbul may be due to the permanent migration from other parts of the country. Early diagnosis and initiation of appropriate treatment are the keys for reducing morbidity and mortality in patients with EPT, particularly in the cases of older ages.

Sevgi DY; Derin O; Alpay AS; Gündüz A; Konuklar AS; Bayraktar B; Bulut E; Uzun N; Sonmez E

2013-09-01

234

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

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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.

dos Santos Rodrigo P; Scheid Karin L; Willers Denise MC; Goldani Luciano Z

2008-01-01

235

Mimics in chest disease: interstitial opacities.  

Science.gov (United States)

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

Oikonomou, Anastasia; Prassopoulos, Panos

2012-12-18

236

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

International Nuclear Information System (INIS)

To review the indications, diagnostic yields and complications of transbronchial biopsy (TBB) in a tertiary hospital in the State of Qatar. A retrospective review of our records revealed 1006 adult flexible fibre optic bronchoscopies (FFB) at Hamad General Hospital, State of Qatar between January 1999 and December 2003. A total of 85 (8.4%) TBB were performed, but complete data were available for 71/85 (83.5%), which were reviewed for indications, diagnostic yields and complications. Adequate samples were obtained in 58/71 TBBs (81.7%), while 13/71 TBBs (18.3%) yielded mucosa. The main indications in 16/71 (22.5%) TBBs for radiographic localized pulmonary diseases were to rule out (TB) in 13 cases, and malignancy in 3 cases. Tuberculosis was verified in 3 (23%) of 13 cases with localized disease. 45 out of 71 (77.5%) TBBs were performed for radiographic diffuse pulmonary disease: 16/55 (29%) for miliary shadows, while 39/55 (70.9%) were carried out for reticular /reticulonodular infiltrates. Histopathology showed granulomatous lesions consistent with TB in 10/16 (62.5%) cases of miliary shadow. In other pattern of diffuse disease, the histopathological diagnosis were obtained in 25/39 (64%) cases. It showed non-specific pulmonary fibrosis in 13 cases, sarcoidosis in 4 cases, connective tissue disease associated interstitial fibrosis in 4 cases, bronchiolitis obliterans organizing pneumonia (BOOP) in one case, eosinophilic pneumonia in one case, amiodarone toxicity in one case and lymphangitis carcinomatosis in one case. The main complications were minor bleeding

2005-01-01

237

Tuberculosis extrapulmonar en nuestro medio: Formas de presentación/ Extrapulmonary tuberculosis in our area: Forms of presentation  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish Objetivo: Analizar la distribución de las formas de presentación de tuberculosis extrapulmonar (FPE) en nuestro medio. Material y métodos: Se revisaron los casos de tuberculosis extrapulmonar registrados en la Unidad de Prevención y Control de la Tuberculosis del Área Sanitaria de Santiago de Compostela en un periodo de tres años. Clasificamos las FPE en: formas extrapulmonares (FE), definida por una localización extrapulmonar; formas mixtas (FM), localización pul (more) monar y extrapulmonar; formas diseminadas (FD), dos o más localizaciones extrapulmonares; y TB miliares, definida por patrón radiológico miliar y/o enfermedad diseminada en necropsia. Resultados: Se registraron 921 tuberculosis de las cuales 370 (40,2%) fueron extrapulmonares. De ellos 199 eran varones y 171 mujeres. Edad media de 36,9 años (rango, 19 y 68). Se constató infección por el virus de la inmunodeficiencia humana (VIH) en 22 casos (25,9%). La distribución de las FPE fue: FE 307 casos (83,0%): pleural 140 (45,6%), ganglionar 87 (28,3%), intestinal 16 (5,2%), osteoarticular 14 (4,5%), genitourinaria 11 (3,6%), cutánea 11 (3,6%), meníngea 10 (3,3%), otras 18 (5,9%); FM 38 (10,3%); FD 8 (2,1%) y TB miliares 17 casos (4,6%). Los pacientes con infección por el VIH presentaron FE en 17 casos (77,3%) en su mayoría ganglionar (64,7%); FD en 4 (18,2%); y TB miliar en 1 (4,5%). Conclusiones: La tuberculosis extrapulmonar supera las expectativas esperables, no en vano refleja un porcentaje próximo a la localización pulmonar. Ello indica por una parte, un cambio significativo en la presentación clásica de la enfermedad, y por otra una extrema sensibilidad en el diagnóstico localizatorio de la enfermedad. Abstract in english Objetive: To analyse the distribution of the extrapulmonary forms of presentation of tuberculosis (EFP) in our health district. Materials and methods: The medical records of patients diagnosed with extrapulmonary tuberculosis attending the Tuberculosis Prevention and Control Unit of the Santiago Health District were reviewed over a three years period. The classification of EFP was: extrapulmonary forms (EF), disease outside the lung; mixed forms (MF), the presence of both (more) pulmonary and extrapulmonary tuberculosis; disseminated forms (DF), the pressence of two or more extrapulmonary locations; and miliary TB, which was definied by a diffuse pulmonary radiographic pattern or diagnosis was undertaken by necropsy. Results: A total of 921 tuberculosis infected patients were observed, of which 370 (40.2%) were extrapulmonary forms; of these, 199 were men and 171 women (mean age was 36.9 years, range 19-68). The distribution of EFP was: 307 EF (83%) of which 140 (45.6%) were pleural, 87 (28.3%) ganglionary, 16 (5.2%) intestinal, 14 (4.5%) bone and joint, 11 (3.6%) genitourinary, 11 (3.6%) cutaneous, 10 (3.3%) meningeal, and other locations 18 (5.9); MF 38 cases (10.3%); DF 8 cases (2.1%) and miliary TB 1 cases (4.6%). In HIV infected patients 17 EF (77.3%), which were mainly ganglionary (64.7%); 4 DF (18.2%); and 1miliary TB (4.5%) cases were observed. Conclusions: Our findings confirm the high incidence of extrapulmonary TB, similar to the number of pulmonary forms. Our experience shows a significant modification to the classical presentation of the disease, and thus the need for sensitivity in locating the disease.

Lado Lado, F. L.; Túñez Bastida, V.; Golpe Gómez, A. L.; Ferreiro Regueiro, M. J.; Cabarcos Ortiz de Barrón, A.

2000-12-01

238

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

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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).

Azadeh Moghadam; Elham Esmi; Shahram Kahkouee

2010-01-01

239

Radiological patterns of childhood pulmonary tuberculosis in Khartoum state  

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

1996-01-01

240

Parameters from the community of leaf-litter frogs from Estacao Ecologica Estadual Paraiso, Guapimirim, Rio de Janeiro State, southeastern Brazil.  

UK PubMed Central (United Kingdom)

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 m(2). Haddadus binotatus had the highest density (1.1 ind/100 m(2)). 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.

Rocha CF; Vrcibradic D; Kiefer MC; Siqueira CC; Almeida-Gomes M; Borges Júnior VN; Hatano FH; Fontes AF; Pontes JA; Klaion T; Gil LO; Sluys MV

2011-12-01

 
 
 
 
241

A toxicity identification evaluation of silty marine harbor sediments to characterize persistent and non-persistent constituents.  

UK PubMed Central (United Kingdom)

Sediment toxicity in silty marine harbor sediments is frequently dominated by ammonia or sulfide, leaving the adverse effects of persistent toxic substances unnoticed. To investigate the latter, we subjected interstitial water from three contaminated silty sediments to toxicity identification evaluation (TIE) phase I manipulations and tested for toxicity with four bioassays: the amphipod Corophium volutator (survival as an endpoint), the sea urchin Psammechinus miliaris (fertilization, embryo development) and the bacterium Vibrio fischeri (bioluminescence inhibition). The graduated pH manipulations identified the prominent toxicity of ammonia in the amphipod and sea urchin embryo tests, and also sulfide toxicity in the bacterium test. In two of the three samples tested with the amphipods, sea urchin embryos and bacteria, a small but significant reduction in interstitial water toxicity was achieved by removing persistent compounds through C(18) solid phase extraction. EDTA chelation resulted in a slight detoxification of the interstitial water for the amphipods and sea urchin embryos, but this was not related to any measured trace metals. Despite the presence of toxic levels of ammonia and sulfide in the harbor sediments, we established the adverse biological effects of persistent constituents by means of the TIE manipulations and in vivo interstitial water bioassays.

Stronkhorst J; Schot ME; Dubbeldam MC; Ho KT

2003-01-01

242

A toxicity identification evaluation of silty marine harbor sediments to characterize persistent and non-persistent constituents.  

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Sediment toxicity in silty marine harbor sediments is frequently dominated by ammonia or sulfide, leaving the adverse effects of persistent toxic substances unnoticed. To investigate the latter, we subjected interstitial water from three contaminated silty sediments to toxicity identification evaluation (TIE) phase I manipulations and tested for toxicity with four bioassays: the amphipod Corophium volutator (survival as an endpoint), the sea urchin Psammechinus miliaris (fertilization, embryo development) and the bacterium Vibrio fischeri (bioluminescence inhibition). The graduated pH manipulations identified the prominent toxicity of ammonia in the amphipod and sea urchin embryo tests, and also sulfide toxicity in the bacterium test. In two of the three samples tested with the amphipods, sea urchin embryos and bacteria, a small but significant reduction in interstitial water toxicity was achieved by removing persistent compounds through C(18) solid phase extraction. EDTA chelation resulted in a slight detoxification of the interstitial water for the amphipods and sea urchin embryos, but this was not related to any measured trace metals. Despite the presence of toxic levels of ammonia and sulfide in the harbor sediments, we established the adverse biological effects of persistent constituents by means of the TIE manipulations and in vivo interstitial water bioassays. PMID:12535970

Stronkhorst, Joost; Schot, Marlies E; Dubbeldam, Marco C; Ho, Kay T

2003-01-01

243

Development of a clinical scoring system for the diagnosis of smear-negative pulmonary tuberculosis  

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Full Text Available Abstract in english This study developed a clinical score based on clinical and radiographic data for the diagnosis of smear-negative pulmonary tuberculosis (SNPT). SNPT was defined as a positive culture in Ogawa in a patient with two negative sputum smears. Data from patients admitted to the emergency ward with respiratory symptoms and negative acid-fast bacilli (AFB) smears was analyzed by means of logistic regression to develop the predictive score.Two hundred and sixty two patients were (more) included. Twenty patients had SNPT. The variables included in the final model were hemoptysis, weight loss, age > 45 years old, productive cough, upper-lobe infiltrate, and miliary infiltrate. With those, a score was constructed. The score values ranged from -2 to 6. The area under the curve for the ROC curve was 0.83 (95% CI 0.74-0.90). A score of value 0 or less was associated with a sensitivity of 93% and a score of more than 4 points was associated with a specificity of 92% for SNPT. Fifty-two point twenty-nine percent of patients had scores of less than one or more than four, what provided strong evidence against and in favor, respectively, for the diagnosis of SNPT. The score developed is a cheap and useful clinical tool for the diagnosis of SNPT and can be used to help therapeutic decisions in patients with suspicion of having SNPT.

Soto, Alonso; Solari, Lely; Agapito, Juan; Acuna-Villaorduna, Carlos; Lambert, Marie-Laurence; Gotuzzo, Eduardo; Stuyft, Patrick Van der

2008-04-01

244

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

UK PubMed Central (United Kingdom)

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

Tchernev G

2011-05-01

245

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

Science.gov (United States)

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

Tchernev, Georgi

2011-05-01

246

A multinational outbreak of histoplasmosis following a biology field trip in the Ugandan rainforest.  

UK PubMed Central (United Kingdom)

BACKGROUND: Outbreaks of histoplasmosis have been increasingly reported in association with travel to endemic areas. Multiple outbreaks have been reported following travel to the Americas, but reports of pulmonary histoplasmosis in short-term immunocompetent travelers to Africa are rare. METHODS: A biology student was referred to our unit with suspected pulmonary histoplasmosis following her return from a field trip in the Ugandan rainforest. The patient informed us that several of her multinational student colleagues on the same expedition had developed a similar illness. Using an alert in ProMED-mail and a questionnaire forwarded to each of the symptomatic students, we accumulated data on the other cases involved in this apparent outbreak of pulmonary histoplasmosis. RESULTS: Thirteen of 24 students developed respiratory symptoms following the expedition. Chest X-ray appearances were often suggestive of miliary tuberculosis but in most cases a final diagnosis of histoplasmosis was made (confirmed with serology in five cases, clinically diagnosed in six, and retrospectively suspected in two). Detailed questioning indicated that the likely source was a large hollow bat-infested tree within the rainforest. CONCLUSIONS: This is an unusual outbreak of histoplasmosis following short-term travel to Africa. Pulmonary histoplasmosis should always be considered in the differential diagnosis of an acute febrile respiratory illness in travelers returning from endemic areas or reporting activities suggesting exposure.

Cottle LE; Gkrania-Klotsas E; Williams HJ; Brindle HE; Carmichael AJ; Fry G; Beeching NJ

2013-03-01

247

Differentiation of etiology of nodular changes in high resolution computed tomography (HRCT) in interstitial lung diseases.  

UK PubMed Central (United Kingdom)

High resolution computed tomography (HRCT) enables imaging of morphological changes invisible on plain chest radiograms or conventional CT. This is related to thin collimations of the scans and sharp (bone) algorithm of image reconstruction. In HRCT the lung interstitium may be evaluated at the level of the smallest functional unit, namely pulmonary lobule. Nodular changes are among the most frequent morphological changes in interstitial lung diseases. The aim of the study is evaluation of frequency and character of nodular changes in HRCT in interstitial lung diseases. HRCT enables imaging of nodular changes in miliary tuberculosis, before they are visible on radiograms. Perilymphatic nodules are typical in sarcoidosis, lymphangitic spread of carcinoma and pneumoconiosis. In sarcoidosis nodules predominate along the peribronchovascular cuffs and in subpleural regions, in lymphangitic spread of carcinoma they are septal and peribronchovascular. In pneumoconiosis nodules are centrilobular and subpleural. The assessment of character and localization of nodules in interstitial lung disease is not sufficient in reliable differentiation, but may be helpful in differential diagnosis in association in other HRCT findings.

Pas?awski M; Szafranek J; Krupski W; Z?omaniec J

2003-01-01

248

Neonatal liver abscesses associated with candidemia. Three cases and review of literature.  

UK PubMed Central (United Kingdom)

Abstract Background: Our aim was to identify risk factors for the development of neonatal Candida liver abscess and to find useful information to better manage this potentially fatal complication. Methods: A computerized search was conducted using PubMed and SCOPUS. Overall, three articles describing the history of seven infants were finally considered. The characteristics of these seven cases were analyzed together with those of three new cases that we treated in the recent past. Results: All the neonates were premature. Previous antibiotic use was reported in all the cases, umbilical venous catheterization (UVC) in 9/10 and total parenteral nutrition in 8/10. C. albicans was isolated in 9/10. All the patients presented with aspecific signs of sepsis. Liver abscesses were described as "microabscesses" or "miliary abscesses" in three cases, as solitary lesion in two cases. In one case two lesions and in one four lesions were reported. Three infants died. Conclusions: Liver ultrasonography should be performed in all the neonates with signs of sepsis, especially in presence of candidemia and/or hepatomegaly and/or significant change in liver enzymes. UVC should be removed, and peripheral IV access should be used until there is documented clearance from the blood with three or more negative blood cultures.

Cascio A; Pantaleo D; Corona G; Barberi G; Delfino D; Romeo O; Iaria C; Barberi I

2013-08-01

249

Tuberculous meningitis in a Filipino maid.  

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Tuberculous meningitis, while not uncommon in Taiwan, has not been reported among foreign workers. We report the first case of tuberculous meningitis in a 37-year-old Filipino maid in Taiwan, who presented with headache, fever and vomiting. She had been well before this episode and the small screening films of the chest radiograph obtained on her arrival in Taiwan 15 months previously, and every 6 months thereafter showed no evidence of tuberculosis. The suspicion of tuberculous meningitis was delayed until disturbance of consciousness manifested and a standard chest radiograph showed a diffuse miliary pattern in both lung fields. A cerebrospinal fluid sample that was sent for a polymerase chain reaction-based assay specific for Mycobacterium tuberculosis showed a positive result. The patient recovered with sequelae of mildly incoherent speech and urinary incontinence after antituberculous medication and short-course steroid treatment. Clinicians should be aware of the possibility of tuberculous meningitis in foreign workers with complaints of fever and headache. Because high-quality chest radiographs are a prerequisite for early detection of pulmonary tuberculosis, we recommended that standard posterior-anterior chest radiographs should be obtained as part of the routine health examination for foreign workers. PMID:10705697

Sheu, J J; Yuan, R Y; Lu, J J; Chung, C L; Hsu, C Y

1999-11-01

250

Tuberculous meningitis in a Filipino maid.  

UK PubMed Central (United Kingdom)

Tuberculous meningitis, while not uncommon in Taiwan, has not been reported among foreign workers. We report the first case of tuberculous meningitis in a 37-year-old Filipino maid in Taiwan, who presented with headache, fever and vomiting. She had been well before this episode and the small screening films of the chest radiograph obtained on her arrival in Taiwan 15 months previously, and every 6 months thereafter showed no evidence of tuberculosis. The suspicion of tuberculous meningitis was delayed until disturbance of consciousness manifested and a standard chest radiograph showed a diffuse miliary pattern in both lung fields. A cerebrospinal fluid sample that was sent for a polymerase chain reaction-based assay specific for Mycobacterium tuberculosis showed a positive result. The patient recovered with sequelae of mildly incoherent speech and urinary incontinence after antituberculous medication and short-course steroid treatment. Clinicians should be aware of the possibility of tuberculous meningitis in foreign workers with complaints of fever and headache. Because high-quality chest radiographs are a prerequisite for early detection of pulmonary tuberculosis, we recommended that standard posterior-anterior chest radiographs should be obtained as part of the routine health examination for foreign workers.

Sheu JJ; Yuan RY; Lu JJ; Chung CL; Hsu CY

1999-11-01

251

Recruitment of Th1 effector cells in human tuberculosis: hierarchy of chemokine receptor(s) and their ligands.  

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Selective recruitment of IFN-? biased Th1 effector cells at the pathologic site(s) determines the local immunity of tuberculosis (TB). We observed the enrichment of CXCR3, CCR5 and CD11a(high) T cells in the peripheral blood, pleural fluid and bronchoalveolar lavage of TB pleural effusion (TB-PE) and miliary tuberculosis (MTB) patients respectively. CXCR3(+)CCR5(+) T cells were significantly high at the local disease site(s) in both the forms of TB and their frequency was highest among activated lymphocytes in TB-PE. Interestingly, all CCR5(+) cells were invariably positive for CXCR3 but all CXCR3(+) cells did not co-express CCR5 in pleural fluid whereas the situation was reverse in bronchoalveolar lavage. These CXCR3(+)CCR5(+) cells dominantly produced IFN-? in response to Mycobacterium tuberculosis antigen. In vitro chemotaxis assay indicates dominant role of RANTES and IP-10 in the selective recruitment of CXCR3(+)CCR5(+)cells at the tubercular pathologic sites. PMID:23643185

Saha, Pradip K; Sharma, Prabhat K; Sharma, Surendra K; Singh, Amar; Mitra, Dipendra K

2013-05-01

252

Radiological manifestations of pulmonary tuberculosis  

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Pulmonary tuberculosis (TB) is a common worldwide lung infection. The radiological features show considerable variation, but in most cases they are characteristic enough to suggest the diagnosis. Classically, tuberculosis is divided into primary, common in childhood, and postprimary, usually presenting in adults. The most characteristic radiological feature in primary tuberculosis is lymphadenopathy. On enhanced CT, hilar and mediastinal nodes with a central hypodense area suggest the diagnosis. Cavitation is the hallmark of postprimary tuberculosis and appears in around half of patients. Patchy, poorly defined consolidation in the apical and posterior segments of the upper lobes, and in the superior segment of the lower lobe is also commonly observed. Several complications are associated with tuberculous infection, such as hematogenous dissemination (miliary tuberculosis) or extension to the pleura, resulting in pleural effusion. Late complications of tuberculosis comprise a heterogeneous group of processes including tuberculoma, bronchial stenosis bronchiectasis, broncholithiasis, aspergilloma, bronchoesophageal fistula and fibrosing mediastinitis. Radiology provides essential information for the management and follow up of these patients and is extremely valuable for monitoring complications.

Andreu, J. E-mail: andreuj@hg.vhebron.es; Caceres, J.; Pallisa, E.; Martinez-Rodriguez, M

2004-08-01

253

Tuberculosis in patients with myelodysplastic syndromes  

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AIM: The purpose of our study was to describe radiological manifestations of tuberculosis in patients with myelodysplastic syndromes. MATERIALS AND METHODS: Chest radiographs and CTs of 12 patients with tuberculosis among 195 consecutive patients with myelodysplastic syndrome, proved by bone marrow biopsy, were reviewed. Six of the 12 patients presented with tuberculosis and were subsequently found to have myelodysplastic syndrome. RESULTS: Chest radiographs and CTs revealed pulmonary tuberculosis in all 12 patients and extrapulmonary tuberculous involvement in six (50%). Initial chest radiographic findings of pulmonary tuberculosis included a primary pattern (n = 6), a post-primary pattern (n = 3), a miliary pattern (n = 1), atypical infiltrates (n = 1) and normal radiograph (n = 1). Tuberculosis involved extrathoracic lymph nodes (n = 5), liver (n = 2), spleen (n = 2), kidney (n 2), bowel (n = 2), pericardium (n = 2) peritoneum (n = 1) and rib (n = 1). CONCLUSION: Tuberculosis is a relatively common cause of infection in patients with myelodysplastic syndromes. The radiological appearance of pulmonary tuberculosis in myelodysplastic syndromes is often a primary pattern, and there is frequently extrapulmonary involvement. Kim, H-C. et al. (2002)

Kim, Hyo-Cheol; Goo, Jin Mo; Kim, Hyun Beom; Lee, Joon Woo; Seo, Joon Beom; Im, Jung-Gi

2002-05-01

254

Radiological manifestations of pulmonary tuberculosis  

International Nuclear Information System (INIS)

Pulmonary tuberculosis (TB) is a common worldwide lung infection. The radiological features show considerable variation, but in most cases they are characteristic enough to suggest the diagnosis. Classically, tuberculosis is divided into primary, common in childhood, and postprimary, usually presenting in adults. The most characteristic radiological feature in primary tuberculosis is lymphadenopathy. On enhanced CT, hilar and mediastinal nodes with a central hypodense area suggest the diagnosis. Cavitation is the hallmark of postprimary tuberculosis and appears in around half of patients. Patchy, poorly defined consolidation in the apical and posterior segments of the upper lobes, and in the superior segment of the lower lobe is also commonly observed. Several complications are associated with tuberculous infection, such as hematogenous dissemination (miliary tuberculosis) or extension to the pleura, resulting in pleural effusion. Late complications of tuberculosis comprise a heterogeneous group of processes including tuberculoma, bronchial stenosis bronchiectasis, broncholithiasis, aspergilloma, bronchoesophageal fistula and fibrosing mediastinitis. Radiology provides essential information for the management and follow up of these patients and is extremely valuable for monitoring complications

2004-01-01

255

Thoracic CT findings of behcet disease  

International Nuclear Information System (INIS)

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

2010-01-01

256

Infections caused by mycobacterium tuberculosis in patients with hematological disorders and in recipients of hematopoietic stem cell transplant, a twelve year retrospective study  

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Full Text Available Abstract Background Tuberculous infections in patients with hematological disorders and hematopoietic stem cell transplant vary in incidence, complications and response to treatment. Methods and materials A retrospective study of patients with various benign and malignant hematological disorders and recipients of hematopoietic stem cell transplant who were treated at Riyadh Armed Forces Hospital, Saudi Arabia between January 1991 and December 2002 and who developed tuberculous infections was conducted. Results Tuberculous infections occurred in eighteen patients with hematological disorders and hematopoietic stem cell transplant. The main associated factors were: reduced immunity due to the primary hematological disorder, age more than 50 years and the administration of cytotoxic chemotherapy, steroids or radiotherapy. These infections frequently involved the lungs and predominantly occurred in males and in patients with chronic myeloproliferative disorders, myelodysplastic syndrome and acute myeloid leukemia. In patients treated with intravenous cytotoxic chemotherapy, tuberculous infections tended to occur earlier and also tended to be more disseminated compared to infections occurring in patients treated with oral chemotherapy. Anti-tuberculous treatment was given to 16 patients and it was successful in 15 of these patients. Conclusion Tuberculous infections cause significant morbidity and mortality in patients with various hematological disorders and in recipients of hematopoietic stem cell transplant. The early administration of anti-tuberculous therapy and compliance with drug treatment are associated with successful outcomes while delayed management, drug resistance and the presence of miliary infections are associated with poor prognosis and high mortality rates.

Al-Anazi Khalid; Al-Jasser Asma; Evans David

2007-01-01

257

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

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

G. Kalema-Zikusoka; R.G. Bengis; A.L. Michel; M.H. Woodford

2010-01-01

258

[An analysis of the clinical and radiological features of bronchioloalveolar carcinoma].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To describe the clinical and radiological features of bronchioloalveolar carcinoma. METHODS: Data of 1 050 inpatients of lung cancer, including 50 cases of pathology-proven bronchioloalveolar carcinoma, diagnosed in our hospital between 1993 and 2003, were retrospectively reviewed. The clinical information of all the patients and the HRCT findings of 31 cases of bronchioloalveolar carcinoma were analyzed. RESULTS: There was a female predominance (60%) in the 50 patients with bronchioloalveolar carcinoma. Cough was the most common presenting symptom (20/50). Twenty-four patients sought medical attention because of abnormal chest X-rays, most of which were of nodular type at the early stage. Twenty patients were completely asymptomatic at presentation. Out of the 31 cases with HRCT, eight were of the miliary type. "Bubble-like lucency" and calcifications inside nodules were present in 7 cases respectively out of the 11 cases of the nodular type. There were 9 cases each with low attenuation consolidation, pseudocavities, reticular shadowing and ground-glass opacities. The signs of "crazy paving" and "CT angiogram sign" (distinct vasculature at the background of low-attenuated consolidation at the peak of contrast scanning) were found in 2 cases. CONCLUSIONS: Bronchioloalveolar carcinoma accounted for 4.76% of lung carcinoma in our series, with a female predominance. High prevalence of asymptomatic patients at presentation and unusual long course should prompt regular chest X-ray examination. The characteristics of HRCT findings are very helpful in its diagnosis and differential diagnosis.

Que CL; Zhang PJ; Wang WH; He B; Yin HF; Wang RG

2006-10-01

259

Value of irrigoscopy and computed tomography in the demonstration of gynaecological relapse tumours  

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By means of a retrospective evaluation of time-correlated irrigoscopy and CT examinations in 22 female patients with ovarial cancers either operated or treated radiochemically, the accuracy of both methods for demonstrating gynaecological relapse tumours were studied comparatively. Five radiologists of different experience background took part in this study evaluating pictures independent of each other thus providing the opportunity of studying the influence of personal experience on the accuracy of these methods. As expected, CT proved to be the superior method by far in terms of sensitivity and specificity; however, irrigoscopy will remain an integral part of post operative aftercare since it provides information on the functional and morphological condition of the colon. When calculating the specificity of irrigoscopy, a noticeably broad range of scatter obtained with the figures calculated by the individual evaluators leading to the conclusion that evaluation of irrigoscopy pictures is more difficult and closely related to more experience than is the case with CT pictures. Both methods failed to detect micronodular miliary carcinomatosis in all cases which can be clarified by diagnostic laparotomy (or laparoscopy) only.

Schratter, M.; Wittich, G.; Imhof, H.; Kumpan, W.; Fruehwald, F.

1985-03-01

260

The value of irrigoscopy and computed tomography in the demonstration of gynaecological relapse tumours  

International Nuclear Information System (INIS)

By means of a retrospective evaluation of time-correlated irrigoscopy and CT examinations in 22 female patients with ovarial cancers either operated or treated radiochemically, the accuracy of both methods for demonstrating gynaecological relapse tumours were studied comparatively. Five radiologists of different experience background took part in this study evaluating pictures independent of each other thus providing the opportunity of studying the influence of personal experience on the accuracy of these methods. As expected, CT proved to be the superior method by far in terms of sensitivity and specificity; however, irrigoscopy will remain an integral part of post operative aftercare since it provides information on the functional and morphological condition of the colon. When calculating the specificity of irrigoscopy, a noticeably broad range of scatter obtained with the figures calculated by the individual evaluators leading to the conclusion that evaluation of irrigoscopy pictures is more difficult and closely related to more experience than is the case with CT pictures. Both methods failed to detect micronodular miliary carcinomatosis in all cases which can be clarified by diagnostic laparotomy (or laparoscopy) only. (orig./WU).

1985-01-01

 
 
 
 
261

Congenital tuberculosis.  

UK PubMed Central (United Kingdom)

This is a retrospective study of congenital tuberculosis in Queen Sirikit National Institute of Child Health from 1979 to 1998. There were 9 patients with a mean birth weight of 2,500 grams (range 1,800-3,300). The onset of symptoms and age of diagnosis ranged from 7 to 42 (mean, 21) days and 14 to 75 (mean, 54) days after birth, respectively. The presenting signs and symptoms were fever (100%), poor feeding (100%), irritability (100%), failure to gain weight (100%), hepatomegaly (100%), splenomegaly (77.8%), cough (88.9%), respiratory distress (66.7%) and abdominal distension (77.8%). The tuberculin skin test reaction with > or = 10 mm induration was found in 2 of 8 patients. Their abnormal chest radiographs revealed bronchopneumonia 66.7 per cent, miliary pattern 33.3 per cent and multiple cystic lesion 11.1 per cent. The bacteriological study from gastric aspirate content for acid-fast bacilli (AFB) staining and culture were positive in 62.5 and 71.4 per cent respectively. Fatality rate was 33.3 per cent with no sequele found in the survivors. Congenital tuberculosis is a rare entity and difficult to give an early diagnosis. There should be a high index of suspicion for tuberculosis in those who had pneumonia and were unresponsive to aggressive antibiotics or had unexplained etiology.

Chotpitayasunondh T; Sangtawesin V

2003-08-01

262

Transplant tourism--a dangerous journey?  

UK PubMed Central (United Kingdom)

INTRODUCTION: While the ethical aspects of transplant tourism have received much attention recently, less has been written about the medical safety of this practice. We retrospectively evaluated the outcomes of patients who purchased organs internationally and presented to our center for follow-up care. METHODS: Baseline demographic characteristics were recorded. Post-operative outcomes including patient survival, graft survival, five-yr graft function, and complications were assessed. RESULTS: Eight patients who purchased international organs for transplant were identified. The country of transplant was China (n = 3), Pakistan (n = 3), India (n = 1), and the Philippines (n = 1). All patients were born in either Asia or the Middle East and traveled to the region of their ethnicity for transplantation. The mean time to presentation was 49 d post-operatively. The overall one- and two-yr patient survival rates were 87% and 75%, respectively. One patient died of miliary tuberculosis and another of Acinetobacter baumanii sepsis. There was one case of newly acquired hepatitis B infection. At last follow-up, all six surviving patients had functioning grafts with a mean creatinine level of 1.26 mg/dL at five yr. CONCLUSION: Although intermediate-term graft function is acceptable, the early morbidity and mortality among transplant tourists is high. These results suggest that the associated risks may not justify the trip.

Polcari AJ; Hugen CM; Farooq AV; Holt DR; Hou SH; Milner JE

2011-07-01

263

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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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.

MARIA LÚCIA VELLUTINI PIMENTEL; SILVIA MARIA VIDAL ALVES; SÉRGIO A. PEREIRA NOVIS; RAFAEL ZANDANI BRANDÃO; EPAMINONDAS BELO NETO

2000-01-01

264

Study of tuberculous meningitis by CT  

International Nuclear Information System (INIS)

[en] 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.)

1980-01-01

265

The chest radiological manifestation in psittacosis  

International Nuclear Information System (INIS)

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

2005-01-01

266

Feline Non-Flea Induced Hypersensitivity Dermatitis: Clinical features, diagnosis and treatment.  

UK PubMed Central (United Kingdom)

Practical relevance: Hypersensitivity dermatitis (HD) is often suspected in cats and is mostly caused by insect bites, food or environmental allergens. Cats with non-flea induced HD are reported to present frequently with one or more of the following cutaneous reaction patterns: miliary dermatitis, eosinophilic dermatitis, self-induced symmetrical alopecia or head and neck excoriations/pruritus. Clinical challenges: None of the above patterns are, however, pathognomonic for non-flea induced HD and the diagnosis of this condition is based on exclusion of diseases presenting similarly and an adequate response to treatment. Therapeutic approaches to affected cats include use of immunomodulatory drugs (ciclosporin, glucocorticoids, antihistamines), hypoallergenic diets and allergen-specific immunotherapy. Evidence base: This review provides an update on the clinical signs, diagnosis and treatment of feline non-flea induced HD. It draws on the findings of a recent large-scale study that described the clinical signs of numerous cats with non-flea HD and has proposed criteria to facilitate the diagnosis of the condition.

Favrot C

2013-09-01

267

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

Science.gov (United States)

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

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

2013-01-07

268

Recurrence of sarcoidosis: the follow-up of splenic involvement.  

Science.gov (United States)

We report the case of a 53-year-old woman who initially presented with an intermittent dry cough that had lasted for 6 months. An investigation into these symptoms with thoracic computed tomography demonstrated hyperdense shadows in her lungs, and ultrasonography showed the presence of multiple hypoechoic nodules on her spleen. A lung biopsy was then performed, which revealed noncaseating epithelioid cell granulomas. Magnetic resonance imagining of her spleen was performed, which showed low signal intensity. The patient was treated with glucocorticoids, and 3 months later the lesions in her lungs had disappeared completely. Five months later, the lesions in her spleen had disappeared also. However, after 13 months of low-dose prednisone, a miliary pattern was observed on the patient's chest x-ray, although no lesions were observed in her spleen. Laboratory tests demonstrated that her blood level of angiotensin-converting enzyme had increased to 96 IU/L. The dose of prednisone was then increased, and the lung images returned to normal after 2 months of therapy. PMID:22018598

Wang, Ying-Ting; Han, Yi-Ping; Li, Qiang; Chen, He-Zhong

2011-10-21

269

Efficacy of imidacloprid on dogs and cats with natural infestations of fleas, with special emphasis on flea hypersensitivity.  

UK PubMed Central (United Kingdom)

In this study the efficacy of a 10% weight per volume solution of imidacloprid--registered as a flea control agent with the trademark Advantage topical solution--was assessed in Italy under field conditions in a total of 3272 dogs and cats. During the 4-week trial the number of fleas on each animal was assessed and lesions of flea allergy dermatitis (FAD; i.e., miliary or maculopapular dermatitis, hyperpigmentation, and crusty thickenings of the skin), alopecia, and pruritus were evaluated. Imidacloprid had a notable adulticidal effect and residual activity that controlled fleas and prevented reinfestation of treated animals for at least 4 weeks. In addition, a significant decrease of the clinical signs was documented regardless of each animal's breed, sex, body size, haircoat length, and living conditions. Some of the dogs were washed or shampooed after treatment without showing statistical differences in efficacy. This study demonstrates that a single treatment with imidacloprid is able to effectively control flea infestations in dogs and cats for at least 28 days and significantly contributes to the improvement or disappearance of clinical signs of FAD.

Genchi C; Traldi PG; Bianciardi PP

2000-01-01

270

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).

1992-01-01

271

Abnormal chest shadow on CT in immunosuppressed patients  

Energy Technology Data Exchange (ETDEWEB)

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).

Tanaka, Nobuyuki; Matsumoto, Tsuneo; Nakamura, Hiroshi (Yamaguchi Univ., Ube (Japan). School of Medicine) (and others)

1992-12-01

272

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

UK PubMed Central (United Kingdom)

Hematogenous 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 abuse. Blood tests indicated anemia, leukocytosis, elevated CRP and ESR and mild hyponatremia; hematuria, moderate bacteriuria and 2+ proteinuria on urine analysis 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 HCV seropositivity were detected and the patient remained in a coma for five days with a Glassgow Coma Scale of 6/15. Finally, the diagnosis of hematogenous 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 to after appropriate treatment of tuberculosis.

Tourchi A; Ebadi M; Hosseinzadeh A; Shabaninia M

2013-08-01

273

[Long-term results following radioiodine treatment of patients with metastasizing follicular and papillary thyroid carcinoma  

UK PubMed Central (United Kingdom)

From 1963 to 1988, 94 patients with mediastinal and/or distant metastasis of follicular or papillary thyroid cancer have been treated in our department by subtotal or near total thyroidectomy, 131-iodine ablation of the thyroid recurrent thyroid hormone and 131-iodine applications. Patients with locally advanced tumours had also percutaneous irradiation. Some patients had also surgical excision and percutaneous irradiation of the metastasis. Rates of complete and permanent remissions were: 53% (all pap.), 7% (all foll.), 75% (lung and/or mediastinal metastasis), 100% (miliary or micronodular lung metastasis and small mediastinal nodes), 6% (bone metastasis). Tumor specific survival rates were: 95% and 90% 10 and 20 years in patients less than 40 years old at the beginning of the treatment, 65% (5 years), 40% (10 years), 25% (15 years) and 18% (20 years) in patients at least 40 years old. Serious complications due to radioiodine were observed in three patients (one acute leukemia, one macroscopic haematuria with irradiation cystitis and one cancer of the bladder). Furthermore five patients suffered from grade III/IV thrombocytopenia: these patients had also multiple bone metastasis and percutaneous irradiation of various bone regions.

Sartorelli B; Glanzmann C; Lütolf UM

1990-12-01

274

[The diagnostic value of medical thoracoscopy for unexplained pleural effusion].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To explore the endoscopic features of patients with unexplained pleural effusion, and to evaluate the diagnostic value of medical thoracoscopy. METHODS: A retrospective analysis of 2380 patients with unexplained pleural effusion (1320 males and 1060 females; age 15-94 years) in Shandong Provincial Hospital from 1992 to 2011 were performed .The diagnosis was confirmed by medical thoracoscopy. RESULTS: The endoscopic findings of malignant pleural effusion mostly showed nodules of varying sizes. The nodules could be grape-like, cauliflower-like, fused into masses, or diffused small nodules . The appearance of cancerous nodules was more diversified compared to tuberculous nodules. Tuberculous pleurisy was manifested as diffuse pleural congestion and miliary changes, multiple small gray-white nodules, fibrin deposition and adhesion in the pleural cavity, pleural thickening and loculation . The pathological diagnosis was as follows: pleural metastases in 899 (37.8%), primary pleural mesothelioma in 439 (18.4%), tuberculous pleurisy in 514 (21.6%), non-specific inflammation in 226 (9.5%), empyema in 190 (8.0%), hepatic pleural effusion in 36 (1.5%) and pleural effusion of unknown causes in 76 (3.2%) cases. The diagnostic positive rate of medical thoracoscopy was 96.8%. No serious complications were observed. CONCLUSION: Medical thoracoscopy is a relatively safe procedure and has an important application value in the diagnosis of unexplained pleural effusion.

Jiang SJ; Mu XY; Zhang S; Su LL; Ma WX

2013-05-01

275

Tuberculose hepática pseudotumoral Pseudotumoral hepatic tuberculosis  

Directory of Open Access Journals (Sweden)

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.

Antonio Nocchi Kalil; Fernanda Alvarez Coelho; Gislaine Silveira Olm

1999-01-01

276

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

Science.gov (United States)

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

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

2002-01-01

277

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

UK PubMed Central (United Kingdom)

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.

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

2002-01-01

278

Computed tomography in predicting smear-negative pulmonary tuberculosis in AIDS patients.  

UK PubMed Central (United Kingdom)

BACKGROUND: The correct diagnosis of sputum smear-negative pulmonary tuberculosis in AIDS patients is very important to their therapy. We aimed to assess the value of the computed tomography (CT) and clinical findings in predicting smear-negative pulmonary tuberculosis in AIDS patients. METHODS: A total of 121 AIDS patients suspected of smear-negative pulmonary tuberculosis by clinical and radiographic findings were recruited. Pulmonary tuberculosis was diagnosed in 57 (47.1%) patients. The CT and clinical predictors were selected to diagnose AIDS-related pulmonary tuberculosis through univariate and multivariate Logistic analysis. RESULTS: Multivariate analysis showed that five variables, including weight loss, presence of miliary nodules, necrotic lymph node, lobular consolidation, tree-in-bud sign, were independent predictors of pulmonary tuberculosis in AIDS patients. Predicted scores based on the five variables were used to identify pulmonary tuberculosis. If the predicted score of 3 was taken as the ideal cut-off point in the diagnosis of AIDS-related smear-negative pulmonary tuberculosis, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 84.2%, 81.2%, 80.0%, 85.2%, and 82.6%, respectively. CONCLUSION: The prediction method based on five key factors of clinical and CT findings are useful in guiding the diagnosis of smear-negative pulmonary tuberculosis in AIDS patients.

Feng F; Shi YX; Xia GL; Zhu Y; Lu HZ; Zhang ZY

2013-01-01

279

Recruitment of Th1 effector cells in human tuberculosis: hierarchy of chemokine receptor(s) and their ligands.  

UK PubMed Central (United Kingdom)

Selective recruitment of IFN-? biased Th1 effector cells at the pathologic site(s) determines the local immunity of tuberculosis (TB). We observed the enrichment of CXCR3, CCR5 and CD11a(high) T cells in the peripheral blood, pleural fluid and bronchoalveolar lavage of TB pleural effusion (TB-PE) and miliary tuberculosis (MTB) patients respectively. CXCR3(+)CCR5(+) T cells were significantly high at the local disease site(s) in both the forms of TB and their frequency was highest among activated lymphocytes in TB-PE. Interestingly, all CCR5(+) cells were invariably positive for CXCR3 but all CXCR3(+) cells did not co-express CCR5 in pleural fluid whereas the situation was reverse in bronchoalveolar lavage. These CXCR3(+)CCR5(+) cells dominantly produced IFN-? in response to Mycobacterium tuberculosis antigen. In vitro chemotaxis assay indicates dominant role of RANTES and IP-10 in the selective recruitment of CXCR3(+)CCR5(+)cells at the tubercular pathologic sites.

Saha PK; Sharma PK; Sharma SK; Singh A; Mitra DK

2013-07-01

280

Recurrence of sarcoidosis: the follow-up of splenic involvement.  

UK PubMed Central (United Kingdom)

We report the case of a 53-year-old woman who initially presented with an intermittent dry cough that had lasted for 6 months. An investigation into these symptoms with thoracic computed tomography demonstrated hyperdense shadows in her lungs, and ultrasonography showed the presence of multiple hypoechoic nodules on her spleen. A lung biopsy was then performed, which revealed noncaseating epithelioid cell granulomas. Magnetic resonance imagining of her spleen was performed, which showed low signal intensity. The patient was treated with glucocorticoids, and 3 months later the lesions in her lungs had disappeared completely. Five months later, the lesions in her spleen had disappeared also. However, after 13 months of low-dose prednisone, a miliary pattern was observed on the patient's chest x-ray, although no lesions were observed in her spleen. Laboratory tests demonstrated that her blood level of angiotensin-converting enzyme had increased to 96 IU/L. The dose of prednisone was then increased, and the lung images returned to normal after 2 months of therapy.

Wang YT; Han YP; Li Q; Chen HZ

2012-11-01

 
 
 
 
281

The amino acid sequences of two alpha chains of hemoglobins from Komodo dragon Varanus komodoensis and phylogenetic relationships of amniotes.  

UK PubMed Central (United Kingdom)

To elucidate phylogenetic relationships among amniotes and the evolution of alpha globins, hemoglobins were analyzed from the Komodo dragon (Komodo monitor lizard) Varanus komodoensis, the world's largest extant lizard, inhabiting Komodo Islands, Indonesia. Four unique globin chains (alpha A, alpha D, beta B, and beta C) were isolated in an equal molar ratio by high performance liquid chromatography from the hemolysate. The amino acid sequences of two alpha chains were determined. The alpha D chain has a glutamine at E7 as does an alpha chain of a snake, Liophis miliaris, but the alpha A chain has a histidine at E7 like the majority of hemoglobins. Phylogenetic analyses of 19 globins including two alpha chains of Komodo dragon and ones from representative amniotes showed the following results: (1) The a chains of squamates (snakes and lizards), which have a glutamine at E7, are clustered with the embryonic alpha globin family, which typically includes the alpha D chain from birds; (2) birds form a sister group with other reptiles but not with mammals; (3) the genes for embryonic and adult types of alpha globins were possibly produced by duplication of the ancestral alpha gene before ancestral amniotes diverged, indicating that each of the present amniotes might carry descendants of the two types of alpha globin genes; (4) squamates first split off from the ancestor of other reptiles and birds.

Fushitani K; Higashiyama K; Moriyama EN; Imai K; Hosokawa K

1996-09-01

282

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

UK PubMed Central (United Kingdom)

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.

Wehner A; Katzenberger J; Groth A; Dorsch R; Koelle P; Hartmann K; Weber K

2013-08-01

283

[Sun rays diaphragm: an ultrasonographic sign of interstitial involvement in the base of the lung].  

UK PubMed Central (United Kingdom)

OBJECTIVES: The purpose of this article is to present a new ultrasonographic sign: the spiculated diaphragm or sun rays diaphragm, that makes it possible to suspect disease in the base of the lung, generally involving the subpleural interstitium, during abdominal ultrasound examination. MATERIAL AND METHODS: We present a study of seven patients in whom the diaphragm was observed as an echogenic, curvilinear, thickened image with numerous echogenic vertical lines or bands radiating from it posteriorly during abdominal ultrasound examination using a sectorial transducer. We have named this spiculated appearance of the diaphragm sun rays diaphragm. All patients underwent posteroanterior and lateral plain-film chest x-rays and high-resolution chest computed tomography (CT) with slices of the bases of the lungs. RESULTS: The chest pathology responsible for this finding was pulmonary fibrosis (n = 2), mitral valulopathy with heart failure (n = 2), unilateral atresia of the pulmonary vein (n = 1); combined miliary tuberculosis and Pneumocystis infection in an AIDS patient (n = 1), and carcinomatous lymphangitis (n = 1). CONCLUSIONS: When a spiculated or sun rays diaphragm is observed during abdominal ultrasonography, disease involving the base of the lung (generally the subpleural interstitium) should be suspected; thus, in the absence of prior clinical knowledge of lung disease, additional examinations such as plain-film chest x-rays or thin slice chest CT should be performed.

Ramos FS; Puche FS; Casares MM; Pardal AG; Bustos GA

2008-03-01

284

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

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

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

2003-01-01

285

Computed tomography ub abdominal tuberculosis  

International Nuclear Information System (INIS)

Computed tomography (CT) examination of abdomen and pelvis was undertaken omongst suspected abdominal tuberculosis (TB) subjects and the findings were correlated with barium meal follow through (BMFT), surgical and pathological findings wherever possible. CT features highly suggestive of abdominal tuberculosis in 50 cases studied so far, include: mesenteric and omental masses or lymph nodes usually with hypodense centres (25 cases), bowel wall thickening (20 cases), inflammatory reaction of mesentery and omentum (28 cases), psoas abscesses (two cases), contracted caecum (six cases), tubo-ovarian masses (five cases) miliary tubercles (one case), fistula and sinus tract (two cases). To the best of our knowledge, the latter four findings have not previously been reported in the CT literature. CT proved supreior to BMFT in demonstrating mural, serosal and mesenteric abnormalities. It was especially useful in defining the nature of mass effects, separation or displacement of small bowel segments seen on barium meal follow through. CT features of intra-abdominal tuberculosis need to be recognized so that laparotomy may be avoided wherever possible. Less invasive procedures, such as ultrasound or CT-guided needle aspiration biopsy or a trial of antituberculous therapy (ATT) should be instituted early in the disease. (author). 19 refs.; 5 figs.; 1 tab.

1989-01-01

286

Lessons from Mycobacterium avium complex-associated pneumonitis: a case report  

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Full Text Available Abstract Introduction Mycobacterium avium complex (MAC) is an increasingly recognized cause of pulmonary disease in immunocompetent individuals. An acute form of MAC lung disease, MAC-associated pneumonitis, has generally been associated with the use of hot tubs. There is controversy in the literature about whether MAC-associated pneumonitis is a classic hypersensitivity pneumonitis or is a direct manifestation of mycobacterial infection. Case presentation We report the second case in the literature of MAC-associated pneumonitis not related to the use of hot tubs. The source of MAC in a 52-year-old immunocompetent patient was an intrapulmonary cyst containing numerous acid-fast bacilli. The patient developed disseminated miliary nodules throughout both lung fields. Histological examination of resected lung tissue revealed well-formed, acid-fast negative granulomas composed predominantly of CD4+ T-cells and CD68+ histiocytes. The granulomas were strongly positive for tumor necrosis factor-?, a pro-inflammatory cytokine. Conclusion The attempt to classify MAC-associated pneumonitis as either a classic hypersensitivity pneumonitis or a direct manifestation of mycobacterial infection is not particularly useful. Our case demonstrates that MAC-associated pneumonitis is characterized by a vigorous T-helper 1-like, pro-inflammatory, immune response to pulmonary mycobacterial infection. The immunopathology provides a rationale for clinical studies of anti-MAC therapy with the addition of anti-inflammatory agents (for example, corticosteroids) to hasten the resolution of infection and symptoms.

Zota Victor; Angelis Sheryn M; Fraire Armando E; McNamee Ciaran; Kielbasa Shasta; Libraty Daniel H

2008-01-01

287

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

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

Ahmad Qazi; Shah Iffat; Nauman Qazi; Sameem Farah; Sultan Javaid

2008-01-01

288

INCREASED INCIDENCE OF TUBERCULOSIS IN PATIENTS OF SYSTEMIC SCLEROSIS ON DEXAMETHASONE PULSE THERAPY: A SHORT COMMUNICATION FROM KASHMIR  

Science.gov (United States)

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

Ahmad, Qazi Masood; Shah, Iffat Hassan; Nauman, Qazi; Sameem, Farah; Sultan, Javaid

2008-01-01

289

Computed tomography of intracranial tuberculosis  

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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.

Park, Yong Lan; Lee, Jung Suk; Eun, Chung Kie; Kim, Soon Yong [School of Medicine, Kyung Hee University, Seoul (Korea, Republic of)

1981-09-15

290

Acute renal failure after rifampicin Insuficiência renal aguda por rifampicina  

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Full Text Available A patient with miliary tuberculosis and a chronic urogenital focus is described, who had a borderline renal function at diagnosis and developed overt renal failure upon daily treatment with rifampin (RMP), isoniazid (INH) and ethambutol (EMB). This is the first Brazilian report of BMP induced renal damage. A renal biopsy taken on the third day of oliguria showed recent tubular necrosis with acute interstitial inflammation and granuloma formation. The aspect of the granulomatous lesion hightly suggested drug etiology because of the lack of palisading, high incidence of neutrophils and absence of facid-fast bacilli. This is the first presentation of an acute granulomatous interstitial nephritis probably due to RMP. Furthermore the pathogenesis of the renal damage caused by tuberculosis and RMP are discussed.Apresentamos um paciente com tuberculose miliar a partir de um foco crônico urogenital. Em sua entrada no hospital tinha uma função renal limítrofe e desenvolveu franca insuficiência renal na vigência da terapêutica específica constituída por RMP, INH e EMB. Bióp-sia renal realizada no 3° dia de uremia revelou necrose tubular recente, com inflamação intersticial aguda, permeada por granulomas. As formações granulomatosas foram altamente sugestivas de reação alérgica à droga devido à ausência de paliçadas, alta incidência de neutrófilos e o não encontro de bacilos-álcool-ácido-resistentes. Esta é a primeira descrição de nefrite intersticial granulomatosa provavelmente causada pela RMP. São discutidos os principais aspectos fisiopatogênicos da insuficiência renal causada pela tuberculose acrescida dos efeitos nefrotóxicos da RMP.

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

1984-01-01

291

[Tuberculosis in children infected with HIV followed at Charles de Gaulle pediatric teaching hospital of Ouagadougou (Burkina Faso)].  

UK PubMed Central (United Kingdom)

AIMS: To study the epidemiological aspects, diagnosis and outcome of tuberculosis in children infected with HIV at the University Hospital Pediatric Charles de Gaulle, Ouagadougou. MATERIAL AND METHODS: We conducted a retrospective chart review of children under 15 years followed from 2002 to 2008 for HIV infection. RESULTS: The incidence of tuberculosis was 5.5%. The average patient age was 5 years with a female predominance of 63.6%. Prolonged fever, chronic cough and weight loss were the main reasons for consultation. Pulmonary tuberculosis was the most frequent clinical form with 11 cases. The contribution of the direct smear was low: 13.6%. At the radiological images of miliary (36.4%) were the most frequently encountered followed by non-parenchymal opacities systematized (31.8%). The lethality of co-infection TB-HIV was 18.2%. The prognostic factors were younger age, severe immunosuppression and orphan status or total mother. CONCLUSION: Early detection of HIV infection in children and the capacity of TB diagnosis should improve the management of co-infection in a pediatric setting.

Kouéta F; Ouédraogo G; Dao L; Néboua D; Yé D

2011-01-01

292

Hyponatremia due to pulmonary tuberculosis: review of 200 cases.  

UK PubMed Central (United Kingdom)

BACKGROUND: Pulmonary Tuberculosis (PTB) is one of the common diseases with high prevalence of mortality and morbidity in developing countries. Various complications have been reported along with PTB. The subclinical electrolyte imbalances are customary in cases with PTB. OBJECTIVES: The aim of this study was the evaluation of patients with PTB and hyponatremia. PATIENTS AND METHODS: We evaluated patients with diagnosis of secondary PTB who have been admitted to Baqiyatallah hospital, Tehran, Iran from 2005 till 2010. The diagnosis of PTB was based on the appearance of acid fast bacilli in sputum smears or sputum cultures, without any evidence of miliary TB. Demographic and laboratory characteristics relative to electrolytes were recorded according inclusion and exclusion criteria. RESULTS: The mean age was 59.22 ± 20.57 years and 91 (45.5%) patients were male. The mean serum sodium concentration was 134.54 ± 4.95 mmol/L and more than half of subjects (51%) have shown hyponatremia. The mean age difference between hyponatremic and eunatremic groups was statistically significant (61.95 versus 56.02 years) (P = 0.047). No significant relationship was found between hyponatremia and gender, anti-TB medications and co-morbidity conditions. CONCLUSIONS: In this study, an older age was suggested as an important predisposing factor for hyponatremia in patients with PTB which had been observed as less of a determinant. We recommend further evaluations for hyponatremia in patients presenting with PTB, particularly for those who are older.

Jonaidi Jafari N; Izadi M; Sarrafzadeh F; Heidari A; Ranjbar R; Saburi A

2013-01-01

293

Tuberculose hepática pseudotumoral/ Pseudotumoral hepatic tuberculosis  

Scientific Electronic Library Online (English)

Full Text Available Abstract in english 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, (more) 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.

Kalil, Antonio Nocchi; Coelho, Fernanda Alvarez; Olm, Gislaine Silveira

1999-06-01

294

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

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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.

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

2011-01-01

295

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

Scientific Electronic Library Online (English)

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

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

2009-11-01

296

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

Directory of Open Access Journals (Sweden)

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

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

2009-01-01

297

Hepatobiliary tuberculosis in western India  

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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.

Amarapurkar Deepak; Patel Nikhil; Amarapurkar Anjali

2008-01-01

298

Pulmonary tuberculosis: relationship between sputum bacilloscopy and radiological lesions  

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Full Text Available OBJECTIVES: To determine the frequency of radiological manifestations of chest tuberculosis among the tuberculosis outpatients at the Santa Casa de Misericórdia de São Paulo Hospital, and to correlate these radiological findings with the sputum bacilloscopy. SAMPLE AND METHODS: A review was made of the medical record cards and chest X-rays of all patients attended between January 1996 and December 1998. Patients with a diagnosis of tuberculosis who presented intrathoracic manifestations of the disease and negative anti-HIV serology were selected. RESULTS: The selection included 153 patients, with an average age of 37.5 years, who were predominantly male (60.8%) and white (56.9%). Pulmonary lesions were present in 121 (79.9%) and extrapulmonary lesions in 32 (20.1%). Parenchymal-infiltrate lesions appeared in 56 patients (36.6%), cavity lesions in 55 (36.0%), pleural effusion in 28 (18.3%), isolated nodules in 6 (3.9%), mediastinal enlargement in 4 (2.6%) and miliary pattern in 4 (2.6%). Cavities were present in 45.5% of the patients with pulmonary lesions, generally in association with the parenchymal-infiltrate lesions. Parenchymal infiltrate was present in 86.8% of the patients with pulmonary lesions. There was significant presence of alcohol-acid resistant bacillus in the sputum of patients with cavities (76.4%), in comparison with those without cavities (50%) (p = 0.003). CONCLUSIONS: Parenchymal-infiltrate lesions are the most frequent radiological manifestation of pulmonary tuberculosis, and they are generally associated with cavities. There is a relationship between the presence of acid fast bacilli in sputum and pulmonary cavity lesions.

Gomes Mauro; Saad Jr. Roberto; Stirbulov Roberto

2003-01-01

299

Assessment of immune response to repeat stimulation with BCG vaccine using in vitro PBMC model  

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Full Text Available Abstract Background Tuberculosis (TB) is one of the most prevalent cause of death due to a single pathogen. Bacillus Calmette Guérin (BCG) is the only vaccine available for clinical use that protects against miliary TB; however, this vaccine has shown variable levels of efficacy against pulmonary TB. In India, a single dose of BCG vaccine is given and there are few countries where repeated doses of BCG are given. The incidence of TB in India is very high inspite of primary vaccination in neonatal period and therefore requires consideration for repeated immunization. Methods To improve BCG immunogenicity, we have evaluated specific antimycobacterial immune responses (anti-BCG IgG and IFN-?), T cell activity-ADA, CD4 and CD8 T cell count, and CD4/CD8 ratio in a peripheral blood mononuclear cells (PBMC) model using boost immunization protocols with the BCG vaccine. PBMC were induced with a repeat dose of BCG at 24 and 72 hrs of cell culture. Results At the end of the experimental time, supernatant was collected to estimate anti-BCG IgG titer, interferon ?, ADA activity, CD 4 and CD8 T cell count, and CD4/CD8 ratio. We demonstrated that PBMC induced with a repeat dose of BCG showed an increased specific anti-mycobacterial immune responses, T cell activity, and ADA activity as compared to PBMC induced with BCG alone or without BCG induction. Conclusion The repeat BCG stimulation of PBMC obtained from BCG vaccinated individuals shows enhanced immune activation with respect to increased anti-BCG titre, IFN-? and ADA activity without concomitant increase in CD4 and CD8 cells. This study provides some basic data in future experiments in animal models with respect to repeat BCG vaccination.

Kashyap Rajpal S; Husain Aliabbas A; Morey Shweta H; Panchbhai Milind S; Deshpande Poonam S; Purohit Hemant J; Taori Girdhar M; Daginawala Hatim F

2010-01-01

300

High resolution computed tomographic patterns in adults with pulmonary tuberculosis.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To determine the High Resolution Computed Tomographic (HRCT) patterns in adults with Acid Fast Bacillus (AFB) positive new cases of Pulmonary Tuberculosis (PTB). STUDY DESIGN: A descriptive case series. PLACE AND DURATION OF STUDY: The study was carried out at the Department of Pulmonology and Department of Radiology, Military Hospital, Rawalpindi, from June 2006 to August 2007. METHODOLOGY: Fifty adults with AFB positive new pulmonary tuberculosis were included in the study, while PTB cases in the retreatment category, Multi Drug Resistant (MDR) tuberculosis, PTB with Chronic Obstructive Airways Disease (COPD), pneumoconiosis, Diffuse Parenchymal Lung Diseases (DPLDs) etc. were excluded. All cases underwent HRCT chest with 2 mm collimations at 10 mm intervals. Relevant data was collected on a pre-designed patient proforma. RESULTS: The mean age was 40.18 +/- 14.55 years with 88% males; 46% and 30% samples were sputum and endobronchial washings smear positive for AFB respectively, while the rest were culture positive. HRCT findings included centrilobular nodules in 92% cases, lobular consolidation in 84%, cavitation in 76%, 'tree-in-bud' appearance in 68%, lymphadenopathy in 8% and miliary nodules in 4% cases. HRCT patterns included centrilobular nodules and lobular consolidation in 80% cases, while centrilobular nodules with cavitation and centrilobular nodules with 'tree-in-bud' appearance were noted in 72% and 68% patients respectively. Thirty two (64%) cases had centrilobular nodules, cavitation and lobular consolidations and about half cases had centrilobular nodules, 'tree-in-bud' appearance and lobular consolidation. CONCLUSION: Centrilobular nodules and lobular consolidations (80%), centrilobular nodules with cavitation (72%) and centrilobular nodules with 'tree-in-bud' appearance (68%) were the most common HRCT patterns in adults newly diagnosed with pulmonary tuberculosis.

Naseem A; Saeed W; Khan S

2008-11-01

 
 
 
 
301

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

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

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

2013-01-01

302

Unusual radiological findings of adult-onset pulmonary tuberculosis  

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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.

Lee, Yong Chul; Lee, Jong Beum; Kim, Sue Hyun [College of Medicine, Chung-Ang University, Seoul (Korea, Republic of)

1987-06-15

303

[Tuberculosis Annual Report 2010--(3) Childhood tuberculosis].  

UK PubMed Central (United Kingdom)

The number of newly notified childhood tuberculosis (TB) cases (TB in patients aged 0-14 years) in Japan in 2010 was 89, which corresponds to a notification rate of 0.53 per 100,000 population. The annual notified numbers and rates of childhood TB decreased steadily until 2006, after which the number dropped to below 100 and have since remained stable. Among the 89 childhood TB patients notified in 2010, 30 (33.7%) were aged 0-4 years, 26 (29.2%) were 5-9 years, and 33 (37.1%) were 10-14 years. In 2010, the number and proportion of TB patients aged 10-14 years were remarkably increased as compared to those in previous years. In the same year, 25 (28.1%) extrapulmonary TB cases were reported in children, while no TB meningitis or miliary TB cases were reported. The number of foreigners with childhood TB increased from 5 in 2008 and 3 in 2009 to 9 (10.1%) in 2010. In 2010, 30 patients (33.7%) with TB symptoms were identified at medical institutions, and 40 (44.9%) were identified by contact investigation of household members. These accounted for nearly 80% of the childhood TB cases detected, similar to the trend in previous years. Of the 47 prefectures in Japan, 15 reported no cases of childhood TB in 2010. Childhood TB cases were concentrated in the metropolitan areas such as the Tokyo Metropolitan Area (23 cases) and Kanagawa Prefecture (9 cases). In recent years, the number and rate of childhood TB cases in Japan have remained low; however, further efforts to eliminate childhood TB will require early detection and treatment of infectious cases, efficient contact investigations, and sustaining good TB prevention practices.

2012-08-01

304

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

1987-01-01

305

Description of pediatric tuberculosis evaluated in a referral center in istanbul Turkey.  

UK PubMed Central (United Kingdom)

PURPOSE: Diagnosis of tuberculosis (TB) in children is more challenging than in adults. This study aimed to describe demographical, clinical and laboratory findings of children diagnosed with tuberculosis in Turkey, including the issues of contact tracing, culture positivity and forms of the disease. MATERIALS AND METHODS: Clinical and laboratory data of 51 children with a mean age of 8.0±4.6 years who were diagnosed with TB were retrospectively reviewed. Main diagnostic tools included tuberculin skin test, chest X-ray, sputum/gastric aspirate culture with sensitivity testing, and direct microscopy for acid-fast bacilli on available samples. Clinical characteristics and outcomes of the patients were examined. RESULTS: Thirty-six (70.6%) children were diagnosed with intra-thoracic and 15 (29.4%) with extra-thoracic tuberculosis. Twenty-eight of the patients had a positive Bacillus Calmette-Guérin vaccine scar (28/51, 54.9%) and 23/51 (45.1%) had a positive tuberculin skin test. An adult TB contact was identified in 27 (52.9%) of the cases. On direct microscopy, acid-fast bacilli were found in nine (17.6%) patients and positive culture for Mycobacterium tuberculosis was found in 19 (37.3%). Drug resistance to isoniazid was detected in four (7.8%). One patient with nephrotic syndrome and miliary tuberculosis died during follow-up. All other patients responded well to the treatment. CONCLUSION: Focusing on active contact tracing among all household contacts of tuberculous cases may be helpful in early identification and controlling childhood disease, even in regions with low disease prevalence. Adopting a suspicious and proactive approach in this particular age group is warranted.

Gulec SG; Telhan L; Koçkaya T; Erdem E; Bayraktar B; Palanduz A

2012-11-01

306

How to optimize current (available) diagnostic tests.  

UK PubMed Central (United Kingdom)

Isolation of mycobacterium tuberculosis is the gold standard in the diagnosis of childhood tuberculosis. However, it has inherent limitations due to paucibacillary nature of the disease in children and technical difficulties encountered in collection of appropriate sample. Thus, diagnosis is dependent on circumstantial evidence at best supported by conventional tests such as tuberculin test and chest radiograph. Several new tests are being developed but they lack ideal sensitivity and specificity. Hence, it is important to optimise use of current diagnostic tests. Clinical suspicion based on protocol developed by IAP is a pre-requisite of ordering tests and it is only then that proper interpretation is possible. Tuberculin skin test is still a useful screening test. It does help in establishing presence of infection though not necessarily disease. Attention must be paid to ideal test solution, proper technique and cautious interpretation. BCG test is not recommended. Miliary shadows and fibrocaseious cavitary lesions in chest radiograph are highly suggestive of tuberculosis in our epidemiology. CT scan is rarely necessary and is not cost and radiation-effective. It is ideal to attempt bacteriological examination in every suspected case of childhood tuberculosis. Most practical method is collection of gastric aspirate for smear and culture. It is possible to carry out this procedure in out-patient clinic. Better yield is likely with increasing expertise especially in extensive disease. Bronchoalveolar lavage is an invasive test and bacterial yield is comparable to that of gastric aspirate. Tissue collected for histopathological examination must be submitted for bacteriological tests. PCR is not easily available. It has high sensitivity but lower specificity and thus, is not routinely recommended. Serology has no place in diagnosis of tuberculosis. Interferon gamma release assays are also now available. Sensitivity and specificity of Quantiferon Gold and T-spot tests have not been studied in children and hence are not recommended in routine practice. Instead of trying newer tests, it may be best to avail an expert advice in difficult cases.

Amdekar YK

2011-03-01

307

How to optimize current (available) diagnostic tests.  

Science.gov (United States)

Isolation of mycobacterium tuberculosis is the gold standard in the diagnosis of childhood tuberculosis. However, it has inherent limitations due to paucibacillary nature of the disease in children and technical difficulties encountered in collection of appropriate sample. Thus, diagnosis is dependent on circumstantial evidence at best supported by conventional tests such as tuberculin test and chest radiograph. Several new tests are being developed but they lack ideal sensitivity and specificity. Hence, it is important to optimise use of current diagnostic tests. Clinical suspicion based on protocol developed by IAP is a pre-requisite of ordering tests and it is only then that proper interpretation is possible. Tuberculin skin test is still a useful screening test. It does help in establishing presence of infection though not necessarily disease. Attention must be paid to ideal test solution, proper technique and cautious interpretation. BCG test is not recommended. Miliary shadows and fibrocaseious cavitary lesions in chest radiograph are highly suggestive of tuberculosis in our epidemiology. CT scan is rarely necessary and is not cost and radiation-effective. It is ideal to attempt bacteriological examination in every suspected case of childhood tuberculosis. Most practical method is collection of gastric aspirate for smear and culture. It is possible to carry out this procedure in out-patient clinic. Better yield is likely with increasing expertise especially in extensive disease. Bronchoalveolar lavage is an invasive test and bacterial yield is comparable to that of gastric aspirate. Tissue collected for histopathological examination must be submitted for bacteriological tests. PCR is not easily available. It has high sensitivity but lower specificity and thus, is not routinely recommended. Serology has no place in diagnosis of tuberculosis. Interferon gamma release assays are also now available. Sensitivity and specificity of Quantiferon Gold and T-spot tests have not been studied in children and hence are not recommended in routine practice. Instead of trying newer tests, it may be best to avail an expert advice in difficult cases. PMID:21057899

Amdekar, Yeshwant Krishna

2010-11-06

308

[Tuberculosis Annual Report 2010--(3) Childhood tuberculosis].  

Science.gov (United States)

The number of newly notified childhood tuberculosis (TB) cases (TB in patients aged 0-14 years) in Japan in 2010 was 89, which corresponds to a notification rate of 0.53 per 100,000 population. The annual notified numbers and rates of childhood TB decreased steadily until 2006, after which the number dropped to below 100 and have since remained stable. Among the 89 childhood TB patients notified in 2010, 30 (33.7%) were aged 0-4 years, 26 (29.2%) were 5-9 years, and 33 (37.1%) were 10-14 years. In 2010, the number and proportion of TB patients aged 10-14 years were remarkably increased as compared to those in previous years. In the same year, 25 (28.1%) extrapulmonary TB cases were reported in children, while no TB meningitis or miliary TB cases were reported. The number of foreigners with childhood TB increased from 5 in 2008 and 3 in 2009 to 9 (10.1%) in 2010. In 2010, 30 patients (33.7%) with TB symptoms were identified at medical institutions, and 40 (44.9%) were identified by contact investigation of household members. These accounted for nearly 80% of the childhood TB cases detected, similar to the trend in previous years. Of the 47 prefectures in Japan, 15 reported no cases of childhood TB in 2010. Childhood TB cases were concentrated in the metropolitan areas such as the Tokyo Metropolitan Area (23 cases) and Kanagawa Prefecture (9 cases). In recent years, the number and rate of childhood TB cases in Japan have remained low; however, further efforts to eliminate childhood TB will require early detection and treatment of infectious cases, efficient contact investigations, and sustaining good TB prevention practices. PMID:23025015

2012-08-01

309

Flexible fiberoptic bronchoscopy; Diagnostic yield  

International Nuclear Information System (INIS)

[en] Fiberoptic bronchoscopy is a minimally invasive procedure with a high diagnostic yield. The aim of this study was to document the usefulness of the procedure in the diagnosis of various respiratory disorders in a Middle East country. Data on all bronchoscopies carried out in Chest Diseases Hospital, Kuwait from January 1996 to December 1998 were retrospectively collected. Out of 968 cases, only 620 (64%) patients had a full follow up. Suspected pulmonary tuberculosis (TB) (51.6%), unresolving pneumonia (16.1%), hemoptysis with a normal chest radiograph (8.4%), lung mass (7.7%) and hilar lymphadenopathy (3.2%) were the most common indications. Eleven percent of patients who underwent bronchoscopy had a normal chest radiograph, the reason being hemoptysis in 75.4%, inhalation injury in 21.8% and suspected upper airway obstruction in 2.9%. In smear negative suspected TB cases, 22.5% proved to have active disease. Acid fast bacillus was identified in bronchoalveolar lavage, either by smear or culture, in 44 (73.3%) patients with suspected pulmonary TB and in 6 (54.5%) patients with miliary shadows. An underlying cause was identified in 28 (28%) patients with unresolving pneumonia. Ninety-four percent of cases with clinical impression of bronchogenic carcinoma could be diagnosed. Transbronchial biopsy was diagnostic in 79% patients with diffuse parenchymal lung disease. No complications other than transient hypoxemia and controllable bleeding were noticed. Generally, the indications for flexible fiberoptic bronchoscopy remained similar to elsewhere. Unlike western series, the majority of the cases were for the diagnosis of pulmonary infections especially TB. (author)

2004-01-01

310

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

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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.

Hwang, K. H.; Park, Chan H.; Soh, E. Y.; Yoon, S. N.; Joh, C. W.; Lee, M. H. [College of Medicine, Ajou Univ., Suwon (Korea, Republic of)

2001-07-01

311

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

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish El objetivo del estudio fue determinar la asociación entre la inmunización con BCG y tuberculosis grave (TB). Se realizó un estudio retrospectivo, se incluyó fichas de pacientes atendidos en el servicio de neumología del Instituto Nacional de Salud del Niño de Perú, entre los años 1990-2000. Se 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 inmuniz (more) ación con BCG; 202 tenían TB grave y 295 TB no grave (OR= 0,05; IC 95%= 0,03-0,07). En conclusión, los niños con diagnóstico de TB y que han sido inmunizados con BCG, tienen 94% menos riesgo de desarrollar TB grave, en comparación a los niños con diagnóstico no inmunizados con BCG. Abstract in english The objective of the study was to determine the association between BCG immunization and severe tuberculosis (TB). We performed a retrospective study, including medical records from patients of the pneumology department at the National Children?s Institute in Peru, between the years 1990-2000. A 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 (more) had severe TB and 295 non-severe TB (OR = 0.05, 95% CI = 0.03 to 0.07). In conclusion, children diagnosed with TB and who have been immunized with BCG, has 94% lower risk of developing severe TB, compared to children with TB non-immunized with BCG.

Llanos-Tejada, Félix; del Castillo, Hernán

2012-03-01

312

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

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

Tejinder Kaur; Alpna Thakur; Kritika Pandey; Suresh Kumar Malhotra; Karan Jit Pal Singh Puri

2013-01-01

313

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  

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Full Text Available Abstract 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.

Jung Chan-Hee; Goong Hyeon-Jeong; Kim Bo-Yeon; Park Jung-Mi; Kwak Jeong-Ja; Kim Chul-Hee; Hong Hyun-Sook; Kang Sung-Koo; Mok Ji-Oh

2012-01-01

314

Relação entre o diagnóstico sorológico (ELISA) e a gravidade da tuberculose pulmonar na infância Relationship between serological diagnosis (ELISA) and gravity of pulmonary tuberculosis in children  

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Full Text Available Foram estudadas 48 crianças de 0 a 13 anos através da realização do ensaio imunoenzimático ligado a enzima (ELISA) para pesquisa de anticorpos da classe IgG antiPPD, visando estabelecer correlação entre a resposta imune humoral medida pela sorologia e a gravidade da tuberculose, segundo formas radiológicas (leve, moderada e grave). A amostra foi composta de 29 crianças com tuberculose e 19 sem tuberculose comunicantes de tuberculose). Os valores médios (medianas) da densidade óptica do teste ELISA foram, respectivamente: 0,098 na forma gânglio-pulmonar (leve), 0,092 na forma pneumônica (moderada) e 0,134 na tuberculose miliar (grave). Nas crianças não tuberculosas com radiografia de tórax normal, o ELISA foi igual a 0,020. Os achados evidenciam valores mais elevados do teste sorológico relacionados à maior gravidade da doença (p= 0,0007).Forty eight children from 0 to 13 years old were submitted to the enzyme-linked immunosorbent assay (ELISA) serological test with a view to detect anti PPD IgG antibodies, for diagnosis of pulmonary tuberculosis and to establish the relationship between immune response and radiological gravity of pulmonary tuberculosis (mild, moderate and severe). There were 29 children with pulmonary tuberculosis and 19 children without tuberculosis. The median ELISA optical density were: 0.098 in children with primary complex (mild); 0.092 in children with pneumonic pattern (moderate) and 0.134 in children with miliary tuberculosis (severe). These data show higher positive serological test results in severe forms of pulmonary tuberculosis (p = 0.0007).

Clemax Couto Sant'Anna; Leila de Souza Fonseca; Maria Helena Féres Saad

2001-01-01

315

Reactivation of immune responses against Mycobacterium tuberculosis by boosting with the CpG oligomer in aged mice primarily vaccinated with Mycobacterium bovis BCG  

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Background Mycobacterium bovis bacillus Calmette Guérin (BCG) vaccine, which has been inoculated to more than one billion people world-wide, has significant effect in preventing tuberculous meningitis and miliary tuberculosis (TB) in neonate and early childhood. However, BCG fails to adequately protect against pulmonary TB and reactivation of latent infections in adults. To overcome this problem, adequate booster is urgently desired in adult who received prior BCG vaccination, and appropriate animal models that substitute human cases would be highly valuable for further experimentation. Findings The booster effect of the synthesized CpG oligomer (Oligo-B) on aged mice which had been primarily vaccinated with BCG at the age of 4-week old. The specific Th1 type reaction, production of interferon-?, in response to TB antigens, purified protein derivatives (PPD) and protection against challenge with Mycobacterium tuberculosis (MTB) H37Rv decreased with increasing age and were not observed in 89-week old mice. In order to rejuvenate the Th1 type response against PPD and protection activity against MTB infection, Oligo-B, which is known to augment Th1 responses, was administered as a booster to 81-90-week old mice (late 50’s in human equivalent) vaccinated with BCG at 4-week old. The boosting with Oligo-B increased the number of CD4+ CD44high CD62Lhigh, central memory type T cell. Furthermore, the Oligo-B boosting rejuvenated the ability of mice to protect against infection with MTB H37Rv. Conclusions Th1-adjuvant CpG oligo DNA, such as Oligo-B, may be a promising booster when coupled with BCG priming.

2013-01-01

316

Acute renal failure after rifampicin/ Insuficiência renal aguda por rifampicina  

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Full Text Available Abstract in portuguese Apresentamos um paciente com tuberculose miliar a partir de um foco crônico urogenital. Em sua entrada no hospital tinha uma função renal limítrofe e desenvolveu franca insuficiência renal na vigência da terapêutica específica constituída por RMP, INH e EMB. Bióp-sia renal realizada no 3° dia de uremia revelou necrose tubular recente, com inflamação intersticial aguda, permeada por granulomas. As formações granulomatosas foram altamente sugestivas de reaç? (more) ?o alérgica à droga devido à ausência de paliçadas, alta incidência de neutrófilos e o não encontro de bacilos-álcool-ácido-resistentes. Esta é a primeira descrição de nefrite intersticial granulomatosa provavelmente causada pela RMP. São discutidos os principais aspectos fisiopatogênicos da insuficiência renal causada pela tuberculose acrescida dos efeitos nefrotóxicos da RMP. Abstract in english A patient with miliary tuberculosis and a chronic urogenital focus is described, who had a borderline renal function at diagnosis and developed overt renal failure upon daily treatment with rifampin (RMP), isoniazid (INH) and ethambutol (EMB). This is the first Brazilian report of BMP induced renal damage. A renal biopsy taken on the third day of oliguria showed recent tubular necrosis with acute interstitial inflammation and granuloma formation. The aspect of the granulo (more) matous lesion hightly suggested drug etiology because of the lack of palisading, high incidence of neutrophils and absence of facid-fast bacilli. This is the first presentation of an acute granulomatous interstitial nephritis probably due to RMP. Furthermore the pathogenesis of the renal damage caused by tuberculosis and RMP are discussed.

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

1984-12-01

317

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

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

Yatin N. Dholakia; Desiree T.B. D'souza; Monica P. Tolani; Anirvan Chatterjee; Nerges F. Mistry

2012-01-01

318

Infections in nonleukopenic compromised hosts (diabetes mellitus, SLE, steroids, and asplenia) in critical care.  

UK PubMed Central (United Kingdom)

Acutely ill patients who are immunocompromised but not neutropenic most commonly are: (1) diabetic; (2) on chronic high-dose steroid therapy; (3) have lupus; or (4) have impaired or absent splenic function. These patients often present in the CCU because of the severity of their infection. Differential diagnosis may be approached by first considering the patient's underlying disease, i.e., SLE. The next step in the diagnostic process is to appreciate the immune defect associated with these disorders. The nature of the immune defect determines which clinical pathogens are related to the immune defect. Pathogens are associated with a sterotyped pattern of organ involvement. The object of the diagnostic analysis is to determine the most likely organism affecting a particular organ system, given the defect in host defenses associated with the patient's underlying illness. In this way, a useful clinical diagnosis can be made rapidly, and appropriate clinical specimens obtained for diagnostic testing. Often empiric therapy must be started pending the results of diagnostic testing. In such situations, empiric therapy ordinarily is directed against the bacterial pathogens most likely to cause disease relevant to the patient's impaired defenses. Specific therapy for unusual or exotic pathogens should not be empiric and should be based on demonstration of a pathogenic role by the microorganism. In the case of miliary tuberculosis or invasive fungal disease, a case may be made for early empiric therapy to cover these organisms if there is sufficient clinical suspicion based on the presenting signs and symptoms as well as the pattern of organ involvement. As with all infections, but particularly in immunocompromised patients, the early initiation of appropriate antimicrobial therapy is essential and often life-saving.

Cunha BA

1998-04-01

319

Infections in nonleukopenic compromised hosts (diabetes mellitus, SLE, steroids, and asplenia) in critical care.  

Science.gov (United States)

Acutely ill patients who are immunocompromised but not neutropenic most commonly are: (1) diabetic; (2) on chronic high-dose steroid therapy; (3) have lupus; or (4) have impaired or absent splenic function. These patients often present in the CCU because of the severity of their infection. Differential diagnosis may be approached by first considering the patient's underlying disease, i.e., SLE. The next step in the diagnostic process is to appreciate the immune defect associated with these disorders. The nature of the immune defect determines which clinical pathogens are related to the immune defect. Pathogens are associated with a sterotyped pattern of organ involvement. The object of the diagnostic analysis is to determine the most likely organism affecting a particular organ system, given the defect in host defenses associated with the patient's underlying illness. In this way, a useful clinical diagnosis can be made rapidly, and appropriate clinical specimens obtained for diagnostic testing. Often empiric therapy must be started pending the results of diagnostic testing. In such situations, empiric therapy ordinarily is directed against the bacterial pathogens most likely to cause disease relevant to the patient's impaired defenses. Specific therapy for unusual or exotic pathogens should not be empiric and should be based on demonstration of a pathogenic role by the microorganism. In the case of miliary tuberculosis or invasive fungal disease, a case may be made for early empiric therapy to cover these organisms if there is sufficient clinical suspicion based on the presenting signs and symptoms as well as the pattern of organ involvement. As with all infections, but particularly in immunocompromised patients, the early initiation of appropriate antimicrobial therapy is essential and often life-saving. PMID:9561817

Cunha, B A

1998-04-01

320

Radiographic Findings of Pulmonary Tuberculosis in Tehran in Comparison with Other Institutional Studies  

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Full Text Available Background/Objective: Tuberculosis (TB) is one of the most common worldwide infections, especially in developing countries. Early diagnosis is very important for prevention of the chronic form of the disease and sequel formation. Chest x-ray (CXR) is an easy, feasible, non-expensive and quick tool for the diagnosis of pulmonary tuberculosis. "nPatients and Methods: We retrospectively evaluated 200 chest x-rays of secondary pulmonary TB cases in university-affiliated hospitals. These cases were all proved by a positive sputum smear or culture for mycobacterium tuberculosis. "nResults: In this study, we correlated CXR findings of 100 male and 100 female patients. The peak age of involvement in both groups was 61-80 years. None of the chest x-rays were normal. The main radiographic findings were consolidation-infiltration, fibrosis, pleural effusion, cavitation, pleural thickening and bronchiectasis. Mediastinal lymphadenopathy was detected in 9% of the cases. Pulmonary infiltration with consolidation was the most common finding (55%). Miliary shadowing, atelectasis and pneumomediastinum were the least common presentations. Lymphadenopathy was more common in 40 to 60-year-old women. Right lung involvement was more common than the left side and the upper zones were involved in most cases. The most common underlying diseases were hypertension and diabetes mellitus. Infiltration in diabetic patients and fibrotic appearances in hypertensive patients were common findings. "nConclusion: There was no significant difference between our data and the other studies carried out in Iran. The patients were younger in the studies from other countries. However, cavitary lesions were more common in other studies than this study, which seems to be due to the higher prevalence of underlying diseases such as HIV or diabetes.

A. Jamzad; M. Shahnazi; A. Khatami; Gh. Azimi; L. Salimi; M. Mehrafarin

2009-01-01

 
 
 
 
321

Efficacy of selamectin in the treatment and control of clinical signs of flea allergy dermatitis in dogs and cats experimentally infested with fleas.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To determine whether treatment with selamectin would reduce clinical signs of flea allergy dermatitis (FAD) in dogs and cats housed in flea-infested environments. DESIGN: Randomized controlled trial. ANIMALS: 22 dogs and 17 cats confirmed to have FAD. PROCEDURE: Animals were housed in carpeted pens capable of supporting the flea life cycle and infested with 100 fleas (Ctenocephalides felis) on days -13 and -2 and on alternate weeks with 10 to 20 fleas. On day 0, 11 dogs and 8 cats were treated with selamectin (6 mg/kg [2.7 mg/lb]). Dogs were retreated on day 30; cats were retreated on days 30 and 60. All animals were examined periodically for clinical signs of FAD. Flea counts were conducted at weekly intervals. RESULTS: Throughout the study, geometric mean flea counts exceeded 100 for control animals and were < or = 11 for selamectin-treated animals. Selamectin-treated cats had significant improvements in the severity of miliary lesions and scaling or crusting on days 42 and 84, compared with conditions on day -8, and in severity of excoriation on day 42. In contrast, control cats did not have any significant improvements in any of the clinical signs of FAD. Selamectin-treated dogs had significant improvements in all clinical signs on days 28 and 61, but in control dogs, severity of clinical signs of FAD was not significantly different from baseline severity at any time. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that topical administration of selamectin, even without the use of supplementary environmental control measures and with minimal therapeutic intervention, can reduce the severity of clinical signs of FAD in dogs and cats.

Dickin SK; McTier TL; Murphy MG; Bond R; Mason IS; Payne-Johnson M; Smith DG; Evans NA; Jernigan AD; Rowan TG

2003-09-01

322

Clinical analysis of 68 patients with pulmonary mycosis in China  

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Full Text Available Abstract Background Due to the lack of specific clinical manifestations and imaging features, the diagnosis of pulmonary mycosis is difficult. This study aimed to investigate the pathogens, clinical manifestations, imaging features, diagnosis and management of pulmonary mycosis. Methods Data on 68 patients diagnosed as pulmonary mycosis in Xiang Ya hospital from January 2001 to December 2010 were collected and their clinical manifestations, radiographic characterization, diagnostic methods and management were analyzed. Results All patients were diagnosed by pathological examination. Of the 68 cases, 38 (55.9%) had pulmonary aspergillosis and 19 (27.9%) pulmonary cryptococcosis. Open-lung surgery was performed in 38 patients (55.9%), transbronchial biopsy in 15 (22.0%), and computerized tomography (CT) guided percutaneous needle biopsy in 11 (16.2%). Main symptoms were as follows: cough in 51 cases (75.0%), expectoration in 38 (55.9%), hemoptysis in 25 (37.8%), fever in 20 (29.4%), while 6 cases (11.1%) were asymptomatic. X-ray and chest CT showed masses or nodular lesions in 52 cases (76.5%), patchy lesions in 10 (14.7%), cavity formation in 15 (22.0%), and diffuse miliary nodules in 1 case. In 51 cases (75.0%) misdiagnosis before pathological examination occurred. Surgical resection was performed in 38 patients (55.9%). In 25 patients (36.7%) systemic antifungal therapy was administered, and 20 patients (29.4%) experienced complete responses or partial responses. Conclusion The main pathogens of pulmonary mycosis are Aspergillus, followed by cryptococcosis. Final diagnosis of pulmonary mycosis mainly depends on pathological examination. The clinical manifestations, imaging features, diagnostic methods and management differ depending on the pathogens. Satisfactory therapy can be obtained by both antifungal and surgical treatment.

Luo Bai-ling; Zhang Le-meng; Hu Cheng-ping; Xiong Zeng

2011-01-01

323

Histone genes in macronuclear DNA of the ciliate Stylonychia mytilus.  

UK PubMed Central (United Kingdom)

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

Elsevier SM; Lipps HJ; Steinbrück G

1978-12-01

324

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

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

Susan M Pereira; Odimariles Maria Souza Dantas; Ricardo Ximenes; Mauricio L Barreto

2007-01-01

325

Effects of tissue handling and processing steps on PCR for detection of Mycobacterium tuberculosis in formalin-fixed paraffin-embedded samples Efeitos das etapas de tratamento e processamento do tecido na PCR para detecção de Mycobacterium tuberculosis em amostras fixadas em formalina e incluídas em parafina  

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Full Text Available Development and standardization of reliable methods for detection of Mycobacterium tuberculosis in clinical samples is an important goal in laboratories throughout the world. In this work, lung and spleen fragments from a patient who died with the diagnosis of miliary tuberculosis were used to evaluate the influence of the type of fixative as well as the fixation and paraffin inclusion protocols on PCR performance in paraffin embedded specimens. Tissue fragments were fixed for four h to 48 h, using either 10% non-buffered or 10% buffered formalin, and embedded in pure paraffin or paraffin mixed with bee wax. Specimens were submitted to PCR for amplification of the human beta-actin gene and separately for amplification of the insertion sequence IS6110, specific from the M. tuberculosis complex. Amplification of the beta-actin gene was positive in all samples. No amplicons were generated by PCR-IS6110 when lung tissue fragments were fixed using 10% non-buffered formalin and were embedded in paraffin containing bee wax. In conclusion, combined inhibitory factors interfere in the detection of M. tuberculosis in stored material. It is important to control these inhibitory factors in order to implement molecular diagnosis in pathology laboratories.O desenvolvimento e a padronização de métodos confiáveis para a detecção de Mycobacterium tuberculosis em amostras clínicas é um objetivo importante nos laboratórios de todo o mundo. Neste trabalho, fragmentos de pulmão e baço de paciente que morreu com o diagnóstico de tuberculose miliar foram usados para avaliar a influência do tipo de fixador e dos protocolos de fixação e inclusão em parafina na performance da PCR. Fragmentos de tecido foram fixados por quatro h a 48 h, usando formalina não tamponada a 10% ou formalina tamponada a 10% e incluídos em parafina pura ou misturada a cera de abelha. As amostras foram submetidas a PCR para amplificação do gene da beta-actina humana e, separadamente, para amplificação da sequência de inserção IS6110, específica do complexo M. tuberculosis. O resultado da amplificação do gene da beta-actina foi positivo em todas as amostras. Não foram gerados amplicons na PCR-IS6110 em amostras de tecido pulmonar fixadas usando formalina não tamponada a 10% e incluídas em parafina com cera de abelha. Em conclusão, fatores inibitórios combinados interferiram na detecção de M. tuberculosis em material de arquivo. É importante controlar estes fatores inibitórios para poder implementar o diagnóstico molecular em laboratórios de patologia.

Denise Barcelos; Marcello F. Franco; Sylvia Cardoso Leão

2008-01-01

326

Adiaspiromicose humana. Relato de um caso tratado com cetoconazol  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese 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 ab (more) erto. 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. Abstract in english 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 (more) 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.

Martins, Ricardo Luiz M.; Santos, Clarice G. F.; França, Filomena Rita F.C.; Moraes, Mário A.P.

1997-12-01

327

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%)

1981-01-01

328

Effects of tissue handling and processing steps on PCR for detection of Mycobacterium tuberculosis in formalin-fixed paraffin-embedded samples/ Efeitos das etapas de tratamento e processamento do tecido na PCR para detecção de Mycobacterium tuberculosis em amostras fixadas em formalina e incluídas em parafina  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese O desenvolvimento e a padronização de métodos confiáveis para a detecção de Mycobacterium tuberculosis em amostras clínicas é um objetivo importante nos laboratórios de todo o mundo. Neste trabalho, fragmentos de pulmão e baço de paciente que morreu com o diagnóstico de tuberculose miliar foram usados para avaliar a influência do tipo de fixador e dos protocolos de fixação e inclusão em parafina na performance da PCR. Fragmentos de tecido foram fixados por (more) quatro h a 48 h, usando formalina não tamponada a 10% ou formalina tamponada a 10% e incluídos em parafina pura ou misturada a cera de abelha. As amostras foram submetidas a PCR para amplificação do gene da beta-actina humana e, separadamente, para amplificação da sequência de inserção IS6110, específica do complexo M. tuberculosis. O resultado da amplificação do gene da beta-actina foi positivo em todas as amostras. Não foram gerados amplicons na PCR-IS6110 em amostras de tecido pulmonar fixadas usando formalina não tamponada a 10% e incluídas em parafina com cera de abelha. Em conclusão, fatores inibitórios combinados interferiram na detecção de M. tuberculosis em material de arquivo. É importante controlar estes fatores inibitórios para poder implementar o diagnóstico molecular em laboratórios de patologia. Abstract in english Development and standardization of reliable methods for detection of Mycobacterium tuberculosis in clinical samples is an important goal in laboratories throughout the world. In this work, lung and spleen fragments from a patient who died with the diagnosis of miliary tuberculosis were used to evaluate the influence of the type of fixative as well as the fixation and paraffin inclusion protocols on PCR performance in paraffin embedded specimens. Tissue fragments were fixe (more) d for four h to 48 h, using either 10% non-buffered or 10% buffered formalin, and embedded in pure paraffin or paraffin mixed with bee wax. Specimens were submitted to PCR for amplification of the human beta-actin gene and separately for amplification of the insertion sequence IS6110, specific from the M. tuberculosis complex. Amplification of the beta-actin gene was positive in all samples. No amplicons were generated by PCR-IS6110 when lung tissue fragments were fixed using 10% non-buffered formalin and were embedded in paraffin containing bee wax. In conclusion, combined inhibitory factors interfere in the detection of M. tuberculosis in stored material. It is important to control these inhibitory factors in order to implement molecular diagnosis in pathology laboratories.

Barcelos, Denise; Franco, Marcello F.; Leão, Sylvia Cardoso

2008-12-01

329

Making wider use of the world's most widely used vaccine: Bacille Calmette-Guerin revaccination reconsidered.  

UK PubMed Central (United Kingdom)

Approximately 100 million newborn children receive Bacille Calmette-Guérin (BCG) annually, because vaccination is consistently protective against childhood tuberculous meningitis and miliary TB. By contrast, BCG efficacy against pulmonary TB in children and adults is highly variable, ranging from 0% to 80%, though it tends to be higher in individuals who have no detectable prior exposure to mycobacterial infections, as judged by the absence of delayed-type hypersensitivity response (a negative tuberculin skin test, TST). The duration of protection against pulmonary TB is also variable, but lasts about 10 years on average. These observations raise the possibility that BCG revaccination, following primary vaccination in infancy, could be efficacious among TST-negative adolescents as they move into adulthood, the period of highest risk for pulmonary disease. To inform continuing debate about revaccination, this paper assesses the effectiveness and cost-effectiveness of revaccinating adolescents in a setting with intense transmission-Cape Town, South Africa. For a cost of revaccination in the range US$1-10 per person, and vaccine efficacy between 10% and 80% with protection for 10 years, the incremental cost per year of healthy life recovered (disability-adjusted life years, DALY) in the vaccinated population lies between US$116 and US$9237. The intervention is about twice as cost-effective when allowing for the extra benefits of preventing transmission, with costs per DALY recovered in the range US$52-$4540. At 80% efficacy, revaccination averted 17% of cases. Under the scenarios investigated, BCG revaccination is cost-effective against international benchmarks, though not highly effective. Cost-effectiveness ratios would be more favourable if we also allow for TB cases averted by preventing transmission to HIV-positive people, for the protection of HIV-negative people who later acquire HIV infection, for the possible non-specific benefits of BCG, for the fact that some adolescents would receive BCG for the first time, and for cost sharing when BCG is integrated into an adolescent immunization programme. These findings suggest, subject to further evaluation, that BCG revaccination could be cost-effective in some settings.

Dye C

2013-10-01

330

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

Scientific Electronic Library Online (English)

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

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

2003-09-01

331

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

Directory of Open Access Journals (Sweden)

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

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

2003-01-01

332

Cuba's strategy for childhood tuberculosis control, 1995-2005.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Following a tripling of tuberculosis incidence in Cuba between 1991 and 1994 (from 4.7 to 14.7 per 100,000), the National TB Control Program was revamped in 1995 and the National Reference Center for Childhood TB and Provincial Childhood TB Commissions were created as a strategy for addressing this emerging health problem. OBJECTIVE: Assess the impact of Cuba's new strategy for TB control in children aged <15 years during the period 1995-2005. METHODS: A descriptive review of health services and systems was conducted in Cuba, examining 157 cases of TB diagnosed in children aged <15 years during the period 1995-2005 and comparing impact and process indicators for selected years (1995, 2000, and 2005). Impact indicators included reduction in: a) incidence; b) serious forms (peritoneal, meningeal, miliary, combined); c) mortality; and d) case outcomes (cure, death, treatment drop-out, treatment failure). Process indicators were proportion of cases with: a) microbiological tests; b) knowledge of infection source; c) diagnoses obtained through adult case contact tracing; d) time to diagnosis <60 days; and e) post-mortem diagnoses. RESULTS: During the period 1995-2005, TB rates in children aged <15 years fell by 50% (from 1.0 to 0.5 per 100,000), more evident in children <10 years. The Havana rate was three times the national rate. Diagnosis was post-mortem in three serious cases (1.9%); there were four deaths (2.5%), none after 2000. Only seven children (4.5%) had serious forms, none after 2002. Except for cases diagnosed post-mortem, all children received treatment directly supervised by health personnel. Cure rate was 99.4%; there were no treatment drop-outs or chronic cases; one relapse was reported (0.6%). Knowledge of infection source increased to 90% over the selected years. Microbiological tests were conducted in 90% of cases, with isolation in 30.9%. No isolate was drug-resistant, nor were there reports of infectious contacts with resistance. We found no HIV coinfection. At the end of the study, time to diagnosis of ?60 days persisted in 40% of cases. CONCLUSIONS: Creation of a National Reference Center for Childhood TB and Provincial Childhood TB Commissions has contributed to improved TB diagnosis and control in children aged <15 years, achieving incidence similar to that during the period prior to TB re-emergence and to those of some developed countries. Improvements are needed in the work and systematic training of health personnel, especially at the primary health care level, in order to eliminate TB as a national health problem by 2015.

Abreu G; González JA; González E; Bouza I; Velázquez A; Pérez T; Rubán R; González M; Sánchez R; Muñoz R; Sánchez L

2011-07-01

333

Tuberculosis in children undergoing hemodialysis  

Directory of Open Access Journals (Sweden)

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

Gargah Tahar; Goucha-Louzir Rim; Lakhoua Mohamed Rachid

2010-01-01

334

Tuberculosis Frequency in Patients Taking TNF-alpha Blokers  

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

Co?kun Do?an; Nesrin K?ral; Sevda ?ener Cömert; Ali Fidan; Benan Ça?layan; Banu Salepçi

2012-01-01

335

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

DEFF Research Database (Denmark)

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

Ramlov, Anne; Tietze, Anna

2012-01-01

336

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

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese OBJETIVO: Este trabalho tem como finalidade descrever os achados tomográficos da tuberculose pulmonar em pacientes adultos com AIDS atendidos no serviço de radiologia de um hospital de referência em doenças infecciosas, procurar associações desses achados e a contagem de CD4. MATERIAIS E MÉTODOS: Foram estudados 45 pacientes por meio de tomografia computadorizada de tórax durante quatro anos. RESULTADOS: Foram encontrados linfonodomegalia mediastinal e/ou hilar em (more) 31 (68,8%) dos casos, derrame pleural em 29 (64,4%), nódulos centrolobulares de distribuição segmentar em 26 (57,7%), consolidação em 24 (53,3%), confluência de micronódulos em 17 (37,7%), nódulos mal definidos com distribuição centrolobular em 16 (35,5%), padrão de "árvore em brotamento" em 13 (28,9%), espessamento de parede brônquica em 12 (26,6%), cavidade de parede espessa em 10 (22,2%), nódulos miliares em 9 (20%) e bronquiectasias cilíndricas em 6 (13,3%). Dos 45 pacientes, 35 (77,8%) apresentaram CD4 Abstract in english OBJECTIVE: The present study is aimed at describing computed tomography findings pulmonary tuberculosis in adult AIDS patients assisted at a radiology unit of a reference infectious diseases hospital, in an attempt to establish the association between such findings and CD4 count. MATERIALS AND METHODS: Forty-five patients were evaluated by chest computed tomography over a four-year period. RESULTS: Mediastinal and/or hilar lymph node enlargement was found in 31 (68.8%) ca (more) ses, pleural effusion in 29 (64.4%), centrilobular nodules with segmental distribution in 26 (57.7%), consolidation in 24 (53.3%), confluent micronodules in 17 (37.7%), poorly defined nodules with centrilobular distribution in 16 (35.5%), tree-in-bud pattern in 13 (28.9%), bronchial wall thickening in 12 (26.6%), thick-walled cavity in 10 (22.2%), miliary nodules in 9 (20%), and cylindrical bronchiectasis in 6 (13.3%). Among the 45 patients, 35 (77.8%) presented CD4 count

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

2011-02-01

337

Postmortem Investigations Following Human Immunodeficiency Virus Infection  

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

Andrey V. Bychkov; Alexander E. Dorosevich; Jimson W. D'souza

2009-01-01

338

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

Scientific Electronic Library Online (English)

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

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

2010-10-01

339

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

UK PubMed Central (United Kingdom)

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

Ramlov A; Tietze A; Khalil AA; Knap MM

2012-09-01

340

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

Scientific Electronic Library Online (English)

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

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

2007-03-01

 
 
 
 
341

Fase aguda da esquistossomose mansoni  

Scientific Electronic Library Online (English)

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

Tonelli, Edward

1972-10-01

342

Systematic review and meta-analysis of the current evidence on the duration of protection by bacillus Calmette-Guerin vaccination against tuberculosis.  

UK PubMed Central (United Kingdom)

BACKGROUND: Recent evidence suggests that the duration of protection by bacillus Calmette-Guérin (BCG) may exceed previous estimates with potential implications for estimating clinical and cost-efficacy. OBJECTIVES: To estimate the protection and duration of protection provided by BCG vaccination against tuberculosis, explore how this protection changes with time since vaccination, and examine the reasons behind the variation in protection and the rate of waning of protection. DATA SOURCES: Electronic databases including MEDLINE, Excerpta Medica Database (EMBASE), Cochrane Databases, NHS Economic Evaluation Database (NHS EED), Database of Abstracts of Reviews of Effects (DARE), Web of Knowledge, Biosciences Information Service (BIOSIS), Latin American and Caribbean Health Sciences Literature (LILACs), MEDCARIB Database, Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from inception to May 2009. Index to Theses, System for Information on Grey Literature in Europe (SIGLE), Centre for Agricultural Bioscience International (CABI) Abstracts, Scopus, Article First, Academic Complete, Africa-Wide Information, Google Scholar, Global Health, British National Bibliography for Report Literature, and clinical trial registration websites were searched from inception to October 2009. REVIEW METHODS: Electronic databases searches, screening of identified studies, data extraction and analysis were undertaken. Meta-analysis was used to present numerical and graphical summaries of clinical efficacy and efficacy by time since vaccination. Evidence of heterogeneity was assessed using the tau-squared statistic. Meta-regression allowed the investigation of observed heterogeneity. Factors investigated included BCG strain, latitude, stringency of pre-BCG vaccination tuberculin testing, age at vaccination, site of disease, study design and vulnerability to biases. Rate of waning of protection was estimated using the ratio of the measure of efficacy after 10 years compared with the efficacy in the first 10 years of a study. RESULTS: Study selection - A total of 21,030 references were identified, providing data on 132 studies after abstract and full-text review. Efficacy - Protection against pulmonary tuberculosis in adults is variable, ranging from substantial protection in the UK MRC trial {rate ratio 0.22 [95% confidence interval (CI) 0.16 to 0.31]}, to absence of clinically important benefit, as in the large Chingleput trial [rate ratio 1.05 (95% CI 0.88 to 1.25)] and greater in latitudes further away from the equator. BCG vaccination efficacy was usually high, and varied little by form of disease (with higher protection against meningeal and miliary tuberculosis) or study design when BCG vaccination was given only to infants or to children after strict screening for tuberculin sensitivity. High levels of protection against death were observed from both trials and observational studies. The observed protective effect of BCG vaccination did not differ by the strain of BCG vaccine used in trials. DURATION: Reviewed studies showed that BCG vaccination protects against pulmonary and extrapulmonary tuberculosis for up to 10 years. Most studies either did not follow up participants for long enough or had very few cases after 15 years. This should not be taken to indicate an absence of effect: five studies (one trial and four observational studies) provided evidence of measurable protection at least 15 years after vaccination. Efficacy declined with time. The rate of decline was variable, with faster decline in latitudes further from the equator and in situations where BCG vaccination was given to tuberculin-sensitive participants after stringent tuberculin testing. LIMITATIONS: The main limitation of this review relates to quality of included trials, most of which were conducted before current standards for reporting were formulated. In addition, data were lacking in some areas and the review had to rely on evidence from observational studies. CONCLUSIONS: BCG vaccination protection against tuberculosis varies betwee

Abubakar I; Pimpin L; Ariti C; Beynon R; Mangtani P; Sterne J; Fine P; Smith P; Lipman M; Elliman D; Watson J; Drumright L; Whiting P; Vynnycky E; Rodrigues L

2013-09-01

343

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

Directory of Open Access Journals (Sweden)

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

Mauro Gomes; Roberto Saad Jr.; Roberto Stirbulov

2003-01-01

344

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

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese 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 fo (more) ram 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. Abstract in english 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 tuber (more) culosis. 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.

Pereira, Susan M; Dantas, Odimariles Maria Souza; Ximenes, Ricardo; Barreto, Mauricio L

2007-09-01

345

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

Directory of Open Access Journals (Sweden)

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

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

2006-01-01

346

[Comparison of the performances of MTD Gene-Probe® test, BACTEC 960™ system and Löwenstein-Jensen culture methods in the diagnosis of smear-negative tuberculosis cases].  

Science.gov (United States)

The aim of this study was to compare the results of nucleic acid amplification-based MTD (Mycobacterium tuberculosis direct test) Gene-Probe® method in samples obtained from acid-fast bacilli (ARB) smear-negative patients with suspected tuberculosis (TB), with the culture results obtained from automated BACTEC 960™ (MGIT) system and Löwenstein-Jensen (LJ) medium. In addition, the contribution of molecular methods in early diagnosis of pulmonary TB and the effect of radiological prevalence of the disease associated with or without cavity to the molecular diagnosis and/or growth time in culture media have been evaluated. A total of 107 patients (86 male, 21 female; mean age: 49.89 ± 17.1 years, age range: 18-81 years) who were clinically and radiologically suspected of having pulmonary TB and/or TB pleurisy, were included in the study. Of the samples 65 (60.7%) were sputum, 32 (29.9%) were bronchial aspiration, 5 (4.7%) were pleural fluid, and 5 (4.7%) were transthoracic fine needle aspiration biopsy materials. Patient samples were cultured in solid LJ media and liquid-based BACTEC 960 system (Becton Dickinson Co., USA) in the same working day. Meanwhile, MTD Gen-Probe test (Gen-Probe Inc., USA) was studied in two separate working days of the week as specified by the laboratory. The samples were incubated until positivity was determined in BACTEC 960 system and/or growth was detected in LJ medium. Negative cultures were incubated for 42 days and were finalized. When mycobacterial growth was determined in the culture, identification of M.tuberculosis complex (MTBC) and differentiation from nontuberculous mycobacteria were performed by conventional methods and BACTEC 460 NAP test. Forty five (42%) patients were diagnosed as pulmonary paranchimal TB (40 were active pulmonary TB, 1 was miliary TB and 4 were culture-negative pulmonary TB), while 4 (3.7%) patients diagnosed as extrapulmonary TB and 58 (57.9%) patients were diagnosed as other pulmonary diseases unrelated with TB. LJ cultures yielded positive results in 32 of 45 (71%) pulmonary TB patients, and BACTEC 960 were found positive in 84.4% (38/45) of those patients. On the other hand the positivity rate of MTD Gen-Probe test was detected as 37.4% (40/107). The sensitivity, specificity, positive and negative predictive values for MTD Gen-Probe test were estimated as 89%, 100%, 100% and 93%, respectively. Those values for BACTEC 960 system were found as 82%, 98%, 97% and 88%, and for LJ culture method as 71%, 100%, 100% and 83%, respectively. Average periods to make a decision for diagnosis of TB by MTD Gen-Probe, BACTEC 960 (MGIT) and LJ culture methods were calculated as 2.36 days, 20.11 days and 32.49 days, respectively. In comparison of the methods in terms of turnaround times, MTD Gen-Probe test was found superior to LJ culture method, however the turnaround times for BACTEC 960 and LJ culture methods were similar. When the clinical data were evaluated, no effect of radiological density of lesion was identified on the diagnosis time of molecular test and time of growth in liquid based automated BACTEC system and/or LJ culture method. However, LJ culture demonstrated earlier reactivity in patients with cavitary lesions. As a result, MTD Gene-Probe test was observed as a reliable and rapid method for the early diagnosis of pulmonary TB patients, early initiation of therapy, prevention of disease progression and transmission. PMID:23971920

Kundurac?o?lu, Ayperen; Karasu, I??l; Biçmen, Can; Ozsöz, Ay?e; Erbaycu, Ahmet Emin

2013-07-01

347

[Tuberculosis Annual Report 2011--(2) Childhood and elderly tuberculosis].  

UK PubMed Central (United Kingdom)

In 2011, the number of newly notified childhood tuberculosis (TB) cases (tuberculosis patients aged 0-14 years) in Japan was 84, which corresponds to a notification rate of 0.50 per 100,000. The annual notified numbers and rates (per 100,000 population) of childhood TB cases decreased steadily until 2006, when the number became less than 100, after which the numbers have since remained stable. Among the 84 childhood TB patients who were notified in 2011, 33 (39.3%) were aged 0-4 years, 20 (23.8%) were aged 5-9 years, and 31 (36.9%) were aged 10-14 years. The proportion of TB patients aged 10-14 years was higher in 2011 than in previous years. In 2011, one TB meningitis case and two miliary TB cases were reported in children. Further, 23 symptomatic patients (27.4%) were identified at medical institutions and 45 patients (53.6%) were identified by contact investigation of household members. Together, these groups of patients accounted for nearly 80% of the cases of childhood TB that were detected, which was similar to the percentage in previous years. Since 1999, the notification rates of TB patients aged 85 years and above have been consistently higher among those aged 65 years and above in Japan. The annual rate of reduction in the notification rates of TB patients aged 65-79 years has accelerated from 12,625 in 2000 to 6,427 in 2011. The proportion of TB patients aged 65 years and above has consistently increased, reaching up to more than 60% in 2011; notably, the proportion of TB patients aged 80 years and above has increased to more than 30%. The proportion of bacteriologically positive TB cases among pulmonary TB (PTB) cases was higher in those aged 65 years and above than those aged 15-64 years. The proportion of PTB patients with only nonrespiratory symptoms increased with age, reaching 28.9% in those aged 85 years and above. The proportion of TB cases associated with a patient delay of two months or longer was much less in the patients aged 65 years and above than those aged 15-64 years (14.5% vs. 25.8%), whereas the proportion of TB cases associated with a doctor delay of one month or longer was slightly higher in the patients aged 65 years and above than those aged 15-64 years (24.2% vs. 20.0%). Of the newly notified TB patients in 2010 whose treatment outcomes are available as of writing, 28.5% died within a year after the initiation of TB treatment; of these, 16.3% died within three months. The proportion of deaths within three months after the initiation of the TB treatment among the patients aged 65 years and above showed substantial increase with age from 3.6% in 65-69 years old to 17.0% in 90 years and above.

2013-07-01

348

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

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

Vera Maria Neder Galesi; Margarida Maria Mattos Brito de Almeida

2007-01-01

349

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

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Full Text Available Abstract in spanish Objetivos. Mostrar nuestra casuística de pacientes con diagnóstico de tuberculosis intracraneana y describir los diferentes tipos de lesiones documentadas en Resonancia Magnética (RM) que caracterizan a esta entidad. Materiales y Métodos. Para el presente trabajo fueron seleccionados, de forma 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 (more) 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 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 d (more) iagnosis 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.

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

2012-06-01

350

Neurotuberculosis: Hallazgos intracraneanos en RM Neurotuberculosis: Intracranial MRI findings  

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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.

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

2012-01-01

351

[Tuberculosis Annual Report 2011--(2) Childhood and elderly tuberculosis].  

Science.gov (United States)

In 2011, the number of newly notified childhood tuberculosis (TB) cases (tuberculosis patients aged 0-14 years) in Japan was 84, which corresponds to a notification rate of 0.50 per 100,000. The annual notified numbers and rates (per 100,000 population) of childhood TB cases decreased steadily until 2006, when the number became less than 100, after which the numbers have since remained stable. Among the 84 childhood TB patients who were notified in 2011, 33 (39.3%) were aged 0-4 years, 20 (23.8%) were aged 5-9 years, and 31 (36.9%) were aged 10-14 years. The proportion of TB patients aged 10-14 years was higher in 2011 than in previous years. In 2011, one TB meningitis case and two miliary TB cases were reported in children. Further, 23 symptomatic patients (27.4%) were identified at medical institutions and 45 patients (53.6%) were identified by contact investigation of household members. Together, these groups of patients accounted for nearly 80% of the cases of childhood TB that were detected, which was similar to the percentage in previous years. Since 1999, the notification rates of TB patients aged 85 years and above have been consistently higher among those aged 65 years and above in Japan. The annual rate of reduction in the notification rates of TB patients aged 65-79 years has accelerated from 12,625 in 2000 to 6,427 in 2011. The proportion of TB patients aged 65 years and above has consistently increased, reaching up to more than 60% in 2011; notably, the proportion of TB patients aged 80 years and above has increased to more than 30%. The proportion of bacteriologically positive TB cases among pulmonary TB (PTB) cases was higher in those aged 65 years and above than those aged 15-64 years. The proportion of PTB patients with only nonrespiratory symptoms increased with age, reaching 28.9% in those aged 85 years and above. The proportion of TB cases associated with a patient delay of two months or longer was much less in the patients aged 65 years and above than those aged 15-64 years (14.5% vs. 25.8%), whereas the proportion of TB cases associated with a doctor delay of one month or longer was slightly higher in the patients aged 65 years and above than those aged 15-64 years (24.2% vs. 20.0%). Of the newly notified TB patients in 2010 whose treatment outcomes are available as of writing, 28.5% died within a year after the initiation of TB treatment; of these, 16.3% died within three months. The proportion of deaths within three months after the initiation of the TB treatment among the patients aged 65 years and above showed substantial increase with age from 3.6% in 65-69 years old to 17.0% in 90 years and above. PMID:23986943

2013-07-01

352

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

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

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

2008-01-01

353

Development of Pacing, Electrophysiology and Defibrillation in India  

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

Mohan Nair; Johnson Francis; Venugopal K

2002-01-01

354

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

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

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

2003-12-01

355

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

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

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

2011-01-01

356

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

Scientific Electronic Library Online (English)

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

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

2006-07-01

357

[Epidemiological and clinical characteristics of HIV/AIDS patients followed-up in Cappadocia region: 18 years experience].  

UK PubMed Central (United Kingdom)

HIV/AIDS is still an important health problem worldwide and the number of people living with HIV worldwide continued to grow in the last years. The first HIV/AIDS cases had been reported in 1985 from Turkey and with an increasing trend during the following years, the number of cases reached to 3898 with 528 new cases in 2009. The aim of this retrospective study was to share the 18 years experience with the patients who were followed-up in Erciyes University Hospital Infectious Diseases Clinics in Cappadocia region. The records of 55 (81%) HIV/AIDS patients out of 68 who were admitted to our clinic between 1992- 2009 have been attained and the demographic and clinical characteristics, administered therapy regimens and adverse effects of antiretroviral therapy of those cases have been evaluated. Forty-three (78%) of the patients were male and 12 (22%) were female of which 11 (92%) of their spouses had HIV/AIDS. The median age of the patients was 45 and 20 (36%) of them were over 54 years old. Fifty (91%) of patients lived in Cappadocia region, and 24 (44%) had lived in foreign countries. Fifty (91%) patients had risky heterosexual contact as a risk factor. Of these patients, 47 (85%) were in full-blown AIDS stage at admission. Twenty-seven (49%) of the patients diagnosed occasionally during routine anti-HIV testing, did not have any symptoms. Fever, weakness and weight loss were the most frequently detected symptoms in the rest of the patients. Ten (18%) patients had underlying diseases such as hypertension, chronic hepatitis B or C, coronary artery disease, diabetes mellitus and chronic renal disfunction. Opportunistic infections were determined in 25 (45.5%) patients and 20 (40%) of these infections were determined at admission. The most frequent opportunistic infection was oral candidiasis, followed by Pneumocystis (carinii) jiroveci pneumonia and tuberculosis. Malignancy was diagnosed in three patients; two had Kaposi's sarcoma and one had multiorgan adenocarcinoma. Antiretroviral therapy was started in 37 (67%) of the patients and lamivudin/zidovudin + lopinavir/ritonavir was the most commonly used combination. Antiretroviral therapy was changed in 13 (35%) patients most frequently due to the development of side effects of the drugs. Nausea, vomiting and hyperlipidemia were the most frequent side effects, while diarrhea, skin rashes, anemia, leucopenia and lipoatrophy have also been detected. One patient discontinued therapy by his own will. Sixteen (27.6%) of 58 patients, whose records could be achieved, died. The mortality rates detected in 1992-1999 and 2000-2009 periods were 78.6% (11/14) and 11.4% (5/44), respectively. The mean exitus time of the patients was six months after the diagnosis. The reasons of mortality were opportunistic infections in six patients, and adenocarcinoma in one patient. Autopsy had been performed in seven cases, however three patients' records could be attained. One had disseminated candidiasis and miliary tuberculosis, one had multiorgan carcinoma, and one had pneumonia, kidney and colon necrosis and condyloma acuminata. In conclusion, increasing awareness of physicians about HIV/AIDS epidemiology in Turkey provides early diagnosis and prevents the dissemination of illness in community.

Alp E; Bozkurt I; Do?anay M

2011-01-01