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PubMed1997

[The role of surgery in tuberculosis in children].

Despite increasingly rigorous preventive measures which have limited the number of cases in France, the number of children undergoing surgery for tuberculosis has remained unchanged. Over the last ten years we operated on 40 children in our pediatric unit. In 10 cases, surgery was indicated for diagnosis, in 19 cases surgery was required in an emergency situation during treatment and in 11 the operation was performed at the stage of sequellae. The type of surgery depended on the clinical situation. Thoracoscopy was used for surgical diagnosis and to empty caseous nodes in the lateral tracheal chain but was generally impossible at the sequellae stage.

Aspergillosis↗
PubMed1992

[Tuberculosis in patients with lymphomas].

In a period of ten years (1980-1989) 6 patients, out of 506 cases of lymphoma, presented an active tuberculosis (1.18%). Five of them had Hodgkin disease in an advanced stage, with predominance of the nodular sclerosis histologic subtype; one had a non Hodgkin lymphoma. Clinical presentation of TBC was mostly focal with a predominance of extra pulmonary involvement (cervical tuberculous lymphadenitis); disseminated disease only appeared in the non Hodgkin lymphoma patient. There was no difference in the severity of the infection when it appeared either before or after multiagent therapy of the hematologic malignancy. There was clinical suspicion of TBC in all of the pulmonary forms of the disease; lymph node tuberculosis, without drainage of caseous material, was a finding related to the routine culture of lymphatic tissue. In biopsy material, in which Mycobacterium tuberculosis was isolated, neither epithelioid cell granulomas with caseation necrosis nor acid-fast bacilli were histopathologically documented. No mortality due to tuberculous infection was registered in this group. TBC prevalence in these lymphoma patients was 1185.7 per 100,000; compared with the prevalence of this disease in the general population (52.3 per 100,000) a significant difference is demonstrated (p < 0.0001) and it is related to Hodgkin lymphoma.

Adolescent↗
PubMed1980

Aetiology of persistent peripheral lymphadenopathy in Nigerian children.

In one year, excisional lymph node biopsy was done in 54 children who presented with persistent peripheral lymph node enlargement. Tuberculosis occured in 26 cases (48%), malignancy in 18 cases (33%); in 10 cases (18.5%) no specific diagnosis was made. Clinical features were not predictive of the histological diagnosis. When the initial biopsy had been non-diagnostic, specific disease did not develop.

Adolescent↗
PubMed1987

Tuberculostearic acid in lymph nodes from patients with sarcoidosis.

It has earlier been suggested that mycobacteria may play an aetiological role in the development of sarcoidosis. To investigate this further we analyzed the presence of a characteristic mycobacterial constituent, tuberculostearic acid (TS, 10-methyloctadecanoic acid), in lymph nodes from 22 patients with sarcoidosis and in eleven children and three adult controls. To detect TS gas chromatography/mass spectrometry was used. These findings were compared with the results from conventional mycobacterial culture and radiometric respirometry. Although the latter techniques failed to detect mycobacteria in all the tested tissue samples, TS was found in various amounts. Thus, 0-3 micrograms TS/g freeze-dried tissue was noted in eight sarcoid patients, 3-50 micrograms TS/g in eight and 51-400 micrograms TS/g in the remaining six patients. Among the controls only 1/14 had detectable TS. In one patient with lymph node tuberculosis TS was in the range 51-400 micrograms/g. We conclude that the findings could be explained by the presence of mycobacteria not cultivable with the studied techniques or with the presence of remnants after an earlier colonisation with mycobacteria, e.g. BCG-vaccination. Mycobacteria or mycobacterial cell-envelope in sarcoid tissue may possibly act as cofactors in the development of the disease, i.e. they might function as triggering agents (adjuvans) of the immune response. On the other hand the findings may be without any aetiological significance. In that latter case a hitherto unknown lack of wax decomposition during several decades has to be considered.

Adult↗
PubMed1997

Abdominal ultrasound findings of disseminated tuberculosis in AIDS.

The sonographic findings of 76 patients with tuberculosis and HIV infection are described. These findings were compared with a control group of 76 HIV-positive patients without associated pathology. Those patients with tuberculosis and positive HIV titers commonly (p = 0.05) showed retroperitoneal and mesenteric adenopathies with node diameters greater than 1.5 cm (n = 27), and multiple, splenic, hypoechoic nodules between 0.5 cm and 1 cm (n = 11). Additional findings include hepatic hyperechoic nodules (n = 1) and retroperitoneal abscess (n = 1). The combination of ultrasound features can help in the diagnosis of abdominal tuberculosis in HIV-positive patients with non-specific clinical infections.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Imaging of extrapulmonary tuberculosis.

Diagnosis of extrapulmonary tuberculosis is often difficult. Although positive chest radiographic findings or a positive tuberculin skin test supports the diagnosis, negative results do not exclude extrapulmonary tuberculosis. However, recognition and understanding of the radiologic findings of extrapulmonary tuberculosis can help in diagnosis. The spine is the most common site of skeletal involvement. The femur, tibia, and small bones of the hands and feet are most commonly involved by tuberculous osteomyelitis. Tuberculosis of the joints is characteristically monoarticular; the knee and hip are most frequently affected. Central nervous system tuberculosis takes various forms, including meningitis, tuberculoma, abscess, cerebritis, and miliary tuberculosis. Ileocecal involvement is seen in 80%-90% of patients with abdominal tuberculosis. The most common manifestation of abdominal tuberculosis is lymphadenopathy. Genitourinary tuberculosis is the most common manifestation of extrapulmonary tuberculosis. Lymphatic tuberculosis is more common among children, with cervical or supraclavicular nodes most frequently involved. Tuberculosis of the breast is extremely rare and occurs most often in young, multiparous, lactating women. The radiologic features of extrapulmonary tuberculosis mimic those of many diseases. A high level of suspicion is required, especially in high-risk populations. A positive culture or histologic analysis of biopsy specimens is still required in many patients for definitive diagnosis.

Adult↗
PubMed1988

[A case of congenital tuberculosis].

A case of lethal acute congenital tuberculosis is reported in a 3-week-old infant who presented a crural adenopathy. An acute miliary pulmonary tuberculosis with extensive cutaneous reaction to tuberculin then appeared. Mycobacterium tuberculosis was found in the node and in urines. Specific treatment was ineffective and the child died within 5 weeks because of extensive lung lesions. A patent pulmonary tuberculosis was discovered in a grandmother that could not be incriminated to contamination because the incubation period was too short and the germ was of different type. A foetopathy could have been transmitted by the mother, who previously had a pulmonary tuberculosis, without late genital localisation. Therefore, a transient bacteriema from an enclosed older lung lesion in the mother may be evoked. A preventive treatment and a tight survey must be undertaken for a next pregnancy.

Acute Disease↗
PubMed1985

[Current status of tuberculosis in children and adolescents of East Germany].

The morbidity from juvenile tuberculosis in the GDR amounts presently to 0.6 per 100.000 in the age group 0 to 15 years. The GDR's centre for treating children affected by tuberculosis is the above hospital for lung diseases in the town of Harzgerode. Between 1980 and 1983 a total of 89 children (48 boys and 41 girls) with various forms of tuberculosis have been treated there. The anamnesis of the children with lung tuberculosis was largely unspecific, only 6 from 29 had pneumonia or pneumonia was suspected respectively. All patients with abdominal tuberculosis had pains in the peritoneal cavity, whereas 26 from 31 children with cervico-glandular tuberculosis developed local lymphatic nodes. The family anamnesis showed primary tuberculous infections, lung tuberculosis and other forms of tuberculosis in the respiratory system among the patient's parents, grandparents and other relatives. The cases were initially registered mainly with the special outpatients' departments for lung diseases and tuberculosis or with other surgically orientated departments. Whilst tuberculin tests with 2 TE on children with lung tuberculosis gave a clear diagnosis, the same tests proved to be negative in nearly all cases with histologically confirmed lymphatic tuberculosis. Tuberculous bacteria could be detected in only 15 from 29 cases of lung tuberculosis. A strict initial therapy with three antituberculous drugs, usually Streptomycin, INH and Ethambutol, is decisive for the successful treatment. In the following intermittent period Streptomycin and INH are preferred. The total duration of chemotherapy of all forms of juvenile tuberculosis is at present 9 months.

Adolescent↗
PubMed1996

Isolated lymphadenopathy on chest radiographs of HIV-infected patients.

AIM: To determine the aetiology of isolated intrathoracic lymphadenopathy on chest radiographs of HIV-infected patients. PATIENTS AND METHODS: Over a 40 month span in 1990-1993, 18 HIV-infected patients (13 men, 5 women) from our New York City adult HIV outpatient clinic development isolated intrathoracic lymphadenopathy (defined as intrathoracic nodal enlargement without other persistent abnormalities on chest radiographs). Serial chest radiographs (n = 18), CT scans when available (n = 7), and clinical charts (n = 18) were reviewed retrospectively. RESULTS: Median patient age was 34 (range 25-49) years. The diagnoses associated with adenopathy were Mycobacterium tuberculosis (Mtb) in eight (44%), Mycobacterium avium intracellulare complex (MAC) in four (22%), and Mtb and MAC co-infection in three (17%). Cryptococcal infection, thymic hyperplasia, and spontaneous resolution without diagnosis or treatment occurred in one patient each. In 16 (89%) of the 18 patients, lymphadenopathy was present in more than one nodal station. Enlarged nodes were found in the following sites: paratracheal/tracheobronchial (n = 14), aortopulmonary window (n = 9), hilar (n = 7), anterior mediastinum (n = 3), subcarinal (n = 2), and left paraesophageal (n = 2). CONCLUSION: Mycobacterial infection was the aetiology of isolated intrathoracic lymphadenopathy in 15 of 18 (83%) HIV-infected patients. When an inner city HIV-infected patient presents with isolated intrathoracic lymphadenopathy, we recommend an aggressive work-up for mycobacterial disease.

AIDS-Related Complex↗
PubMed2005

Comparing axillary and mediastinal lymphadenopathy on CT in children with suspected pulmonary tuberculosis.

BACKGROUND: Radiographic demonstration of mediastinal lymphadenopathy is important for the diagnosis of pulmonary tuberculosis (PTB). Plain radiographs are unreliable for this and CT, which is relatively more expensive and carries a high radiation burden, remains the gold standard. No studies correlating the presence of axillary with mediastinal lymphadenopathy have been reported. Such a correlation would allow for clinical or ultrasound diagnosis of PTB via the axilla. OBJECTIVE: To correlate the presence of axillary lymphadenopathy with mediastinal lymphadenopathy in children with suspected PTB. MATERIALS AND METHODS: CT scans were performed and reviewed in 100 children (prospectively recruited) with suspected PTB. The axilla and mediastinum were reviewed separately by covering the non-relevant sections on the CT scans prior to reading. Only nodes greater than 1 cm were regarded as pathological. RESULTS: Mediastinal lymphadenopathy was present in 46% of children; 70% had lymphadenopathy in either axilla. Bilateral axillary lymphadenopathy was identified in 47%. Axillary lymphadenopathy showed a sensitivity of 74% and a specificity of 33% for the presence of mediastinal adenopathy. Bilateral axillary adenopathy had a sensitivity of 50% and a specificity of 56%. CONCLUSIONS: Axillary lymphadenopathy has a moderate sensitivity and low specificity for the presence of mediastinal and hilar lymphadenopathy in children with suspected PTB. Further research should be aimed at correlating ultrasound-detected axillary lymphadenopathy with FNA results in children.

Axilla↗
PubMed1998

Isolated cervical tuberculosis in patients with HIV infection.

OBJECTIVE: Tuberculosis isolated to the head and neck region is common in patients with HIV infection. However, the management of isolated head and neck tuberculosis has not been reported in the literature. This study was done to describe the characteristics of tuberculosis isolated to the head and neck region in patients infected with HIV and to detect differences in presentation and diagnostic management based on the status of HIV infection at presentation. METHODS: A retrospective study was performed including 38 patients infected with HIV who were seen with tuberculosis isolated to the head and neck region at two tertiary care centers during a 10-year period. These patients were divided into two groups on the basis of the HIV status at presentation, which indirectly reflects the level of immunosuppression. Group 1 included 11 patients (29%) with AIDS at presentation. Group 2 included 27 patients (71%) with HIV infection but not AIDS. RESULTS: The cervical lymphatics were the most common site for isolated head and neck tuberculosis (89%), with the supraclavicular nodes most often involved (53%). Extralymphatic involvement was less common (11%), but involved a variety of anatomic locations (skin, spinal cord, larynx, parotid). The presenting history and physical examination had a low sensitivity for tuberculosis in patients with HIV infection, mainly because of the presence of multiple confounding factors. Purified protein derivative testing was highly sensitive for tuberculosis in patients with HIV infection alone (61 %); however, its usefulness was diminished in patients with AIDS (14%; p=0.03). Fine-needle aspiration biopsy was 94% sensitive for diagnosing tuberculosis and was not affected by the status of HIV infection. Surgical biopsy was the gold standard for diagnosing tuberculosis but was associated with chronically draining fistulas in a significant number of cases (14%). CONCLUSIONS: These data suggest that tuberculosis should be considered in the differential diagnosis of all head and neck lesions in patients infected with HIV, even in the absence of pulmonary involvement. Purified protein derivative testing should be done liberally in these patients, with realization that the sensitivity of purified protein derivative testing is reduced in patients with AIDS. Fine-needle aspiration biopsy should be the key diagnostic test in this patient population, with open surgical biopsy reserved for highly suspicious cases in which other measures were not diagnostic.

Adult↗
PubMed1975

Diagnosis and management of tuberculous cervical adenitis.

In a series of 133 patients with a primary diagnosis of tuberculosis admitted to the Naval Regional Medical Center, San Diego, Calif, during a four-year period from July 1967 to July 1971, 29 (16.7%) had extrapulmonary lymphadenitis. The cervical region was involved in 20 (68.7%) of these cases. This report reviews the history of scrofula and deals with specific diagnostic tests which are helpful in separating tuberculous adenitis from other masses found commonly in the neck. Excisional biopsy and methods of handling these specimens are stressed. The higher incidence of tuberculous lymphadenitis in dark-skinned individuals, especially Orientals, when compared with a similar population group with pulmonary tuberculosis is noted and theories for this stated.

Adult↗