Clinical aspects of atypical mycobacterial infection.

Summary: Atypical mycobacterial infections may give rise to various clinical difficulties. Case reports of six patients--three adult patients with pulmonary lesions, two children with cervical lymphadentis and one patient in whom the atypical mycobacterium appeared to be present as a commensal--illustrate these difficulties. Determination of the significance of the organism and differentiation of condition from tuberculosis and others requires consideration of the clinical picture, the results of skin testing, histologic features and cultural characteristics. Three patients, including the two children, were treated with a combination of surgery and chemotherapy, with satisfactory results. An elderly patient with chronic bronchitis and a pulmonary infection due to M. kansasii was treated successfully with antiuberculosis agents alone. Chemotherapy is being tried on a fifth patient with cavitary disease due to M. intracellulare, but is seems likely that an operation will also be required.     

Tuberculosis as a Cause of Upper Lobe Bronchiectasis

Bronchiectasis occurs frequently in association with pulmonary tuberculosis and is caused primarily by tuberculous bronchitis. It is common in all types of tuberculosis, especially in the fibroid lesion stage. It may occur with active tuberculosis and become part of the tuberculous picture. It may also occur with inactive tuberculosis and then present a distinct symptom complex. It is easy to diagnose. It is a relatively benign disease and usually no special treatment is needed; but when it becomes severe, pulmonary resection is the procedure of choice.     

多层螺旋CT对肺结核合并肺癌患者的诊断价值

目的:研究多层螺旋CT对肺结核合并肺癌的鉴别诊断价值。方法:选择2013年3月至2015年9月在我院确诊的肺结核合并肺癌患者32例和单纯肺结核患者39例应用多层螺旋CT扫描患者肺部病变情况。结果:肺结核合并肺癌组:陈旧性肺结核28例、活动性肺结核4例;病灶位置经典部位29例、非经典部位3例,合并鳞癌11例、腺癌13例、小细胞癌5例、未分化癌3例;10例结核病灶与肺癌病灶不同侧、13例结核病灶与肺癌病灶同侧不同叶、9例结核病灶于肺癌病灶同侧同叶。单纯性肺结核组胨旧性肺结核36例、活动性肺结核3例;病灶位置经典部位34例(上叶尖段11例、后段9例、下叶背段14例)、非经典部位5例。肺结核合并肺癌组患者分叶征、毛刺征、胸膜凹陷征、阻塞性肺炎及肺不张以及棘状突起比例高于单纯肺结核组,而空泡影比例低于单纯肺结核组,差异具有统计学意义(P0.05);两组钙化、斑片条索影、结节影以及空洞或空腔比较,差异无统计学意义(P0.05)。结论:多层螺旋CT对肺结核合并肺癌具有较高的临床鉴别诊断价值。     

7例影像学表现为弥漫肺间质性病变的肺结核报道及文献复习

目的:通过对7例高分辨CT(High Resolution Computed Tomography,HRCT)表现为弥漫肺间质性病变的肺结核患者的相关资料进行分析,结合相关文献,提高对该类肺结核的认识。方法:分析本院2012.2~2015.3确诊的7例HRCT表现为弥漫肺间质性病变的肺结核的临床症状、体征、影像学资料及痰抗酸杆菌、结核菌素纯蛋白衍生物(Purified Protein Derivative,PPD)试验、T细胞斑点试验(T-SPOT.TB)、抗结核抗体、血常规、血沉(Erythrocyte Sedimentation Rate,ESR)等实验室检查、病理检查等资料。结果:6例经2次以上痰涂片阳性确诊为肺结核,1例抗结核治疗有效诊断为肺结核;弥漫肺间质性病变的肺结核患者HRCT上间质性病变的范围与抗酸杆菌的检出及发热症状的出现有关联;与盗汗、乏力、咯血等结核中毒症状及PPD、结核抗体、ESR等指标无明显相关关系。结论:弥漫肺间质性病变也可为肺结核的一种特殊表现,极易误诊为其他间质病变。当患者临床表现及实验室检查无特殊发现时,需考虑肺结核的可能并进行结核病相关检查,尤其是抗酸杆菌及肺组织病理检查,以尽早明确诊断。     

PULMONARY RESECTION IN TUBERCULOSIS

Newer surgical and anesthetic techniques and the use of streptomycin and para-aminosalicylic acid (PAS) have made possible increased success in pulmonary resection for tuberculosis. Especially in early cases, however, bed rest and pneumothorax or pneumoperitoneum should be given adequate trial before resection is decided upon. In all cases a thorough bronchoscopic examination should be made first and the findings carefully evaluated.Pulmonary resection may be advisable for lesions of certain kinds which do not respond well to thoracotomy; for lesions which have not responded to trial of other methods; for a lung destroyed by tuberculosis; and in cases of active disease in an unexpanded lung.The experience of the author and of others emphasizes the importance of correct postoperative care. Since tuberculosis is rarely limited to the resected area, at least six months'' rest in bed under medical supervision is necessary to permit cure of residual disease. Streptomycin with PAS is particularly valuable in the postoperative period; therefore indiscriminate use of it in earlier treatment should be avoided lest resistance develop.     

CANCER OF THE LUNG IN TUBERCULOUS PATIENTS

Of all tuberculous patients over 45 years of age admitted to Olive View Sanatorium in the five-year period ended July, 1958, 1.4 per cent had cancer of the lung. This is a much higher incidence than in a comparable segment of the general population.Careful examination of serial roentgenographic studies in all cases of suspected pulmonary lesions was found to increase diagnostic acuity. Scalene node biopsy, cytologic study and bronchoscopy were of less help. Diagnostic thoracotomy was the single most useful procedure for diagnosis.As to operability, the results in patients with both cancer and tuberculosis compared very well with those in patients who had only cancer. Patients who have inactive pulmonary tuberculosis and cancer have much poorer results than patients with active tuberculosis and cancer. There are difficulties in accurately diagnosing cancer in the presence of tuberculosis; and there are special problems in patients with inactive tuberculosis and cancer.     

Congenital tuberculosis associated with maternal disseminated miliary tuberculosis

Untreated tuberculosis during pregnancy presents a serious risk for transmission of disease to the newborn and can result in adverse perinatal and obstetrical outcomes. Tuberculosis during pregnancy and congenital tuberculosis are infrequent conditions and are difficult to diagnose due the non-specificity of the symptoms. A case report is presented of a woman who had no children previously with disseminated miliary tuberculosis. Tuberculosis symptoms appeared immediately after birth of the first child, with a clinical diagnosis on the second month after childbirth, whereupon the patient died. The son, a premature infant, showed disease symptoms from the first day, with primary pulmonary complex and persistent atelectasis due to bronchial obstruction. The obstruction was due to thoracic lymphadenitis and coinfection with cytomegalovirus. The infant received standard treatment and his condition improved.     

The Physical Status of Men in the Lowest Income Group in the Sixth Decade of Life

Forty-one men between the ages of 50 and 60 from the indigent population in Montreal have been studied during two winters. Clinical evaluation, completion of a respiratory questionnaire, electrocardiograms, plain chest radiographs and full chest tomograms, and a battery of pulmonary function tests were completed on each.No difference in pulmonary function could be demonstrated among nine men who gave no history of chronic bronchitis and 14 who gave positive answers to the same questionnaire.Five who had had dusty occupations in the past had more evidence of function impairment than men not exposed to this hazard.Thirteen were found to have complicating disease; two had active tuberculosis, one a mediastinal tumour, and the remaining 10 various forms of heart disease.Considering the group as a whole, only 18 (44%) had no objective evidence of any organic disease.     

Rib lesions in chronic pulmonary tuberculosis

The diagnosis of skeletal tuberculosis in human remains has traditionally been based upon the detection of secondary skeletal lesions which result from hemotogenous dissemination of tubercle bacilli (e.g., Pott's disease). Since such lesions develop in less than 7% of cases of human tuberculosis, the paleodemography and paleoepidemiology of this disease have been difficult to assess from skeletal remains. This study presents a new diagnostic approach to tuberculosis, focusing on the skeletal manifestations of chronic pulmonary disease (which comprises approximately 90% of human-form tuberculosis). Four hundred forty-five skeletal remains from persons dying of tuberculosis during the first half of the 20th century were examined. A total of 70/445 (16%) exhibited skeletal lesions in one or more locations as a response to infection. Of these 70, 39 (56%) were found to display a specific set of lesions restricted to the internal aspect of the ribs. These lesions take one of two forms: (1) diffuse periostitis or (2) localized abscess, and appear to correspond to areas of chronic pulmonary infection. The diffuse type of rib lesion is more commonly observed than the localized type. In our observations (and according to the natural history of tuberculosis) the occurrence of chronic pulmonary tuberculosis is usually mutually exclusive with hematogenous dissemination to secondary bone locations. Thus, the detection of rib lesions in cases of chronic pulmonary disease increases the absolute sample size of skeletal tuberculosis by a factor of two in this study.     

定西市2007—2010年外出务工人员肺结核线索调査情况分析

目的为了了解外出务工人群的结核病疫情状况,进一步加强对这部分人群结核病的控制工作。方法利用大多外出务工人员春节前集中返乡与家人团聚的时机,对有咳嗽、咳痰超过3周等可疑肺结核病症状者进行摸底调查和造册登记,并由县(区)疾控中心组织免费检查,对确诊患者进行免费抗结核治疗。结果 4年中调查返乡务工人员102万余人次,有可疑肺结核症状者占2.56%,共确诊活动性肺结核患者346例,其中涂阳108例,初治涂阴238例,男女之比为2.15∶1,以青壮年人群为主,20～39岁占73.99%;年均涂阳和活动性肺结核登记率分别为10.59/10万和33.92/10万,涂阳比例为31.21%,其中初治涂阳比例为95.37%。结论外出务工人员是结核病的高发人群,应加强外出务工人员的结核病防治工作,利用外出务工人员春节集中返乡的有利时机开展肺结核病线索调查是主动发现病人的有效方法。     

HIV合并肺结核与单纯肺结核的临床特征分析及抗结核治疗效果对比

目的:分析HIV合并肺结核患者的临床特征及抗结核治疗的疗效。方法:将我院收治的HIV感染合并肺结核初治患者53例作为A组,将同期收治的单纯肺结核患者176例作为B组,对两组患者临床资料、实验室检查结果以及治疗效果等进行回顾性分析。结果:A组患者并发症发生率以及肺外结核发生率显著高于B组(P0.05),A组咳嗽发生率低于B组,但发热发生率高于B组(P0.05);A组患者斑点实验、PPD实验、痰查抗酸杆菌阳性率均低于B组(P0.05),A组患者肝功能异常、肾功能异常以及CD4+计数200发生率高于B组(P0.05);A组抗结核治疗的临床疗效低于B组(P0.05);两组患者治疗后CD4+水平均高于治疗前,且B组高于A组(P0.05)。结论:与单纯感染肺结核的患者相比,HIV合并肺结核患者并发症以及肺外结核发生率较高,实验室相关检查敏感性较低,抗结核治疗的效果较差,临床应给予重视。     

Occurrence of subcutaneous zygomycosis (Entomophthoromycosis Basidiobolae) caused by Basidiobolus haptosporus with pulmonary involvement

A case of a two-year-old boy with multiple subcutaneous lesions caused by Basidiobolus haptosporus is presented.The child had also a non-toxic familial goiter and clinical and radiological features of a pulmonary illness. The pulmonary manifestations only disappeared with the treatment with potassium iodide. The authors think that the pulmonary lesions must have arisen by direct spread of the fungus from the subcutaneous lesions of the chest.     

肺结核残留空洞的诊断再评价

目的 探讨初治肺结核患者临床治愈后残留空洞的诊断再评价。方法 2003 年1 月- 2007 年6 月, 67 例初治痰菌阳性肺结核患者在完成短程化疗后痰菌阴转, 达到临床治愈, 但X 线胸片检查仍残留空洞, 通过支气管肺泡灌洗( BAL)经皮肺穿刺活检( PLB) , 对肺结核合并疾病的诊断进行再评价。结果 67 例患者均进行BAL, 证实结核分枝杆菌阴性, 经知情并同意后, 其中的59 例患者进行PLB 62 例次, 发现肺癌2 例次( 鳞癌1 例次、腺癌1 例次) , 真菌感染5 例次( 曲霉感染2例次、隐球菌感染2 例次、白假丝酵母感染1 例次) , 结核分枝杆菌阳性5 例次, 细菌培养阳性3 例次( 铜绿假单胞菌、鲍曼不动杆菌、产酸克雷伯菌各1 例次) 。结论 即使在肺结核诊断成立并且治疗有效, 对肺结核合并疾病的诊断仍应受到高度重视,临床治愈后若残留空洞, 仍有必要对诊断进行评价, 以免延误肺结核合并的肿瘤和感染性疾病的诊断, 必要时需进行BAL 或PLB 明确诊断。     

Some Social and Forensic Aspects of Exhumation and Reinterment of Industrial Revolution Remains

The aetiological aspects of exhumed remains from two burial sites were examined using 1839 and 1879 as years of comparison. We tried to discover whether the sample of recovered remains was representative of those buried. The state of the remains varied according to the type of soil and coffin material in which they were buried. At the earlier date most deaths were caused by infectious lesions rather than degenerative ones and 76% of those who died were below employable age—whereas in 1879 the commonest causes of death were tuberculosis (“phthisis”) and bronchitis, and 42% died before they could be employed. The registration of deaths were recorded more accurately at the later date, and it was easier to build up a picture of the age, sex, and occupation of the people who died.     

Chest radiography findings in primary pulmonary tuberculosis in children

Plain chest radiography plays a major role in the diagnosis and follow-up of pulmonary tuberculosis in childhood. The aim of our study was to investigate the distribution of characteristic chest radiographic findings at diagnosis in children with pulmonary tuberculosis. The age of the patients and the type and localization of radiographic changes at admission were retrospectively analyzed. We reviewed chest radiographs in 204 children admitted from January 1, 1991 until June 30, 1994 for newly diagnosed pulmonary tuberculosis. Mean age +/- SD was 6.4 +/- 4.2 years (range 0-14). The most common lesion was lymphadenopathy (found in 172 children, 84.3%). It was significantly more common in the youngest age group (0-4 years) and was more significantly present in the right hilo-mediastinal region. Parenchymal changes were found in 125 children (61.3%). They were also significantly more common in the young age group and in the right lung. Other less common lesions included pleuritis, atelectasis, destructive-cavitary lesions and miliary dissemination. In conclusion, the leading radiographic finding in pulmonary tuberculosis in childhood remains hilar lymphadenopathy, but parenchymal changes are clearly strongly present, and should be sought and appreciated in the diagnostic work-up for pulmonary tuberculosis in childhood.     

Childhood cancer and drugs in pregnancy.

A study was carried out on 11 169 matched case-control pairs of children aged up to 15 years included in the Oxford Survey of Childhood Cancers to see whether an association exists between cancer in children and drugs given to their mothers during pregnancy. The mothers of children who developed cancer reported about 25% more illnesses during pregnancy than mothers of healthy control children. Two specific illnesses, pulmonary tuberculosis and epilepsy, were investigated. For these there was a higher than average case-control excess of reports and there had been a suggestion that the drugs used in treatment, isoniazid and phenytoin, might be carcinogenic. The results of this investigation provide no real evidence for any association between the drugs taken by the mothers during pregnancy and subsequent cancer in the child.     

Reassessment of inflammation of airways in chronic bronchitis.

The term chronic bronchitis has been criticised because it is associated with hypersecretion of mucus rather than bronchial inflammation. This study was designed to establish the presence or absence of clinical chronic bronchitis and measure pulmonary function in 45 patients about to undergo resection of the lung. The condition in the cartilaginous and small airways and the severity of the emphysema were then measured in the resected specimen. The results from 20 patients who had clinical chronic bronchitis were compared with those in 25 patients who did not. The data show that patients with chronic bronchitis had greater inflammation (a) on mucosal surfaces (p less than 0.05) of all bronchi larger than 2 mm luminal diameter and (b) around glands (p less than 0.005) and gland ducts (p less than 0.05) in bronchi larger than 4 mm diameter. A variable degree of inflammation was present in the submucosa of smaller bronchi. The groups had equivalent proportions of mucous glands and Reid''s indices in central airways, and no differences were noted in measurements of pulmonary function, condition of small airways, or emphysema. These data show that the term chronic bronchitis is justified by inflammation of cartilaginous airways and suggest that this abnormality may be the cause of the chronic productive cough.     

Effect of Diagnostic and Treatment Delay on the Risk of Tuberculosis Transmission in Shenzhen,China: An Observational Cohort Study, 1993–2010

Introduction

To understand better the risk of tuberculosis transmission with increasing delay in tuberculosis treatment, we undertook a retrospective cohort study in Shenzhen, China.

Methods

All pulmonary tuberculosis cases in the Shenzhen tuberculosis surveillance database from 1993–2010 were included. Sputum smear positivity and presence of pulmonary cavity were used as proxies for risk of tuberculosis transmission.

Results

Among 48,441pulmonary tuberculosis cases, 70% presented with symptoms of pulmonary TB, 62% were sputum smear positive, and 21% had a pulmonary cavity on chest x-ray. 95.3% of patients self-presented for evaluation of illness after a median 58 days of delay after symptoms began. The proportion presenting sputum smear positive (p<0.001) and with a pulmonary cavity (p<0.001) increased significantly with increasing duration of delay.

Conclusions

Delayed diagnosis and treatment of tuberculosis is associated with a significantly increased risk of pulmonary sputum smear positivity and pulmonary cavity. To decrease risk of transmission, treatment delay needs to be reduced further.     

Successful use of an inhalational phytochemical to treat pulmonary tuberculosis: a case report.

Multi-drug resistant strains of tuberculosis pose a serious threat in many third- and first-world countries. The aim of this case report is to describe a potential new method for treating those with primary pulmonary tuberculosis using phytochemicals via inhalation. We report the first case of using inhaled phytochemicals in treating primary pulmonary tuberculosis. A 28-year-old female presented with symptoms suggestive of primary pulmonary tuberculosis, and she was found to be positive via chest X-ray and sputum culture. She subsequently underwent treatment with conventional DOTS treatment. Ten days post-inhalation of the phytochemical, the patient is tuberculosis negative (via sputum culture), with no clinical symptoms. This may be a potential new method and type of treatment for pulmonary tuberculosis.