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[Tuberculosis in patients with HIV infection].

Within 1987-1995 the authors observed 16 cases of tuberculosis in HIV-infected patients which accounted for 26.7% of AIDS patients treated by them. 14 cases were diagnosed intravitally, 2 postmortem. Infiltrative, generalized, cavernous, intrathoracic lymph node, intraabdominal lymph node tuberculosis and tuberculous pleurisy were identified in 5, 6, 2, 1, 1 and 1 patients, respectively. 6 patients from the above are still alive and are receiving treatment (5 of them with infiltrative tuberculosis), 10 died. Tuberculosis course and outcomes in HIV-infected subjects depended on the stage of their immunodeficiency. In moderate immunodeficiency (CD4-lymphocyte > 200/mm3) tuberculosis ran, as a rule, as local and infiltrative, sensitive to specific therapy. In severe damage to immune system (CD4 < 100/mm3) tuberculosis acquired a generalized course, sometimes fulminant, resistant to treatment. It is inferred that HIV-infected subjects with immunodeficiency need tuberculosis prophylaxis with isoniazide or rifampicin.

AIDS-Related Opportunistic Infections↗

[The spectrum of lymphadenopathy in HIV-positive patients. Prospective analysis of 45 cases].

In the prospective analysis of 45 patients (intravenous drug addicts and homosexuals) with lymphadenopathy and positive HIV virus titers, including serology, immunological and histological lymph node studies, we examined the etiology and diagnostic results of the methods used. We found 19 cases with lymphoid follicular hyperplasia, 9 with lymph node tuberculosis, 7 with lymphoid depletion, 2 non-Hodgkin's lymphoma and one case with Hodgkin's disease. Routine serology did not provide more information concerning the lymphadenopathy and the immunological study showed a relationship, however not lineal, between the immunosuppression and the stage of HIV infection, while the histologic diagnosis did not, except in the cases with lymphoid depletion and non-Hodgkin's disease. In the asymptomatic patients (10 cases) biopsy results did not change the given treatment as well as the prognosis, thus, it could be eliminated in a routine study. Biopsy on occasions implied therapeutic management (lymph node tuberculosis) or a change in prognosis (lymphoma or lymphoid depletion) in symptomatic patients (35), therefore, it seems to de justified. Fine needle aspiration of the lymph nodes was harmless and safe and was shown to have good sensitivity (79%), thus, it can be recommended as a first elective diagnostic method for lymph node histology.

Adult↗

[Tuberculosis in Hodgkin's disease in a child].

During its evolution, Hodgkin disease is accompanied by changes in the cell immunity, mainly of delayed type. Tuberculosis can precede Hodgkin disease or complicate its evolution during a simultaneous development of both diseases, or the lymph node tuberculosis can hurry hemopathy onset. Tb lesions in such patients can have atypical features.

Biopsy, Needle↗

Circulating markers of free radical activity in patients with pulmonary tuberculosis.

SETTING: Toxic free radicals have been implicated in the development of lung fibrosis which may be a long-term sequela of pulmonary tuberculosis. OBJECTIVE: To measure circulating indicators of free radical activity in patients with pulmonary tuberculosis in order to determine whether patients with active pulmonary TB have elevated levels of circulating free radical activity, and whether these levels correlated with disease activity as determined by other blood markers of inflammation. DESIGN: 17 patients with active pulmonary tuberculosis were studied. Serial serum levels of 3 assays of free radical activity were measured at diagnosis (17 patients), and over a 2-7 month period on chemotherapy (8 patients). 3 patients with active lymph node tuberculosis were also studied and 4 patients with old lung scarring from previously treated tuberculosis had their serum markers analysed. RESULTS: All 3 serum markers of free radical activity were elevated in patients with active pulmonary tuberculosis. During serial measurement in 8 patients the % molar ratio of 9,11 linoleic acid/9,12 linoleic acid fell progressively with treatment. Thiobarbituric acid reactive substances (TBARS) were initially elevated in 6/8 patients and remained elevated despite treatment. In 2 patients TBARS were in the normal range at presentation but subsequently rose with treatment. Desferrioxamine-chelatable iron was initially normal in all but 1 patient, remained normal in 2 patients, rose in 4 patients and fell in 1 patient. CONCLUSIONS: These results suggest that increased circulating levels of free radical activity are found in active pulmonary tuberculosis and hence may play a role in the resultant fibrosis. It also reinforces the belief that a range of free radical activity (FRA) indicators are produced in any inflammatory process with fibrogenic potential and that these indicators may be measuring different stages of the disease process.

Adolescent↗

[LYMPHOMA COLLI].

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Head and Neck Neoplasms↗

An unusual case of active tuberculosis of the oesophagus in an adult.

A case is reported of a 56-year-old woman of Libyan origin presenting with dysphagia, retrosternal pain and weight loss. Oesophago-gastroduodenoscopy revealed an ulcerated tumor in the upper oesophagus strongly suggesting a malignancy. A positive Mendel-Mantoux test along with histological evidence of epitheloid cell granulomas and clinical findings consistent with pulmonary and lymph node tuberculosis led to the presumptive diagnosis of oesophageal tuberculosis. The diagnosis was later confirmed by positive bacteriological cultures of oesophageal biopsies and gastric washings. It is very unusual for dysphagia to be the presenting symptom of active adult tuberculosis. Oesophageal tuberculosis is extremely rare and must be distinguished predominantly from oesophageal carcinoma.

Deglutition Disorders↗

[Diagnosis and treatment of tuberculosis of peripheral lymph nodes in children and adolescents].

Among lymphadenopathies of different etiology, tuberculosis of peripheral lymph nodes was detected in 28% of cases in children and adolescents, as shown by our data. In its diagnosis in the children, the most informative methods include a morphological study of lymph node biopsy specimens and the results of experimental treatment. History data, clinical findings, and tuberculin diagnosis were also of great importance in verifying the disease. Lymphotropic administration of antituberculosis agents in patients with tuberculosis of peripheral lymph nodes enhances the efficiency of chemotherapy.

Adolescent↗

Clinical evaluation of the gen-probe amplified mycobacterium tuberculosis direct test for rapid diagnosis of tuberculosis lymphadenitis.

This prospective study evaluated the performance of the Amplified Mycobacterium Tuberculosis Direct Test (MTD) for the diagnosis of lymph node tuberculosis in Djibouti, Republic of Djibouti. Of 197 specimens sampled from 153 patients, 123 were from 95 tuberculous patients. The sensitivity and specificity of MTD were 93 and 100%, respectively. The sensitivity of culture was 89%.

Culture Media↗

[Lymphography in tuberculosis in black African immigrants].

Lymphographic data in 23 negro immigrants with lymph nodes tuberculosis almost always mediastinal and/or superficial are reported. In six cases, including two cases with abdominal latero-aortic lymph nodes clinically obvious, lymphography showed abnormalities without doubt. These aspects are compared with data of literature and discussed according to interpretation and significance in tuberculosis very peculiar in negro immigrants.20

Adult↗