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PubMed2000

Extra-pulmonary tuberculosis in children.

METHODS: The clinical and epidemiological features of 102 children with extra-pulmonary tuberculosis, diagnosed between 1982 and 1998 at P & A Kyriakou Children's Hospital were reviewed. RESULTS: During the past decade, a 50% increase of admissions for extra-pulmonary tuberculosis was observed. The source of infection was disclosed in 48 patients. Diagnoses included superficial lymphadenitis (n = 48), pleural effusion (n = 27), meningitis (n = 16), skeletal tuberculosis (n = 5), miliary tuberculosis (n = 3), abdominal tuberculosis (n = 2), and pericarditis (n = 1). Miliary tuberculosis developed in infants, lymphadenitis and meningitis in preschool children, and pleural effusion and skeletal tuberculosis in older children. None of the patients with extra-pulmonary tuberculosis died; however, six patients with meningitis developed permanent neurological deficits. In these patients, antituberculous treatment was introduced at a median of six days following admission as compared with one day in patients with no complications. Poverty, immigration, and limited access to medical services were common among patients with meningitis.

Adolescent↗
PubMed1995

Tuberculosis cutis miliaris disseminata due to multidrug-resistant Mycobacterium tuberculosis in AIDS patients.

Two patients with AIDS and disseminated tuberculosis characterized by cutaneous involvement are reported. They developed a maculopapular skin eruption, from which a multidrug-resistant Mycobacterium tuberculosis strain was isolated. In both cases the clinical course was rapidly fatal. Tuberculosis cutis miliaris disseminata should be differentiated from the skin lesions frequently seen in HIV-infected patients, especially from folliculitis. In patients with tuberculosis, the appearance of cutaneous lesions may be due to the haematogenous dissemination of mycobacteria. Therefore, early identification of the causative organism by use of optimal microbiological methods is fundamental.

Acquired Immunodeficiency Syndrome↗
PubMed2002

[Variability and diagnosis of pulmonary tuberculosis].

Five hundred-ninety new cases of tuberculosis were analyzed in Republic Santariskiu Tuberculosis and Lung Disease Hospital during 06 1997-06 2001. Mean age of patients - 47+/-30 years. All cases were classified based on international tuberculosis classification: pulmonary tuberculosis (A15, A16) - 409 cases; tuberculosis pleurisy (A15.6, A16.5) - 169; miliary tuberculosis (A19) - 11; generalized tuberculous lymphadenitis (A18.5) - 1. Pulmonary tuberculosis confirmed by sputum smear (A15.0) was prevalent in the structure of new tuberculosis cases (26.4%); pulmonary tuberculosis was confirmed by culture (A15.1) in 14.1%; by histology (A15.2) - in 10.3%. Unconfirmed pulmonary tuberculosis (A16) and tuberculous pleurisy (A16.5) amounted to 28.5%. Liver biopsy and positive sputum cultures for mycobacterias mostly confirmed tuberculosis diagnosis in miliary tuberculosis cases. From all tuberculous pleurisy cases in 65% the diagnosis was confirmed by bacteriology and/or histology.

Adult↗
PubMed1976

[Angiographic findings in primary miliary hepatic tuberculosis (author's transl)].

The authors describe the hepatic angiographic findings in two patients with primary miliary hepatic tuberculosis. The main angiographic features are abnormalities of the distal arterioles, with small, nodular and irregular formations. The hepatic and portal veins are normal. To our knowledge, it is the first report of angiographic abnormalities in miliary tuberculosis of the liver. The diagnostic and pronostic interest of these findings are discussed.

Adult↗
PubMed2003

[Miliary pulmonary tuberculosis following intravesical BCG-therapy].

A patient given intravesical BCG immunotherapy developed miliary pulmonary tuberculosis. After resection of a superficial bladder tumor, the patient was given weekly intravesical BCG infusions. After the 4th session, the patient developed fever (40 degrees C), shivers, dry cough, profuse sweating, and weight loss. Initially, the chest x-ray was normal. The patient was given isoniazid (5 mg/kg) in a single-drug regimen. Rapid degradation of the general status led to a new chest x-ray, 10 days later, which demonstrated a reticulonodular syndrome. High-resolution thoracic CT confirmed the diagnosis of miliary pulmonary tuberculosis. A three-drug antituberculosis regimen associated with corticosteroids was followed by restoration of the general status. Antituberculosis therapy was continued for 9 months. The 9-month thoracic CT revealed a smaller number of micronodules in the pulmonary parenchyma. This case illustrates the discussion concerning the appropriate treatment for patients who develop a systemic infection after intravesical BCG-therapy.

Adjuvants, Immunologic↗
PubMed1993

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

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.

Adult↗
PubMed1999

[Intrahepatic calcification--a differential diagnostic problem].

HISTORY AND CLINICAL FINDINGS: A 57-year-old woman was admitted for investigation of intrahepatic calcifications. Intrahepatic cholangiolithiasis was suspected. In 1993 she underwent cholecystectomy because of lithiasis. The examination with endoscopic retrograde cholangiography (ERC) was planned. INVESTIGATIONS: The laboratory findings were normal except for a mild elevation of alkaline phosphatase and gammaglutamyl transpeptidase. The sonographic examination of the abdomen showed multiple hyperechoic calcifications along non-dilated bile ducts. In the spleen of normal size there were found a lot of intraparenchymatous calcifications. The abdominal roentgenography revealed calcifications also in the pancreas. In ERC, the intra- and extrahepatic bile ducts were normal with simultaneous proof of parenchymatous calcifications. TREATMENT AND COURSE: Because of the medical history of the patient and the radiologic findings the multiple parenchymatous calcifications could be referred to a miliary tuberculosis during childhood. In miliary tuberculosis, the liver almost always is involved by acute granulomatous inflammation. The therapy of hepatic tuberculosis follows the guidelines of systemic tuberculostatic therapy according to other presentations of this disease. Under sufficient therapy, tuberculotic granulomas normally heal without cicatrization. Sometimes tissue reactions in form of local fibrosis and calcification lead to a mild reduction in hepatic function as seen in this case. CONCLUSION: In the European population, intrahepatic cholangiolithiasis is a rare cause of focal hyperechoic liver lesions. In differential diagnosis, numerous diseases of possible systemic course have to be considered, which may induce calcifications of the liver or other organs. Among systemic diseases characterized by granulomatous inflammation and possible calcification tuberculosis and sarcoidosis have to be mentioned first.

Calcinosis↗
PubMed2006

BCG vaccine: efficacy and indications for vaccination and revaccination.

OBJECTIVES: To review the protective efficacy of the first and second doses of BCG vaccine and to assess its major indications and contraindications. SOURCES OF DATA: A systematic review of the literature was made by searching PubMed and selecting studies carried out in the last 50 years. The studies were grouped according to their design (clinical trials, case-control studies, and meta-analyses) and the results were presented separately for each type of study. Other relevant topics such as BCG and HIV/AIDS, use of tuberculin skin test, issues related to vaccine scars and to the development of new vaccines were also reviewed. SUMMARY OF THE FINDINGS: BCG vaccine has been used since 1921. However, the data concerning its use are variable and inconsistent. The protective efficacy of the first dose of BCG vaccine against miliary tuberculosis or tuberculous meningitis is remarkably important. Nevertheless, results regarding pulmonary tuberculosis have been inconsistent, either showing no efficacy or a protective efficacy rate around 80%. There is some evidence that a second dose of BCG vaccine does not increase its protective efficacy. Studies have shown that BCG vaccine protects against leprosy. The development of new vaccines to replace BCG in the future has been investigated. CONCLUSIONS: Despite the hope that a new vaccine against tuberculosis will be available in the future, BCG vaccine, in spite of its deficiencies, is today and will 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.

Animals↗
PubMed2000

[Choroidal tuberculoma in a patient with acquired immunodeficiency syndrome].

BACKGROUND: In Japan, since the introduction of antituberculosis chemotherapy, the typical choroidal tuberculoma has been considered uncommon. A patient with acquired immunodeficiency syndrome (AIDS), because of the suppression of cell mediated immunity, faces the risk of tuberculous infection. CASE: A 30-year-old Malayan man had continuous cough for six months. He was diagnosed as having miliary tuberculosis of the lung and spine. Because the serum test of human immunodeficiency virus (HIV) was positive, he was also diagnosed as having AIDS. FINDINGS: Fundus examination showed a yellow white swollen lesion of the choroid with distinct border in his right eye, probably caused by tuberculosis. After three months of therapy with antituberculosis and anti HIV drugs, his systemic and ocular findings were markedly improved. CONCLUSION: Because of the recent increase in the incidence of tuberculosis with the epidemic of HIV prevailing in the world, the recognition of ocular tuberculosis is important.

Acquired Immunodeficiency Syndrome↗
PubMed2000

[Diffuse infiltrative lung diseases of infectious and neoplastic origin].

Among the causes of chronic diffuse infiltrative lung diseases, infection and neoplasia have to be suspected in priority because of their frequency and their therapeutic specificities. Diffuse infiltrative lung diseases related to infection, often acute and feverish, are due to Pneumocystis carinii pneumonia, miliary tuberculosis, or virus and atypical pneumonia. Strategy for microbiological diagnosis depends on the pathogen suspected and the pulmonary disease severity. By contrast, diffuse infiltrative lung diseases due to neoplasia, mostly chronic diseases, include lymphangitic carcinomatosis and more rarely diffuse bronchoalveolar carcinoma and lymphoproliferative diseases.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed2000

[An uncommon cause of persistent fever in France].

Miliary tuberculosis is rare and requires rapid diagnosis. Outcome is fatal in 25% of the cases. Since radiography and laboratory tests contribute little to early diagnosis, clinical findings are primordial. Antituberculosis antibiotic therapy is frequently started before microbiological confirmation of the diagnosis.

Adult↗