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PubMed2002

HRCT findings of chest complications in patients with leukemia.

High-resolution CT (HRCT) findings of several chest complications occurring in leukemic patients were reviewed. Although most entities show non-specific HRCT findings including ground-glass opacity and air-space consolidation, characteristic findings are observed in several pulmonary complications including Pneumocystis carinii pneumonia, fungal infections, miliary tuberculosis, leukemic infiltration, pulmonary edema, bronchiolitis obliterans, and bronchiolitis obliterans organizing pneumonia. A combination of these characteristic HRCT findings and the information obtained from the clinical setting may help in achieving a correct diagnosis of chest complications occurring in leukemic patients.

Bronchiolitis Obliterans↗
PubMed1989

Acquired immune deficiency syndrome presenting as a palatal perforation.

Head and neck manifestations are particularly frequent in the acquired immune deficiency syndrome. An unusual case of acquired immune deficiency syndrome in a female prostitute whose initial presentation included a palatal perforation is reported. This case is also noteworthy because the patient died of disseminated miliary tuberculosis, a disease only recently included in the Centers for Disease Control case definition of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1979

Ethambutol in pregnancy--foetal exposure.

We report a case of miliary tuberculosis in a pregnant Jamaican woman in whom foetal exposure to ethambutol has been assessed. The mother received 15 mg/kg ethambutol as part of her antituberculosis therapy. Immediately after delivery, amniotic fluid, maternal, placental, and cord blood specimens were obtained and analysed for ethambutol concentrations. The levels were within the therapeutic range in all 4 samples. The concentrations indicate that the placenta is not a significant physiological barrier to the transfer of ethambutol to the foetus.

Adult↗
PubMed1990

Tuberculous pancreatitis.

We describe a case of severe tuberculous pancreatitis in a 26-year-old woman with miliary tuberculosis. Recognition of this complication is important as it may interfere with adequate absorption of anti-tuberculous drugs and it can lead to unnecessary laparotomy.

Adult↗
PubMed1985

Reversible total esophageal exclusion.

A 23-year-old man with miliary tuberculosis had severe esophageal hemorrhage secondary to eroding tuberculous nodes. Balloon tamponade and packing with gauze did not alter the profuse bleeding. Empyema of the right thorax, massive mediastinal nodes, an unknown site of bleeding in the esophagus, and diffuse pulmonary involvement with tuberculosis precluded a thoracotomy. Because of widespread peritoneal tuberculosis, permanent esophageal exclusion by ligation was rejected as bowel interposition would have been extremely difficult at a later time. Reversible total esophageal exclusion was successfully utilized.

Adult↗
PubMed1980

Cerebral tuberculomas developing during treatment of tuberculous meningitis.

Cerebral tuberculomas developed in two adult Asian immigrants during treatment for miliary tuberculosis and tuberculous meningitis. Both were infected by strains of Mycobacterium tuberculosis sensitive in vitro to all antituberculous drugs, and no evidence of immunodeficiency was detected. Focal neurological signs appeared and the lesions led to the death of one patient despite maximum treatment. The importance of systemic corticosteroids in controlling the raised intracranial pressure is discussed.

Adolescent↗
PubMed2003

The sensitivity and specificity of Brucella agglutination tests.

Brucellosis is a systemic infectious disease caused by Gram-negative bacilli, the genus Brucella, and clinical features are diverse. Therefore, several infectious and non-infectious diseases are considered in its differential diagnosis. In this study, we aimed to determine the positivity rate of Brucella agglutination tests in the culture-positive brucellosis and in diseases mimicking brucellosis clinically.Thirty patients with culture-positive brucellosis, and 280 patients with the diseases mimicking brucellosis clinically (20 with miliary tuberculosis, 33 with malaria, 20 with typhoid fever, 20 with adult-onset Still's disease, 47 with systemic lupus erythematosus, 50 with rheumatoid arthritis, 27 with sarcoidosis, and 63 with active lymphoma) were included in the study. Brucella agglutination tests (Rose-Bengal and Wright) were studied in serum samples of these 310 patients. Both Rose-Bengal and Wright tests (the latter in a titer of 1/160 or higher) were positive in all patients with brucellosis. For the other diseases, the test was slightly positive (1/40) in one patient with malaria and another with non-Hodgkin's lymphoma, and weakly positive (1/20) in a patient with typhoid fever. It remained negative in the remaining. In conclusion, agglutination tests currently used in the diagnosis of brucellosis are very sensitive and specific. Brucellosis can be effectively excluded from the diseases having similar clinical features by the use of agglutination tests.

Agglutination Tests↗
PubMed2004

CD14 gene promoter polymorphism in different clinical forms of tuberculosis.

Mycobacterium tuberculosis interacts with monocyte-macrophages through cell surface molecules including CD14. A soluble form of CD14 (sCD14) exists in human serum, and higher amounts of it are found in tuberculosis. A polymorphism on CD14 gene promoter was associated with increased sCD14 levels in some diseases. To evaluate whether this polymorphism associates with tuberculosis, its clinical forms, and increased sCD14, genotype/allele frequencies in tuberculosis patients were compared with the controls. Results confirmed increased levels of sCD14 in patients with tuberculosis, and those with miliary tuberculosis had the highest levels. sCD14 decreased to normal levels after anti-tuberculosis treatment. No association was found between the CD14 polymorphism and tuberculosis or sCD14 levels. Results suggest that sCD14 may be involved in anti-tuberculosis immune response, but its increase is a consequence of infection rather than a predisposed genetic trait. Measuring sCD14 in tuberculosis may help monitor anti-tuberculosis treatment.

Adolescent↗
PubMed1994

[HIV-associated histoplasmosis with pulmonary manifestation in Europe].

A 35-year-old man developed weight loss, lower abdominal pain, diarrhoea, cough, fever and general deterioration in his health. He had been born and resident in the USA until 1991, when he moved to Germany. Since 1991 he had known that he was HIV-positive. The chest radiograph showed bilateral diffuse spotty marking and a rounded cardiac silhouette, the latter echocardiographically due to pericardial effusion. Tuberculostatic drugs were started because miliary tuberculosis was suspected. But as his condition worsened and he was thought to have Pneumocystis pneumonia high doses of co-trimoxazole were administered. Perbronchial lung biopsy showed nonspecific chronic inflammatory changes. Periodide acid-Schiff reaction and Grocott staining demonstrated numerous histoplasma in alveolar macrophages and connective tissue. The organism was also cultured from bronchial secretions. Treatment was now changed to itraconazole (400 mg daily), 2 weeks later changed to liposomal amphotericin B (100 mg daily) because of renewed fever. After 6 weeks the patient became free of symptoms and the radiological changes had largely regressed. To prevent recurrence, treatment with itraconazole (400 mg daily) is being continued.

AIDS-Related Opportunistic Infections↗
PubMed1993

Tuberculous laryngitis in a Nigerian child.

A 12.5-year-old Nigerian child presented with progressively worsening hoarseness of 9 months duration, without overt features of chronic ill health. Superficial discrete cervical adenitis, radiological evidence of miliary tuberculosis and hilar adenopathy were identified on admission. The laryngoscopic findings comprised fully mobile but 'beefy' red, oedematous vocal cords and interarytenoid region. The diagnosis of tuberculous laryngitis was made on the basis of the laryngoscopic, radiological and clinical improvement that followed antituberculous therapy. The possible pathogeneses of tuberculous laryngitis are discussed. We emphasize the importance of considering tuberculous laryngitis in a child with persistent hoarseness.

Child↗
PubMed1996

Pneumocystis carinii pneumonia with an atypical granulomatous response.

Pneumonia due to Pneumocystis carinii may present atypical radiographic and pathologic findings. We report the case of a 32-year-old man with acquired immune deficiency syndrome (AIDS) whose chest roentgenogram showed a bilateral diffuse nodular pattern suggestive of miliary tuberculosis. Diagnosis ultimately required open lung biopsy, which showed evidence of an atypical granulomatous reaction with Pneumocystis carinii in the absence of other organisms. P carinii pneumonia must be considered in the differential diagnosis of patients with AIDS with nodular pulmonary densities and evidence of an atypical granulomatous reaction on pathologic specimens.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Bayesian estimation of streptomycin pharmacokinetics.

Streptomycin dose requirements were determined in an 83-year-old man with renal impairment who was being treated for miliary tuberculosis. Concentration measurements were interpreted using a Bayesian parameter estimation program. Estimated creatinine clearance (1.1 L/h) was used as a starting value for streptomycin clearance, and volume was initially assumed to be 0.3 L/kg. Bayesian estimates of clearance were close to the starting value and declined from 1.4 L/h to 0.9 L/h during the course of therapy. Volume was higher than the initial estimate (0.4-0.5 L/kg), possibly due to the patient having a low albumin and being underweight. Satisfactory concentrations were maintained for several weeks with doses of 500 mg every 36-48 h.

Aged↗
PubMed1985

Systemic lupus erythematosus with multiple calcified fibrous nodules of the spleen.

An autopsy case of systemic lupus erythematosus (SLE) in a 39-year-old woman with peculiar multiple splenic nodules is reported. Multiple calcific nodular shadows were incidentally found in the left hypochondrial region on chest and abdominal X-ray films taken at admission. The patient died of chronic heart failure due to massive pericardial effusion as one of the manifestations of SLE with 2 and a half years' clinical course. Lupus nephritis and terminal miliary tuberculosis were the other conspicuous autopsy findings. The splenic nodules were almost evenly distributed on each cut-surface of the spleen at the density of about 5/cm2. Each nodule was spherical in shape and 1 to 3 mm in diameter. Most of the nodules were calcified in variable degrees. Semi-serial sectionings and reconstruction procedure of the nodules disclosed that they were formed around the central or penicillary arteries and had a close relation to so called "onion-skin lesion" of the spleen in SLE. The true nature, pathogenesis, and relation of the nodules to SLE are discussed.

Adult↗
PubMed1983

Tuberculosis in the geriatric patient.

Active tuberculosis is highly prevalent in the geriatric population. The clinical syndromes and diagnostic indications of the different forms of tuberculosis are described. Reactivation pulmonary tuberculosis and miliary tuberculosis in the elderly are particularly difficult to diagnose. A high index of suspicion, a tuberculin skin test, and appropriate laboratory studies are essential for early diagnosis. Therapy for tuberculosis in the elderly must consider efficacy, patient compliance, and toxicity.

Adolescent↗
PubMed1999

[Analysis of tuberculin reaction of tuberculous children below 4 years of age].

To clarify whether the size of tuberculin reaction could be used as an useful index of the severity of tuberculosis, we analyzed the sizes of tuberculin reaction (TR) of 60 children below 4 years of age with active tuberculosis at the time of diagnosis. Of 60 patients, 53 (88.9%) had positive reactions to tuberculin. The mean size of TR of 60 patients was 24.0 +/- 13.9 mm and maximum size was 60 mm. Seven patients who had no reaction to the tuberculin skin test consisted of three primary complex and four serious tuberculosis (two miliary tuberculosis and two tuberculous meningitis). The patients without BCG vaccination showed significantly smaller TR than the patients with BCG vaccination (p < 0.05). The patients less than 1 year of age showed significantly smaller TR than the patients of 4 years of age (p < 0.05). The patients with serious tuberculosis showed significantly smaller TR than the patients with primary complex (p < 0.05). Of patients with primary complex, there were no difference of the size of TR between the patients with pulmonary tuberculosis (III) and hilar lymphadenopathy (H). Together with, it did not necessarily mean that negative TR showed no infection with tuberculosis and the sizes of TR depended on the severity of tuberculosis in infantis and young children.

Child, Preschool↗
PubMed1975

Fatal infections in protein-calorie malnourished children with thymolymphatic atrophy.

The clinicopathological features of 25 children who died with protein-calorie malnutrition were studied. All but four subjects were found at necropsy to have nutritional thymectomy and all but 3 died of infectious diseases. The infectious agents were chiefly intracellular micro-organisms including miliary tuberculosis, Herpes simplex, varicella, measles, Pneumocystis carinii, and Plasmodium falciparum. Staphylococcal infections, salmonellosis, shigellosis, strongyloidiasis, and hookworm were other significant infectious agents. Nutritionally acquired defective immunity, especially cell-mediated immunity, probably permitted these infectious agents to multiply and to disseminate widely.

Atrophy↗
PubMed1984

Value of C reactive protein measurement in tuberculous, bacterial, and viral meningitis.

The value of C reactive protein measurement in the differential diagnosis of meningitis was assessed in a population where tuberculous meningitis is prevalent. C reactive protein was measured serially with a sensitive radioimmunoassay in sera from 31 children with bacterial meningitis, 15 with tuberculous meningitis (6 with miliary tuberculosis), and 28 with viral meningitis. Concentrations of C reactive protein in patients with tuberculous meningitis lay between those of patients with bacterial and viral meningitis--a finding which detracts from the virtually absolute discrimination C reactive protein measurement allows between bacterial and viral meningitis. In all but two of the patients with tuberculous meningitis, C reactive protein concentrations fell rapidly after treatment began and became normal after 10 days. This fall did not, however, exclude the development of hydrocephalus as a complication. Measurement of C reactive protein remains a useful additional parameter in the diagnosis and management of the various types of meningitis.

Adolescent↗
PubMed1980

Para-aminosalicylic acid-induced hypoglycaemia in a patient with diabetic nephropathy.

A 62-year-old Indian with diabetic nephropathy controlled with metformin, developed miliary tuberculosis for which he was treated with rifampicin, isoniazid and ethambutol. Soon afterwards he developed cholestatic hepatitis and visual disturbance. Rifampicin and ethambutol were stopped. Streptomycin caused vertigo and had to be stopped. The introduction of para-aminosalicylic acid (PAS) led to hypoglycaemic coma. Metformin was stopped. Hypoglycaemic coma recurred. PAS was stopped and the patient's blood glucose concentrations became normal. Treatment with isoniazid and ethambutol led to total recovery from pulmonary tuberculosis. The induction of hypoglycaemia with PAS in this patient suggests a potential role for PAS in the treatment of diabetes mellitus.

Aminosalicylic Acid↗