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.     

耐药性结核性脑膜炎研究进展

结核性脑膜炎是由结核杆菌引起的中枢感染性疾病,是肺外结核病中最严重的一种,其多侵袭脑膜,有时可累及脑实质、脊髓,有很高的致死率。结核病在发展中国家中的感染趋势尤为突出。我国为人口大国,抗结核治疗和预防的形势异常严峻。随着抗结核药物的广泛使用,耐药性结核性脑膜炎患者数量增加,严重影响了结核性脑膜炎的预后。在耐药性结核性脑膜炎患者的治疗中,早期诊断、经验性治疗、调整治疗方案对患者的预后尤为重要。本文对耐药性结核性脑膜炎的分布、临床诊断、基因检测、治疗方案及预后进行系统性的总结。     

The Ulcerating Tuberculous Hilar Gland

In primary infection tuberculosis, the infected hilar gland(s) may cause involvement of peripheral lung tissue not only by pressure but also by rupture and discharge of caseous material into a bronchus. Atelectasis or lung infection or both may result and bronchiectasis may ensue.Early bronchoscopy is required when this form of tuberculosis fails to subside promptly under treatment.Bronchography is indicated to detect residual bronchiectasis which should be removed surgically.Three of six proved cases of Group A tuberculous tracheobronchitis caused by an ulcerating hilar gland required pulmonary resection for removal of residual bronchiectasis; two of these were complicated by atelectasis. All six patients are alive and well.     

Fine needle aspiration cytology and immunocytochemistry in tuberculous thyroiditis: a case report

BACKGROUND: Tuberculosis of the thyroid is very rare and does not strike the clinician as a first clinical diagnosis of a thyroid nodule. To our knowledge, only 40 cases of tuberculous thyroiditis diagnosed by fine needle aspiration cytology (FNAC) are described in the English literature. CASE: We report a case of tuberculous thyroiditis in a young woman who presented with a right-side solitary thyroid nodule of short duration (15 days), diagnosed by FNAC and confirmed by positive immunocytochemistry with monoclonal antibody to Mycobacterium tuberculosis complex. Ziehl Neelsen staining for acid-fast bacilli (AFB) was negative. CONCLUSION: FNAC provides a confident preoperative diagnosis of thyroid tuberculosis, obviating the need for unnecessary surgical removal of thyroid nodule. Immunocytochemistry is an important diagnostic adjunct to FNAC in AFB-negative cases.     

Tuberculous Enteritis

Tuberculous enteritis occurs in about 2 percent of patients with pulmonary tuberculosis. Although it is uncommon in the United States, tuberculous enteritis should be considered in any patient with active pulmonary tuberculosis and abdominal complaints.Eight cases of T. enteritis have been treated at Harbor General Hospital in the last 25 years. Associated pulmonary disease was shown radiologically to be present in seven of eight patients. Findings on contrast studies of the gastrointestinal tract showed disease in six of six patients examined.In five patients, surgical operation was required for diagnosis or complications. Resection of diseased bowel with primary anastomosis was done in five patients. Although medical therapy is the mainstay in the treatment of both pulmonary and intestinal tuberculosis, one staged resection of diseased bowel with primary anastomosis is the procedure of choice for complications such as obstruction, hemorrhage or perforation.     

The use of antithyroid drugs

The preoperative use of antithyroid drugs is mandatory if surgical treatment of complicated hyperthyroidism is contemplated. Six months to a year may be required for suitable preparation. The long-term use of antithyroid drugs is less effective for the "cure" of hyperthyroidism than is operation or the use of radioactive iodine. Propyl and methyl thiouracil are the antithyroid drugs of choice. Either of these thiouracil derivatives is capable of producing leukopenia. The antithyroid drugs exert no favorable effect on exophthalmos. The antithyroid drugs are suitable for the control of hyperthyroidism during pregnancy. The patient probably should not be kept hypothyroid during pregnancy but rather in a state of mild hyperthyroidism.     

局部注药联合口服康复新液辅助治疗颈淋巴结结核疗效观察

目的:探讨局部注射药物联合口服康复新液辅助治疗颈淋巴结结核的临床疗效及安全性。方法:按照随机数字表法将2010年1月-2014年1月我院收治的140例颈淋巴结结核患者分为对照组(n=70)和观察组(n=70),对照组口服异烟肼、利福平、乙胺丁醇、吡嗪酰胺及肌注链霉素进行全身抗结核治疗,观察组在对照组的基础上局部注射异烟肼、链霉素粉联合口服康复新液治疗。比较两组患者治疗后1个月、3个月及6个月症状缓解率,淋巴结吸收率,治疗后3个月复发率及不良反应发生率。结果:观察组治疗后1个月、3个月及6个月的症状缓解率、淋巴结吸收率均高于对照组(P0.05)。治疗后3个月,观察组复发率为2.86%,显著低于对照组的11.43%(P0.05)。观察组恶心、局部反应、白细胞减少及肝功能损害发生率均低于对照组(P0.05)。结论:局部注射抗结核药物联合口服康复新液辅助治疗颈淋巴结结核可提高患者的症状缓解率和淋巴结吸收率,且安全性高,有重要的临床推广价值。     

THE USE OF ANTITHYROID DRUGS

The preoperative use of antithyroid drugs is mandatory if surgical treatment of complicated hyperthyroidism is contemplated. Six months to a year may be required for suitable preparation.The long-term use of antithyroid drugs is less effective for the “cure” of hyperthyroidism than is operation or the use of radioactive iodine.Propyl and methyl thiouracil are the antithyroid drugs of choice.Either of these thiouracil derivatives is capable of producing leukopenia.The antithyroid drugs exert no favorable effect on exophthalmos.The antithyroid drugs are suitable for the control of hyperthyroidism during pregnancy. The patient probably should not be kept hypothyroid during pregnancy but rather in a state of mild hyperthyroidism.     

Tubercular involvement of the thyroid gland: a report of two cases

Thyroid tuberculosis is rare. In the last decade, however, the incidence of extrapulmonary forms of tuberculosis has increased. We report on 2 cases of thyroid tuberculosis. In case 1, a tubercular abscess mimicking acute thyroiditis was found which was correctly diagnosed by fine-needle aspiration biopsy (FNAb). No evidence of active disease was noticed. Pleural thickening on chest X-ray was the only sign compatible with a previous infection. In case 2, tubercular thyroiditis with lymph node enlargement was also diagnosed by FNAb in a reevaluation setting. In both cases treatment with antitubercular drugs resulted in complete recovery. Thyroid tuberculosis should be kept in mind in the differential diagnosis of thyroid nodules, notably in patients with a history of tuberculous disease. FNAb represents the main approach to making the diagnosis.     

INDICATIONS FOR SURGICAL TREATMENT IN GENITO-URINARY TUBERCULOSIS

Proper methods of surgical treatment effect arrest of localized tuberculosis in 90 per cent of cases, but as early and latent renal tuberculosis can be controlled in 50 per cent of cases by conservative treatment, careful deliberation as to choice of method of treatment is necessary in each case. In some circumstances, operation is definitely contraindicated. These observations apply also to tuberculosis elsewhere in the urogenital tract. When surgical treatment is carried out, careful preoperative and postoperative medical care is an important factor.The primary site of urogenital tuberculosis is the kidney, from which organ the infection spreads to the ureter, the bladder and the prostate gland. The prostate gland is the initial site of invasion in the genital tract, extension to other genital structures following. This sequence of infection is an important consideration in determining the management of urogenital tuberculosis.     

CORRELATION OF GENITO-URINARY AND GENERAL TUBERCULOSIS

Genito-urinary tuberculosis is considered to be a local manifestation of a generalized tuberculous infection which, for all practical purposes, has gained entrance to the body through the respiratory tract. Even though clinical or roentgenographic evidence of the pulmonary infection is found in only a small percentage of cases, the problem must be attacked as a whole.Indolent or inactive disease in other parts of the body may become reactivated as the result of surgical intervention or severe complicating infection.The importance of thorough general antituberculosis treatment in every case cannot be overemphasized.     

Dialyzable leukocyte extract (transfer factor) in the treatment of superinfected fistulating tuberculosis of the bone

The effect of the addition of dialyzable leukocyte extract (DLE) (transfer factor) to tuberculostatic drugs in the treatment of superinfected fistulating tuberculosis of bones and joints was evaluated in a controlled study. Eleven patients whose disease had persisted for a mean of 20 ± 4.8 years and had proved to be resistant to antibiotics and tuberculostatic drugs were treated with an additional combined tuberculostatic drug regimen consisting of isoniazide, ethambutol, and rifampin for a control period of 2 years; after this therapy had failed as judged by the persistence of the superinfected fistulae and of the symptoms, DLE was added to the regimen. The result of this therapeutic approach was evaluated after another 2 years. Through this therapy, a closure of the fistulae was achieved in 9 out of the 11 patients (P < 0.001) with a concomitant decrease of symptoms. DLE may prove beneficial in the treatment of patients with superinfected fistulating tuberculous osteomyelitis.     

Modern management of tuberculosis; the public health implications of recent advances

Modern treatment for tuberculosis has greatly increased the problem of preventing spread of infection. BCG vaccination, for instance, would cause all persons to react to tuberculin test so that the possibility of tuberculosis could never be ruled out by this means. Streptomycin and more recently developed drugs may sterilize sputum so that diagnosis cannot be confirmed for some time after use of such drugs; when by use of these drugs the disease had been confined to caseous encapsulations, later breakdown of the encapsulations may release strains of bacilli resistant to the drugs both in the patient and in others infected with them. The temporary sterilization of sputum, coupled with the euphoria resulting in part from abrupt remission of the toxic state, may lead to premature discharge of patients from sanatoria and further spread of tuberculosis. Both the public and the profession must be impressed with these facts.For more profitable than minifilm surveys of normal populations are routine x-ray examination of all patients admitted to hospitals (by which two to five times as many cases have been found) and follow-up of persons who have had contact with tuberculosis patients (thirteen times as many cases found).A study being conducted by the California Tuberculosis and Health Association indicates that in many counties neither the number of x-rays made in public surveys nor the number of cases found is known or even to be estimated from existing records. Because of reduction in deaths due to tuberculosis some public officials are reluctant to spend for further treatment facilities. As the actual number of cases is increasing in many areas, however, expenditures will have to be increased.     

MODERN MANAGEMENT OF TUBERCULOSIS—The Public Health Implications of Recent Advances

Modern treatment for tuberculosis has greatly increased the problem of preventing spread of infection. BCG vaccination, for instance, would cause all persons to react to tuberculin test so that the possibility of tuberculosis could never be ruled out by this means. Streptomycin and more recently developed drugs may sterilize sputum so that diagnosis cannot be confirmed for some time after use of such drugs; when by use of these drugs the disease had been confined to caseous encapsulations, later breakdown of the encapsulations may release strains of bacilli resistant to the drugs both in the patient and in others infected with them. The temporary sterilization of sputum, coupled with the euphoria resulting in part from abrupt remission of the toxic state, may lead to premature discharge of patients from sanatoria and further spread of tuberculosis. Both the public and the profession must be impressed with these facts.For more profitable than minifilm surveys of normal populations are routine x-ray examination of all patients admitted to hospitals (by which two to five times as many cases have been found) and follow-up of persons who have had contact with tuberculosis patients (thirteen times as many cases found).A study being conducted by the California Tuberculosis and Health Association indicates that in many counties neither the number of x-rays made in public surveys nor the number of cases found is known or even to be estimated from existing records.Because of reduction in deaths due to tuberculosis some public officials are reluctant to spend for further treatment facilities. As the actual number of cases is increasing in many areas, however, expenditures will have to be increased.     

Engineering More Stable,Selectable Marker-Free Autoluminescent Mycobacteria by One Step

In our previous study, we demonstrated that the use of the autoluminescent Mycobacterium tuberculosis as a reporter strain had the potential to drastically reduce the time, effort, animals and costs consumed in evaluation of the activities of drugs and vaccines in live mice. However, the strains were relatively unstable and lost reporter with time without selection. The kanamycin selection marker used wasn’t the best choice as it provides resistance to amino glycosides which are an important class of second line drugs used in tuberculosis treatment. In addition, the marker could limit utility of the strains for screening of new potential drugs or evaluating drug combinations for tuberculosis treatment. Limited selection marker genes for mycobacterial genetic manipulation is a major drawback for such a marker-containing strain in many research fields. Therefore, selectable marker-free, more stable autoluminescent mycobacteria are highly needed. After trying several strategies, we created such mycobacterial strains successfully by using an integrative vector and removing both the resistance maker and integrase genes by Xer site-specific recombination in one step. The corresponding plasmid vectors developed in this study could be very convenient in constructing other selectable marker-free, more stable reporter mycobacteria with diverse applications.     

Tuberculous Lymphadenitis

A total of 43 episodes of tuberculosis lymphadenitis were treated in 32 adult patients. In 12 instances the affected lymph node was excised without any chemotherapy; there were 10 relapses. The treatment was local excision of the affected lymph nodes together with antituberculosis chemotherapy with at least two drugs in 30 instances; there were no relapses following such therapy.Presumably patients with tuberculosis lymphadenitis are still sometimes treated with surgery alone because that was at one time the orthodox line of surgical teaching. Such a view is out of date: these patients should always be given antituberculosis therapy in addition to any surgical measures.     

TUBERCULOUS BRONCHITIS IN CHILDREN

Of 63 children with primary pulmonary tuberculosis who were examined bronchoscopically without particular regard for the usual criteria for the procedure, 18 (28.5 per cent) had visible tuberculous bronchitis.Certain endobronchial lesions resolved spontaneously, others responded to bronchoscopic treatment, and still others persisted despite all efforts.X-ray observations and clinical signs were of limited value in determining prior to bronchoscopy which child would have visible bronchial disease.Bronchoscopy is essential for both diagnosis and treatment of these lesions.Tuberculous bronchitis should be suspected whenever a child who is being treated for pulmonary tuberculosis by conservative means does not improve.     

IgG antibody to Mycobacterium tuberculosis antigen-5 in cerebrospinal fluid and its diagnostic application in tuberculous meningitis

IgG antibody to M. tuberculosis antigen-5 was detected by non-competitive ELISA in cerebrospinal fluid specimens (CSF), from 40 patients with clinical diagnosis of tuberculous meningitis and in 42 patients of non-tuberculous neurological diseases. The geometric mean antibody titer in CSF specimen for tuberculous and non-tuberculous groups were 156 and 8 respectively. The antibody titer in CSF specimens showed no correlation to IgG levels, tuberculin reactor status and duration of chemotherapy in patients with tuberculous meningitis. At a dilution end-point 1:40, the assay had a sensitivity of 84% and specificity of 92%. However at dilution end-point 1:80, the specificity of the assay could be increased to 100% but sensitivity of the assay decreased to 75%. IgG antibody detection against M. tuberculosis antigen-5 by non-competitive ELISA, described in this communication has potential application in the laboratory diagnosis of tuberculous meningitis, particularly in developing countries where the incidence and prevalence of tuberculous meningitis is still high. In culture-negative cases of tuberculous meningitis, non-competitive ELISA could be applied as an alternative diagnostic tool.     

Caseous, necrotic material and epithelioid cell granulomas in synovial fluid from a patient with tuberculous infection: a case report

BACKGROUND: The gross appearance and cytologic findings in synovial fluid in tuberculous infections are similar to those in other types of chronic synovial effusion. Demonstration of acid-fast bacilli (AFB) is required for a definitive diagnosis of tuberculous effusion; it is reported in only 20% of cases. The presence of frank caseous necrotic material and epithelioid cell granulomas in synovial fluid samples is unusual but strongly indicative of tuberculous infection. CASE: A 28-year-old man, on treatment for pulmonary tuberculosis, presented with a history of right ankle swelling, which was clinically interpreted as nonspecific synovitis. The synovial fluid was yellowish, with fluffy, whitish material. Cytologic smears showed abundant, caseous, necrotic material; a few histiocytic aggregates; and occasional epithelioid cell granulomas. Although stain for AFB was negative, considering the clinical presentation, a diagnosis of tuberculous synovitis could be rendered. CONCLUSION: Caseous, necrotic material and epithelioid granulomas in synovial fluid are highly unusual but, when present, can be considered definitive evidence of tuberculous effusion, particularly in a known case of pulmonary tuberculosis.     

Diagnosis of mycobacterial infection in acquired immunodeficiency syndrome (AIDS) patients and HIV carriers.

Differences in tuberculosis diagnosis between infected and non-infected HIV patients were described. In Barcelona, tuberculosis is present in 41.6% of 851 patients in whom AIDS was detected between 1981 and the first quarter of 1990. We reviewed the results of the methods used for tuberculosis diagnosis in 270 AIDS patients controlled in our hospital, in whom tuberculosis was detected (33.3%), and we compared these data with the results obtained in HIV carriers with tuberculosis and with tuberculous patients without HIV infection. Statistically significant differences were found between the three groups with respect to sex, age, results of Ziehl-Neelsen stain in pulmonary specimens and skin test reaction; between AIDS patients and the non-HIV infected population differences were observed in tuberculosis site. Positive skin test reaction diminished from tuberculous individuals non-HIV infected (95%), to HIV carriers with tuberculosis (71.8%) and AIDS patients with tuberculosis (21.8%). Acid-fast smears from pulmonary specimens were positive in 35.7%, 23.5% and 43.7% respectively. Statistically significant differences were found in tuberculosis localization between tuberculous patients non-HIV infected and tuberculous patients with AIDS, in the last group tuberculosis lymphadenitis was the most frequent localization (33.3%) of extrapulmonary tuberculosis, followed by abdominal tuberculosis (15.5%). The incidence of HIV infection among tuberculous patients was 4.6 in our study, but could be higher if patients between 19 and 30 years old were always checked for anti-HIV antibodies.