Sample records for miliaris disseminatus faciei

  1. Lupus miliaris disseminatus faciei

    Gupta Dinesh


    Full Text Available Lupus miliaris disseminatus faciei also known as acne agminata is a rare disease affecting face in adults. Previously, it was thought to be a tuberculid; and its relation with rosacea is undefined. We report a case who had multiple yellowish brown to erythematous small papular lesions and many pitted atrophic scars on the face of 8 months duration. Investigations for tuberculosis were negative. Histopathology revealed tuberculoid granuloma.

  2. Lupus Miliaris Disseminatus Faciei: A Case Report

    Emel Bülbül Başkan


    Full Text Available Lupus miliaris disseminatus faciei (LMDF is a chronic, rare inflammatory dermatosis characterized by yellowish-red papules with a smooth surface especially on the face and around the eyelids. Recently, due to its histological appearance and different involvement areas, the predominated idea is that it is a granulomatous reaction against to the hair follicle destruction and ruptured epidermoid cysts. A 32-year-old female patient admitted to our outpatient clinic because of the acne lesions on her face and hands for 2 months. The patient was diagnosed as LMDF with clinical and histopathologic findings. In addition, biopsy of the papules around the eyelids revealed epidermoid cyst structures associated with the granulomas. On the occasion of this case, we revised LMDF, a dermatosis which still causes different ideas about naming and etiopathogenesis, in the light of the literature; we discussed differential diagnosis and we analyzed the association with epidermoid cysts.

  3. Lupus miliaris disseminatus faciei report of 4 cases

    Sule R


    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.

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

    Kaur S


    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.

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

    Kaur S


    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.

  6. Recurrent lupus miliaris disseminatus faciei: a case report



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

  7. Lupus miliaris disseminatus faciei: a distinctive rosacea-like syndrome and not a granulomatous form of rosacea.

    Scheur, van de M.R.; Waal, van der RI; Starink, T.M.


    BACKGROUND: Lupus miliaris disseminatus faciei is an eruption of discrete red-brown, dome-shaped papules, histologically characterized by epithelioid cell granulomas. The pathogenesis of the disorder remains controversial. OBJECTIVE: The authors discuss the place of lupus miliaris disseminatus facie

  8. Miliary tuberculosis

    Mert, Ali; Arslan, Ferhat; Kuyucu, Tülin; Koç, Emine Nur; Yılmaz, Mesut; Turan, Demet; Altın, Sedat; Pehlivanoglu, Filiz; Sengoz, Gonul; Yıldız, Dilek; Dokmetas, Ilyas; Komur, Suheyla; Kurtaran, Behice; Demirdal, Tuna; Erdem, Hüseyin A.; Sipahi, Oguz Resat; Batirel, Ayse; Parlak, Emine; Tekin, Recep; Tunçcan, Özlem Güzel; Balkan, Ilker Inanc; Hayran, Osman; Ceylan, Bahadır


    Abstract The aim of this study was to determine the clinical features, and outcome of the patients with miliary tuberculosis (TB). We retrospectively evaluated 263 patients (142 male, 121 female, mean age: 44 years, range: 16–89 years) with miliary TB. Criteria for the diagnosis of miliary TB were at least one of the followings in the presence of clinical presentation suggestive of miliary TB such as prolonged fever, night sweats, anorexia, weight loss: radiologic criterion and pathological criterion and/or microbiological criterion; pathological criterion and/or microbiological criterion. The miliary pattern was seen in 88% of the patients. Predisposing factors were found in 41% of the patients. Most frequent clinical features and laboratory findings were fever (100%), fatigue (91%), anorexia (85%), weight loss (66%), hepatomegaly (20%), splenomegaly (19%), choroid tubercules (8%), anemia (86%), pancytopenia (12%), and accelerated erythrocyte sedimentation rate (89%). Tuberculin skin test was positive in 29% of cases. Fifty percent of the patients met the criteria for fever of unknown origin. Acid-fast bacilli were demonstrated in 41% of patients (81/195), and cultures for Mycobacterium tuberculosis were positive in 51% (148/292) of tested specimens (predominantly sputum, CSF, and bronchial lavage). Blood cultures were positive in 20% (19/97). Granulomas in tissue samples of liver, lung, and bone marrow were present in 100% (21/21), 95% (18/19), and 82% (23/28), respectively. A total of 223 patients (85%) were given a quadruple anti-TB treatment. Forty-four (17%) patients died within 1 year after diagnosis established. Age, serum albumin, presence of military pattern, presence of mental changes, and hemoglobin concentration were found as independent predictors of mortality. Fever resolved within first 21 days in the majority (90%) of the cases. Miliary infiltrates on chest X-ray should raise the possibility of miliary TB especially in countries where TB is

  9. Rosacea-like Tinea Faciei

    César Bimbi


    Full Text Available Tinea faciei, is a facial superficial mycosis. The most frequent etiological agents are Microsporum canis, Trichophyton rubrum and T. tonsurans. It is often overlooked when considering the differential diagnoses of Rosacea. The most well known dermatology textbooks list acne, LE, perioral dermatitis, nasal sarcoidosis, carcinoid syndrom and other conditions but do not mention TF. We describe 3 patients with lesions that clinically appeared to be Rosacea.

  10. Rosacea-like Tinea Faciei

    César Bimbi; Piotr Brzezinski


    Tinea faciei, is a facial superficial mycosis. The most frequent etiological agents are Microsporum canis, Trichophyton rubrum and T. tonsurans. It is often overlooked when considering the differential diagnoses of Rosacea. The most well known dermatology textbooks list acne, LE, perioral dermatitis, nasal sarcoidosis, carcinoid syndrom and other conditions but do not mention TF. We describe 3 patients with lesions that clinically appeared to be Rosacea.

  11. Miliary pulmonary cryptococcosis

    Shane Kelly


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

  12. Miliary pulmonary cryptococcosis

    Kelly, Shane; Marriott, Deborah


    A 32-year-old HIV positive male presents with fevers and a non-productive cough. Initial X-ray and subsequent computerised tomography of the chest shows a bilateral miliary pattern of pulmonary infiltration highly suggestive of disseminated tuberculosis. However subsequent results were consistent with disseminated cryptococcosis, including pulmonary involvement, with cryptococcus identified on transbronchial tissue biopsy, and on blood and cerebrospinal fluid cultures. Imaging features of pulmonary cryptococcosis are generally of well-defined pleural-based nodules and less commonly alveolar infiltrates, lymphadenopathy, pleural effusions or cavitating lesions. Miliary pulmonary infiltrates are an exceptionally rare presentation. PMID:25379393

  13. Miliary tuberculosis in an Indian lady: Looking beyond miliary tuberculosis

    Arjun Lakshman


    Full Text Available Presence of miliary shadows in chest imaging in the appropriate clinical setting is often taken as a marker of miliary tuberculosis. If sputum is negative for acid -fast bacillus, empirical anti-tubercular therapy is given without securing a histological or microbiological diagnosis. We report a young female with human immunodeficiency virus infection who had miliary infiltrates on chest radiography. She was started on empirical anti-tubercular therapy. But an alternate diagnosis was achieved later with invasive sampling and ATT was stopped. This case illustrates the need for physicians to remain alert to diseases which mimic tuberculosis in presentation.

  14. Tinea faciei in a newborn due to Trichophyton tonsurans

    Fu, Meihua; Ge, Yiping; Chen, Wei; Feng, Suying; She, Xiaodong; Li, Xiaofang; Liu, Weida


    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 inf...

  15. Tinea faciei on the right eyebrow caused by Trichophyton interdigitale*

    Zhuang, Kai Wen; Dai, Ya Ling; Ran, Yu Ping; Lama, Jebina; Fan, Yi Ming


    Tinea faciei is a relatively uncommon dermatophyte infection entailing atypical clinical symptoms, usually misdiagnosed and treated with corticosteroids. The authors describe a case of tinea faciei on the right eyebrow caused by Trichophyton interdigitale. The patient was an 18-year-old girl, who had an inflammatory plaque with a scaly, pustular surface on the right eyebrow and upper eyelid, which had persisted for over 1 month. She was once misdiagnosed as having eczema and was treated using corticosteroid cream. A diagnosis of tinea faciei was made based on direct microscopy and culture. The sequencing of the nuclear ribosomal ITS region and β-tubulin gene of the isolate established its T. interdigitale lineage. The patient was cured by treatment with systemic terbinafine in combination with topical application of 1% naftifine-0.25% ketaconazole cream for 2 weeks. PMID:28099612

  16. Tinea faciei in a newborn due to Trichophyton tonsurans.

    Fu, Meihua; Ge, Yiping; Chen, Wei; Feng, Suying; She, Xiaodong; Li, Xiaofang; Liu, Weida


    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.

  17. Miliary tuberculosis and adult respiratory distress syndrome.

    Piqueras, A R; Marruecos, L; Artigas, A; Rodriguez, C


    Although, miliary tuberculosis is an unusual cause of severe acute respiratory failure, we describe nine patients with miliary tuberculosis who developed adult respiratory distress syndrome. This complication occurred in seven patients despite treatment with antituberculous drugs. In two patients who developed the syndrome, miliary tuberculosis was diagnosed only at postmortem. The presence of pulmonary hypertension in all cases and disseminated intravascular coagulation in seven cases suggests a possible pathophysiologic relationship with severe pulmonary vascular damage. The high mortality rate (88.8%) was associated with nonpulmonary organ system failure. Miliary tuberculosis should be considered in patients with adult respiratory distress syndrome of unknown etiology, and simple diagnostic procedures such as sputum, bronchial brushing, and gastric examination should be followed by invasive diagnostic procedures to confirm this etiology. Since untreated miliary tuberculosis is usually fatal, early recognition of this disease is of great importance, and specific therapy may play a lifesaving role.

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

    Mittal R


    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.

  19. MRI findings of miliary tuberculosis of the brain

    Choi, Chang Lak; Song, Chang June; Ahn, Young Jun; Youn, Wan Gyu; Jung, Youn Sin; Cho, June Sik [Chungnam National Univ. College of Medicine, Taejon (Korea, Republic of)


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

  20. A case of anxiety associated with miliary tuberculosis

    Alosaimi FD


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

  1. Miliarial gout: a rare presentation of extensive cutaneous tophi.

    Hung, T-L; Wang, W-M; Chiang, C-P


    Gout is a systemic disorder characterized by hyperuricemia and recurrent arthritis, most involvement of ankles, midfoot joint and first metatarsophalangeal joint, with monosodium urate crystals deposition in synovial fluid and other tissues. We present a case of 53-year-old male, who had several nontender, white-yellow papules and plaques over his elbows, knees and arms with chalk-like substances and crust on inflammatory base wax and wane in the past 2 years. Upon histopathology examination of the skin lesions, it reported as intradermal urate tophi and miliarial gout was diagnosed. This case highlights the importance of considering unusual cutaneous tophi in the differential diagnosis of deposition disorders.

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

    Czaika, Viktor A


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

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

    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)


    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.)

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

    Ballaekere Jayaram Subhashchandra


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

  5. Miliary Osteoma Cutis of the Face: A Case

    Selma Emre


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

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

    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:; 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


    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)

  7. Erythromelanosis Follicularis Faciei et Colli - A Cross-sectional, Descriptive study

    Rather, Shagufta; Yaseen, Atiya; Mukhija, Mani


    Background: Erythromelanosis follicularis faciei et colli (EFFC) has always been reported as a rare disorder, and more data are needed to define its etiology and epidemiology. Objectives: To present a descriptive study of this disorder from Kashmir and present a review of literature on the same. Materials and Methods: A cross-sectional, descriptive study was conducted on 14 patients with clinical lesions suggestive of EFFC, presenting to our dermatology outpatient clinic between May 2013 and April 2015. After obtaining informed consent from all patients, the demographic and clinical data were collected and punch biopsies were taken which after being fixed in formalin were stained for hematoxylin and eosin. The study was approved by Institutional Review Board. Results: Age of the patients ranged from 12 to 35 years with a mean age of 24.8 years. Females outnumbered males in a ratio of 1.3:1. Family history was positive in one case, and one patient had unilateral presentation. The classical triad of erythema, pigmentation, and follicular papules were present in 100% patients. Telangiectasias were observed in 28.57% patients only. Classical sites described were involved in all the cases (100%). In addition, lesions were found to involve eyebrows (28.57%), forehead (28.57%), upper lips (14.28%), and pinna (21.42%). Keratosis pilaris was present in all patients (100%); most common sites affected were upper arms and thighs. Two (14.28%) had generalized distribution. Histopathology in all correlated well with clinical findings. Conclusion: EFFC has always been reported as a rare disorder, but we believe that it is not so. The reason could be either lack of awareness of the disease by the patient due to its generally asymptomatic nature or under-recognition by the physicians. Awareness about the disease on part of dermatologist and recognition of clinical presentation is important for correct diagnosis and to help find more effective therapeutic modalities. PMID:27293252

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

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

    A large-scale, ongoing study conducted by the National Institute of Oceanography, India, from 2003 onward in support of India’s ocean color program, has documented for the first time ever the appearance of extensive blooms of Noctiluca miliaris...

  9. [A case of miliary tuberculosis presenting with acute resiratory distress syndrome].

    Nojima, Daisuke; Ozaki, Shinji; Fujii, Yasuhiro; Wada, Sae; Ono, Katsuichiro; Fujimoto, Nobukazu; Gemba, Kenichi; Kishimoto, Takumi


    An 87-year-old woman was admitted because of high fever, progressive dyspnea and abnormal shadows on chest roentgenogram. Laboratory investigation on admission demonstrated a normal white cell count with neutrophilia (4000/microl, 90.5% neutrophils), an erythrocyte sedimentation rate of 10 mm/h and C-reactive protein value of 9.0mg/dl. Roentgenogram and computed tomographic scan of the chest shows bilateral infiltration and diffuse ground glass opacity, indicating acute respiratory distress syndrome (ARDS), but disseminated nodules, indicating miliary tuberculosis, were not found. Blood gas analysis demonstrated severe hypoxemia (PaO2 43.2Torr with 6L/ min oxygen). Based on the diagnosis of acute pneumonia and ARDS, intravenous administration of sivelestat sodium hydrate (100 mg/day), and continuous infusion of hydrocortisone (200 mg/day) were started. PaO2/FiO2 ratio improved but X-ray findings showed no improvement and a blood test revealed pancytopenia. Bone marrow biopsy revealed necrotizing epithelioid granuloma and acid-fast bacilli. A polymerase chain reaction (PCR) test detected Mycobacterium tuberculosis. Mycobacterium tuberculosis was also detected in sputum and urine. Therefore, we diagnosed miliary tuberculosis and transferred the patient to an infectious disease hospital. Miliary tuberculosis complicated with ARDS is relatively rare and the prognosis is extremely poor. Miliary tuberculosis should be kept in mind as a cause of ARDS.

  10. 面癣误诊1例%Tinea faciei misdiagnosed as other dermatoses:a case report

    唐黎; 王宏伟


    报道由须癣毛癣菌感染引起并被长期误诊的面癣1例.患者女,37岁,因“面部反复红斑、丘疹、水疱伴瘙痒半年”就诊.多次被误诊为单纯疱疹、脓疱疮、湿疹、皮肤感染、脂溢性皮炎及玫瑰痤疮等,先后应用抗病毒、抗感染和抗过敏治疗,皮损未能完全消退并逐渐扩大.再次就诊,真菌学直接镜检阳性,真菌培养为须癣毛癣菌.给予口服特比萘芬片、外用联苯苄唑乳膏治疗后痊愈.%To report a case of tinea faciei caused by Trichophyton mentagrophytes which had been misdiagnosed for a long time. A 37-year-old female presented recurrent erythema, papule and blister on her face, accompanying with itching. She was misdiagnosed as Herpes simplex, Impetigo, Eczema, Skin infection, Seborrheic dermatitis and Acne rosacea, and successively treated with anti-viral, anti-bacterial and antianaphylaxis drugs. The lesion didnt resolve, but gradually expanded. After fungal examination, she was diagnosed as tinea faciei caused by Trichophyton mentagrophytes . The patient was cured by oral terbinafine combined with bi-fonazole cream.


    Mohan Lal


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

  12. Miliary tuberculosis infection during hepatitis C treatment with sofosbuvir and ledipasvir plus ribavirin.

    Ballester-Ferré, Maria Pilar; Martínez, Fernando; Garcia-Gimeno, Natalia; Mora, Francisco; Serra, Miguel A


    Chronic hepatitis C virus (HCV) infection is one of the main causes of chronic liver disease worldwide. In the last 5 years, treatment for HCV infection has experienced a marked development. In 2014, the use of ledipasvir/sofosbuvir with or without concomitant weight-based ribavirin was approved with a very significant increase in the sustained virological response. However, new side effects have been associated. We report the first case of an HCV infected patient treated for 12 wk with the combination of sofosbuvir/ledipasvir plus ribavirin who developed a miliary tuberculosis (TB) infection while on therapy. The patient was a 65-year-old woman, who referred malaise, asthenia, hyporexia, 7 kg weight loss, productive cough, evening fever and night sweats, right after finishing the treatment. The chest computed tomography-scan revealed a superior mediastinal widening secondary to numerous lymphadenopathies with extensive necrosis and bilateral diffuse lung miliary pattern with little subsequent bilateral pleural effusion, highly suggestive of lymph node tuberculosis with lung miliary spread. A bronchoscopy was performed and bronchial suction showed more than 50 acid-alcohol resistant bacillus per line. A Mycobacterium tuberculosis DNA was detected in blood by polymerase chain reaction, which confirmed the diagnosis of miliary tuberculosis. Some cases of TB infection have been identified with α-interferon-based therapy and with the triple therapy of pegylated interferon, ribavirin and boceprevir or telaprevir. However, significant infection has not been reported with sofosbuvir/ledipasvir plus ribavirin. We believe that the case is relevant to increase awareness of opportunistic infections and particularly TB infection. Although the international guidelines offer no recommendation regarding TB screening, we wonder whether it would be advisable to screen for opportunistic infections prior to the introduction of HCV therapy.

  13. 面癣118例的真菌学和临床因素分析%Pathogenic fungi and clinical analysis of 118 cases with tinea faciei

    杨虹; 高志琴; 李民; 戴鹤骏; 杨连娟


    Objective To assess the age distribution of the tinea faciei patients, the most common causative dermatophytes and clinical presentation of tinea faciei. Methods The patients with tinea facie treated in Dermatological Clinic during the period Jan 2012-Jun 2012 were evaluated. The diagnosis was confirmed by microscopic examination of skin specimens and culture on Sabouraud 's medium with added chloramphenicol. Data of basic information, medicine histories and clinical characteristics from the 118 cases of tinea faciei were analyzed. Results Tinea faciei could occur in any age groups, however, could often been observed between 51 to 70 year old . Most frequently isolated dermatophytes are Trichophyton rubrum ( 68. 0% ) , Microsporum canis (20. 4% ) , Trichophyton mentagrophytes (9.7%) , Microsporum gypseum ( 1. 9% ) . Autoinoculation, contacting with infected pets and immoderate using of corticosteroid cream were the significant risk factors of tinea faciei. Using medical swab can enhance fungal smear and culture quality on the obvious inflammatory sites. Conclusion As tinea faciei was easily misdiagnosed; more attention should be given on mycological examination of skin specimens.%目的 探讨面癣的致病菌、临床特点、易感年龄等相关因素.方法 分析本院门诊2012年1~6月的真菌直接涂片镜检发现菌丝或孢子的面癣患者.记录患者的一般资料、有无动物接触史、有无并发其他部位浅部真菌病、用药史.取皮屑直接镜检的同时进行真菌培养鉴定.结果 面癣见于各年龄段,在51~ 70岁之间有一个年龄高峰.分离皮肤癣菌103株,包括红色毛癣菌70株(68.0%)、犬小孢子菌21株(20.4%)、须癣毛癣菌10株(9.7%)、石膏样小孢子菌2株(1.9%).合并其他浅部真菌病、使用激素类药物、动物接触史是面癣发病的重要因素.部分炎症明显的面癣使用医用拭子取材,可以提高真菌涂片和培养的质量.结论 不典型的面癣容

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

    Iguchi, Yohei; Mano, Kazuo; Goto, Yoji; Nakano, Tomonobu [Japanese Red Cross Nagoya First Hospital, Department of Neurology Medicine, Nagoya, Aichi (Japan); Nomura, Fumio; Shimokata, Tomoya [Japanese Red Cross Nagoya First Hospital, Department of Respiratory Medicine, Nagoya, Aichi (Japan); Iwamizu-Watanabe, Sachiko [Nagoya University Graduate School of Medicine, Department of Pathology of Molecular Diagnosis, Nagoya (Japan); Hashizume, Yoshio [Aichi Medical University, Institute for Medical Science of Aging, Nagakute, Aichi (Japan)


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

  15. Tinea faciei caused by Trichophyton mentagrophytes (molecular type Arthroderma benhamiae ) mimics impetigo : a case report and literature review of cases in Japan.

    Kimura, Utako; Yokoyama, Kae; Hiruma, Masataro; Kano, Rui; Takamori, Kenji; Suga, Yasushi


    A 36-year-old female elementary schoolteacher presented with aggregated serous papules surrounded by mild erythema, extending from both nasal wings/nostrils down to the upper lip. No improvement was seen following treatment of the lesions with topical antibiotics for impetigo. Potassium hydroxide (KOH) direct microscopy confirmed the presence of mycelia, and the infection was diagnosed as tinea faciei. The isolate was identified as Trichophyton mentagrophytes using morphological analysis and as Arthroderma benhamiae using genetic analysis. Here we describe that case and summarize the clinical features of other cases of A. benhamiae infection in Japan that have been reported in the literature.

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

    Evangelia Fouka


    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.

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

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


    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.

  18. Lung Adenocarcinoma with Pulmonary Miliary Metastases and Complex Somatic Heterozygous EGFR Mutation

    Alexandre Schaller


    Full Text Available The pretreatment detection of an activating mutation of EGFR is now routinely performed in metastatic nonsquamous non-small cell lung cancer (NSCLC. The therapeutic impact of such a detection is major, as patients with advanced NSCLC exhibiting a mutation of exon 19 or 21 will benefit from EGFR-tyrosine kinase inhibitors (TKI. The presence of an EGFR resistance mutation, such as T790M in EGFR-TKI-naïve patients, is seldom looked for and is related either to a germinal mutation or to somatically mutated subclones. It has a negative predictive impact. We present the case of a patient with a lung papillary adenocarcinoma and miliary intrapulmonary metastases whose tumor displays a somatic complex heterozygous EGFR mutation, combining L858R (exon 21 and a primary resistance mutation T790M (exon 20, both detected by direct sequencing.

  19. Shifting baselines in Antarctic ecosystems; ecophysiological response to warming in Lissarca miliaris at Signy Island, Antarctica.

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


    The Antarctic Peninsula has experienced a rapid increase in atmospheric temperature over the last 50 years. Whether or not marine organisms thriving in this cold stenothermal environment are able to cope with warming is of concern. Here, we present changes to the growth and shell characteristics of the ecologically important, small and short lived brooding bivalve Lissarca miliaris from Signy Island, Antarctica. Using material collected from the 1970's to the present day, we show an increase in growth rate and adult shell deterioration accompanied by a decrease in offspring size, associated with an increase in annual average temperatures. Critical changes to the bivalve's ecology seen today evidence the problem of a shift in baseline since the onset of warming recorded in Antarctica. These small bivalves are demonstrating ecophysiological responses to subtle warming that, provided warming continues, could soon surpass a physiological tipping point, adding to warming associated threats such as increased predatory pressure and ocean acidification.

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

    Nehal H Patel


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

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

    Swaminathan S


    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.

  2. Epithelioid pleural mesothelioma concurrently associated with miliary pulmonary metastases and minimal change nephrotic syndrome - A hitherto undescribed case.

    Tsukamoto, Yoshitane; Otsuki, Taiichiro; Hao, Hiroyuki; Kuribayashi, Kozo; Nakano, Takashi; Kida, Aritoshi; Nakanishi, Takeshi; Funatsu, Eriko; Noguchi, Chihiro; Yoshihara, Shunya; Kaku, Koji; Hirota, Seiichi


    Malignant pleural mesothelioma (MPM) is the aggressive disease typically spreading along the pleural surface and encasing the lung, leading to respiratory failure or cachexia. Rare cases with atypical clinical manifestation or presentation have been reported in MPM. We experienced a unique case of MPM concurrently associated with miliary pulmonary metastases and nephrotic syndrome. A 73-year-old Japanese man with past history of asbestos exposure was referred to our hospital for the investigation of the left pleural effusion. Chest computed tomography showed thickening of the left parietal pleura. Biopsy specimen of the pleura showed proliferating epithelioid tumor cells, leading to the pathological diagnosis of epithelioid MPM with the aid of immunohistochemistry. After the diagnosis of MPM, chemotherapy was performed without effect. Soon after the clinical diagnosis of progressive disease with skull metastasis, edema and weight gain appeared. Laboratory data met the criteria of nephrotic syndrome, and renal biopsy with electron microscopic examination revealed the minimal change disease. Steroid therapy was started but showed no effect. Around the same time of onset of nephrotic syndrome, multiple miliary lung nodules appeared on chest CT. Transbronchial biopsy specimen of the nodules showed the metastatic MPM in the lung. The patient died because of the worsening of the general condition. To our knowledge, this is the first case of MPM concurrently associated with multiple miliary pulmonary metastases and nephrotic syndrome.

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

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


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

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

    Ray S


    Full Text Available Ray S, Talukdar A, Kundu S, Khanra D, Sonthalia N. Ther Clin Risk Mngmt. 2013;9:9–26.The editor of the Indian Journal of Medical Research has brought to our attention the unacknowledged re-use of significant portions of text in the above article. The source of much of the text appears to be from:Sharma SK, Mohan A, Sharma A. Challenges in the diagnosis and treatment of miliary tuberculosis. Indian J Med Res. 135, May 2012, pp 703–730.Dr Ray comments thus: “Regarding the similarities found we want to clarify that this apparent plagiarism is not an intentional act and likely to be factual error. In any way, we do not want to undermine scientific pursuit or vitiate the investigational spirit of hard work and creativity. Please be informed that the different portions of the review were written by different co-authors and most of them were postgraduate students at that time. It seems that they have taken materials/ideas from previously published source unaware of the issues of plagiarism.” This retraction relates to this paper

  5. Miliary tuberculosis and acquired immunodeficiency syndrome – ‘a cursed duet’

    Atif Tatari


    Full Text Available Tuberculous osteomyelitis is rare and usually involves the vertebrae but is seldom found in the foot. The uncommon site and ability to mimic other disorders clinically and radiographically leads to diagnostic and therapeutic delays. We report a case of a 40-year-old man who initially presented to his podiatrist with intermittent pain and swelling of his right ankle and foot that lasted for a year. He also started to exhibit significant weight loss and unexplained fevers and was subsequently hospitalized for cellulitis of his right foot. On further workup, patient was found to have miliary tuberculosis (TB and acquired immunodeficiency syndrome (AIDS. Patient was treated with anti-TB therapy for 9 months and highly active anti-retroviral therapy. Our patient presented with ongoing chronic right foot and ankle pain that was proven to be secondary to TB osteomyelitis of cuneiform bones of the right ankle in the setting of AIDS. The patient's clinical presentation was unusual due to symptom duration and lack of systemic characteristics. Like our case, reported incidence of osteomyelitis of bone/joint in extrapulmonary TB is estimated to be 10%, and out of all bones/joint TB cases, only 1% are found to be in the foot.

  6. Miliary tuberculosis and acquired immunodeficiency syndrome – ‘a cursed duet’

    Tatari, Atif; Ramanujam, Sahana; Mathai, Suja; Karabulut, Nigahus; Moser, Robert L.; Wallach, Sara L.


    Tuberculous osteomyelitis is rare and usually involves the vertebrae but is seldom found in the foot. The uncommon site and ability to mimic other disorders clinically and radiographically leads to diagnostic and therapeutic delays. We report a case of a 40-year-old man who initially presented to his podiatrist with intermittent pain and swelling of his right ankle and foot that lasted for a year. He also started to exhibit significant weight loss and unexplained fevers and was subsequently hospitalized for cellulitis of his right foot. On further workup, patient was found to have miliary tuberculosis (TB) and acquired immunodeficiency syndrome (AIDS). Patient was treated with anti-TB therapy for 9 months and highly active anti-retroviral therapy. Our patient presented with ongoing chronic right foot and ankle pain that was proven to be secondary to TB osteomyelitis of cuneiform bones of the right ankle in the setting of AIDS. The patient's clinical presentation was unusual due to symptom duration and lack of systemic characteristics. Like our case, reported incidence of osteomyelitis of bone/joint in extrapulmonary TB is estimated to be 10%, and out of all bones/joint TB cases, only 1% are found to be in the foot. PMID:27802849


    Okabayashi, Ken; Nishio, Kazumi; Aida, Shinji; Nakano, Yasushi


    A 27-year-old man with a 4-month history of treatment for miliary tuberculosis at another hospital was admitted to our hospital for continued treatment. Computed tomography showed new lesions in the S8 area of the liver and spleen, despite resolution of chest radiographic findings. Because these new lesions were still present after 8 months of treatment, we performed laparoscopic drainage of the liver abscess. Purulent material drained from the lesion revealed positive polymerase chain reaction results for Mycobacterium tuberculosis, and identification of granuloma with infiltrating lymphocytes and plasma cells confirmed the diagnosis of tubercular liver abscess. Pathological changes in the spleen over the clinical course were also regarded as representing tubercular abscess. Postoperative course was good, and tuberculosis treatment ended after 12 months. Tubercular liver abscess subsequently showed prominent reduction, and the tubercular splenic abscess disappeared on abdominal ultrasonography. Tubercular hepatosplenic abscesses appearing during tubercular treatment are rare. We report this valuable case in which laparoscopic drainage of a liver abscess proved useful for diagnosis and treatment.

  8. A Case of Sarcoidosis with Unusual Radiographic Findings that Developed 5 Years after Silicone Augmentation Mammoplasty Complicated by Miliary Tuberculosis during Corticosteroid Treatment

    Tomoko Miyashita


    Full Text Available A 54-year-old woman with a past history of silicone augmentation mammoplasty was admitted with fever and dyspnea with diffuse interstitial shadows on computed tomography (CT. Although radiological findings were atypical, we diagnosed sarcoidosis by laboratory, microbiological, and bronchoalveolar lavage fluid analysis. Corticosteroids ameliorated the condition, but she had recurrent of fever and CT revealed miliary nodules while interstitial shadows disappeared. Liver biopsy showed that noncaseating granuloma and Ziehl-Neelsen stain was positive. We diagnosed miliary tuberculosis which developed during corticosteroid therapy. Antituberculotic therapy resulted in favorable outcome. Possibility exists that onset of sarcoidosis was induced by mammoplasty, namely, human adjuvant disease.

  9. 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.

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


    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.

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

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


    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.

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

    BASU Subhajit; MATONDKAR SG Prabhu; FURTADO Irene


    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 ofNAS (20°N-17°N and 64°E-70°E),during the spring-inter-monsoon cruise ofSagar 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 NaC1),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%NaC1 (w/v),and (2.82-9.49)× 102 cells/mL at 25% (w/v) NaC1 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) NaC1,and (0.4-7)× 104 CFU/mL at 25% NaC1 (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,Bacillusflexus,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.

  12. Differential diagnosis of acute miliary pulmonary tuberculosis from widespread-metastatic cancer for postoperative lung cancer patients: two cases

    Zhao, Wei; Tian, Yuke; Peng, Feng; Long, Jianlin; Liu, Lan; Lu, You


    Pulmonary infections and lung cancer can resemble each other on radiographic images, which makes it difficult to diagnosis accurately and apply an appropriate therapy. Here we report two cases that two postoperative patients with lung adenocarcinoma developed diffuse nodules in bilateral lungs in a month which needed to be distinguished between metastatic malignancies and infectious diseases. Although there are much similarities in disease characteristics of two cases, patient in case one was diagnosed as acute miliary pulmonary tuberculosis (TB) while patient in case two was diagnosed as metastatic disease. The symptoms and pulmonary foci on CT scan of patient in case one improved distinctly after the immediate anti-TB treatment, but the disease of patient in case two progressed after chemotherapy. These findings caution us that differential diagnosis is crucial and have significance in guiding clinical work.

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

    Hairong Chen


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

  14. 儿童粟粒性肺结核误诊45例分析%Analysis of 45 cases of children miliary tuberculosis misdiagnosis



    Objective:To explore the clinical characteristics of children miliary tuberculosis,to analyze the misdiagnosis condition and assimilate experience.Methods:45 cases with children miliary tuberculosis misdiagnosis were selected in 8 years.Their diagnosis and treatment conditions were retrospectively analyzed.Results:In the study group,clinical symptoms were turn fever, weight loss,night sweats,hepatomegaly,meningeal irritation sign and so on.The misdiagnosed disease incidence rates were turn upper respiratory tract infection,bronchitis,pneumonia,suppurative meningitis.Conclusion:For reducing children miliary tuberculosis misdiagnosis,clinicians should grasp the diagnostic criteria of children miliary tuberculosis,strengthen the understanding of the pathogenesis,and correctly apply chest X-ray and chest CT to diagnose this disease.%目的:探讨儿童粟粒性肺结核的临床特点,分析误诊情况及吸取经验。方法:8年来收治儿童急性粟粒性肺结核误诊患者45例,对其诊治情况进行回顾性分析。结果:本组研究中临床症状依次是发热、消瘦、盗汗、肝肿大、脑膜刺激征等,误诊疾病发生率依次是上呼吸道感染、支气管炎、肺炎、化脓性脑膜炎。结论:为减少儿童粟粒性肺结核误诊,临床医师应掌握儿童粟粒性肺结核诊断标准,加强对发病诱因认识,正确运用胸部X线及胸部CT诊断本病。

  15. Assessment of intense pulsed light in the treatment of erythromelanosis follicularis faciei et colli%强脉冲光治疗面颈部毛囊性红斑黑变病疗效评价

    屈慧明; 王娜; 张衍国


    目的::评价强脉冲光治疗面颈部毛囊红斑黑变病的疗效。方法:采用强脉冲光治疗15例患者,波长560~585 nm,脉宽20~40 ms,能量密度18~23 J/cm2,每4周治疗1次,共治疗3~8次。结果:痊愈3例,显效7例,好转4例,无效1例,有效率为66.67%。治疗后15例患者均无疤痕形成。结论:强脉冲光治疗面颈部毛囊红斑黑变病安全有效。%Objective: To assess the efficacy of intense pulsed light in the treatment of erythromelanosis follicularis faciei et colli. Methods:Fifteen patients were treated with intense pulsed light ( wavelengths 560-585 nm, pulse-band 20-30 ms and energy density 18-23 J/cm2 ) , once every 4 weeks for 3-8 times. Re-sults:Three patients were cured, 7 were significantly improved, 4 were improved and 1 was ineffective. The effective rate was 66.67%. There was no scar in all the 15 patients. Conclusion:Intense pulsed light is effec-tive and safe in the treatment of erythromelanosis follicularis faciei et colli.

  16. A case of isoniazid-resistant miliary tuberculosis in which tuberculous meningitis paradoxically developed despite systemic improvement.

    Ikegame, Satoshi; Wakamatsu, Kentaro; Fujita, Masaki; Nakanishi, Yoichi; Harada, Mine; Kajiki, Akira


    A 63-year-old man with chronic myelomonocytic leukemia was admitted to our hospital with miliary tuberculosis. He received anti-tuberculosis drugs: isoniazid (INH), rifampicin (RFP), ethambutol (EB), and pyrazinamide (PZA). His condition clearly and immediately improved after the therapy, but he experienced a high fever of about 38°C every day from 1 month after the initiation of the therapy. Drug-induced fever and tumor fever were suspected as causes, but the etiology could not be determined. The tuberculosis was identified as an INH-resistant strain, so INH was stopped and levofloxacin (LVFX) was introduced, with streptomycin (SM), in addition to RFP, EB, and PZA. At 2 months after the initiation of the therapy (about one week after the change in the anti-tuberculosis drug regimen), his spinal fluid was examined, given his complaints of headache and vomiting. The spinal fluid analysis revealed invasion of lymphocytic inflammatory cells and high adenosine deaminase activity; the patient was thus diagnosed with tuberculous meningitis. His condition gradually improved after the changing of the anti-tuberculosis drugs. Thus, to summarize, the tuberculous meningitis had worsened paradoxically despite his systemic improvement, although it was successfully treated by the addition of LVFX and SM. We must keep in mind that a potential cause of fever during anti-tuberculosis therapy may be INH-resistant tuberculous meningitis.

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

    Rudolf Barth


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

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

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


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

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

    Krambovitis Elias


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

  20. Clinical and imaging features of miliary tuberculosis meningoencephalitis (report of 2 cases)%粟粒性结核性脑膜脑炎的临床及影像学特点(附2例报告)

    蒋祝昌; 邓珊; 陈仕检


    Objective To investigate the clinical and imaging features of miliary tuberculosis meningoencephalitis. Methods The clinical data of 2 patients with miliary tuberculosis meningoencephalitis were analyzed retrospectively. Results There was one male patient and one female patient in this group, the onset age was 45 and 76 years old respectively, and the tuberculosis course was 1-5 years. The main clinical manifestations were fever and headache with acute onset and active pulmonary tuberculosis, and 1 case also complicated with thoracic spine tuberculosis. MRI examination showed some miliary tuberculosis lesions with similar size at the meningeal and intraparenchymal, and the lesions were enhanced with the enhanced scanning. After the anti-tuberculosis treatment for 1 month, the reexamination of MRI showed that the lesions were disappeared. Conclusions Patients with miliary tuberculosis meningoencephalitis are usually with active tuberculosis. MRI examination showed some miliary tuberculosis lesions intracranial and the lesions enhanced with the enhanced scanning is the characteristic imaging manifestation. The anti-tuberculosis treatment is effective.%目的 探讨粟粒性结核性脑膜脑炎的临床及影像学特点.方法 回顾性分析2例粟粒性结核性脑膜脑炎患者的临床资料.结果 本组患者男、女各1例,发病年龄分别为45、76岁,结核病病程1~5年.临床表现以发热、头痛为主,均为急性起病且有活动性肺结核,其中1例合并有胸椎结核.头颅MRI检查示2例患者脑膜及脑实质内均可见大小相似的粟粒性结核病灶,增强扫描可见病灶强化.经抗结核治疗1个月后,复查头颅MRI示病灶消失.结论 粟粒性结核性脑膜脑炎患者常伴活动性结核病,头颅MRI检查示颅内大量粟粒性结核病灶且增强扫描后明显强化为其特征性影像学表现,抗结核治疗的效果较好.

  1. Primary multiple miliary osteoma cutis: a case report%原发性多发性粟粒样皮肤骨瘤

    胡蓉; 宋联进; 杨扬; 李廷慧; 马慧军


    A case of primary multiple miliary osteoma cutis is reported. A 25-year-old female presented with a 5 year history of light-yellow papules in zonal distribution on her parietal scalp. The lesions gradually increased in number and spread to the forehead and lower eyelids. Histopathological study of biopsy showed multiple ossification and calcification foci as well as osteocytes in the dermis. The diagnosis of primary multiple military, osteoma cutis was made. The differential diagnosis includes comedones, sebaceous nevus, plaque-like osteomas cutis and cutaneous calcinosis.%报告1例头部原发性多发性粟粒样皮肤骨瘤.患者女,25岁.因发现右头顶出现呈带状分布的淡黄色丘疹,进行性增多并延及额部和下眼睑 5年来诊.皮损组织病理检查可见真皮内多个骨化伴钙化灶,可见骨细胞.结合皮疹特点诊断为原发性多发性粟粒样皮肤骨瘤.该病临床需要与粉刺、皮脂腺痣、斑块状皮肤骨瘤、皮肤钙质沉着症相鉴别.

  2. 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

    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)


    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


    A. Modjtabai


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

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

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

    stream_size 69885 stream_content_type text/plain stream_name Deep-Sea_Res_I_55_751.pdf.txt stream_source_info Deep-Sea_Res_I_55_751.pdf.txt Content-Encoding UTF-8 Content-Type text/plain; charset=UTF-8 ARTICLE IN PRESS... at ScienceDirect Deep-Sea Resear Deep-Sea Research I 55 (2008) 751–765 0967-0637/$-see front matter & 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.dsr.2008.03.003 conducted by the National Institute of Oceanography (NIO), Goa, India, since 2003...


    Carla Gomes Garcez


    Discussion: Tuberculosis remains a relevant diagnosis in children with prolonged fever. The classic image on chest radiography, tubercular choroiditis and the presence of acid-fast bacilli in gastric aspirate were essential in making a prompt diagnosis and appropriate implementation of therapy. It emphasized the importance of maintaining a high index of suspicion for a condition that is treatable.

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

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


    A 16-year-old girl presented with pain, redness, watering, and blurring of vision in her right eye. Slit lamp examination revealed the presence of peripheral ulcerative keratitis (PUK) and nodular scleritis. On clinical examination, the patient had stunted growth, low body mass index, and enlarged axillary nodes. Giardia cysts were present in the stool sample and histopathology of axillary lymph nodes showed caseating necrosis suggestive of tuberculosis (TB). A diagnosis of PUK with chronic m...

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

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

    the Redfield molar ratio of 16 within the upper 60 m (Fig. 6C). The fluorescence ratios provide insight into the phyto- plankton community composition (Fig. 7). Although there is some spatial coherence between each ratio and some features in the Chl... three molar ratio values of nitrate to either silicate (0.5, 1.0, and 2.0) or phosphate (1, 10, 16) concentrations; dashed, solid, and bold indicate lowest to highest molar ratio values. 2048 Thibodeau et al. (F532 :F440 vs. F470 :F440) to look...

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

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

    cohnii, Bacillus flexus, and Bacillus cereus. The approx. 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...

  9. Impetigo-like tinea faciei around the nostrils caused by Arthroderma vanbreuseghemii identified using polymerase chain reaction-based sequencing of crusts.

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


    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.

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

    Brzezińska-Wcisło Ligia; Lis-Święty Anna; Bergler-Czop Beata


    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 ...

  11. Tinea Faciei Caused by Trichophyton Mentagrophytes and Microsporum Canis%须癣毛癣菌和犬小孢子菌共同致面癣1例

    张晓辉; 张静; 薛汝增; 黄怀球; 朱国兴; 李美荣; 尹颂超



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

    Brzezińska-Wcisło Ligia


    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.

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

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

    , NO. 4, AUGUST 2012 306 Schools of flying fishes and large size squids were observed during night at one bloom station in March 2007 (FORV-253). Also, on one occasion baby sharks were found swimming inside the bloom patch. These observations...

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

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

    et al., 1991; Jeffrey 1997; Bidigare and Charles 2002). Accessory pigments can provide class-specific differentiation, allowing for the recognition of major taxonomic groups of marine phytoplankton(Wright et al., 1991). Over the last twenty years... the west coast of India 5 , during the NE monsoon (November – February) when winter cooling takes place (Banse et al., 1993; Banse and English 2000; Madhupratap et al., 1996; Kumar et al., 2001) and during the inter-monsoon (March-May) when the water...

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

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

    is the most frequent one. Noctiluca red tide observed on 29 September 2004, seems to be significant since the phenomenon has occurred within a fortnight of the stench event that had created panic among people living along the southern Kerala coast. Mass fish...

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

    Ramallo, Geraldine


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

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

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

    for Nitrogen removal from these high-organic micro-niches of the Noctiluca bloom in the Arabian Sea, also known for high denitrification activity. The results indicate that culturable euphotic bacterial associates of Noctiluca are likely to play a critical...'s instructions. Utilization of carbohydrates and amino-acids were determined by suitably modifying a micro-titre well plate method incorporating the respiratory dye tetrazolium chloride (TTC) as indicator. 150μl of a mineral salts  5    basal media...

  18. False-positive radioactive iodine uptake mimicking miliary lung metastases in a patient affected by papillary thyroid cancer and IgA deficiency

    Demidowich, Andrew Paul; Reynolds, James C. [National Institutes of Health, Bethesda (United States); Kundu, Amartya [Dept. of MedicineUniversity of Massachusetts Medical School, Worcester (United States); Celi, Francesco S. [Div. of Endocrinology and MetabolismVirginia Commonwealth UniversityRichmond (United States)


    A 42-year-old female with immunoglobulin A deficiency and recurrent sinopulmonary infections underwent thyroidectomy for papillary thyroid cancer (PTC). Follow-up {sup 123}I scintigraphy demonstrated diffuse pulmonary uptake, suggesting metastatic disease. However, subsequent pathologic, biochemical and radiographic testing proved that she was in fact disease free, and the initial {sup 123}I pulmonary uptake was identified as a false positive. Inflammatory conditions may rarely cause iodine uptake in non-thyroidal tissues due to local retention, organification, and/or immunologic utilization. To avoid exposing patients to unnecessary treatments, it is critical for clinicians to recognize that comorbid pulmonary conditions may mimic metastatic PTC on radioiodine scintigraphy.

  19. A Case of Dermatophytic Blepharitis

    Mustafa Kulaç


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

  20. 蜘蛛抱蛋属一新种%A new species of Aspidistra Ker-Gawl. (Liliaceae) from Guizhou, China



    @@ 刺果蜘蛛抱蛋新种图1 Aspidistra spinula S. Z. He, sp. nov. (sect. Luridae G. Z. Li), Fig. 1 Species A. longanensi Y. Wan affinis, quae stigmate medio faciei superae valde convexo, tetrapartito, margine 16-lobo, facie infera aciebus 16 longitudinalibus aliformibus ornato differt; et similis A. cruciformi Y. Wan et X. H. Lu, quae lobis perianthii basi intus sine projecturis calcariformibus.

  1. The Unspoken Consequence of Command, Control Communications Technology: Enhanced Micromanagement by Risk-Averse Commanders


    commanders the opportunity to experiment with the application and misapplication of C3 in a relatively low-risk environment. Failure to maximize the...39 Yaacov Y. Vertzberger, Risk Taking and Decisionmaking; Foreign Miliary Intervention Decisions (Stanford: Standford University

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

    Breitsameter, C


    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.

  3. A Case of Choroidal Tubercles

    Chaoran Zhang


    Purpose: To report a case of choroidal tubercles in a miliary tuberculosis boy.Method: Clinical features description.Results: A 14-year-old boy was found to have multifocal choroidal tubercles. Angiography was performed. He was followed up for 12 months. The choroidal lesions regressed after using anti-tuberculosis drugs for 8 months. Pigment changes remained. Conclusion: Tuberculosis may present as a posterior segment inflammation. In miliary tuberculosis, choroid is also a target tissue. Eye Science 2004;20:23-24.

  4. Unusual presentation of tuberculosis in chronic hemodialysis patients.

    Amedia, C; Oettinger, C W


    Four patients developed miliary tuberculosis while undergoing chronic hemodialysis. Two patients had diabetes mellitus. Three of the four patients were hemodialyzed 18--24 months prior to the onset of symptoms. Signs and symptoms included prolonged fever, pleural effusion, pericarditis with pericardial effusion, abdominal pain, weight loss, and ascites. All patients were PPD negative and without historical or radiographic evidence of latent tuberculosis. Disseminated tuberculosis was proven at autopsy in three patients. M. tuberculosis was eventually recovered from pleural fluid and urine in the fourth patient. The immune deficiencies of chronic renal failure and diabetes mellitus are suspected predisposing factors to the development of miliary tuberculosis in these patients.

  5. The Use of Megestrol Acetate in Some Feline Dermatological Problems

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


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

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

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


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

  7. NCBI nr-aa BLAST: CBRC-OPRI-01-1433 [SEVENS

    Full Text Available CBRC-OPRI-01-1433 ref|NP_001041572.1| G protein-coupled receptor 44 [Canis lupus fa...miliaris] emb|CAJ77887.1| G-protein coupled receptor [Canis lupus familiaris] NP_001041572.1 1e-133 66% ...

  8. NCBI nr-aa BLAST: CBRC-GACU-08-0023 [SEVENS

    Full Text Available CBRC-GACU-08-0023 ref|NP_001041562.1| prostaglandin F receptor (FP) [Canis lupus fa...miliaris] gb|AAZ53353.1| prostaglandin F2-alpha receptor [Canis lupus familiaris] NP_001041562.1 7e-91 47% ...

  9. NCBI nr-aa BLAST: CBRC-XTRO-01-1851 [SEVENS

    Full Text Available CBRC-XTRO-01-1851 ref|NP_001041562.1| prostaglandin F receptor (FP) [Canis lupus fa...miliaris] gb|AAZ53353.1| prostaglandin F2-alpha receptor [Canis lupus familiaris] NP_001041562.1 1e-147 73% ...

  10. NCBI nr-aa BLAST: CBRC-TTRU-01-0756 [SEVENS

    Full Text Available CBRC-TTRU-01-0756 ref|NP_001138703.1| G protein-coupled receptor 81 [Canis lupus fa...miliaris] gb|ACJ03849.1| G-protein coupled receptor 81 [Canis lupus familiaris] NP_001138703.1 1e-171 86% ...

  11. NCBI nr-aa BLAST: CBRC-DNOV-01-3181 [SEVENS

    Full Text Available CBRC-DNOV-01-3181 ref|NP_001041562.1| prostaglandin F receptor (FP) [Canis lupus fa...miliaris] gb|AAZ53353.1| prostaglandin F2-alpha receptor [Canis lupus familiaris] NP_001041562.1 1e-153 94% ...

  12. NCBI nr-aa BLAST: CBRC-PCAP-01-0075 [SEVENS

    Full Text Available CBRC-PCAP-01-0075 ref|NP_001138703.1| G protein-coupled receptor 81 [Canis lupus fa...miliaris] gb|ACJ03849.1| G-protein coupled receptor 81 [Canis lupus familiaris] NP_001138703.1 1e-64 83% ...

  13. NCBI nr-aa BLAST: CBRC-ACAR-01-1165 [SEVENS

    Full Text Available CBRC-ACAR-01-1165 ref|NP_001041562.1| prostaglandin F receptor (FP) [Canis lupus fa...miliaris] gb|AAZ53353.1| prostaglandin F2-alpha receptor [Canis lupus familiaris] NP_001041562.1 6e-76 41% ...

  14. NCBI nr-aa BLAST: CBRC-MLUC-01-0701 [SEVENS

    Full Text Available CBRC-MLUC-01-0701 ref|NP_001138703.1| G protein-coupled receptor 81 [Canis lupus fa...miliaris] gb|ACJ03849.1| G-protein coupled receptor 81 [Canis lupus familiaris] NP_001138703.1 1e-157 74% ...

  15. NCBI nr-aa BLAST: CBRC-CPOR-01-1448 [SEVENS

    Full Text Available CBRC-CPOR-01-1448 ref|NP_001041562.1| prostaglandin F receptor (FP) [Canis lupus fa...miliaris] gb|AAZ53353.1| prostaglandin F2-alpha receptor [Canis lupus familiaris] NP_001041562.1 1e-141 93% ...

  16. NCBI nr-aa BLAST: CBRC-OPRI-01-0260 [SEVENS

    Full Text Available CBRC-OPRI-01-0260 ref|NP_001138703.1| G protein-coupled receptor 81 [Canis lupus fa...miliaris] gb|ACJ03849.1| G-protein coupled receptor 81 [Canis lupus familiaris] NP_001138703.1 1e-146 75% ...

  17. NCBI nr-aa BLAST: CBRC-CFAM-06-0037 [SEVENS

    Full Text Available CBRC-CFAM-06-0037 ref|NP_001041562.1| prostaglandin F receptor (FP) [Canis lupus fa...miliaris] gb|AAZ53353.1| prostaglandin F2-alpha receptor [Canis lupus familiaris] NP_001041562.1 0.0 100% ...

  18. NCBI nr-aa BLAST: CBRC-TTRU-01-0899 [SEVENS

    Full Text Available CBRC-TTRU-01-0899 ref|NP_001041562.1| prostaglandin F receptor (FP) [Canis lupus fa...miliaris] gb|AAZ53353.1| prostaglandin F2-alpha receptor [Canis lupus familiaris] NP_001041562.1 0.0 86% ...

  19. NCBI nr-aa BLAST: CBRC-MEUG-01-1732 [SEVENS

    Full Text Available CBRC-MEUG-01-1732 ref|NP_001041562.1| prostaglandin F receptor (FP) [Canis lupus fa...miliaris] gb|AAZ53353.1| prostaglandin F2-alpha receptor [Canis lupus familiaris] NP_001041562.1 1e-178 83% ...

  20. NCBI nr-aa BLAST: CBRC-OLAT-01-0032 [SEVENS

    Full Text Available CBRC-OLAT-01-0032 ref|NP_001041562.1| prostaglandin F receptor (FP) [Canis lupus fa...miliaris] gb|AAZ53353.1| prostaglandin F2-alpha receptor [Canis lupus familiaris] NP_001041562.1 7e-61 41% ...

  1. NCBI nr-aa BLAST: CBRC-MMUS-03-0082 [SEVENS

    Full Text Available CBRC-MMUS-03-0082 ref|NP_001041562.1| prostaglandin F receptor (FP) [Canis lupus fa...miliaris] gb|AAZ53353.1| prostaglandin F2-alpha receptor [Canis lupus familiaris] NP_001041562.1 0.0 87% ...

  2. NCBI nr-aa BLAST: CBRC-PVAM-01-1222 [SEVENS

    Full Text Available CBRC-PVAM-01-1222 ref|NP_001041562.1| prostaglandin F receptor (FP) [Canis lupus fa...miliaris] gb|AAZ53353.1| prostaglandin F2-alpha receptor [Canis lupus familiaris] NP_001041562.1 0.0 92% ...

  3. NCBI nr-aa BLAST: CBRC-DRER-11-0014 [SEVENS

    Full Text Available CBRC-DRER-11-0014 ref|NP_001041562.1| prostaglandin F receptor (FP) [Canis lupus fa...miliaris] gb|AAZ53353.1| prostaglandin F2-alpha receptor [Canis lupus familiaris] NP_001041562.1 1e-93 52% ...

  4. NCBI nr-aa BLAST: CBRC-RNOR-23-0122 [SEVENS

    Full Text Available CBRC-RNOR-23-0122 ref|NP_001041562.1| prostaglandin F receptor (FP) [Canis lupus fa...miliaris] gb|AAZ53353.1| prostaglandin F2-alpha receptor [Canis lupus familiaris] NP_001041562.1 0.0 86% ...

  5. NCBI nr-aa BLAST: CBRC-DNOV-01-3056 [SEVENS

    Full Text Available CBRC-DNOV-01-3056 ref|NP_001041562.1| prostaglandin F receptor (FP) [Canis lupus fa...miliaris] gb|AAZ53353.1| prostaglandin F2-alpha receptor [Canis lupus familiaris] NP_001041562.1 6e-38 86% ...

  6. NCBI nr-aa BLAST: CBRC-LAFR-01-3130 [SEVENS

    Full Text Available CBRC-LAFR-01-3130 ref|NP_001041562.1| prostaglandin F receptor (FP) [Canis lupus fa...miliaris] gb|AAZ53353.1| prostaglandin F2-alpha receptor [Canis lupus familiaris] NP_001041562.1 0.0 91% ...

  7. NCBI nr-aa BLAST: CBRC-MDOM-03-0298 [SEVENS

    Full Text Available CBRC-MDOM-03-0298 ref|NP_001138703.1| G protein-coupled receptor 81 [Canis lupus fa...miliaris] gb|ACJ03849.1| G-protein coupled receptor 81 [Canis lupus familiaris] NP_001138703.1 1e-154 76% ...


    Kampirapap, Kowit; Reangchainam, Sutthirat; Ornpaew, Pornpit; Tresukosol, Poohglin


    An unusual case of chromoblastomycosis is reported, it resembled dermatophytosis, tinea faciei due to the presence of a well-demarcated scaly ery- thematous patch on the face. The patient was a 63-year-old farmer from central Thailand, who had the skin lesion for 10 years. Mycological and histopathologi- cal investigations of scales and skin biopsy specimen revealed a granulomatous infiltrate with sclerotic bodies, the hallmark of chromoblastomycosis. The infec- tion showed only localized superficial expansion with a scaly patch suggesting a new clinical type of the disease. The causative organism was identified by DNA sequencing as Rhinocladiella phaeophora. R.phaeophora originally was a saprophytic dematiaceous fungus recovered from maize field soil from Colombia. The case was unusual in its clinical presentation and this is the first case of chromoblastomycosis reported to be caused by a new opportunistic species of the genus Rhinocladiella. The disease was not responsive to itraconazole, but was later treated successfully with terbinafine.

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

    Kim Woo


    Full Text Available Abstract Background Disseminated mycobacterium avium complex (MAC occurs mainly in immunocompromised hosts, which is associated with abnormal cellular immunity. Case presentation A 26-year-old pregnant woman presented with fever and general weakness. Miliary lung nodules were noted on chest X-ray. Under the impression of miliary tuberculosis, anti-tuberculosis medication was administered. However, the patient was not improved. Further work-up demonstrated MAC in the sputum and placenta. The patient was treated successfully with clarithromycin-based combination regimen. Conclusion This appears to be the first case of disseminated MAC in an otherwise healthy pregnant woman. Clinicians should be alert for the diagnosis of MAC infection in diverse clinical conditions.


    Peter Okokhere O.


    Full Text Available Multiple cerebral tuberculomas complicating miliary tuberculosis are a rare occurrence. It is rarer still for multiple cerebral tuberculomas to present without focal neurological deficits. We report the case of a middle-aged Nigerian male with the co-morbidity of miliary tuberculosis and multiple cerebral tuberculomaswho presented without focal neurological deficits buthad complete resolution of symptoms and signs following a 6-month course of antituberculous therapy. This unique case emphasizes the need for a high index of suspicion in the diagnosis of atypical presentations of cerebral tuberculomas while also further illustrating the place of computed tomographic scan of the brain in diagnosis. The case also illustrates the place of therapeutic trial in management.

  11. Rare lung manifestation of multifocal micronodular pneumocyte hyperplasia in a teenage girl with tuberous sclerosis complex

    Ha, Seung Mi; Yoon, Hye Kyung; Lee, Seung Koo [Kangwon National University Hospital, Chuncheon (Korea, Republic of)


    Multifocal micronodular pneumocyte hyperplasia (MMPH) is a relatively rare pulmonary disorder that can be associated with tuberous sclerosis complex (TSC). It has been rarely reported in children or adolescents. MMPH is a hamartomatous process of the lung with multiple small nodules, composed of type II pneumocytes. Plain radiography and chest CT in MMPH may demonstrate numerous small nodules measuring 1-10 mm in diameters, distributed randomly throughout both lungs. If MMPH is an initial presentation of TSC, and unless we are familiar with this lung manifestation of TSC, radiologic findings can mimic miliary tuberculosis or metastatic disease. We report a teenage girl with TSC and histologically confirmed MMPH which mimicked miliary tuberculosis at the initial presentation.

  12. October 2014 imaging case of the month

    Sakla S


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

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

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


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

  14. Feline familial pedal eosinophilic dermatosis in two littermates

    Charline Pressanti; Marie-Christine Cadiergues


    In cats, the most common eosinophilic dermatoses are feline miliary dermatitis and eosinophilic granuloma complex. The most commonly identified underlying cause is a hypersensitivity reaction. Few cases of familial forms of eosinophilic dermatoses are reported in the literature. Two young adult cats from the same litter presented 2 years apart with a severe and chronic fluid or tissue infiltration of the distal part of several limbs. Lesions started on the forelegs and developed on the other ...

  15. Clinical characteristics and causes of pruritus in cats

    S. Hobi


    Hypersensitivity dermatitides (HD) are often suspected in cats. Cats with HD are reported to present with one or more of the following patterns: miliary dermatitis, eosinophilic dermatitis, self-induced symmetrical alopecia or head and/or neck excoriations. Previous reports on feline HD included small numbers of animals, took place in geographically restricted areas or did not compare these conditions with other causes of pruritus. The goal of the present study was to analyse 7...

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

    Amir Hossein Sarrami


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

  17. Diagnosing Pulmonary Tubercolosis And Extrapulmonary Tubercolosis Using Certainty Factor (CF) Algorithm



    Tuberculosis is not only attacking the lungs (called pulmonary Tuberculosis ), but it also can infect other organs such as the brain (Miningitis Tuberculosis), lymphatic (Lymphedenopathy Tuberculosis), lung (Pleyrisy Tuberculosis), skin (Miliary Tuberculosis), Spin of Tuberculosis, and urogenital tuberculosis. The algorithm used in the diagnosis is the algorithm Certainty Factor. there are 6 tuberkulosis disease that will be diagnosed such as Pulmonary TB , TB Miningitis , TB lymphadenopathy ...

  18. Imaging diagnosis of 12 patients with hepatic tuberculosis

    Ri-Sheng Yu; Shi-Zheng Zhang; Jian-Jun Wu; Rong-Fen Li


    AIM: To assess CT, MR manifestations and their diagnostic value in hepatic tuberculosis.METHODS: CT findings in 12 cases and MR findings in 4cases of hepatic tuberculosis proved by surgery or biopsy were retrospectively analyzed.RESULTS: (1) CT findings: One case of serohepatic type of hepatic tuberculosis had multiple-nodular lesions in the subcapsule of liver. Parenchymal type was found in 10cases, including multiple, miliary, micronodular and lowdensity lesions with miliary calcifications in 2 cases; singular,low-density mass with multiple flecked calcifications in 3cases; multiple cystic lesions in 1 case; multiple micronodular and low-density lesions fusing into multiloculated cystic mass or "cluser" sign in 3 cases; and singular, macronodular and low-density lesion with multiple miliary calcifications in 1case. One case of tuberculous cholangitis showed marked dilated intrahepatic ducts with multiple flecked calcifications in the porta hepatis. (2) MR findings in 4 cases were hypointense on both T1-weighted imagings and T2-weighted imagings in one case, hypointense on T1-weighted imagings and hyperintense on T2-weighted imagings in 3 cases. Enhanced MR in 3 cases was slightly shown peripheral enhancement or with multilocular enhancement.CONCLUSION:Various types of hepatic tuberculosis have different imaging fimdings,and typicla CT and MR findings can suggest the diagnosis.

  19. Differential expression of HLA-G and ILT-2 receptor in human tuberculosis: Localized versus disseminated disease.

    Saurabh, Abhinav; Thakral, Deepshi; Mourya, Manish K; Singh, Amar; Mohan, Anant; Bhatnagar, Anuj K; Mitra, Dipendra K; Kanga, Uma


    Human leukocyte antigen-G (HLA-G) is an anti-inflammatory and immunosuppressive molecule that can modulate immune cell activation. The role of HLA-G in tuberculosis, an immune-mediated and chronic bacterial disease remains to be elucidated. We investigated the expression profile of soluble and membrane bound HLA-G in pulmonary TB (PTB), TB pleural effusion (TB-PE, localized disease) and Miliary TB (disseminated form). The expression of HLA-G receptor, ILT-2 was also determined on the immune cells. We observed that the plasma sHLA-G levels were significantly increased in Miliary TB than in TB-PE patients. In contrast, immunophenotyping revealed that the percent frequency of CD3(+) T cells expressing HLA-G was significantly reduced in Miliary TB as compared to TB-PE, whereas frequency of CD14(+) monocytes expressing HLA-G was significantly higher in TB-PE patients. Strikingly in the TB-PE cases, comparison of disease site, i.e. pleural effusion with peripheral blood showed increased expression of both soluble and surface HLA-G, whereas ILT-2 expressing cells were reduced at the local disease site. Furthermore, we demonstrated that in TB-PE cases, HLA-G expression on CD3(+) T cells was influenced by broad spectrum MMP inhibitor. Thus, differential expression of HLA-G could potentially be a useful biomarker to distinguish different states of TB disease.

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

    Thomas F Duda

    Full Text Available 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.

  1. [Standardized indirect immunofluorescence. Differentiation of mitochondrial, microsomal and ribosomal antibodies].

    Storch, W


    By an extensive standardisation of the indirect immunofluorescence for the demonstration espeially of mitochondrial antibodies we succeeded in recognizing atypical fluorescence patterns and in describing their exact localisation. On the basis of absorption studies with mitochondrias, microsomas and ribosomas by comparative observation of sections of liver, stomach and kidneys of rats the preferred sort of reaction and the intensity of fluorescence of antibodies against mitochondria, microsomas and ribosomas were empirically established. Antimitochondrial antibodies react above all with the parietal cells of the stomach and the distal epithelia of the tubulus of the kidney. Antibodies against microsomas of liver and kidney are characterized by a brilliant diffuse cytoplasmatic fluorescence of the hepatocytes and by a comparatively weaker fluorescence of exclusively proximal tubuli of the kidneys of rats. Antibodies against ribosomas lead to a fluorescence especially of the main cells of the stomach. The differentiation of several cytoplasmatic antibodies is among others of interest for the diagnosis of certain autoimmune diseases. Although there are numerous still unclear findings and "overlap" phenomena the existence of high titre antibodies against mitochondrias speaks for a primarily biliary cirrhosis or a pseudo-LE-syndrome, the existence of antibodies against microsomas of kidney and liver of rats for a special form of a chronically active hepatitis and the existence of the very rare antibodies against ribosomas for an active lupus erythematodes disseminatus.

  2. Human Immunodeficiency Virus Infection-Associated Mortality during Pulmonary Tuberculosis Treatment in Six Provinces of China

    LAI Yu Ji; LIU Er Yong; WANG Li Ming; Jamie P MORANO; WANG Ning; Kaveh KHOSHNOOD; ZHOU Lin; CHENG Shi Ming


    Objective To investigate the risk factors attributable to tuberculosis-related deaths in areas with human immunodeficiency virus (HIV) infection epidemics. Methods A prospective cohort study of newly registered patients in tuberculosis (TB) dispensaries in six representative Chinese provinces was conducted from September 1, 2009 to August 31, 2011. Risk factors for TB-associated death were identified through logistic regression analysis. Results Of 19,103 newly registered pulmonary TB patients, 925 (4.8%) were found to be HIV-positive. Miliary TB and acid-fast bacillus smear-negative TB were more common among these patients. Out of a total of 322 (1.7%) deaths that occurred during TB treatment, 85 (26%) of the patients were co-infected with HIV. Multivariate analysis revealed that HIV infection was the strongest predictor of death [adjusted odds ratio (aOR) 7.86]. Other significant mortality risk factors included presentation with miliary TB (aOR 4.10; 95% confidence interval: 2.14-7.88), ≥35 years of age (aOR 3.04), non-Han ethnicity (aOR 1.67), and farming as an occupation (aOR 1.59). For patients with TB/HIV co-infection, miliary TB was the strongest risk factor for death (aOR 5.48). A low CD4 count (≤200 cells/µL) (aOR 3.27) at the time of TB treatment initiation and a lack of antiretroviral therapy (ART) administration (aOR 3.78) were also correlated with an increased risk of death. Conclusion Infection with HIV was independently associated with increased mortality during TB treatment. Offering HIV testing at the time of diagnosis with TB, early TB diagnosis among HIV/acquired immunodeficiency syndrome patients, and the timely provision of ART were identified as the key approaches that could reduce the number of HIV-associated TB deaths.

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

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


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

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

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


    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.

  5. Differential diagnosis of feline pruritus.

    Foil, C S


    Pruritic skin diseases in the cat are best approached in a problem-oriented fashion. The presentations of pruritic skin disease in the cat include miliary dermatitis, pruritus of the head, scaling and crusting dermatoses, alopecia, erythroderma and exfoliation, eosinophilic granuloma complex, macular and pustular eruptions, and pruritic nodular dermatoses. There is a specific differential diagnosis for each presentation. A rational diagnostic plan, based on the likelihood of each disease in the differential diagnosis, may be formulated for each presentation of pruritus in the cat.

  6. Aerospace Technologies and Applications for Dual Use

     the Planet safety and security. In this frame, the concept of dual use - the set of technologies and applications that can be exploied for both civil and military purposes - becomes a key-topic. In addition, the aerospace is a strategic building block in the deployment of a network centric environment......Events which occurred over the past years have shown how the threat related to both intentional and natural disasters could bring the civil and the miliary worlds closer in the conception and deployment of countermeasures, as well as in the identification of effective strategies for enhancing...

  7. [Update on the radiological study of pulmonary tuberculosis].

    Navarro Ballester, A; Marco Domenech, S F


    Tuberculosis has made a comeback in recent years. This upsurge has been attributed to factors such as increased immigration and the human immunodeficiency virus epidemic. Primary pulmonary tuberculosis manifests radiologically with parenchymal involvement, lymph node involvement, pleural effusion, and/or miliary disease. In post-primary tuberculosis, the earliest radiological sign is small nodules and branching centrilobular lesions that increase in size and coalesce to form ill-defined patchy consolidations; cavitations are very characteristic of active disease. The aim of this article is to describe the radiologic findings for pulmonary tuberculosis and its complications.

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

    Ma, Jihong


    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.

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

    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))


    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.)

  10. HRCT findings of chest complications in patients with leukemia

    Tanaka, Nobuyuki; Matsumoto, Tsuneo; Miura, Gouji; Emoto, Takuya; Matsunaga, Naofumi [Department of Radiology, Yamaguchi University School of Medicine (Japan)


    High-resolution CT (HRCT) findings of several chest complications occurring in leukemic patients were reviewed. Although most entities show non-specific HRCT findings including ground-glass opacity and air-space consolidation, characteristic findings are observed in several pulmonary complications including Pneumocystis carinii pneumonia, fungal infections, miliary tuberculosis, leukemic infiltration, pulmonary edema, bronchiolitis obliterans, and bronchiolitis obliterans organizing pneumonia. A combination of these characteristic HRCT findings and the information obtained from the clinical setting may help in achieving a correct diagnosis of chest complications occurring in leukemic patients. (orig.)

  11. Primary abdominal tuberculosis presenting as peritonitis in a young child-managed surgically

    Rikki Singal; Sunita Gupta; Samita Gupta


    ABSTRACT Abdominal tuberculosis(TB) is the sixth commonest extra-pulmonaryTB form after lymphatic, genitourinary, bone and joint, miliary and meningeal tuberculosis.We are presenting a rare case in a young female of age7 year diagnosed as peritonitis and intestinal obstruction.Operative findings revealed dense fibrosis in interloops and perforation of the small bowel.She was put on antitubercular treatment for one year.Patient was discharged in satisfactory condition and is in follow up for2 months.

  12. Enemy release an unlikely explanation for the invasive potential of the brown alga Sargassum muticum: experimental results, literature review and meta-analysis

    Pedersen, Morten Foldager; Johnsen, Kathrine L.; Halle, Louise L.


    -choice trials, P. miliaris consumed S. muticum faster than it consumed slow-growing Fucus vesiculosus and Halidrys siliquosa, whereas Saccharina latissima, Ceramium virgatum and Ulva intestinalis were grazed upon at higher or the same rates as S. muticum. More or less identical patterns were seen in the two......- and multiple-choice experiments, where S. muticum was generally consumed faster than F. vesiculosus and H. siliquose, but slower than S. latissima and the two most fast-growing algal species (U. intestinalis and C. virgatum). We screened the literature for comparable data and found 26 experiments with 27...

  13. Obstructing mass lesion of epiglottis: it can be tubercular.

    Gupta, Rajesh; Fotedar, Sajay; Sansanwal, Pradeep; Yadav, S P S; Gupta, Anupama; Gupta, K B; Saini, Kuldeep


    We report a case of 60-year old male who had difficulty in breathing as well as in swallowing. On examination, he was found to be having proliferative growth of epiglottis and right aryepiglottic fold mimicking neoplasm. So emergency tracheostomy was performed and biopsy taken. He was found to be having asymptomatic miliary mottling on routine x-ray chest PA view. Further on HRCT, it turned out to be lesion suggesting tubercular etiology. Histopathology (epiglottic biopsy) report confirmed the whole process as tubercular. The patient recovered promptly in due course with anti-tubercular treatment. Point remains to be seen that if we can avoid tracheostomy and its complications in such cases.

  14. Radiological analysis of image on geriatric pulmonary tuberculosis


    Objective: To evaluate the radiological features in the cases with geriatric pulmonary tuberculosis(GPTB). Methods: One hundred and two elderly patients with tuberculosis were studied in this paper. All patients had an examination on chest X-ray, and 63 of them had a chest scan of CT. Results: The pulmonary tuberculosis infiltration, caseous pneumonia and cavitary lesions were found in 85, 11 and 19 cases with GPTB respectively. Acute miliary tuberculosis was diagnosed in 2 cases. Pleural effusion was in 26 cases. In addition, Hilar and mediastinal lymphadenopathy was presented in the other 13 cases. Conclusion: Radiological findings of GPTB were atypical in general.

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

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


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

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

    Vladík, P; Prouza, A; Vítovec, J


    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.

  17. CT appearances of abdominal tuberculosis

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


    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.

  18. The Prevalence and Pattern of Superficial Fungal Infections among School Children in Ile-Ife, South-Western Nigeria

    Oke, Olaide Olutoyin; Onayemi, Olaniyi; Olasode, Olayinka Abimbola; Omisore, Akinlolu Gabriel; Oninla, Olumayowa Abimbola


    Fungal infections of the skin and nails are common global problems with attendant morbidity among affected individuals. Children are mostly affected due to predisposing factors such as overcrowding and low socioeconomic factors. The aim of this study was to determine the prevalence and the clinical patterns of superficial fungal infections among primary school children in Ile-Ife. A multistage sampling was conducted to select eight hundred pupils from ten primary schools in Ile-Ife. Data on epidemiological characteristics and clinical history was collected using a semistructured questionnaire and skin scrapings were done. The prevalence of superficial fungal infections among the 800 respondents was 35.0%. Male pupils constituted 51.0% of respondents while the females were 49.0%. The mean age for all the respondents was 9.42 ± 2.00. Tinea capitis was the commonest infection with a prevalence of 26.9% and tinea unguium, tinea corporis, and tinea faciei had a prevalence of 0.8%, 0.6%, and 0.5%, respectively. Tinea manuum had the least prevalence of 0.1%. Pityriasis versicolor had a prevalence of 4.4%. Microsporum audouinii was the leading organism isolated. The study shows that the prevalence of superficial fungal infection (SFI) among primary school children in Ile-Ife is high with tinea capitis as the commonest SFI. PMID:25574161

  19. The Prevalence and Pattern of Superficial Fungal Infections among School Children in Ile-Ife, South-Western Nigeria

    Olaide Olutoyin Oke


    Full Text Available Fungal infections of the skin and nails are common global problems with attendant morbidity among affected individuals. Children are mostly affected due to predisposing factors such as overcrowding and low socioeconomic factors. The aim of this study was to determine the prevalence and the clinical patterns of superficial fungal infections among primary school children in Ile-Ife. A multistage sampling was conducted to select eight hundred pupils from ten primary schools in Ile-Ife. Data on epidemiological characteristics and clinical history was collected using a semistructured questionnaire and skin scrapings were done. The prevalence of superficial fungal infections among the 800 respondents was 35.0%. Male pupils constituted 51.0% of respondents while the females were 49.0%. The mean age for all the respondents was 9.42 ± 2.00. Tinea capitis was the commonest infection with a prevalence of 26.9% and tinea unguium, tinea corporis, and tinea faciei had a prevalence of 0.8%, 0.6%, and 0.5%, respectively. Tinea manuum had the least prevalence of 0.1%. Pityriasis versicolor had a prevalence of 4.4%. Microsporum audouinii was the leading organism isolated. The study shows that the prevalence of superficial fungal infection (SFI among primary school children in Ile-Ife is high with tinea capitis as the commonest SFI.

  20. The Prevalence and Pattern of Superficial Fungal Infections among School Children in Ile-Ife, South-Western Nigeria.

    Oke, Olaide Olutoyin; Onayemi, Olaniyi; Olasode, Olayinka Abimbola; Omisore, Akinlolu Gabriel; Oninla, Olumayowa Abimbola


    Fungal infections of the skin and nails are common global problems with attendant morbidity among affected individuals. Children are mostly affected due to predisposing factors such as overcrowding and low socioeconomic factors. The aim of this study was to determine the prevalence and the clinical patterns of superficial fungal infections among primary school children in Ile-Ife. A multistage sampling was conducted to select eight hundred pupils from ten primary schools in Ile-Ife. Data on epidemiological characteristics and clinical history was collected using a semistructured questionnaire and skin scrapings were done. The prevalence of superficial fungal infections among the 800 respondents was 35.0%. Male pupils constituted 51.0% of respondents while the females were 49.0%. The mean age for all the respondents was 9.42 ± 2.00. Tinea capitis was the commonest infection with a prevalence of 26.9% and tinea unguium, tinea corporis, and tinea faciei had a prevalence of 0.8%, 0.6%, and 0.5%, respectively. Tinea manuum had the least prevalence of 0.1%. Pityriasis versicolor had a prevalence of 4.4%. Microsporum audouinii was the leading organism isolated. The study shows that the prevalence of superficial fungal infection (SFI) among primary school children in Ile-Ife is high with tinea capitis as the commonest SFI.

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

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


    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.)

  2. Sediment Burial Intolerance of Marine Macroinvertebrates.

    Vicki J Hendrick

    Full Text Available The marine environment contains suspended particulate matter which originates from natural and anthropogenic sources. Settlement of this material can leave benthic organisms susceptible to smothering, especially if burial is sudden i.e. following storms or activities such as dredging. Their survival will depend on their tolerance to, and their ability to escape from burial. Here we present data from a multi-factorial experiment measuring burial responses incorporating duration, sediment fraction and depth. Six macroinvertebrates commonly found in sediment rich environments were selected for their commercial and/or conservation importance. Assessments revealed that the brittle star (Ophiura ophiura, the queen scallop (Aequipecten opercularis and the sea squirt (Ciona intestinalis were all highly intolerant to burial whilst the green urchin (Psammichinus miliaris and the anemone (Sagartiogeton laceratus, showed intermediate and low intolerance respectively, to burial. The least intolerant, with very high survival was the Ross worm (Sabellaria spinulosa. With the exception of C. intestinalis, increasing duration and depth of burial with finer sediment fractions resulted in increased mortality for all species assessed. For C. intestinalis depth of burial and sediment fraction were found to be inconsequential since there was complete mortality of all specimens buried for more than one day. When burial emergence was assessed O. ophiura emerged most frequently, followed by P. miliaris. The former emerged most frequently from the medium and fine sediments whereas P. miliaris emerged more frequently from coarse sediment. Both A. opercularis and S. laceratus showed similar emergence responses over time, with A. opercularis emerging more frequently under coarse sediments. The frequency of emergence of S. laceratus increased with progressively finer sediment and C. intestinalis did not emerge from burial irrespective of sediment fraction or depth. Finally

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

    Bassiri-Jahromi Shahindokht


    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.

  4. [Clinical symptomps, diagnosis and therapy of feline allergic dermatitis].

    Favrot, C; Rostaher, A; Fischer, N


    Allergies are often suspected in cats and they are mainly hypersensitivity reactions against insect bites, food- or environmental allergens. Cats, with non flea induced atopic dermatitis, normally present with one oft he following reaction patterns: miliary dermatitis, eosinophilic dermatitis, selfinduced alopecia or head and neck excoriations. None of these reaction patterns is nevertheless pathognomonic for allergic dermatitis, therefore the diagnosis is based on the one hand on the exclusion of similar diseases on the other hand on the successful response on a certain therapy. Recently a study on the clinical presentation of cats with non flea induced atopic dermatitis was published. In this study certain criteria for diagnosing atopy in cats were proposed. For therapy of allergic cats cyclosporin, glucocorticoids, antihistamines, hypoallergenic diets and allergen specific immunotherapy are used. This article should provide a recent overview on the clinical symptoms, diagnosis and therapy of feline allergic dermatitis.

  5. The use of megestrol acetate in some feline dermatological problems.

    Gosselin, Y; Chalifoux, A; Papageorges, M


    Twenty-one cats were treated with megestrol acetate because they were showing clinical signs associated with one of the following problems: eosinophilic ulcer, eosinophilic plaque, neurodermatitis, endocrine alopecia and miliary dermatitis. The dosage schedule was 5 mg orally per day per cat for seven days, then 5 mg every three days for 21 days. In all cats, we noted a good improvement of the lesions as soon as treatment was started. In 25% of the patients, one treatment schedule was sufficient to control the skin disease for at least 18 months. In the remaining 75%, two treatment schedules and/or a maintenance dosage had to be established.Side effects encountered were increased appetite, personality changes and depression.

  6. Isolated Pancreatic Tuberculosis Mimicking Malignancy in an Immunocompetent Host

    Pooja Raghavan


    Full Text Available Despite the high prevalence of tuberculosis (TB worldwide, pancreatic TB is rare. When present, pancreatic TB is frequently associated with miliary TB, often in immunocompromised hosts. Pancreatic TB may present as a pancreatic abscess, acute or chronic pancreatitis, and cystic or solid pancreatic masses. We present a case of an immunocompetent patient who presented with two discrete pancreatic masses and was subsequently diagnosed with isolated pancreatic TB. This case suggests that clinicians should have a heightened suspicion of pancreatic TB when faced with discrete pancreatic lesions, especially in patients from areas where the infection is endemic. Such recognition may lead to appropriate diagnostic testing, and possible resolution of pancreatic lesions with antituberculin therapy.

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

    Bittencourt Achiléa


    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.

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

    Bittencourt Achiléa


    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.

  9. Enemy release an unlikely explanation for the invasive potential of the brown alga Sargassum muticum: experimental results, literature review and meta-analysis

    Pedersen, Morten Foldager; Johnsen, Kathrine L.; L. Halle, Louise;


    of algae included in the comparison. We conducted therefore a series of feeding experiments to test if Danish S. muticum is grazed less upon than a range of native algae by the sea urchin Psammechinus miliaris and complemented the experiments with a meta-analysis based on published data. In no...... species of algae and 14 species of invertebrate grazers. Meta-analysis on these data showed the same overall trend as observed in our experiments; S. muticum is generally consumed at the same rate or faster than other thick, leathery and canopy-forming algae, which are assumed to constitute the major...... competitors to S. muticum, but slower than more fast-growing sub-canopy species and more opportunistic algae. We question therefore that enemy release can explain the invasion success of S. muticum....

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

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


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

  11. Encefalitis carcinomatosa Carcinomatous encephalitis

    Flavio Sánchez


    Full Text Available 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.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.

  12. Abdomen agudo por peritonitis tuberculosa. Presentación de un caso

    Abraham Reyes Pérez


    Full Text Available Extrapulmonary tuberculosis is a bacterial infection that occurs outside the lung parenchyma. It is caused by different types of mycobacteria; the most common causative agent in humans is Mycobacterium tuberculosis. The case of a 17-year-old Angolan patient treated in a municipal hospital in Angola due to severe abdominal pain with generalized peritoneal reaction is presented. Several tests were performed, but they did not clarify the patient’s condition. Finally, she underwent surgery and an omental biopsy was taken. The histological study revealed the presence of tuberculoid granulomas, which led to the diagnosis of miliary tuberculosis. Cases of acute abdomen due to tuberculous peritonitis are very uncommon, in fact, this is the first case seen by the author of this report in forty years practicing as a surgeon.

  13. Lupus vulgaris with squamous cell carcinoma.

    Motswaledi, Mojakgomo Hendrick; Doman, Chantal


    Tuberculosis is still a significant problem in developing countries. Cutaneous forms of tuberculosis account for approximately 10% of all cases of extrapulmonary tuberculosis. Cutaneous tuberculosis may be because of true infection with Mycobacterium tuberculosis or because of tuberculids. Tuberculids are immunological reactions to haematogenously spread antigenic components of M. tuberculosis. True cutaneous tuberculosis may be because of inoculation or haematogenous spread of M. tuberculosis to the skin. Lupus vulgaris is the commonest form of true cutaneous tuberculosis. Other forms of true cutaneous tuberculosis are tuberculous chancre, tuberculosis verrucosa cutis, scrofuloderma, periorificial tuberculosis and miliary tuberculosis of the skin. Lupus vulgaris is usually chronic and progressive. It occurs in patients with moderate to high immunity against M. tuberculosis as evidenced by strongly positive tuberculin test. Long-standing cases of lupus vulgaris may be complicated by squamous cell carcinoma (SCC). We describe a patient who had undiagnosed lupus vulgaris for 35 years until she developed SCC on the lesion of lupus vulgaris.

  14. Paradoxical reaction to antituberculosis therapy in a patient with lupus vulgaris.

    Santesteban, R; Bonaut, B; Córdoba, A; Yanguas, I


    Patients receiving treatment for tuberculosis may experience an unexpected deterioration of their disease; this is known as a paradoxical reaction. We present the case of a 59-year-old man with lupus vulgaris who experienced a paradoxical deterioration of cutaneous lesions after starting antituberculosis therapy. The reaction was self-limiting; the lesions gradually improved, and the final outcome was very good. Paradoxical reactions are well-known in patients with human immunodeficiency virus (HIV) infection who start antiretroviral therapy, but they can also occur in non-HIV-infected patients with tuberculosis who start antituberculosis therapy. In the literature reviewed, paradoxical reactions involving skin lesions were described in patients with miliary tuberculosis. The case we report is the first of a paradoxical reaction in lupus vulgaris. The increasing frequency of tuberculosis in Spain could lead to a rise in the number of paradoxical reactions.

  15. Concurrent cryptococcal meningitis and disseminated tuberculosis occurring in an immunocompetent male.

    Musabende, Marcellin; Mukabatsinda, Constance; Riviello, Elisabeth D; Ogbuagu, Onyema


    A 61-year-old man living in rural Rwanda presented with a 2-month history of fevers, headaches, dry cough, weight loss and confusion. A cerebrospinal fluid analysis revealed neutrophilic pleocytosis, yeast and a positive cryptococcal antigen (CrAg). An HIV antibody test was negative. The patient's cough worsened while on antifungal induction therapy with intravenous conventional amphotericin B and high-dose oral fluconazole. Computerised tomography (CT) scan of the chest showed extensive miliary infiltrates. Bronchoalveolar lavage revealed acid-fast bacilli on smear and a positive GeneXpert test without rifampicin resistance. The patient improved with the addition of antitubercular therapy. In this case report, we describe an unusual presentation of two opportunistic infections occurring together in an HIV-negative man with no other known immunocompromising conditions. The case highlights the fact that, in disease endemic areas, multiple disseminated infections can occur in individuals without obvious immunocompromise.

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

    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)


    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.)

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

    Pawan Kumar


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

  18. Detection of tuberculosis using hybrid features from chest radiographs

    Fatima, Ayesha; Akram, M. Usman; Akhtar, Mahmood; Shafique, Irrum


    Tuberculosis is an infectious disease and becomes a major threat all over the world but still diagnosis of tuberculosis is a challenging task. In literature, chest radiographs are considered as most commonly used medical images in under developed countries for the diagnosis of TB. Different methods have been proposed but they are not helpful for radiologists due to cost and accuracy issues. Our paper presents a methodology in which different combinations of features are extracted based on intensities, shape and texture of chest radiograph and given to classifier for the detection of TB. The performance of our methodology is evaluated using publically available standard dataset Montgomery Country (MC) which contains 138 CXRs among which 80 CXRs are normal and 58 CXRs are abnormal including effusion and miliary patterns etc. The accuracy of 81.16% was achieved and the results show that proposed method have outperformed existing state of the art methods on MC dataset.

  19. Diagnosing Pulmonary Tubercolosis And Extrapulmonary Tubercolosis Using Certainty Factor (CF Algorithm



    Full Text Available Tuberculosis is not only attacking the lungs (called pulmonary Tuberculosis , but it also can infect other organs such as the brain (Miningitis Tuberculosis, lymphatic (Lymphedenopathy Tuberculosis, lung (Pleyrisy Tuberculosis, skin (Miliary Tuberculosis, Spin of Tuberculosis, and urogenital tuberculosis. The algorithm used in the diagnosis is the algorithm Certainty Factor. there are 6 tuberkulosis disease that will be diagnosed such as Pulmonary TB , TB Miningitis , TB lymphadenopathy , TB Pleurisy , TB of the Spine , and urogenital tuberculosis . While the number of symptoms that will be asked to the user there are 31 symptoms . The number of rules stored in the knowledge base amounted to 52 rules. Results of applications made available a similar conclusion with manual calculations using formulas certainty factor.

  20. Hepatic tuberculosis mimicking Klatskin tumor: A diagnostic dilemma

    Arora Raman


    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.

  1. Hepatic tuberculosis mimicking Klatskin tumor: a diagnostic dilemma.

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


    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.

  2. Dicty_cDB: VHE225 [Dicty_cDB

    Full Text Available miliaris genomic,genomic survey sequence. 40 0.058 2 EK225313 |EK225313.1 1095460156784 Global-Ocean-Samplin...g_GS-31-01-01-1P3-1P8KB marine metagenome genomic clone 1061005707342 3', genomic survey... fsbb001f209i23k0 Sorghum methylation filtered library (LibID: 104) Sorghum bicolor genomic clone fsbb001f209i23, genomic survey...ibrary (LibID: 104) Sorghum bicolor genomic clone fsbb001f208d23, genomic survey ...orghum bicolor genomic clone fsbb001f137c21, genomic survey sequence. 46 1.1 1 CL168450 |CL168450.1 104_366_

  3. 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.

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


    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 μM, 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.

  4. Ultrasonographic and CT findings 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)


    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.

  5. Extra-intestinal coccidiosis in the kiwi (Apteryx spp.).

    Morgan, Kerri J; Alley, Maurice R; Pomroy, William E; Gartrell, Brett D; Castro, Isabel; Howe, Laryssa


    Despite significant conservation intervention, the kiwi (Apteryx spp.) is in serious population decline. To increase survival in the wild, conservation management includes rearing of young birds in captivity, safe from introduced mammalian predators. However, an increase in density of immunologically naïve kiwi increases the risk of exposure to disease, including coccidia. Intestinal coccidiosis has recently been described in the kiwi, and although extra-intestinal coccidiosis was first recognized in kiwi in 1978, very little is known about this disease entity. This study used archived histological tissues and reports from routine necropsies to describe the pathology of naturally occurring extra-intestinal coccidiosis. At least 4.5% of all kiwi necropsied during 1991 to 2011 (n=558) were affected by extra-intestinal coccidiosis, and it is estimated that it caused death in 0.9 to 1.2% of kiwi in the study group. Four forms were recognized: renal, hepatic, and, less commonly, splenic and pulmonary. At necropsy, renal coccidiosis was associated with miliary white streaks and foci through the kidneys, renomegaly, and renal pallor or congestion. Renal meronts and gametocytes were confined to the distal convoluted tubules and collecting ducts, and were associated with renal tubular necrosis and tubular obstruction. Hepatic miliary pinpoint foci were present throughout the hepatic parenchyma associated microscopically with macromeronts measuring 304×227 µm. In two cases, clusters of splenic meronts were identified, and a similar lesion was identified in the pulmonary interstitium of another case. Juvenile, captive kiwi were most often affected with extra-intestinal coccidiosis, illustrating an increased expression of disease with population manipulation for conservation purposes.

  6. Clinical characteristics and imaging manifestations of AIDS complicated with disseminated Penicillium marneffei infection

    LU Pu-xuan; ZHU Wen-ke; ZHAN Neng-yong; LIU Yan; CHEN Xin-chun; YE Ru-xin; CAI Li-sheng; ZHU Bo-ping


    Objective To investigate the clinical characteristics and imaging manifestations of AIDS complicated with disseminated Penicillium marneffei (PM) infection. Methods A total of 12 patients with AIDS complicated with disseminated PM infection were collected and the symptoms, signs, laboratory examination results and image manifestations of these patients were analyzed retrospectively. Results (1) The diagnosis of PM infection in all the 12 cases were confirmed by peripheral blood culture.All the 12 cases (100%) had irregular fever (38-41 ℃) and enlarged lymph nodes, 8 cases (66%) had skin rashes; 8 cases (66%) had hepatomegaly; 9 cases (75%) had splenomegaly while 8 cases (66%) had anemia. (2) Imaging manifestation: Five cases manifested bilateral pulmonary disseminated miliary nodular shadows or lattice signs; 1 case showed enlarged hilar lymph node and 2 zases showed patchy shadow with pleuritis. One case presented sub-pleural curve line shadow at the posterior part of the right lower lung,and adhesion between the intestinal wall and intestinal mesentery in mass form in the abdomen by CT examination. Conclusion Patients suffering from AIDS (CD4T lymphocytes <50/μ L) with impaired immunity might be susceptible to complication of disseminated PM infection, which presents mainly damage of multiple organs and symptoms such as fever; enlargement of liver,spleen and lymph nodes, as well as specific skin maculopapular rashes. Imaging manifestations in the lungs were revealed as miliary nodular shadows and lattice-like shadows. Intensified abdominal CT might reveal presence of several enlarged postperitoneal lymph nodes and intestinal adhesion in shape of "cakes".

  7. Exposure to 2,4-decadienal negatively impacts upon marine invertebrate larval fitness.

    Caldwell, Gary S; Lewis, Ceri; Olive, Peter J W; Bentley, Matthew G


    Diatoms liberate volatile, biologically active unsaturated aldehydes following cell damage, which negatively impact upon invertebrate reproductive processes such as fertilization, embryogenesis and larval survival. 2,4-Decadienal is frequently identified among the aldehydes produced and is one of the more biologically active. The majority of studies which have examined the toxic effects of diatom aldehydes to invertebrate reproduction have scored egg production and/or hatching success as indicators of biological impacts. There are very few studies which have dealt specifically with the impacts of diatom-derived aldehydes on larval fitness. Larval stages of the polychaetes Arenicola marina and Nereis virens and the echinoderms Asterias rubens and Psammechinus miliaris exposed to 2,4-decadienal at sub 1 microg ml(-1) concentrations suffered reduced survival over the incubation period (day 1-8 post fertilization) with detectable differences for the polychates at a concentration of 0.005 and 0.01-0.1 microg ml(-1) for the echinoderms. Susceptibility of larval N. virens was investigated using stage specific 24 h exposures at 2,4-decadienal concentrations up to 1.5 microg ml(-1). A clear stage specific effect was found, with earlier larval stages most vulnerable. Nectochaete larvae (9-10 d) showed no reduction in survival at the concentrations assayed. Fluctuating asymmetry (FA), defined as random deviations from perfect bilateral symmetry, was used to analyse fitness of larval P. miliaris exposed to 2,4-decadienal at concentrations of 0.1, 0.5 and 1 microg ml(-1). The degree and frequency of asymmetrical development increased with increasing 2,4-decadienal concentration. Equally, as FA increased larval survival decreased. These results provide further support for the teratogenic nature of 2,4-decadienal and its negative impact on invertebrate larval fitness.

  8. Epidemiological Aspects of Dermatophytosis in Khuzestan, southwestern Iran, an Update.

    Rezaei-Matehkolaei, Ali; Rafiei, Abdollah; Makimura, Koichi; Gräser, Yvonne; Gharghani, Maral; Sadeghi-Nejad, Batool


    Dermatophytosis is among the most common superficial mycoses in Iran. The purpose of this report was to update the clinical and mycological features of human dermatophytosis in the Khuzestan, southwestern Iran. In the framework of a one-year survey, a total of 4120 skin, hair and nail samples obtained from the outpatients with symptoms suggestive of tinea were analyzed by using direct microscopy, culture and molecular identification methods. Strains isolated from cultures were subjected to amplification of the nuclear rDNA ITS regions in a PCR assay followed by an early established RFLP analysis. For confirmation of species identification, 100 isolates as representatives of all presumable species were subjected to ITS sequencing. Infection was confirmed in 1123 individuals (27.25 %) in the age range of 1-89 years by direct microscopy and/or culture including 603 males versus 520 females. Frequencies of infections were the highest and the lowest in age groups of 21-30 and 11-20 years, respectively. Tinea corporis was the most prevalent clinical manifestation followed by tinea cruris, tinea capitis, tinea manuum, tinea pedis, tinea unguium, tinea faciei and tinea barbae. Trichophyton interdigitale (58.7 %) was the most dominant isolate followed by Epidermophyton floccosum (35.4 %), Microsporum canis (3 %), T. rubrum (1.5 %), T. species of Arthroderma benhamiae (0.5 %), T. tonsurans (0.3 %) and T. violaceum (0.3 %). Other species included M. gypseum, M. fulvum and T. verrucosum (each one 0.1 %). Such a high occurrence of infection with T. interdigitale, which has not been reported from Iran, is due to the use of accurate molecular methods based on new species concept in dermatophytes. The prevalence of dermatophytoses caused by zoophilic species remarkably increased and Trichophyton species of A. benhamiae has emerged as a new agent of dermatophytosis in southwestern Iran, while infections due to anthropophilic species, except E. floccosum, took a

  9. CT Diagnosis and Clinical Manifestations of Chest Malignant Lymphoma%胸部恶性淋巴瘤的CT诊断及临床表现



    Objective: lymphoma of chest CT diagnosis and clinical manifestations of method retrospective analysis of 43 cases with pathologically proved pulmonary lymphoma clinical and CT (HRCT) data. Results:pulmonary lymphoma CT basic performance can be classified as mass, nodule type;inflammatory alveolar type;bronchial lymph vessels tube type;miliary hematogenous dissemi-nated. According to the performance of the image:mass and nodular type in 18 cases (43%);inflammatory alveolar type in 12 cases (28%), bronchial lymph vessels tube type in 5 cases (accounted for 11%);3 cases of miliary (7%);mixed type in 5 cases (11%), which its mass and nodular type. The most common. Conclusion: lymphoma of chest CT manifestations, but has some characteristics. CT plain scan and multi-phase enhanced scanning is helpful to the diagnosis.%目的:探讨胸部淋巴瘤的CT诊断及临床表现特征.方法:回顾分析43例经病理证实的肺淋巴瘤的临床及CT (部分HRCT)资料.结果:肺淋巴瘤的CT基本表现可以分为肿块、结节型;炎症肺泡型;支气管血管淋巴管型;粟粒型血行播散型.根据影像表现:肿块、结节型18例(占43%);炎症肺泡型12例(占28%),支气管血管淋巴管型5例(占11%);粟粒型3例(占7%);混合型5例(占11%),其中以肿块结节型最多见.结论:胸部淋巴瘤的CT表现形式多样,但具有一定特征性,CT平扫及多期增强扫描有助于诊断.

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

    Shahram Kahkouee


    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

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

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


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

  12. Feline familial pedal eosinophilic dermatosis in two littermates

    Charline Pressanti


    Full Text Available In cats, the most common eosinophilic dermatoses are feline miliary dermatitis and eosinophilic granuloma complex. The most commonly identified underlying cause is a hypersensitivity reaction. Few cases of familial forms of eosinophilic dermatoses are reported in the literature. Two young adult cats from the same litter presented 2 years apart with a severe and chronic fluid or tissue infiltration of the distal part of several limbs. Lesions started on the forelegs and developed on the other limbs. Cytological and histopathological examinations showed lesions consistent with an atypical form of feline eosinophilic dermatosis associated with secondary bacterial infection. In both cats, antibiotics combined with immunosuppressive treatment partially improved the lesions, which continued to progress on a waxing and waning course, even in the absence of treatment. Allergy work-up did not permit the identification of an underlying allergic triggering factor. The severity of the lesions, the unusual presentation and the unsatisfactory response to immunosuppressive therapy in two feline littermates suggested a genetic form of eosinophilic dermatosis.

  13. Establishment of diagnostic criteria for feline nonflea-induced hypersensitivity dermatitis.

    Favrot, Claude; Steffan, Jean; Seewald, Wolfgang; Hobi, Stefan; Linek, Monika; Marignac, Geneviève; Olivry, Thierry; Beco, Luc; Nett, Claudia; Fontaine, Jacques; Roosje, Petra; Bergvall, Kerstin; Belova, Svetlana; Koebrich, Stefanie; Pin, Didier; Kovalik, Marcel; Meury, Sabrina; Wilhelm, Sylvia


    Hypersensitivity dermatitides (HD) are commonly seen in cats, and they are usually caused by environmental, food and/or flea allergens. Affected cats normally present with one of the following clinical reaction patterns: head and neck excoriations, usually symmetrical self-induced alopecia, eosinophilic skin lesions or miliary dermatitis. Importantly, none of these clinical presentations is considered to be pathognomonic for HD skin diseases, and the diagnosis of HD is usually based on the exclusion of other pruritic diseases and on a positive response to therapy. The objectives of this study were to propose sets of criteria for the diagnosis of nonflea-induced HD (NFHD). We recruited 501 cats with pruritus and skin lesions and compared clinical parameters between cats with NFHD (encompassing those with nonflea, nonfood HD and those with food HD), flea HD and other pruritic conditions. Using simulated annealing techniques, we established two sets of proposed criteria for the following two different clinical situations: (i) the diagnosis of NFHD in a population of pruritic cats; and (ii) the diagnosis of NFHD after exclusion of cats with flea HD. These criteria sets were associated with good sensitivity and specificity and may be useful for homogeneity of enrolment in clinical trials and to evaluate the probability of diagnosis of NFHD in clinical practice. Finally, these criteria were not useful to differentiate cats with NFHD from those with food HD.

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

    Tchernev, Georgi


    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.

  15. Diagnosis of Aelurostrongylus abstrusus verminous pneumonia via sonography-guided fine-needle pulmonary parenchymal aspiration in a cat

    Jennifer Gambino


    Full Text Available Case summary A 9-year-old, male neutered, indoor–outdoor domestic shorthair cat from the northern Alabama countryside presented for a 3 week history of coughing, lethargy and an episode of self-resolving dyspnea that occurred 1 week prior to presentation. Three-view thoracic radiographs revealed a moderate-to-severe, diffuse, mixed bronchial to structured interstitial (miliary-to-nodular pulmonary pattern in all lung lobes with peribronchial cuffing and multifocal areas of mild patchy alveolar opacity. Ultrasound-guided evaluation and fine-needle aspiration of the caudodorsal lung parenchyma was performed with sedation. Cytology revealed many widely scattered Aelurostrongylus abstrusus larvae and ova. Upon the confirmed diagnosis of A abstrusus verminous pneumonia, treatment with fenbendazole and selamectin resulted in complete resolution of clinical signs within 6 weeks of the initial diagnosis. Relevance and novel information We report herein the first documented case in the Americas of A abstrusus verminous pneumonia diagnosed via cytologic evaluation of an in vivo, percutaneous ultrasound-guided fine-needle aspirate of affected lung. Additionally, to our knowledge, we offer the first account of the sonographic (pulmonary features of the disease.

  16. Bilateral atypical optic neuritis associated with tuberculosis in an immunocompromised patient

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


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

  17. Clinical characteristics and causes of pruritus in cats: a multicentre study on feline hypersensitivity-associated dermatoses.

    Hobi, Stefan; Linek, Monika; Marignac, Geneviève; Olivry, Thierry; Beco, Luc; Nett, Claudia; Fontaine, Jacques; Roosje, Petra; Bergvall, Kerstin; Belova, Sveta; Koebrich, Stefanie; Pin, Didier; Kovalik, Marcel; Meury, Sabrina; Wilhelm, Sylvie; Favrot, Claude


    Hypersensitivity dermatitides (HD) are often suspected in cats. Cats with HD are reported to present with one or more of the following patterns: miliary dermatitis, eosinophilic dermatitis, self-induced symmetrical alopecia or head and/or neck excoriations. Previous reports on feline HD included small numbers of animals, took place in geographically restricted areas or did not compare these conditions with other causes of pruritus. The goal of the present study was to analyse 72 parameters covering signalment, clinical, laboratory and treatment characteristics from a large group of pruritic cats from different geographical areas. Of the 502 cats, the following diagnoses were made: flea HD (29% of cases), food HD (12%) nonflea/nonfood HD (20%) and other diseases in which pruritus was a feature (24%). Cats with signs consistent with a HD but which did not complete a food trial were not analysed further (15% of cases). Most cats with nonflea HD exhibited signs compatible with one or more of the four typical lesional patterns, but none of these patterns was found to be pathognomonic for any specific diagnosis. Food HD and nonflea/nonfood HD were found to be clinically undistinguishable. Young adult, purebred and female cats appeared predisposed to nonflea/nonfood HD. As many diagnoses presented with similar lesional patterns, a thorough clinical work-up is required for establishment of a specific diagnosis.

  18. The Rocky Horror (Picture Show: a Camp Parody of the Gothic between Mary Shelley, J. B. Priestley and James Whale

    Armando Rotondi


    Full Text Available Lo spettacolo teatrale The Rocky Horror Show (1973 di Richard O’Brien e, successivamente, l’adattamento cinematografico The Rocky Horror Picture Show (1975 di Jim Sharman possono essere considerate due pietre miliari del musical. Per temi e struttura, essi rappresentano la massima espressione della rivoluzione sessuale che va a cavalli tra gli anni '60 e '70 ed emblema del movimento di libertà sessuale. Il successo del musical risiede nella presa in giro degli stereotipi del gotico sia letterario che cinematografico, creando una enorme, irriverente parodia. Se il riferimento più evidente è il Frankenstein di Mary Shelley e la versione cinematografica di James Whale, meno analizzato è il rapporto con Benighted (1927 by John B. Priestley e la pellicola The Old Dark House (1932 sempre di Whale e adattata dal romanzo di Priestley. Proprio questa risulta, infatti, vera fonte di ispirazione per il lavoro di O’Brien, piuttosto che il Frankestein. Il contributo analizzerà questo rapporto, focalizzando la sua attenzione sugli elementi della “liturgia del Rocky Horror Show”, sui riferimenti in parodia e proponendo una visione dell’opera di O’Brien come una meta-aprodia.

  19. A comparative study of clinical manifestations caused by tuberculosis in immunocompromised and non-immunocompromised patients

    邵长周; 瞿介明; 何礼贤


    Objective To characterize the differences between clinical manifestations in immunocompromised patients (ICPs) and non-immunocompromised patients (non-ICPs) with tuberculosis.Methods Underlying diseases, clinical presentations, misdiagnosis, treatment and prognosis, etc, were analyzed retrospectively in 115 tuberculosis patients, including 39 ICPs and 76 non-ICPs.Results Compared with non-ICPs, the individuals who were ICP had more expectoration (64.1% vs 35.5%), pulmonary moist rale (41.0% vs 9.2%), miliary pulmonary tuberculosis (30.8% vs 2.6%), pleural effusion (48.7% vs 25.0%) and lymphadenopathy (18.0% vs 4.0 %). ICPs had less lung cavity (15.4% vs 22.4%) and pleural thickening (15.4% vs 23.7%) compared to non-ICPs. Pulmonary tuberculosis in ICPs was prone to be misdiagnosed as pneumonia (23.1% vs 6.6%). Pulmonary tuberculosis was found in the apicoposterior segment (SI+SII) in more cases in non-ICPs (21.7%, 10/46) than ICPs (10.3%, 3/29). The diagnostic value of tuberculin skin test and adenosine deaminase in pleural effusions was limited in ICPs. ICPs had significantly poorer prognoses than non-ICPs.Conclusion The clinical manifestations of ICPs with tuberculosis are atypical, misdiagnosis often occurs, resulting in a worse prognosis.

  20. [Epidemiology of tuberculosis in France in 2008].

    Che, D; Antoine, D


    A total of 5,758 tuberculosis cases were notified in France in 2008, giving a rate of nine cases per 100,000 inhabitants. The median age was 45 years and 59% of cases were male patients. Île-de-France (Paris and greater Paris area) and French Guiana had the highest notification rate in 2008 (17.9/10(5) and 22.6/10(5) respectively). The rate of tuberculosis was higher in individuals born abroad (43.2/10(5) vs. 5.0/10(5) for individuals born in France), especially those recently arrived in France. Pulmonary tuberculosis accounted for 72% of notified cases, 76% of which were potentially contagious (positive sputum smear, or culture). Compared to 2007, the number of notified tuberculosis cases increased by 3.3% in 2008. This increase was not accompanied by a rise of severe cases (meningitis and miliary TB); this seemed to be due partly to improvement in identification and notification of cases. However this trend could require specific monitoring in future years. A national tuberculosis control program was launched in France in 2007, aiming at reducing epidemiological disparities. Clinical and public health expertise needs to be maintained on all the territory to ensure that implemented measures can have the expected impact on the epidemiology of the disease.

  1. Redescription of the Advertisement Call of Five Species of Thoropa (Anura, Cycloramphidae), Including Recordings of Rare and Endangered Species

    Assis, Clodoaldo L.; Feio, Renato N.; Toledo, Luís Felipe


    Frogs of the genus Thoropa comprise six endemic Brazilian species on the Eastern side of the country. Little is known about their natural history, especially about their acoustic communication. Therefore, aiming to provide an overview of their vocalizations, we analyzed and redescribed male advertisement calls of three living and two possibly extinct species. The smaller species, T. petropolitana and T. lutzi, produce simple calls (one single note) with a higher frequency range than the remaining larger ones. On the other hand, the larger species present complex calls, with more than one note: T. megatympanum calls have three notes, T. taophora calls have four notes, and T. miliaris calls varies from three to six notes. Population snout-vent length negatively correlated with peak of dominant frequency as expected. However, highlighted differences between two populations of T. lutzi, which could indicate need of further taxonomic evaluation of those lineages. Peculiar morphology, such as the absence of vocal sacs and slits, may have contributed to their call variation and highly banded frequency structure. If the observed population differences reflect species-level differences, T. lutzi may be classified as a critically endangered species, as T. petropolitana. Furthermore, we provided a suggestion to an unusual behavior in frogs: calling with the mouth open in the smaller species of the genus. PMID:27617833

  2. Allergy caused by sodium fluoride glycerin: A case report%氟化钠甘油过敏1例



    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.%近年来药物过敏引起的口腔黏膜溃疡越来越多,但氟化钠甘油过敏引起的溃疡却极少见.山东大学千佛山校区医院遇到氟化钠甘油过敏1例,氟化钠甘油治疗后患者口腔黏膜充血水肿明显,颊、腭黏膜有大量红色粟粒状颗粒,3h后出现吞咽困难,但无呼吸困难,次日出现口腔黏膜大面积溃疡.治疗7d后患者痊愈,氟化钠敏感试验结果为阳性.

  3. Adiaspiromicose pulmonar humana Human pulmonary adiaspiromycosis

    Lina Gomes dos Santos


    Full Text Available A adiaspiromicose é uma doença fúngica sistêmica que acomete usualmente roedores e raramente atinge o homem. É causada pelo fungo Emmonsia crescens e ocorre após a inalação da forma contagiante (conídios. Embora estas formas não se multipliquem nem se disseminem no organismo humano, induzem uma reação inflamatória crônica granulomatosa de padrão miliar que pode levar a falência respiratória e morte. Apresentamos aqui um caso de adiaspiromicose pulmonar humana em paciente imunocompetente que exibia infiltrado intersticial pulmonar difuso ao exame de imagem e fora diagnosticado mediante biópsia pulmonar.Adiaspiromycosis is a systemic fungal disease that usually affects rodents and rarely infects humans. It is caused by the fungus Emmonsia crescens and occurs after inhalation of its contagious form (conidia. Although these forms neither multiply nor spread in the human body, they cause a chronic granulomatous inflammatory reaction of miliary pattern, which may lead to respiratory failure and death. In this study we present a case of human pulmonary adiaspiromycosis in an immunocompetent patient that showed a diffuse pulmonary interstitial infiltrate diagnosed by pulmonary biopsy.

  4. Radiographic grading of extrinsic allergic alveolitis. A comparison between a modified ILO classification and a descriptive method.

    Jaakkola, J; Partanen, K; Terho, E O; Niemitukia, L; Soimakallio, S


    We analyzed the acute phase radiographs of 107 consecutive patients with clinically confirmed extrinsic allergic alveolitis. Three readers independently recorded the profusion and the type of opacities according to the standard ILO criteria extended with categories x, y, z, and ground glass for description as proposed by McLoud et al. The profusion of the changes was grade 0 in 13%, grade 1 in 37%, grade 2 in 35%, and grade 3 in 15% of the interpretations. The type of predominant small opacities was p in 33%, x in 22%, s in 13%, t in 10%, q in 9%, and 0, r, u, y, and z in 13% of the interpretations. Ground glass density was seen in 8% of the recordings. The changes were predominantly located in the middle and lower lung zones. For comparison, according to the classification of Hapke et al. miliary changes (68%) predominated over fibrotic (27%) and normal (11%) recordings. The intraobserver agreement was good by both methods, but there was less interobserver variation with the ILO method. The semiquantitative standardized modified ILO scheme was considered more informative than Hapke's descriptive classification for epidemiologic and research purposes.

  5. Progressive Primary Pulmonary Tuberculosis Presenting as the Sudden Unexpected Death in Infancy: A Case Report

    Dempers, Johan; Sens, Mary Ann; Wadee, Shabbir Ahmed; Kinney, Hannah C.; Odendaal, Hein J.; Wright, Colleen A.


    The classification of an unexpected infant death as the sudden infant death syndrome (SIDS) depends upon a complete autopsy and death scene investigation to exclude known causes of death. Here we report the death of a four-month-old infant in a tuberculosis endemic area that presented as a sudden unexpected death in infancy (SUDI) with no apparent explanation based on the death scene characteristics. The autopsy, however, revealed progressive primary pulmonary tuberculosis with intrathoracic adenopathy, compression of the tracheobronchial tree and miliary lesions in the liver. This case underscores the clinical difficulties in the diagnosis of infantile tuberculosis, as well as the possibility of sudden death as part of its protean manifestations. The pathology and clinical progression of tuberculosis in infants differs from older children and adults due to the immature immune response in infants. This case dramatically highlights the need for complete autopsies in all sudden and unexpected infant deaths, as well as the public health issues in a sentinel infant tuberculosis diagnosis. PMID:20705406

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

    G. Kalema-Zikusoka


    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.

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

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


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

  8. Case of calcified intracranial tuberculoma presenting unique MRI findings

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


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

  9. Computed tomography of intracranial tuberculosis

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


    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.

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

    Maria Bruna Pasticci


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

  11. Tuberkulosis Perinatal Bermanifestasi sebagai Tuberkulosis Milier dan Meningitis

    Heda Melinda D. Nataprawira


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

  12. Immune Vulnerability of Infants to Tuberculosis

    Koen Vanden Driessche


    Full Text Available One of the challenges faced by the infant immune system is learning to distinguish the myriad of foreign but nonthreatening antigens encountered from those expressed by true pathogens. This balance is reflected in the diminished production of proinflammatory cytokines by both innate and adaptive immune cells in the infant. A downside of this bias is that several factors critical for controlling Mycobacterium tuberculosis infection are significantly restricted in infants, including TNF, IL-1, and IL-12. Furthermore, infant T cells are inherently less capable of differentiating into IFN-γ-producing T cells. As a result, infected infants are 5–10 times more likely than adults to develop active tuberculosis (TB and have higher rates of severe disseminated disease, including miliary TB and meningitis. Infant TB is a fundamentally different disease than TB in immune competent adults. Immunotherapeutics, therefore, should be specifically evaluated in infants before they are routinely employed to treat TB in this age group. Modalities aimed at reducing inflammation, which may be beneficial for adjunctive therapy of some forms of TB in older children and adults, may be of no benefit or even harmful in infants who manifest much less inflammatory disease.

  13. Study of tuberculous meningitis by CT

    Rovira, M.; Romero, F.; Torrent, O.; Ibarra, B.


    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.

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

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


    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.

  15. Disseminated mycobacteriosis in a stranded loggerhead sea turtle (Caretta caretta).

    Nardini, Giordano; Florio, Daniela; Di Girolamo, Nicola; Gustinelli, Andrea; Quaglio, Francesco; Fiorentini, Laura; Leopardi, Stefania; Fioravanti, Maria Letizia


    A loggerhead sea turtle (Caretta caretta) was found stranded alive along the Adriatic coast close to Ancona, Italy, displaying obtundation, tachypnea, and increased respiratory effort. It died a few hours after admission, and a postmortem examination was immediately performed. Miliary yellowish nodules were evident in the liver, and a lower number in the heart, stomach, and gut wall. Hundreds of whitish nodules were scattered in the lungs, with the majority of the pulmonary parenchyma being replaced by the lesions. Histologically, all nodular lesions consisted of a small central area of necrosis with acid-fast bacilli surrounded by epithelioid cells, macrophages, and lymphocytes. Giant cells were found in the spleen and the liver. Kidneys, lungs, liver, spleen, brain, and skin lesions were inoculated aseptically onto general isolation media and selective isolation media for mycobacteria. The isolate showed a restriction pattern identical to Mycobacterium chelonae by polymerase chain reaction-restriction fragment length polymorphism. To the best of the authors' knowledge, this is the first description of a disseminated infection caused by a potentially pathogenic mycobacteria in a stranded, free-ranging loggerhead sea turtle. Veterinary staff and biologists who handle sea turtles with suspected mycobacterial disease should protect themselves appropriately.

  16. Association of Hepatic Hydatid Cyst Disease and Liver Tuberculosis

    Songul Ozyurt


    Full Text Available Hydatid cyst and tuberculosis are common infectious diseases in our country. However, co-incidence of these two diseases is a rare case. This refers to spontaneous emergence of cyst hydatid and tuberculosis lesion in liver which is presented in this paper. Liver tuberculosis can be detected either as a component of miliary tuberculosis or isolated liver tuberculosis. Herein we report a case of 46 year-old male. He applied to the emergency due to the severe right-side pain which coupled with breathing and movement. This was reported to last for 10 days. Lesion compatible to cyst hydatid with a size of 151 x 144 x 128 mm was detected in the right lobe anterior in his abdomen ultrasonography. Echinococcus indirect hemagglutination test resulted in 1/640 positive. The patient had liver cystectomy by general surgery clinic. After microscopic examination of excision material, chronic granulomatous inflamation with caseous necrosis was detected in parenchyma to which cyst hydatid and lesion were attached. PPD result was 16 mm. The patient, whose lungs were normal, received antituberculosis treatment due to primary liver tuberculosis.

  17. Inhibition of embryonic development and fertilization in broadcast spawning marine invertebrates by water soluble diatom extracts and the diatom toxin 2-trans,4-trans decadienal.

    Caldwell, Gary S; Olive, Peter J W; Bentley, Matthew G


    Water soluble diatom extracts and the diatom aldehyde 2-trans,4-trans decadienal were assayed on the gametes and embryos of the broadcast spawning polychaetes Arenicola marina and Nereis virens and the echinoderms Asterias rubens and Psammechinus miliaris. Both crude cellular extracts and purified aldehyde were found to inhibit fertilization, embryogenesis and hatching success in a dose dependent manner. Intact diatom cells had no discernable effect on fertilization or development. Extracts of Skeletonema costatum were generally more effective than Nitzschia commutata in inhibiting development and fertilization. There was considerable interspecific variation in terms of toxin sensitivity. The polychaetes were more sensitive to the effects than the echinoderms. Within the polychaetes A. marina was the more tolerant in terms of developmental competence but N. virens had a higher fertilization rate. Echinoid embryos were more tolerant than asteroid embryos. This is the first study to present data on the inhibition of fertilization success by diatom extracts and aldehydes. Our observations are discussed in relation to temporal patterns in spawning and possible adaptive mechanisms to avoid diatom toxicity.

  18. Redescription of the Advertisement Call of Five Species of Thoropa (Anura, Cycloramphidae), Including Recordings of Rare and Endangered Species.

    Nunes-de-Almeida, Carlos H L; Assis, Clodoaldo L; Feio, Renato N; Toledo, Luís Felipe


    Frogs of the genus Thoropa comprise six endemic Brazilian species on the Eastern side of the country. Little is known about their natural history, especially about their acoustic communication. Therefore, aiming to provide an overview of their vocalizations, we analyzed and redescribed male advertisement calls of three living and two possibly extinct species. The smaller species, T. petropolitana and T. lutzi, produce simple calls (one single note) with a higher frequency range than the remaining larger ones. On the other hand, the larger species present complex calls, with more than one note: T. megatympanum calls have three notes, T. taophora calls have four notes, and T. miliaris calls varies from three to six notes. Population snout-vent length negatively correlated with peak of dominant frequency as expected. However, highlighted differences between two populations of T. lutzi, which could indicate need of further taxonomic evaluation of those lineages. Peculiar morphology, such as the absence of vocal sacs and slits, may have contributed to their call variation and highly banded frequency structure. If the observed population differences reflect species-level differences, T. lutzi may be classified as a critically endangered species, as T. petropolitana. Furthermore, we provided a suggestion to an unusual behavior in frogs: calling with the mouth open in the smaller species of the genus.

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

    Short, Jeanmarie; Gram, Dunbar


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

  20. Tuberculosis in kudus (Tragelaphus strepsiceros) in the Kruger National Park.

    Keet, D F; Kriek, N P; Bengis, R G; Michel, A L


    Five kudus (Tragelaphus strepsiceros), three bulls and two cows, within the Greater Kruger National Park complex, were diagnosed with generalized tuberculosis caused by Mycobacterium bovis. The lesions seen in these animals were similar to those previously reported in kudus and included severe tuberculous lymphadenitis of the nodes of the head and neck (that resulted in noticeable uni- or bilateral swelling beneath the ear), thorax, and the mesentery. All the animals also suffered from severe granulomatous pneumonia. The lesions in the lungs were more severe cranially and had a miliary distribution elsewhere in the lungs. Based on the DNA patterns of the M. bovis isolates, at least some of these kudus were infected with strains commonly present in tuberculous buffaloes, lions, cheetahs, and baboons in the Park whereas other strains from these kudus were quite different and may reflect another source of infection. The presence of tuberculous kudus in the Park is expected to complicate control measures that may be instituted to contain or eradicate the disease in the Park.

  1. A Histomorphological Pattern Analysis of Pulmonary Tuberculosis in Lung Autopsy and Surgically Resected Specimens

    Mamta Gupta


    Full Text Available Background. Tuberculosis (TB is a major cause of morbidity and mortality globally. Many cases are diagnosed on autopsy and a subset of patients may require surgical intervention either due to the complication or sequelae of TB. Materials and Methods. 40 cases of resected lung specimens following surgery or autopsy in which a diagnosis of pulmonary tuberculosis was made were included. Histopathological pattern analysis of pulmonary tuberculosis along with associated nonneoplastic changes and identification of Mycobacterium tuberculosis bacilli was done. Results. The mean age of diagnosis was 41 years with male predominance (92.5%. Tuberculosis was suspected in only 12.1% of cases before death. Seven cases were operated upon due to associated complications or suspicion of malignancy. Tubercular consolidation was the most frequent pattern followed by miliary tuberculosis. The presence of necrotizing granulomas was seen in 33 cases (82.5%. Acid fast bacilli were seen in 57.5% cases on Ziehl-Neelsen stain. Conclusion. Histopathology remains one of the most important methods for diagnosing tuberculosis, especially in TB prevalent areas. It should be considered in the differential diagnosis of all respiratory diseases because of its varied clinical presentations and manifestations.

  2. 细支气管肺泡癌1BF FDG PET/CT SUV值与HRCT形态学的相关性研究%Study of the Relationship between 18F-FDG PET/CT SUV and HRCT Morphology in Bronchial Alveolar Carcinoma (BAC)

    何宝明; 王志忠; 刘晓飞; 姚昊; 欧阳晓辉; 苏家贵


    ( re = 5 ) and solid nodule (re = 8 ) . The GGO nodules that the diameter was usually 1. 1-2. 8cm and the mean values SUVlml was less than 1. 5 ,that had the characters of morphology such as tabulation (re =4) , pleural indentation (re =2) , vascular aggregated sign (re = 2). The solid nodules which had a higher uptake(SUVmax: 4. 8-8. 3) , diameter 1. 8-3. 8 cm with short speculation ( re = 8 ) , tabulation ( re = 7 ) , aerated bronchi ( re = 6 ) , vacuoles ( re = 5 ) , pleural indentation ( re = 3 ). Vascular aggregated sign (re =7) , nodules accumulate (re =3). There were 9 cases of multi-nodules which included 4 case of Miliary nodules noduled and 5 case of the number of nodules more than 2. GGO and samll Miliary nodules ( nodule which diameter <3 mm) were without FDG uptake, melt noudle and larger miliary nodules (nodule which diameter <3 mm) had FDG uptake,the SUVmax 2.1-3.9. The pneumonia type;The consolidation was observed in one (n =4) , or two lobes (re =2) , with "aerated bronchi" sign (re =7) , or "honeycomb" sign (re = 1) , bronchial marginal cutoff(re = 1). Radioactive distribution was inhomogeneous, SUVmax 4.5-11, FDG uptake of part lesions is negative results. It conclused there are a correlation between F-FDG PET/CT SUV and HRCT morphology in Bronchial alveolar carcinoma ( BAC). Miliary nodules nodule which diameter less than 3 mm and ground-glass opacity normally are without FDG uptake meanwhile the type of pneumonia and mass almost have higher uptake.

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

    Daniel H. Libraty


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

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

    Ahmad Qazi


    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.

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

    A. Penna de Azevedo


    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.

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

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


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

  7. Tuberculous endocarditis.

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


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

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

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


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

  9. August 2012 imaging case of the month

    Gotway MB


    Full Text Available No abstract available. Article truncated at 150 words. Clinical History: A 48-year-old non-smoking man presented with a history of slowly progressive shortness of breath and recent onset of a headache. Frontal chest radiography (Figure 1 was performed.Figure 1: Frontal chest radiography shows normal cardiomediastinal contours with bilateral peri- and infrahilar predominant ground-glass opacity with a background of linear and reticular abnormalities.Which of the differential diagnostic considerations listed below is the most likely consideration for the chest radiographic abnormality?1.Pneumococcal pneumonia 2.Lung carcinoma3.Idiopathic pulmonary fibrosis4.Pulmonary alveolar proteinosis5.Miliary tuberculosisCorrect!Answer: 4. Pulmonary alveolar proteinosisThe frontal chest radiograph shows bilateral increased lung attenuation consisting of ground-glass opacity and a background of linear and reticular abnormalities. Pneumococcal pneumonia is a possibility, but this infection most commonly presents either with an air-space pneumonia pattern [homogeneous lung opacity with air bronchograms extending towards the pleural surface] or with a bronchopneumonia pattern [patchy …

  10. Radiological analysis of idiopathic pulmonary hemosiderosis in children%儿童特发性肺含铁血黄素沉着症影像学分析

    郭建贵; 王映峰


    Objective To study the imaging characteristics and pathologic findings of idiopathic pulmonary hemosiderosis(IPH).Methods The clinical datas and imaging findings of 23 cases of IPH treated in our hospital between 2000 and 2010 were retrospectively analyzed.Results On plain film,flake consolidation and ground -glass shadows( n =16),diffuse miliary and micronodular shadows( n =8),and difuse reticular shadows( n =5 )were demonstrated in both lungs.On HRCT,diffuse flake consolidation and ground - glass shadows ( n =7 ),diffuse miliary and mieronodular shadows ( n =5 ) and multiple follicular and reticular shadows ( n =4)were displayed in both lungs.Air bronchogram was seen in 2 and thickened interlobular septum in 3 cases.Conclusions Chest film is the important method to detect IPH.Combined analysis of imaging findings(HRCT),clinical manifestation,and laboratory results,particularly the presence of hemosider in macrophagocyte in sputum,gastric juice or lung tissue may provide a confirmed diagnosis of IPH.%目的 探讨儿童特发性肺含铁血黄素沉着症(IPH)的胸部影像学特点.方法 对我院2000年至2010年收治并临床确诊的16例特发性肺含铁血黄素沉着症患者的影像学及临床资料进行回顾性分析.结果 胸部X线表现:16例肺野内弥漫分布有片絮状阴影与磨玻璃样改变,8例表现为双肺弥散分布的粟粒状、小结节影;5例有弥漫分布的网织状影.7例行CT扫描.高分辨率CT(HRCT):7例两肺呈弥漫性分布片絮状实变影及磨玻璃样影,5例两肺弥漫分布粟粒状、小结节状影,4例可见多发小囊状影及网状影,2例可见支气管充气征,3例有小叶间隔增厚.结论 X线平片是发现并提示IPH最基本的检查手段,影像学检查特别是HRCT与临床表现、实验室检查相结合分析,尤其是在痰或胃液中及肺泡灌洗液内查到含铁血黄素巨噬细胞,可以明确诊断.

  11. 经自然腔道内镜手术检查诊断结核性腹膜炎20例%Trans-gastric peritoneoscopy with technique of natural-orifice transluminal endoscopic surgery for diagnosis of tuberculosis peritonitis: a report of 20 cases

    朱惠明; 李迎雪; 王立生; 师瑞月; 黄勋; 王琴; 罗伟香


    目的 探讨经胃的经自然腔道内镜手术(NOTES)腹腔内镜检查对结核性腹膜炎的诊断价值.方法 回顾20例经胃NOTES腹腔内镜检查及病理活检确诊为结核性腹膜炎患者的相关临床资料,并进行性分析总结.结果 20例患者经胃NOETS腹腔内镜检查及病理活检后明确诊断为结核性腹膜炎.内镜检查结果为4型:(1)粟粒型:内镜表现为腹水、腹膜散在分布白色粟粒状结节;(2)粘连型:内镜表现腹膜增厚,腹膜与网膜、肠管之间存在不同程度的粘连;(3)干酪型:内镜表现壁层溃疡及淡黄色干酪样物质;(4)混合型:内镜表现为同时存在2种或3种类型.其他各项实验室及特殊检查的阳性例数分别为血红蛋白下降10例,红细胞沉降率增快16例,C反应蛋白升高13例,CA125升高18例,胸片异常8例,腹部彩超异常2例,腹部CT异常7例,结核菌素实验阳性9例,结肠镜检查阳性1例,20例结核抗体、腹水培养、腹水细菌学检查、胃镜检查均阴性.结论 经胃NOTES腹腔内镜检查及病理活检是确诊结核性腹膜炎非常有效的诊断方法.%Objective To investigate the diagnostic value of trans-gastric peritoneoscopy with technique of natural orifice transluminal endoscopic surgery(NOTES)for tuberculosis peritonitis.Methods Clinical data of 20 patients with tuberculosis peritonitis diagnosed by trans-gastric peritoneoscopy via NOTES were retrospectively analyzed.Results All diagnoses were confirmed by biopsy.The findings of peritoneoscopy were defined as miliary type with miliary nodes scattered in ascites and on peritoneum,adhesive type with thickening of peritoneum and adhesion between peritoneum and intestines,cheese-like type with parietal peritoneal ulcer and cheese-like substances,and mixed type with 2 or 3 of above mentioned types.Positive findings in other laboratory examinations were hemoglobin decrease in 10(50%)patients,blood sedimentation rate increase in 16(80

  12. Imaging findings of disseminated pulmonary tuberculosis in patients with acquired immunodeficiency syndrome%艾滋病并发肺结核播散的影像表现

    宋文艳; 赵祖琦; 赵大伟; 刘晋新; 官宛华; 梁艺; 贾翠宇; 张瑞池


    Objective To study the imaging findings of disseminated pulmonary tuberculosis in patients with acquired immunodeficiency syndrome (AIDS).Methods X-ray and multi-slice CT (MSCT)data from 33 AIDS patients with disseminated pulnonary tuberculosis confirmed by clinical manifestations and laboratory tests were analyzed retrospectively.Results Thirty patients underwent initial chest radiography examination,29 patients showed abnormal appearances,including bilateral disseminations in 21 patients and unilateral multiple disseminations in 8 patients.All patients underwent MSCT examination,26 patients showed bilateral disseminations and 7 patients showed unilateral multiple disseminations.The abnormal pulmonary appearances included nodule (n =25),miliary nodule (n =22),air-space consolidation (n =22),cavity (n =11),fibrosis (n =7),ground-glass opacity (n =7),pneumatocele (n =4),calcification (n =2).There were 20 patients with more than 3 abnormal appearances and 13 patients with one or two abnormal appearances.The extra-pulmonary tuberculosis included pleural effusion (n =33),lymphadenopathy (n =30),intestinal tuberculosis (n =3),splenic tuberculosis (n =1) and cerebral tuberculosis (n =1).Conclusion Disseminated pulmonary tuberculosis should be highly suspected in AIDS patients with diffused nodules,miliary nodules,air-space consolidations or multiple cavities,accompanied with pleural effusion and lymphadenopathy.%目的 探讨艾滋病(AIDS)并发肺结核肺内播散的影像特点.方法 回顾性分析经临床及实验室检查证实的33例AIDS并发肺结核肺内播散的X线胸片及MSCT影像资料,总结其影像表现特征.结果 首诊X线胸片检查30例,29例表现异常,包括病灶呈双侧播散性分布21例,单侧多发病变8例.所有患者均行MSCT扫描,病变呈单侧和双侧肺内多发分布分别为7例和26例;病变形态包括结节(25例)、粟粒(22例)、气腔实变(22例)、空洞(11例)、纤维索条(7例)、磨玻璃影(7

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

    J.I. Aláez


    Full Text Available Presentamos el caso de una paciente de 28 años que consultó por fiebre de hasta 40,8ºC, dolor pleurítico en costado derecho y aparición de una masa dolorosa en la extremidad inferior izquierda de cuatro días de evolución. Mediante tomografía axial computerizada (TAC se objetivó la existencia de una condensación en el lóbulo medio del pulmón derecho con derrame pleural asociado y patrón miliar bilateral. El estudio ecográfico de la extremidad inferior izquierda mostró una masa de partes blandas de aspecto quístico con destrucción de la cortical del peroné y destrucción ósea. La resonancia magnética confirmó la presencia de osteomielitis en el peroné izquierdo y de un absceso de partes blandas asociado. En el material obtenido por punción del citado absceso así como en tres muestras de esputo se aisló Mycobacterium tuberculosis, estableciéndose el diagnóstico de tuberculosis diseminada con afectación pulmonar miliar, osteomielitis peronea y absceso tuberculoso de partes blandas. Se inició tratamiento antituberculoso (rifampicina, isoniacida y pirazinamida seguido, dos semanas después, de tratamiento antirretroviral (AZT, 3TC y NVP. La paciente desarrolló un cuadro de erupción cutánea generalizada que desapareció tras la sustitución de la rifampicina por etambutol. Ante la persistencia de la masa de partes blandas, tras cinco semanas de tratamiento antituberculoso se procedió al drenaje quirúrgico del absceso. La evolución posterior fue favorable, permaneciendo la paciente asintomática al mes de ser dada de alta.We present the case of a 28 year old patient who came for consultation on a fever of up to 40.8º C, pleuritic pain on the right side and the appearance of a painful mass in the lower left extremity of four days evolution. Computerised axial tomography (CAT showed the existence of a condensation in the middle lobe of the right lung with associated pleural effusion and bilateral miliary pattern. The

  14. Serum allergen-specific immunoglobulin E in atopic and healthy cats: comparison of a rapid screening immunoassay and complete-panel analysis.

    Diesel, Alison; DeBoer, Douglas J


    Feline and canine atopic dermatitis are thought to have a similar immunopathogenesis. As with dogs, detection of allergen-specific IgE in cat serum merely supports a diagnosis of feline atopy based on compatible history, clinical signs and elimination of other pruritic dermatoses. In this study, a rapid screening immunoassay (Allercept(®) E-Screen 2nd Generation; Heska AG, Fribourg, Switzerland; ES2G) was compared with a complete-panel serum allergen-specific IgE assay (Allercept(®); Heska AG; CP) in healthy cats with no history of skin disease and in atopic cats. The latter had no diagnosis of external parasitism, infection, food hypersensitivity or other skin disease explaining their pruritus, and expressed cutaneous reaction patterns typically associated with feline allergic skin disease (head, neck or pinnal pruritus, miliary dermatitis, self-induced alopecia, eosinophilic granuloma complex). The proportion of cats positive on either the ES2G or the CP assays was not significantly different between the atopic and healthy cat groups. There was, however, strong agreement between the results of the ES2G and CP assay; overall, the two tests were in agreement for 43 of 49 (88%) serum samples. There was also strong agreement when individual allergen groups were evaluated (agreement noted: indoor, 41 of 49 samples; grasses/weeds, 37 of 49 samples; and trees, 41 of 49 samples). These results indicate that although neither test is diagnostic for feline atopic dermatitis, the screening assay is beneficial for predicting the results of a complete-panel serum allergen-specific IgE assay in cats.

  15. Computed tomographic demonstrations of HIV seropositive pulmonary tuberculosis and their relationship with CD4+T-lymphocyte count

    ZHANG Yu-zhong; LI Hong-jun; CHENG Jing-liang; WU Hao; BAO Dong-ying


    Background Factors of cell-mediated immunity and allergy together play their roles in the pathogenesis of pulmonary tuberculosis (PTB) and its prognosis. The purpose of this study was to investigate the computed tomographic demonstrations of HIV seropositive PTB and the relationship between its pathogenesis and CD4+ T-lymphocyte count.Methods The documented CT images of a total of 44 patients with HIV seropositive PTB, definitely diagnosed by etiological or pathological examinations, their clinical data and their CD4+ T-lymphocyte count were retrospectively reviewed.Results There were 15 cases of miliary tuberculosis, accounting for 34.1% of the total cases; 15 cases of nodular tuberculosis, 34.1%; 6 cases of ground-glass opacity, 13.6%; 5 cases of cord-liked fiber shadows, 11.4%; 16 cases of flaky and flocculating shadows, 36.4%; 5 cases of cavitation, 11.4%; 5 cases of tumor shadows, 11.4%; 2 cases of pleural thickening, 4.5% and 11 cases of pleural effusion, 25.0%; 1 case of calcification, 2.3%; 16 cases of lymphadenectasis,36.4%. The foci were located around the pulmonary hilum, anterior segment of superior lobe, basal segment of inferior lobe, medial lobe and lingual lobe. CD4+ T-lymphocyte count was closely related to the imaging demonstrations of HIV seropositive PTB.Conclusions CT scanning can demonstrate various signs of PTB. CD4+ T-lymphocyte level determines the variety of imaging demonstrations of HIV seropositive PTB and its prognosis.

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

    Yatin N. Dholakia


    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.

  17. [TUBERCULOSIS ANNUAL REPORT 2014--(1) Summary of Statistics on Tuberculosis Notification and Foreign-born Tuberculosis Patients].


    This brief is the first of a series of documents based on the Tuberculosis Annual Report 2014. It includes a summary of tuberculosis (TB) statistics, including data on foreign-born TB patients notified and registered in Japan in 2014. For the first time, the number of newly notified cases (all forms of TB) fell below 20,000. In 2014, a total of 19,615 patients were notified, a rate of 15.4 per 100,000 population The number of sputum-smear positive pulmonary. TB patients notified was 7,651, a rate of 6.0 per 100,000 population. The number of patients with latent TB infections increased slightly from 7,147 in 2013 to 7,562 in 2014. The proportion of miliary TB cases has constantly increased over the past 10 years, especially among women aged 80 years and older. The number of foreign-born TB patients continued to increase from 1,064 in 2013 to 1,101 in 2014. In 2014, new foreign-born TB patients aged 20-29 years accounted for 44.1% of all new TB patients in that age group. Among foreign-born TB patients, half were from the Philippines (26.5%) and China (23.5%). However, the number of patients from Vietnam and Nepal is increasing. Among foreign-born TB patients, 28% were regular employees, 26% were students, and 20% were unemployed. The changing trend in the nationality of foreign students entering Japan may at least partially explain the differences in TB burden among foreign-born patients, by country of birth. As we expect to see the proportion of foreign-born TB patients continue to rise, more tailored case identification and treatment support activities are needed.

  18. Did Jean-Martin Charcot contribute to stroke?

    Bogousslavsky, Julien; Paciaroni, Maurizio


    Stroke was never identified as a significant, autonomous field of activity of the emerging school of neurology at La Salpêtrière, which developed after the appointment of Jean-Martin Charcot (1825-1893) during the last days of 1861. However, stroke was already present in Charcot's first paper (1851), which dealt with a case of multiple organ cardiac embolism, including middle cerebral artery infarction, at a time when the studies of Rudolf Virchow on thromboembolism were unknown in France. A few years later, Charcot made a still up-to-date description of vascular intermittent claudication, which had only been reported in the horse. In the 1860s, Charcot and his pupils presented several major works dealing with cerebrovascular disease, including famous studies on miliary aneurysms in cerebral hemorrhage. This work was done with Charles Bouchard, at the time Charcot's 'interne', but who would become one of his 'political' opponents 2 decades later, when in 1892, as president of the 'agrégation' jury, he rejected the professorship application of 4 protégés of Charcot, including Joseph Babinski and Georges Gilles de la Tourette. Further work on cerebrovascular disease by Charcot included histological studies of brain 'softening', paraneoplastic cerebral arterial occlusion and consequences of stroke (e.g. arthropathies, vegetative changes, contractures and abnormal movements). Brain localization, one of Charcot's major neurological topics, was also largely based on stroke case studies. Charcot's work on stroke remains poorly recognized, but it demonstrates his unique skills in stimulating scientific work in younger colleagues, many of whom subsequently became major figures of neurology and psychiatry.

  19. 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



    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.

  20. Acute renal failure after rifampicin Insuficiência renal aguda por rifampicina

    Adriana Weinberg


    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.

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

    Surendra K Sharma


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

  2. Clinical analysis of 68 patients with pulmonary mycosis in China

    Luo Bai-ling


    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.

  3. Reducing the activity and secretion of microbial antioxidants enhances the immunogenicity of BCG.

    Shanmugalakshmi Sadagopal

    Full Text Available BACKGROUND: In early clinical studies, the live tuberculosis vaccine Mycobacterium bovis BCG exhibited 80% protective efficacy against pulmonary tuberculosis (TB. Although BCG still exhibits reliable protection against TB meningitis and miliary TB in early childhood it has become less reliable in protecting against pulmonary TB. During decades of in vitro cultivation BCG not only lost some genes due to deletions of regions of the chromosome but also underwent gene duplication and other mutations resulting in increased antioxidant production. METHODOLOGY/PRINCIPAL FINDINGS: To determine whether microbial antioxidants influence vaccine immunogenicity, we eliminated duplicated alleles encoding the oxidative stress sigma factor SigH in BCG Tice and reduced the activity and secretion of iron co-factored superoxide dismutase. We then used assays of gene expression and flow cytometry with intracellular cytokine staining to compare BCG-specific immune responses in mice after vaccination with BCG Tice or the modified BCG vaccine. Compared to BCG, the modified vaccine induced greater IL-12p40, RANTES, and IL-21 mRNA in the spleens of mice at three days post-immunization, more cytokine-producing CD8+ lymphocytes at the peak of the primary immune response, and more IL-2-producing CD4+ lymphocytes during the memory phase. The modified vaccine also induced stronger secondary CD4+ lymphocyte responses and greater clearance of challenge bacilli. CONCLUSIONS/SIGNIFICANCE: We conclude that antioxidants produced by BCG suppress host immune responses. These findings challenge the hypothesis that the failure of extensively cultivated BCG vaccines to prevent pulmonary tuberculosis is due to over-attenuation and suggest instead a new model in which BCG evolved to produce more immunity-suppressing antioxidants. By targeting these antioxidants it may be possible to restore BCG's ability to protect against pulmonary TB.

  4. Hepatobiliary tuberculosis in western India

    Amarapurkar Deepak


    Full Text Available Tuberculous involvement of liver as a part of disseminated tuberculosis is seen in up to 50-80% cases, but localized hepatobiliary tuberculosis (HBTB is uncommonly described. During 6 years, a total of 280 consecutive patients with TB were evaluated prospectively for the presence and etiology of liver involvement. Cases with miliary TB or immunosuppression and cases receiving anti-tuberculosis drugs prior to presentation to our unit were excluded (38 cases. Details of clinical, biochemical and imaging findings and histology/microbiology were noted. Of 242 included cases, 38 patients (15.7%; age 38.1 ± 12.5 years; sex ratio 2.5:1 had HBTB, whereas 20 patients (9%; age 39.3 ± 16.3 years; sex ratio 2.1:1 had other liver diseases. Diagnosis of HBTB was based on caseating granuloma on histology (18/23 procedures, positive smear/culture for acid-fast bacilli (21/39 procedures and positive polymerase chain reaction for Mycobacterium tuberculosis (28/29 procedures when diagnostic procedures were guided by imaging results. Thirty-eight cases with HBTB were classified as follows [patients (n, (%]: (A hepatic TB [20 (52.6%]: (1 granulomatous hepatitis - 10 (26.3%, (2 liver abscesses or pseudotumors - 10 (26.3% and (3 calcified hepatic granuloma - 0 (0%; (B biliary TB [15 (39.4%]: (1 biliary strictures - 2 (5.2%, (2 gall bladder involvement - 1 (2.6% and (3 biliary obstruction due to lymph node masses - 12 (31.5%; (C mixed variety [3 (7.8%]: (1 simultaneous granulomatous hepatitis and biliary stricture - 1 (2.6% and (2 simultaneous lymph node involvement and calcified hepatic granuloma - 2 (5.2%. All the cases responded well to standard anti-tuberculosis therapy. HBTB forms an important subgroup in TB cases. It requires a combination of imaging, histological and microbiological procedures to define the diagnosis. HBTB responds well to treatment.

  5. A review of the literature on the economics of vaccination against TB.

    Tu, Hong-Anh T; Vu, Hoa D; Rozenbaum, Mark H; Woerdenbag, Herman J; Postma, Maarten J


    The BCG vaccine was introduced in 1921 and remains the only licensed vaccine for the prevention of TB worldwide. Despite its extensive use, the BCG vaccine lacks the ability to fully control the TB-endemic and -pandemic situations. The BCG vaccine is most effective in preventing pediatric TB, in particular, miliary TB and tuberculous meningitis. However, it has a limited effect in preventing pulmonary TB, which occurs more frequently in adults. BCG vaccination has now been implemented in more than 157 countries worldwide. For various countries, the benefits of vaccination are only limited and potentially not cost effective. The International Union Against Tuberculosis and Lung Diseases had set the criteria for discontinuation of BCG vaccination in 1994. This decision, however, was not based on economic considerations. Many developed countries have met the criteria set by the International Union Against Tuberculosis and Lung Disease and stopped universal BCG vaccination. For developing countries, the BCG vaccine is still an effective intervention in protecting young children from TB infection. A lot of effort has been spent on R&D of new TB vaccines, the first of which are expected to be available within 5-7 years from now. Novel TB vaccines are expected to be better and more effective than the current BCG vaccine and should provide a viable strategy in controlling TB morbidity and mortality. In this review, the aim is to explore economic evaluations that have been carried out for vaccination against TB worldwide. In addition to epidemiological evidence, economic evidence can play a crucial role in supporting the governments of countries in making proper public health decisions on BCG vaccination policies, in particular, to implement, continue, or discontinue.

  6. Study of MRI features of intracranial tuberculosis and its dynamic evolution during antituberculous treatment%颅内结核的MRI特点及抗结核治疗动态分析

    过丽芳; 吕岩; 周新华; 贺伟; 谢汝明; 徐金萍; 宁锋钢; 周震; 赵泽钢


    Objective To explore MRI features of intracranial tuberculosis,and the dynamic evolution of intracranial tuberculosis during antituberculous treatment.Methods From September 2009 to February 2012,seventy-two patients with intracranial tuberculosis were reviewed retrospectively.Intracranial tuberculosis lesions were divided into 3 categories:pure parenchymal tuberculosis,tuberculous meningitis and hybrid type with both parenchymal tuberculosis and tuberculous meningitis.The MRI characteristics of these lesions were analysed.According to the lesion size,pure parenchymal tuberculosis was divided into 3 subtypes:0.3 cm or less was defined as miliary,> 0.3 cm and < 1.0 cm as nodule,greater than or equal to 1.0 cm as tuberculoma.Serial follow-up scans were performed in 36 patients,and dynamic MRI changes in the process of anti-tuberculosis treatment during 3 to 6 months were observed.The disappearance rate of the lesions was calculated and statistically analysed by using Chi-square test.Results There were 883 lesions in 38 cases with parenchymal tuberculosis.Multiple lesions distributed widely,423 lesions (47.9%) ≤0.3 cm,330 lesions (37.4%) between 0.3-1.0 cm,and 130 lesions (14.7%) ≥ 1.0 cm.Twenty-four cases with tuberculous meningitis showed meningeal enhancement at basilar cistern.Ten cases with hybrid type presented both parenchymal tuberculosis and meningitis.Among 36 patients with serial MRI follow-up scans,22 cases were pure parenchymal tuberculosis.The disappearance rates of military,nodules and tuberculomas were 52.2% (59/113),33.3% (33/99) and 0,respectively,after 3 months treatment.The disappearance rates were 87.6% (99/113),50.5% (50/99) and 18.2% (2/11),respectively,after 6 months treatment.Disappearance rate of miliary lesions was obviously higher than that of nodules at both 3 and 6 months,and the difference was statistically significant,(x2 =7.657,34.786,P < 0.01).Nine lesions of parenchymal tuberculosis enlarged with paradoxical

  7. Clinical Characteristics and CT Findings of Pulmonary Mycosis in Children%儿童真菌性肺炎的临床特点及HRCT诊断

    周俊霖; 苗静; 丁山; 吕静; 程力


    目的 探讨儿童真菌性肺炎的临床特点及高分辨率CT(HRCT)表现,以利早期诊断治疗,改善预后.资料与方法回顾性分析2005年至2010年住院确诊为真菌性肺炎的20例患儿资料.结果 20例均伴有基础疾病,并且都有发热.原发病为支气管肺炎者5例,继发于其他疾病者15例(白血病12例.再生障碍性贫血、神经母细胞瘤及重症联合免疫缺陷病各1例).20例均行HRCT检查,肺亚段及肺小叶实变10例,结节或肿块样改变4例,空洞3例,霉菌球3例,"新月征"2例,粟粒样改变1例.结论 儿童真菌性肺炎不易诊断,但恶性血液系统疾病和严重免疫抑制是儿童真菌性肺炎发病的重要因素.应结合临床病史、影像学及实验室检查全面分析,及时诊断.%Objective To investigate clinical characteristics and CT findings of Pulmonary mycosis in children. Materials and Methods Clinical data of twenty children with Pulmonary mycosis between 2005 and 2010 were retrospectively studied. Results All the patients had underlying diseases including bronchopneumonia( n = 5 ) ,leukemia ( n = 12 ) , aplastic anemia( n = 1 ), neuroblastoma( n = 1 ) and severe combined immunodeficiency ( n = 1 ). CT scans were performed in20 eases. HRCT features included segmental or lobar consolidation in 10 cases,nodule or mass-like lesions in 4 eases,cavities with thick/thin wall in 3 cases,fungal balls in 5 cases, "halo" signs in 2 and miliary distribution in 1 case. Conclusion Pulmonary mycosis in children are difficult to diagnose. Hematological malignancy and significant immunosuppression tend to play important roles in Pulmonary mycosis. Clinical history, HRCT features and laboratory results are sufficiently informative for accurate diagnosis.

  8. Postmortem Investigations Following Human Immunodeficiency Virus Infection

    Andrey V. Bychkov


    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

  9. Diagnosis of abdominal tuberculosis:Experience from 11 cases and review of the literature

    Ali Uzunkoy; Muge Harma; Mehmet Harma


    AIM: To analyze the experience within our hospital and to review the literature so as to establish the best means of diagnosis of abdominal tuberculosis.METHODS: The records of 11 patients (4 males, 7 females,mean age 39 years, range 18-65 years) diagnosed with abdominal tuberculosis in Harran University Hospital between January 1996 and October 2003 were analyzed retrospectively and the literature was reviewed.RESULTS: Ascites was present in all cases. Other common findings were weight loss (81%), weakness (81%), abdominal mass (72%), abdominal pain (72%), abdominal distension (63%), anorexia (45%) and night sweat (36%). The average hemoglobin was 8.2 g/dL and the average ESR was 50 mm/h (range 30-125). Elevated levels of cancer antigen CA-125were determined in four patients. Abdominal ultrasound showed abnormalities in all cases: ascites in all, tuboovarian mass in five, omental thickening in 3, and enlarged lymph nodes (mesenteric, para-aortic) in 2. CT scans showed ascites in all, pelvic mass in 5, retroperitoneal lymphadenopathy in 4, mesenteric stranding in 4, omental stranding in 3,bowel wall thickening in 2 and mesenteric lymphadenopathy in 2. Only one patient had a chest radiograph suggestive of a new TB lesion. Two had a positive family history of pulmonary TB. None had acid-fast bacilli (AFB) in the sputum and the tuberculin test was positive in only two. Laparotomy was performed in 6 cases, laparoscopy in 4 and ultrasoundguided fine needle aspiration in 2. In those patients subjected to operation, the findings were multiple diffuse involvement of the visceral and parietal peritoneum, white 'miliary nodules' or plaques, enlarged lymph nodes, ascites,'violin string' fibrinous strands, and omental thickening.Biopsy specimens showed granulomas, while ascitic fluid showed numerous lymphocytes. Both were negative for acid-fast bacilli by staining. PCR of ascitic fluid was positive for Mycobacterium tuberculosis ( M. tuberculosis) in all cases

  10. 汕头市2005~2010年儿童结核病流行病学与临床分析%The clinical epidemiological characteristics of pediatric tuberculosis in Shantou from 2005 to 2010

    卓少宏; 杨仪; 伍成峰; 何端满; 陈伟生; 马兴灶; 詹世广


    Objectives To retrospectively investigate the epidemiology and incidence of tuberculosis of children in a tuberculosis specialist hospital in Shantou,and to further study the characteristics of tuberculosis on epidemiology ,clinical manifestation in children. Methods Clinical data of 123 children with tuberculosis were reviewed by 6 years. Results The incidence was highest in patients aged between 0~6 years (8.53% ),36.58% had contact with patients with active tuberculosis,most of them were the children younger than 6 years. The sources of the infection were the parents and relatives. PPD test was negative in 35.78% of the severely infected patients,such as miliary tuberculosis,tuberculous meningitis. Only half of the patients developed fever and cough. Conclusion The prevalence of tuberculosis in children is still high, and their clinical manifestations could be atypical. Diagnosis of tuberculosis requires methods with higher specificity and sensitivity.%目的 调查分析儿童结核病在汕头市的流行、临床表现与治疗情况.方法 收集近6年收住的出院诊断为结核病的患者病史,并进行重新评估,对符合诊断的123例患儿的临床资料作回顾性分析.结果 结核病诊断率增加,以0~6岁年龄段发病率较高,占58.53%; 36.58%有明显的结核病接触史,主要集中在6岁以下的儿童,传染源多为日常密切接触的家人;35.78%患儿结核菌素试验阴性,其结核类型主要为粟粒型肺结核、结核性脑膜炎等,中、重症结核病表现多见;结核病患儿中出现发热、咳嗽等症状者为50%左右.结论 儿童结核病流行趋势严峻,结核病患儿的临床表现多样化,临床诊断手段匮乏,需要进一步加强研究.

  11. Polymerase chain reaction for Mycobacterium tuberculosis DNA detection from ocular fluids in patients with various types of choroiditis in a referral eye center in India

    Biswas, Jyotirmay; Kazi, Mohmmad Salman; Agarwal, Vishvesh Ashokkumar; Alam, Md. Shahid; Therese, K Lily


    Aims: The aim of this study was to detect Mycobacterium tuberculosis (MTB) DNA with polymerase chain reaction (PCR) in aqueous or vitreous samples of patients suffering from choroiditis presumed to be infectious origin. Settings and Design: Hospital-based, retrospective case–control study. Subjects and Methods: In all, forty eyes of forty patients with choroiditis divided into two groups – Group A (serpiginous-like choroiditis, ampiginous choroiditis, multifocal choroiditis) and Group B (choroidal abscess, miliary tuberculosis (TB), choroidal tubercle) were analyzed retrospectively. In 27 controls (patients without uveitis undergoing phacoemulsification), anterior chamber aspirate was done and sample subjected to real-time PCR. Patients underwent nested PCR for MTB using IS6110 and MPB64 primers from aqueous (n = 39) or vitreous (n = 1). All patients underwent detailed ophthalmological examination by slit-lamp biomicroscopy, fundus examination by indirect ophthalmoscopy, and fundus photograph and fundus fluorescein angiography if required. Statistical Analysis: Positive results of PCR for MTB within the group and between two groups were statistically analyzed using Chi-square test. Results: There were 25 males and 15 females. Mean age at presentation was 34.66 years (range, 14–62). PCR positivity rates were 41.3% (n = 12/29) and 81.82% (n = 9/11) in Groups A and B, respectively. No controls had PCR-positive result. Comparison of PCR positivity rates showed statistically significant difference between Groups A and B (P = 0.028). Systemic TB was detected in 57.14% (n = 12/21) of all PCR-positive cases (Group A - 33.3%, n = 4/12; Group B - 88.9%, n = 8/9). Systemic antitubercular treatment (ATT) for 9 months and oral steroids were successful in resolution of choroiditis in all PCR-positive patients (n = 21) without disease recurrence. Conclusions: Eyes with choroiditis of suspected/presumed tubercular origin should be subjected to PCR for diagnosis of TB and

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

    Ricardo Luiz M. Martins


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

  13. 艾滋病和结核病双重感染的临床分析%Clinical analysis of AIDS and tuberculosis dual infected patients



    Objective To investigate clinical features and treatment methods of AIDS, tuberculosis dual infected patients.Methods Choosing 68 cases of AIDS combined TB patients in our hospital from November 2011 to October 2013 for the study, clinical data were retrospectively analyzed samples, summarize the clinical characteristics and treatment.Results 68 patients for the clinical manifestations of sputum, fever, cough, shortness of breath, weight loss, anemia, which in sputum as the most important manifestations; chest X-ray detection performance is not obvious, the presence of multiple and diffuse sexual run miliary shadows; conducted clinical treatment more complex, the mortality rate was 13.2% after treatment.Conclusion HIV and TB co-infected patients subclinical carry out the relevant checks in the diagnosis of tuberculosis is also a lack of specificity, treatments become more complex, mainly through further line anti-TB treatment after antiviral therapy, play prolong survival effect of time.%目的:探讨艾滋病、结核病双重感染患者的临床特点与治疗方法。方法选取本院2011年11月~2013年10月收治的艾滋病合并结核病患者68例作为研究对象,回顾性分析样本的临床资料,总结临床特点与治疗方式。结果68例患者临床表现为咳痰、发热、咳嗽、气短、消瘦、贫血等,其中,以咳痰为最主要的表现症状;胸部X线检测的表现不明显,多存在弥漫性侵润和粟粒性阴影;临床开展的治疗方式较为复杂,治疗后死亡率为13.2%。结论艾滋病与结核病双重感染患者的临床表现不明显,开展相关检查对结核病的诊断效果也缺乏特异性,治疗方法趋于复杂,主要是通过抗结核治疗后再进一步行抗病毒治疗,起到延长患者生存时间的效果。

  14. An optical system for detecting and describing major algal blooms in coastal and oceanic waters around India

    Gokul, Elamurugu Alias; Shanmugam, Palanisamy


    An optical system is developed with the aim to detect and monitor three major algal blooms (including harmful algal blooms "HABs") over ecologically relevant scales around India and to strengthen algal forecasting system. This system is designed to be capable of utilizing remote sensing, in situ, and radiative transfer techniques to provide species-specific data necessary for increasing capabilities of an algal forecasting system. With the ability to measure in-water optical properties by means of remote sensing and in situ observations, the optical system developed infers the desired phytoplankton signal from spectral distributions and utilize these data in a numerical classification technique to generate species-specific maps at given spatial and temporal scales. A simple radiative transfer model is adopted for this system to provide a means to optimally interpolate to regions with sparse in situ observation data and to provide a central component to generate in-water optical properties from remotely sensed data. For a given set of inherent optical properties along with surface and bottom boundary conditions, the optical system potentially provides researchers and managers coverage at different locations and depths for tracking algal blooms in the water column. Three major algal blooms focused here include Noctiluca scintillans/miliaris, Trichodesmium erythraeum, and Cochlodinium polykrikoides, which are recurring events in coastal and oceanic waters around India. Because satellite sensors provide a synoptic view of the ocean, both spatially and temporally, our initial efforts tested this optical system using several MODIS-Aqua images and ancillary data. Validation of the results with coincident in situ data obtained from either surface samples or depth samples demonstrated the robustness and potential utility of this approach, with an accuracy of 80-90% for delineating the presence of all three blooms in a heterogeneous phytoplankton community. Despite its

  15. 数字胃肠X线造影与内镜检查对真菌性食管炎诊断的对照研究%The value of radiography classificatory criteria for fungal esophagitis in clinical application

    李峰; 赵慧娟; 王玲; 李琳; 李芸芸; 尹成方


    Objective The purpose of this report is to evaluate the role of digital gastrointestinal radiography in the diagnosis of the fungal esophagitis compared with endoscopy , and to explore the clinical application of the X-ray grading scale of fungal esophagitis for digital radiography . Methods 45 cases were conformed by endoscopy and cytology. The roentgenographic features of these fungal esophagitis cases were analyzed respectively, regarding the endoscopy findings as standard . Results The fungal esophagitis' features of esophagography in different grades were compared with that of endoscopy . DR was relatively consistent with endoscopy (the value of Kappa is 0. 543 ). The lesions, which diameter of plaques were less than 1 mm or similar as military, could be observed more clearly at the mucosal phase (9/13) than double-contrast phase(4/13)and filling phase(0/13). Conclusions For miliary-like lesions,we should pay more attention to the use of dynamic monitoring technique. The grading scale for X-ray findings of fungal esophagitis has a good clinical value ,but its operability should be further improved .%目的 通过与内镜分级表现相对照,探讨数字胃肠造影技术对真菌性食管炎的诊断价值,并对真菌性食管炎X线分度标准的临床应用进行评价.方法 选取45例经内镜和涂片病原学检查确诊的病例,对数字胃肠造影和内镜检查中真菌性食管炎的分度/分级表现进行分析.结果 在确定真菌性食管炎的分度/分级表现时,数字胃肠造影检查与内镜检查相比,Kappa值为0.543,具有中高度的一致性.对其中13例病灶很小(直径≤1 mm或病灶呈粟粒样)的真菌性食管炎病例,其在黏膜相中的显示情况(9/13)优于在双对比相(4/13)和钡剂充盈相(0/13)中的显示情况.结论 对于粟粒样的病灶,数字胃肠造影检查的动态黏膜图像往往更易发现病变.真菌性食管炎X线分度标准具有较好的临床应用价值,但在其可操作性上还可以进一步改进.

  16. 美人鱼发光杆菌杀鱼亚种感染卵形鲳鲹的病理学观察%Histopathological analysis of golden pompano Trachinotus ovatus infected with Photobacterium damselae subsp. piscicida

    苏友禄; 冯娟; 郭志勋; 徐力文; 王江勇


    The pathogen Photobacterium damselae subsp.piscicida was isolated from the diseased Trachinotus ovatus.The aim of the study is to observe the pathological changes in T.ovatus after intraperitoneal injection or immersion routes of infection with Photobacterium damselae subsp.piscicida.The infected fishes exhibited acute and/or chronic symptoms,according to the lesional degree.The acute lesions includes slight hemorrhage around the gill covers,abdominal dropsy and multifocal necrosis in the internal organs.The chronic lesions are mainly small white miliary lesions with 0.5~1 mm in diameter observed in spleen,kidney and heart.The histopathological changes were observed under optical microscope and transmission electron microscope.In fishes with acute lesions,degeneration and coagulation necrosis in the gill,liver and kidney,microvillus disorder and mitochondrial cristae destruction in renal tubule,hyperplasia of macrophages and chromatin clumping of lymphocytes in the spleen,and hyperplasia of mitochondrion or multifocal necrosis in the heart were most pronounced in infected fish.Few or no lesions were observed in intestine.Fishes with chronic lesions suffered necrosis of the gill epithelium,disaggregation of mitochondria,Golgi body and endoplasmic reticulum in the spleen.The renal tubule epithelium microvillus underwent desquamation,meanwhile,the Z bands in myofibrils became disorder and mitochondria underwent denaturation in the heart.Typical chronic granulomatous lesions were also observed mainly in spleen,kidney,heart,liver and intestine.Generally,the most significant histopathological changes were detected in spleen,kidney and heart.%病原菌美人鱼发光杆菌杀鱼亚种(Photobacterium damselae subsp.piscicida)分离自发病的卵形鲳鲹(Trachinotus ovatus),本实验利用腹腔注射和浸泡的感染途径,观察卵形鲳鲹发光杆菌病的病理变化。感染发病鱼呈现急性和慢性临床症状,主要急性症状为鳃盖周围轻微

  17. Clinical analysis of 23 cases of disseminated bacillus Calmette-Guerin disease%播散性卡介菌病23例分析

    卢水华; 李涛; 席秀红; 郭建; 黄富礼; 张文宏; 刘旭晖; 范小勇


    Objective To explore the clinical characteristics,diagnosis,treatment and prognosis of disseminated bacillus Calmette-Guerin (BCG) disease.Methods A retrospective study was performed on 23 children diagnosed with disseminated BCG disease at Shanghai Public Health Clinical Center from March 2006 to June 2011.The diagnosis,clinical features,underlying immunodeficiency,treatment and prognosis were evaluated.Results Among the 23 children,13 were male and 10 were female.The age of patients was from 2 months to 5 years old when diagnosed (median age,14.5 months).Clinical manifestations included fever in 23 cases,night sweats in 15.Thoracic and abdominal computed tomography of the 23 cases showed infiltrations or miliary lesion of the lungs with hilar,mediastinal and abdominal lymphadenopathy.Tuberculin skin tests (TST) were positive in 60.9% (14/23),and interferon gamma release assay (IGRA) was positive in 23.1% (3/13).Among the 23 cases,14 cases were diagnosed with primary combined immunodeficiency disease.Co-infections were observed in 14 out of 23 patients.All patients were given 2-4 antituberculous agents,including 12 severe cases with additional linezolid,and 16 cases with thymosin.During follow-up,there were 7 deaths (30.4%).Conclusions Clinical diagnostic criteria of disseminated BCG disease needs to be advised.Disseminated BCG disease tends to occur in children with immunodeficiency.The prognosis is poor and treatment options is limited at present.%目的 探讨播散性卡介菌病的临床特点、诊断、治疗和预后.方法 收集2006年3月至2011年6月在上海市公共卫生临床中心诊断的播散性卡介菌病患儿23例,评价诊断标准,分析临床特点、免疫缺陷、治疗和预后.结果 23例患儿中,男13例,女10例.首诊年龄为2个月~5岁,中位年龄14.5个月.临床表现发热23例、盗汗15例.23例患儿均进行胸腹部CT检查,均发现肺内实质浸润或粟粒样病灶伴肺门、纵隔

  18. 分化型甲状腺癌肺转移的CT影像学表现分析%An Analysis of CT Findings for Pulmonary Metastasis of Differentiated Thyroid Carcinoma



    Objective To investigate the findings and diagnostic value of CT in pulmonary metastasis of differentiated thyroid carcinoma.Methods The clinical data of 121 patients with DTC were retrospectively analyzed. All were confirmed by CT guided biopsy or surgical pathology and underwent chest CT examination. The sensitivity, specificity and accuracy of CT examination in the diagnosis of DTC with pulmonary metastasis were recorded and analyzed and the CT findings of patients with pulmonary metastasis were observed.Results Among the 121 cases of DTC patients, 9 cases were diagnosed with pulmonary metastasis by biopsy or surgical pathology, accounting for 7.4%; 6 cases with pulmonary metastasis and 100 cases of non-pulmonary metastasis were correctly diagnosed by CT. The sensitivity, specificity and accuracy of chest CT for DTC with pulmonary metastasis were 66.7% (6/9), 89.3% (100/112) and 87.6% (106/121), respectively; 6 patients with pulmonary metastasis diagnosed by CT showed that the diameter of the lesions was >3mm, including 3 cases with lesions of 3-5mm and 3 cases larger than 5mm; The images showed multiple different sizes of circular, miliary nodules or masses. The nodules density was homogeneous and the boundaries were clear, most of them distributed in the bilateral lung and outside the inferior field.Conclusion Chest CT examination can be used as an effective method for the clinical assistant diagnosis and treatment of DTC with pulmonary metastasis and provide basis for the successful development of the follow-up treatment.%目的:探讨CT检查在分化型甲状腺癌(differentiated thyroid carcinoma,DTC)肺转移中的表现及诊治价值。方法回顾性分析121例DTC患者临床资料,均经CT引导下穿刺活检或外科手术病理检查确诊,接受胸部CT检查。记录并分析CT检查对DTC肺转移的诊断敏感性、特异性和准确性,观察肺转移患者的CT表现特点。结果此次入组的121例DTC患者经穿刺活检或手

  19. 以肠梗阻为表现的粪类圆线虫1例报道并文献复习%Strongyloides stercoralis infection presenting asintestinal obstruction:A case report with review of literature

    王本贤; 陈晓琴; 周力


    Objective:To investigate the clinical characteristics of strongyloides stercoralis infection presenting as intestinal obstruc -tion, and improving the diagnosis and treatment of clinicians on strongyloides stercoralis infection .Methods:A cases of our hospital which shows the strongyloides stercoralis infection presenting as intestinal obstruction were studied and the similar literature were reviewed .Re-sutl s:One 40~year~old male patien ,with the main complaints as vomiting, nausea ,abdominal pain and rileus, were referred to our hos -pital for further evaluation .Abdominal computed tomography ( CT ) revealed the imaging features of the intestinal obstruction .During gastroduodenoscopy , miliary granulation hyperplasia were seen in duodenum and proximal jejunum of the patient .The diagnosis of strongy-loides stercoralis infection was finally confirmed by biopsy of gastrointestinal mucous .Abdominal pain has improved after aral Albendazole 400 mg twice daily for 7 days and no recurrence until now .Conclusion:Strongyloides stercoralis infection presenting as intestinal obstruc-tion representet a rare condition and easily be misdiagnosed .Careful collection of medical history , numerous pokes for stool examination , gastroduodenoscopy and pathological examinations , especially better understanding of the exceptional manifestations , could help to mini-mize misdiagnosis of sarcoidosis.%目的:了解以肠梗阻为表现的粪类圆线虫的临床特点,以提高诊断及处理水平。方法:对贵阳医学院附院消化内科的1例以肠梗阻为表现的粪类圆线虫的病例进行研究,结合以往国内外相关报告进行分析。结果:男性患者,40岁,以“恶心,呕吐,腹痛,肛门停止排便排气“来就诊,影像学检查发现有肠梗阻征象,内镜下十二指肠、近端空肠多发米粒样增生,经空肠、十二指肠多处活检发现腺上皮内见类圆线虫虫体。予阿苯达唑400 mg口服后症状改

  20. Extrinsic allergic alveolitis in domestic environments (Domestic allergic alveolitis) caused by mouldy tapestry

    Schwarz; Wettengel; Kramer


    Extrinsic allergic alveolitis often occures as bird fancier's lung or is caused by occupational treatment with antigenic materials. In housing environments antigens of allergic alveolitis are also found, especially mould fungi. lf a source of antigens is absent in the anamnesis and the clinical picture as well as the clinical findings are ambiguous, the diagnosis of extrinsic allergic alveolits is delayed or unobtained. The following example shows that in spite of a detailed allergic anamnesis the source of antigens may remain occult and only an inspection of the dwelling rooms leads to an elucidation. - A sixty-one year old non-smoking women was twice admitted to hospital with a temperature of more than 39 degrees C, intense dyspnea on exertion and a strong dry cough under the persumed diagnosis pneumonia. The laboratory values showed nonspecific signs of inflammation, the blood gas analysis was changed to a heavy hypoxemia (pO subset2 49.2 mmHg) and in the chest x-ray there were seen miliary and partly reticular alterations. The chest computed tomography showed extensive densities in both upper and lower parts of the lungs and the pulmonary function test corresponded with a low-grade to middle-grade restriction (VC subsetin = 67%, TLC = 69%). A high dose of corticosteroids produced an improvement of the radiological findings and of the pulmonary function. Also the specialized diagnostic in a hospital for pulmonary diseases yielded no new knowledge, and an interstitial pneumonia was diagnosed. Only the new formation of an acute pneumonic clinical picture on the day of returning to the patients own habitation suggested a noxious substance in the domestic environment. The inspection of the rooms finally showed the source of antigen to be from a condensation water soaked, moulded tapestry on the embrasure of a small unopenable window in the bedroom just on the head of the bed. The nutritive mediums left in the rooms furnished evidence of the mould-species Penicillium

  1. 结核性脑膜炎的CT、MRI诊断价值%Diagnostic value of CT and MRI in tubercular meningitis



    Objective To evaluate the diagnostic value of CT and MRI in the diagnosis of tubercular meningitis.Methods CT and MR1 features were analyzed retrospectively in 12 patients with tubercular meningitis confirmed by clinical diagnosis,in which 5 patients underwent pre contrast CT, 1 contrast enhanced CT, 11 patients pre contrast MR and 9 C,d-DTPA enhanced TI WI. Results CT plain scanning showed stenosis and occlusion of suprasellar cistern,lateral cistern and ambient cistern, calcification, hydrocephalus, hypo density, lacunar infarction in basal ganglia, and obvious enhancement in suprasellar cistern and lateral cistern after contrast injection. MRI showed stenosis and occlu-sion of cerebral sulcus and cistern, abnormal leptomeningcs thickening and significant enhancement in strip, flake, nod-ular or annular shapes after contrast injection in 10 patients;hydrocephalus in 6 cases,intracranial tuberculoma in 5 ,ep-endymal involvement in 4,lacunar infarction in 3,tubercular brain abscess in 2,cerebral miliary tuberculous loci in 1,no abnormal finding in 1. Conclusions The pathological changes in tubercular meningitis could be demonstrated effec-tively on MRI, which provides reliable evidence in clinical diagnosis and observation of effects of tubercular meningitis.The value of MRI is superior to that of CT.%目的 探讨CT、MRI对结核性脑膜炎的诊断价值.方法 回顾性分析12例临床确诊的结核性脑膜炎患者的CT、MRI表现.其中CT平扫5例,1例行增强扫描;MRI平扫11例,9例行增强扫描.结果 CT平扫表现为脑沟、脑裂、脑池狭窄、闭塞,钙化,脑积水,胼胝体、基底节区腔隙性梗塞,增强后显示鞍上池、侧裂池明显强化.MRI平扫表现为脑沟、脑池狭窄和闭塞,邻近的柔脑膜增厚,增强MRI上,受累的脑膜呈条片状、斑块状、结节状或环状显著强化10例;合并脑积水6例,结核球5例,室管膜炎4例,腔隙性脑梗塞3例,结核性脑脓肿2例,粟粒性脑结核1

  2. Computed tomography findings of secondary pneumonomycosis in elderly patients (analyses of 36 cases)%老年患者继发性肺真菌病的CT表现(附36例分析)

    李桂英; 徐建华; 王清; 王清昆; 毕永民


    目的 通过对老年患者继发性肺真菌病的CT表现进行分析,评价CT对老年人肺真菌病的诊断价值.方法对36例经手术、穿刺病理证实的老年患者继发性肺真菌病的CT表现进行分析.观察病变形态、分布、边界、密度和病灶大小等特点,并分析影像与病原菌的关系.结果 36例老年患者继发性肺真菌病致病菌分别为曲霉菌18例.毛霉菌8例,隐球菌6例,白色念珠菌3例,放线菌1例.CT表现为肺叶(或肺段)实变9例,单发或多发结节或肿块9例,其中6例结节边缘见晕征;空洞8例,霉菌球6例.斑片影3例.粟粒影1例.所有病例均有胸膜反应.8例有胸腔积液.结论 老年患者继发性肺真菌病影像学表现缺乏特异性,CT可确诊特征性的肺曲菌球,对表现不典型者应密切结合临床.最终诊断依靠病理学检查.%Objective To appraise the diagnostic value of computed tomography (CT) for secondary pneumonomycosis in elderly patients by analyzing the size and other features of focuses including the relationship of image expression and pathogens. Methods The CT findings of 36 elderly patients with secondary pulmonory fungal diseases proved by surgery or biopsy were analized. including the morphology, distribution, border, density and size of the diseases- and the relationship between the CT findings and the pathogenic bacteria was analizcd too. Results The pathogens for 36 cases ot secondary pneumonomycosis were aspergillus (18 cases). Mildew (8 cases). Cryptococcus (6 cases). Candida albicans (3 cases), and actinomycetcs (1 ease) ■ respectively. The CT showed the consolidation of pulmonary lobes (or pulmonary segments) from 9 cases, single or multiple nodutes from 9 cases (6 cases showing halo sign around nodules) . caverns from 8 cases. mould spheres from 6 cases, shadow plaques from 3 cases, and miliary shadow from 1 case. All the cases displayed pleura reaction, with 8 cases having pleural effusion. Conclusion No

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

    Murilo Gimenes Rodrigues


    Full Text Available OBJECTIVE: To identify prognostic factors predicting a fatal outcome in HIV-negative children with neurotuberculosis based on clinical, epidemiological, and laboratory findings. METHOD: The clinical records of all in-patients diagnosed with neurotuberculosis from 1982 to 2005 were evaluated retrospectively. The following prognostic parameters were examined: gender, age, close contact with a tuberculosis-infected individual, vaccination for bacillus Calmette-Guérin, purified protein derivative (PPD of tuberculin results, concomitant miliary tuberculosis, seizures, CSF results, and hydrocephalus. RESULTS: One hundred forty-one patients diagnosed with neurotuberculosis were included. Seventeen percent of the cases resulted in death. The factors that were correlated with a negative outcome included lack of contact with a tuberculosis-infected individual, negative PPD reaction, coma, and longer hospitalisation time. A multiple logistic regression analysis was performed to identify which of these factors most often resulted in death. CONCLUSION: Coma at diagnosis, lack of tuberculosis contact, and a non-reactive PPD were the most important predictors of fatality in patients with neurotuberculosisOBJETIVO: Identificar elementos prognósticos para a letalidade da neurotuberculose na criança, a partir das manifestações clínicas, dados epidemiológicos e laboratoriais. MÉTODO: Registros de pacientes internados durante o período de 1982 a 2005 foram retrospectivamente avaliados. Os elementos prognósticos considerados foram: sexo, idade, história de contato íntimo com indivíduo com tuberculose, vacinação com o bacilo de Calmette-Guérin (BCG, teste tuberculínico (PPD, concomitância de tuberculose miliar, convulsões, resultados da análise do LCR e presença de hidrocefalia. RESULTADOS: 141 pacientes com diagnóstico de neurotuberculose foram incluídos. Dezessete por cento dos pacientes foram a óbito. Os fatores associados ao óbito foram

  4. 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

    Denise Barcelos


    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

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

    Jorge Docampo


    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.

  6. 肺及气管非霍奇金淋巴瘤的CT诊断%CT diagnosis of the pulmonary and tracheal Non-Hodgkin′s Lymphoma

    白静; 甘新莲


    Objective To study the features of pulmonary and tracheal Non Hodgkin's Lymphomas ( NHL ) on Computed Tomo graphy ( CT ) Scan. Methods CT Scans of ten pathologically proven NHL cases were retrospectively analyzed, which included nine pulmonary and one tracheal NHL. Results Most pulmonary NHL presented as solitary nodules or tumor ( 4 cases ), or a tumor with multiple nodules ( 3 cases ). Less frequently it presented as lobar/ segmental consolidation with ground glass opacity ( 1 case ) or miliary nodules ( 1 case ). Unilateral pulmonary involvement ( 8 cases ) was more common than bilateral ( 1 case ). Air bronchogram was visualized in live ca ses while multiple punctate calcifications and cavitations were encountered in one case each. The tracheal NHL presented as irregular dif fuse thickening with subsequent constriction of the trachea. Conclusions Pulmonary and Tracheal NHLs are rare and their features on CT Scans are diverse. II' a nodule/mass or consolidation with air bronchograms is seen in a chest CT scan, pulmonary NHL should be consid ered as a possibility. Nevertheless, definitive diagnosis can only be made by pathological analysis or by immunohistochemistry.%目的 探讨肺及气管非霍奇金淋巴瘤的CT表现与特征.方法 收集我院经病理及免疫组化确诊的非霍奇金淋巴瘤10例,其中肺内9例,气管1例,对其CT表现进行分析.结果 肺非霍奇金淋巴瘤主要表现为单发结节、肿块型4例,单发肿块伴多发结节型3例,粟粒样结节型1例,肺叶、肺段实变伴毛玻璃影1例.单侧肺受累8例,两肺多发病灶1例.5例见含气支气管征,1例见多发钙化,1例可见空洞.气管内非霍奇淋巴瘤1例主要表现气管壁弥漫性不规则增厚,管腔狭窄,病变与周围结构分界不清,呈浸润表现.结论 肺及气管非霍奇金淋巴瘤是一种少见及罕见疾病,影像学表现多样,若发现肺内结节、肿块及肺炎样浸润影伴含气支气管征时,应想到肺淋巴

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

    Mauricio L. Barreto


    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.

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

    Susan M Pereira


    -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.

  9. 人氟斑牙釉质表面结构及漂白后改变的电镜观察%A Study of the Enamel Surface Morphology and Morphologic Changes after Cold Light Whitening through Scanning Electron Microscope

    张娟; 邓婧; 张慧; 潘克清


    Objective:At present,internal and external research in dental fluorosis is mainly concentrates on the epidemiological investigation and clinical efficacy analysis.However,the extent of cold light whitening after the enamel surface demineralization is very rarely reported.The purpose of this study was to observe the microscopic structure of different degrees of human dental fluorosis,to explore the effect of cold light whitening on fluorosis enamel surface,and to explore cold light whitening safety of the treatment of severe dental fluorosis.Methods:10 complete normal teeth and 50 various types of dental fluorosis without decay were selected as specimens in this experiment.All specimens were chosen from the typical buccal regional.Dental fluorosis specimens were divided into mild,moderate and severe according to the Dean's classification and normal teeth were used as the control group.Each group was randomly divided into four sub-groups:Group A:no treatment; Group B:etching enamel surface; Group C:etching enamel profile; Group D:cold light whitening enamel surface.We observed the morphology of specimens by scanning electron microscopy.Results:Enamel column gap of mild fluorosis widened with small amount of crystal disordered arrangement and grain gap widened.Enamel surface of severe fluorosis were uneven,which appeared as crater or honeycomb.The outline of enamel column was unclear,besides,crystals arranged in disorder or even disappear.Moderate fluorosis was in the between.After cold light whitening,enamel surface of all teeth showed no significant change under low magnification and scattered shallow pits under high magnification.Moreover,moderate and severe fluorosis were also accompanied by a large number of miliary holes.Conclusion:With the aggravation of the severity of dental fluorosis,the enamel surface was damaged severity.Result displayed that cold light whitening can cause enamel surface demineralization,which was more serious in dental fluorosis

  10. 误诊为肺部感染的抗中性粒细胞胞浆抗体相关性小血管炎的CT表现%CT findings of antineutrophil cytoplasimc antibody-associated smallressel vasculitis being misdiagnosed as pulmonary infection

    汤丽珠; 瞿华; 崔凤


    OBJECTIVE To study CT findings of the initial symptom as such antineutrophil cytoplasimc antibody (ANCA)-associated smallressel vasculitis which was misdiagnosed as pulmonary infections so as to improve the cognition of the disease of ANCA and reduce the rate of misdiagnosis. METHODS The CT manifestations of 10 patients with biopsy and clinical verification of being misdiagnosed pulmonary infection of ANCA associated vasculitis as pulmonary infections were analyzed retrospectively by referring to the document. RESULTS Of 10 cases of ANCA associated vasculitis with pulmonary manifestations as the initial symptom, there were 2 (20. 0%) cases of diffuse ground glass samples, diffuse corn grain 1 case (10. 0%)-, there were 3 (30. 0%) cases of interstitial lesions, including 2 cases of grid shape and 1 case of honeycomb; there were 2 cases of interlobular seplal thickening; there were 4 (40. 0%) cases of multiple patches and flake shadows, which revealed obscure edge and uneven density, including 3 cases of air bronchogram, 3 cases of multiple nodules, and 2 cases of cavities ; there were 3 cases of enlargement of lymph node in the mediastinum, 3 cases of pleural effusion and 1 case of pericardial effusion; there were 3 cases misdiagnosed as ordinary interstitial pneumonia, 3 cases as bacterial pneumonia, 1 case as miliary pattern and infiltrating type tuberculosis, 1 case as pneumocyslis carinii pneumonia, 1 case as fungal pneumonia. CONCLUSION The CT findings of ANCA-associated vasculitis with pulmonary manifestations as the initial symptom show diversified and complex, which are easily misdiagnosed as pulmonary infections; it is necessary to make the accurate diagnosis on the basis of the clinical laboratory in combination of pathological examination.%目的 探讨以肺部症状为首发的抗中性粒细胞胞浆抗体(ANCA)相关性小血管炎误诊为肺部感染的CT表现,旨在提高对该炎疾病的肺部影像学认识,减少误诊率.方法 回顾10例

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

    Aoki, M


    continued a little more, because BCG vaccination can protect the development of 7 miliary Tb. and/or meningitis cases during 15 years if BCG is given 70% of the infants in 2000. However, it was strongly recommended to stop re-vaccination of BCG, because it is not so effective, and disturb the diagnosis of Tb. infection by tuberculin testing. 9. Treatment of latent Tb. infection will become more and more important, so that it's indication should be expanded to the adults in the future instead of the present indication up to 29 years of age. It is needed to revise Tuberculosis Control Low to improve control programme in Japan. The author hoped that the members of Japan Tuberculosis Society will promote the improvement and to support the Government to improve the Law.

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

    Mauro Gomes


    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

  13. 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

    Elizabete Abrantes Nunes


    -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

  14. Clinical features and MRI characteristics of tuberculous meningitis in children%小儿结核性脑膜炎的临床表现及磁共振成像特征分析

    徐树明; 关晓力; 杨宏; 胡磊; 高凯


    Objective To investigate the clinical features and magnetic resonance imaging (MRI)characteristics of tuberculous meningitis in children. Methods The clinical features and MRI findings of 28 children with tubercu-lous meningitis, who were hospitalized between 2012 and 2014, were retrospectively analyzed. Results The age of patients ranged from 3 months to 16 years old, including 6 case less than 1 years old, 4 of 3 years old, 2 of 7 years old, and 16 of 16 years old. Clinical features:25 cases of fever, 16 of headache, 10 of vomiting, 6 of convulsions, 5 of cough, 2 of abdominal pain, 1 of unconsciousness, 1 of fatigue, and 1 of neck mass. Six cases underwent PPD test:positive in 3 cases and negative in 3 cases. Thirteen cases underwent Pan′s test: positive in 12 cases and negative in 1 case. The Mycobacterium tuberculosis was found in the cerebrospinal fluid, sputum or gastric juice in 4 cases. Tu-berculous meningitis accompanied with tuberculosis other parts of the body was found in 26 cases (26/28), including 4 of systemic multiple tuberculosis, 5 of miliary pulmonary tuberculosis, and 17 of other pulmonary tuberculosis. MRI findings: 20 cases of basilar cistern changes (20/28); 21 of intracranial tuberculoma (21/28); 7 of cerebral atrophy (7/28); 4 of cerebral infarction (4/28); 22 of hydrocephalus (22/28), including 12 of mild, 5 of moderate and 5 of severe. Effective anti-tuberculosis treatment was found in 21 cases. Six cases in critical condition gave up treatment (3 of se-vere hydrocephalus and 3 of cerebral infarction). One case was not treated and discharged. Conclusion Tuberculous meningitis in children shows complicated clinical features and low positive rate of laboratory examination. MRI exam-ination may identify the location, distribution, characteristics of the lesion, degree of hydrocephalus, and the occur-rence of cerebral infarction and brain atrophy, which is useful in the protocols of clinical treatment, and evaluation of prognosis.%目的

  15. [Fifty years of research on tuberculosis. Lessons I have learnt during 50 years and topics to be investigated in the future].

    Shimao, T


    I have engaged in the research on tuberculosis for 50 years, and lessons I have learnt during this period could be summarized in the following ten topics. First is great research achievements by our predecessors on the establishment of so-called primary infection theory on the pathogenesis of TB, planning of TB control principles based on the theory and development of new technologies used for TB control, such as mass miniature X-ray examination and BCG vaccination in 1920s and 1930s. TB control law was enforced in 1951, and the modern TB programme was initiated. Second, the field is a treasure house of interesting data. Several interesting data on TB soon after the World War II in Tokyo and a rural area were collected and analyzed from the mass health examination. Third, looking at the increase of tuberculin positivity with age, it was found that the tuberculin negativity decreased as the exponential function of age, and the current concept of the annual risk of TB infection was already developed in late 1940s. It was 18.1% in male and 11.6% in female in Tokyo in late 1940s. Based on this concept, age specific TB mortality was analyzed by the type of TB, and the rates of miliary TB and TB meningitis were similar to the rate of newly infected to the total population, while the rate of all forms could be divided into early and late death as shown in Fig. 1. Fourth, I suffered from TB by myself from 1951 to 1953, receiving first thoracoplasty in two stages under local anaesthesia, then right upper lobectomy and segmentectomy of superior segment of right lower lobe. From this experience, I learnt a lot about the psychology and suffering of TB patients. Fifth, the importance of recognition of real magnitude of the problem in such a disease as TB in which many TB cases did not aware of their disease. The answer to this was the first TB prevalence survey in 1953 using stratified random sampling method, and based on the results of the survey, the mass health examination

  16. 重组日本血吸虫磷酸丙糖转移酶免疫保护性的研究%Preliminary study of recombinant the triosephosphate transferase in immuno-protection of Schistosoma japonicum

    陈多玲; 张婧; 姚涌; 汪学龙


    Objective To observe the immuno-protection in mice attacked with cercaria for a new vaccine candidate of Schistosoma japonicum, the recombinant protein triosephosphate transferase (SjTPM). Methods The BALB/c mice were immunized with the recombinant SjTPM in the dose of 50μg/100μl、 100μg/100μl and 200μg/100μl, the saline solution was used for control group, then attacked with cercaria. The percentage of worm reduction and egg reduction was calculated to evaluate the immuno-protection effect. HE staining method was used to detect the hepatic changes and granulomatous changes in the liver tissue. Results The percentage of worm reduction was 27.1%,32.1% and 35.2%, respectively, in the experimental groups. The number of eggs in liver tissue was reduced by 34.2% ,39.29% ,43.66%, respectively. There were remarkable difference among the experimental groups and control group by t-test. There was no remarkable difference between the experimental groups by X2-test. Gross observation showed that the livers in control groups were dark brown and hard, with miliary nodules or worm eggs diffused in the livers. The recombinant SjTPM group has some extent of amelioration, the livers were bright red, relative soft and smooth, with less nodules of worm eggs in livers. Hepatic histological section demonstrated that there're generous large granulo- degeneration and necrosis of hepatic cells. The recombinant SjTPM vaccine group reversed the hepatic injury better than the control group. The structure of hepatic lobule was integrated on the whole, and the inflammatory reaction around the worm egg granulomas was light. Conclusion The molecular vaccine of rSjTPM had some immuno-protection effect.It suggested that rSjTPM was a potential candidate of S.japonicum.%目的 观察重组日本血吸虫磷酸丙糖转移酶(rSj-TPM)在小鼠抗血吸虫感染中的免疫保护作用,寻找新的血吸虫疫苗候选分子.方法 以rSj-TPM每鼠50μg/100μl、100μg/100μl和200μg/100μl

  17. TiO2 nanotubes functionalized with recombinant human bone morphogenetic protein-2 enhance biological activity in vitro%二氧化钛纳米管阵列加载重组人骨形成蛋白2的体外生物活性研究

    孙子环; 夏荣; 孙磊; 胡小晔; 闵曦; 徐基亮


    grafted with rhBMP-2.Mechanically polished pure titanium was used as blank control group,and titanium dioxide nanotubes was used as negative control A group,and titanium dioxide nanotubes + carbonyldiimidazole as negative control B group.Field emission scanning electron microscope(FE-SEM) and X-ray photoelectron spectroscopy(XPS) were used to detect the morphology and physicochemical properties of the experiment group,blank control group and the negative control group.Cell adhesion on the specimen surface of the experiment group,blank control group and negative control group on the 1st day was tested.Cell proliferation on the 1st,3rd and 5th day and alkaline phosphatase activity on the 5th,7th and 11th day was also tested.Results FE-SEM showed that the surface of titanium nanotubes loaded with rhBMP-2 possessed visible miliary particulate matter.XPS showed that nitrogen peak in the group of titanium nanotubes loaded with rhBMP-2 was significantly greater that those in the other groups.FE-SEM showed that the cells on the surface of the experimental group on the 1st day spread well,better than those in the control group and negative control group.Cell proliferation activity on the 1st day in different groups was not obvious(P>0.05),the A value of the experimental group on the 3rd and 5th day (3.295±0.153,3.823±0.059) were significantly higher than those in the control group(2.479±0.064,3.131±0.096) and negative control A group(2.715±0.075,3.371±0.047) and negative control B group(2.756±0.132,3.637±0.047)(P<0.05).Alkaline phosphatase activity on the 5th,7th and 1 1th day in the experimental group (0.0477 ± 0.0287,0.0615 ± 0.0016,0.0667 ± 0.0018) were better than those in the control group,negative control A group and negative control B group(P<0.05).Conclusions Titanium nanotube arrays can be loaded with rhBMP-2 by biochemical methods and have good biocompatibility.

  18. 青海高海拔藏区老年结核性脑膜炎临床特点分析%Clinical Characteristics of Elderly Tuberculous Meningitis in the High-altitude Area on the Qinghai-Tibet Plateau



    - altitude area on the Qinghai -Tibet Plateau. Methods Twenty - eight patients of elderly tuberculous meningitis from the high - altitude area on the Qinghai - Tibet Plateau who were treated in our hospital between January 2006 and December 2010 were included in the study group, and 30 adolescent and young patients with tuberculous meningitis who were treated in our hospital during the same period were randomly selected as the control group. The disease onset, major clinical symptoms and signs, laboratory results ( cerebrospinal fluid routine examination, biochemical test, purified protein derivative intradermal test, Brain CT and/or MRI examination ), treatment, and prognosis were compared between the two groups. Results The number of cases of subacute or chronic disease onset was 22 and 20 in the study group and the control group, respectively. The study group had lower incidence of fever than the control group ( P 0. 05 ). The proportion of cases with CSF pressure > 200 mm H2O ( 1 mm H2O =0. 0098 kPa ) was lower in the study group than in the control group ( P 0. 05 ). The study group included 12 cases of intracephalic malacia, 8 cases of cerebral infarction, 5 cases of ischemic change, 3 cases of brain tuberculoma, among which 18 cases were combined with severe/moderate hydrocephalus. The control group included 14 cases of intracranial hematogenous miliary tubercle, 10 cases of multiple intracephalic ring enhanced lesions, 6 cases of brain tuberculoma, among which 4 cases were combined with severe/moderate hydrocephalus. The incidence rate of hydrocephalus, malnutrition, diabetes, and drug hepatitis was higher in the study group than in the control group ( P < 0. 05 ). The 4HRZE ( S ) IV6HRZ/12HR was routinely used as the main therapy, and glucoeorticoid, dehydration, and liver protection were used as adjuvant therapies. High intracra-nial pressure and hydroeephalus were given caution and treated in a timely manner. In the study group, 11 cases improved and 17 cases

  19. 伴胸部受累的淋巴瘤25例临床分析%Clinical analysis of lymphoma with chest involvement: report of 25 cases

    周庆涛; 朱红; 贺蓓


    膜和肺组织确诊率低.%Objective To study clinical characteristics and diagnostic methods of lymphoma with chest invovement. Methods Twenty-five lymphoma patients with chest involvement were retrospectively analysed, they were all diagnosed in Peking University Third Hospital during 2000 to 2007. The data were collected including clinical manifestations, blood examinations, chest X-ray and CT scan, diagnostic methods and pathologic diagnosis. Results The median age of the 25 patients was 46 years old. Pyrexia(13 cases), weight loss over 10 percent in 6 months(11 cases), cough(10 cases), shortness of breath(9 cases) and painless enlargement of the peripheral lymph nodes(16 cases) were common manifestations. Erythrocyte sedimentation rate and serum lactate dehydrogenase(LDH) level were increased in 72.7% and 81% patients, respectively. The enlargement of mediastinum lymph nodes(16 cases, 64%) was the most common presentation of chest radiography, followed by pulmonary involvement(15 cases, 60%) including infiltration or pulmonary consolidation, mass, multiple nodules, diffuse ground-glass shadow, miliary lesion. There were also presentations of pleural effusion(10 cases, 40%), pericardial effusion(4 cases, 16%), chest wall mass(2 cases, 8%). Eighteen patients(72%) had at least two kinds of these presentations. The appearance of pleural effusion were yellow turbid, bloody or chyliform. Rivaha tests were all positive. The median value of plearal effusion examinations were listed as follows: specific gravity 1.031, total cells 9800×10~6/L, WBC 6.72×10~9/L, lymphocyte 86%, neutrophil 14%, protein 31.4 g/L, LDH 296 U/L,adenosine deaminase (ADA) 67.4 U/L Most patients(16 cases) were diagnosed by surgical biopsy,especialy peripheral lymph nodes biopsy (12 cases). Other patients were diagnosed by ultrasound or CT-guided biopsy (5 cases), video-assisted thoracoscopic pleural biopsy (1 case), video-mediastinoscopic mediastinum lesion biopsy(1 case), bronchial mucosa biopsy through bronchoscope(1 case