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Tuberculosis in the leopard frog (Rana pipiens).
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Tuberculous lymphadenitis: a survey of 94 cases.
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Extrapulmonary tuberculosis in the United States.
In recent years, the decrease in reported tuberculosis in the United States has been due almost entirely to a drop in the number of cases of pulmonary disease. There has been little change in the average number of extrapulmonary cases reported. A retrospective survey of extrapulmonary tuberculosis has shown that it differs from pulmonary tuberculosis with regard to sex and race distribution, diagnosing physician's speciality and proportion of cases bacteriologically confirmed. There is variation within extrapulmonary cases according to specific anatomic site with regard to the above characteristics as well as age distribution. These epidemiologic differences in tuberculosis of different sites are unexplained.
Non-respiratory tuberculosis in Canada. Epidemiologic and bacteriologic features.
Of the total cases of tuberculosis reported in Canada between 1970-1974, approximately one-sixth (3671 cases) involved primarily non-respiratory organs. Common diagnostic entities were genitourinary tuberculosis (1516 cases), lymphadenitis (1083 cases), bone and joint tuberculosis (555 cases), gastrointestinal tuberculosis (155 cases) and meningitis (138 cases). The remainder (224 cases) involved a wide variety of organs. Between 1967 and 1977 the morbidity rates of most non-respiratory manifestations steadily declined, the decline in meningitis being particularly marked. In contrast, lymphadenitis did not decline to the same extent, reflecting changing immigration patterns. The major diagnostic entities differed in their age and sex patterns and in their contribution to total cases by birthplace and ethnic group. In particular, the preponderance of lymphadenitis in females, and in the Asian-born was striking. Mycobacterium bovis was isolated infrequently and bacillary resistance to antituberculosis drugs was also uncommon. In a substantial proportion of cases, active tuberculosis was present concurrently at another site, or there was historical or radiologic evidence of previous active tuberculosis. Despite this additional evidence, delay and failure of diagnosis were common. An increased clinical awareness of tuberculosis is required, particularly in view of the often enigmatic presentation of non-respiratory disease.
The diagnosis of Poncet's disease.
Two cases of polyarthritis in young people with extra-articular tuberculosis are described. The clinical features were consistent with the concept of Poncet's disease. After synovial biopsy one patient proved to have tuberculous peripheral arthritis. This observation raised doubts about the diagnosis in the other patient. Multiple joints may be simultaneously infected with Mycobacterium tuberculosis and Poncet's disease, if it exists, should not be entertained in the absence of synovial biopsy.
Bone cancers induced by 224 Ra (Th X) in children and adults.
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High resolution CT findings of miliary tuberculosis.
PURPOSE: The purpose of this study was to analyze high resolution CT (HRCT) findings of miliary tuberculosis and to assess the clinical utility of HRCT in the management of patients with miliary tuberculosis. METHOD: We reviewed retrospectively HRCT scans of 25 patients with histopathologically (n = 16) and/or microbiologically (n = 9) proven miliary tuberculosis. RESULTS: HRCT scans showed miliary nodules in 24 patients, which varied in size from 1 to 5 mm, with either sharply (n = 21) or poorly (n = 3) defined margins. The nodules had diffuse random distribution throughout both lungs and within the secondary pulmonary lobules. In 23 patients, areas of ground-glass opacities (GGOs) were observed with variable extent and distribution. The patients who had dyspnea showed large areas of GGOs, and two patients with impending adult respiratory distress syndrome revealed extensive GGOs. Both intralobular reticulation and interlobular septal thickening were seen in 10 patients. CONCLUSION: Miliary nodules and GGOs are the predominant HRCT findings in patients with miliary tuberculosis, and HRCT scans are helpful in the early diagnosis and proper management of patients with miliary tuberculosis.
A randomized trial of fully intermittent vs. daily followed by intermittent short course chemotherapy for childhood tuberculosis.
Fully intermittent short course chemotherapy regimens have been used successfully in adults but not in children. We report the results on 76 children with tuberculosis, excluding central nervous system tuberculosis and primary pulmonary complex. Isoniazid, rifampin and pyrazinamide were used for treatment. They were randomly allocated to Regimen A (52 doses) and Regimen B (94 doses). Overall efficacy of both schedules was greater than 95% in 27 children with lymphatic, 43 with pulmonary and 6 with disseminated tuberculosis. Compliance in 10 children after 2 to 4 months of therapy was poor because rapid improvement was mistaken by parents for cure. Two children died, probably of underlying lung disease. Follow-up for up to 2 years did not reveal any case of relapse or recurrence of the disease. Therapy for 6 months involving administration of only 52 or 94 doses of drugs was found to be economical, effective and safe for treating children with tuberculosis.
Mycobacterium bovis versus Mycobacterium tuberculosis as a cause of acute cervical lymphadenitis without pulmonary disease.
Bovine tuberculosis remains a common disease of cattle in countries such as Mexico. Children eating unpasteurized dairy products from Mexican cattle can develop Mycobacterium bovis cervical lymphadenitis. However, the bovine mycobacterium can be misdiagnosed as Mycobacterium tuberculosis based on standard laboratory testing. Accurate speciation is important for selection of the preferred antibiotic regimen for treatment of Mycobacterium bovis infection.
Tuberculous lymphadenopathy masquerading as a bronchial foreign body.
A case of recent onset of wheezing with clinical and radiologic findings suggestive of foreign body aspiration is presented. Rigid bronchoscopy revealed an extraluminal compression of the airway. Histopathologic and microbiologic examination revealed tuberculous lymphadenopathy.
Group III atypical mycobacterial infections.
We retrospectively and prospectively examined the clinical presentation, course of disease, and response to therapy in 63 patients whose mycobacterial isolates were identified as Runyon group III atypical mycobacteria. All of the patients except four had pulmonary disease similar to typical pulmonary tuberculosis. The others had scrofula or abxcess. There was a male predominance and whites were slightly more frequently infected in our series. Forty-six percent of the patients were from rural Oklahoma. Skin testing and chest roentgenography were important, but culture of the organism appeared to be the only productive method of distinguishing the atypical disease from typical tuberculosis. Eighty-one percent had an associated disease. The isolates showed a very high rate of primary drug resistance, and this was reflected in the difficulty in controlling the infection.
Transient lung infiltrates, cervical lymphadenitis, and agranulocytosis in active tuberculosis.
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Intrathoracic lymphadenopathy in postprimary tuberculosis.
In the past, hilar or mediastinal lymphadenopathy was considered by many to be a feature of only the primary or first infection with Mycobacterium tuberculosis, and to exclude the diagnosis of reactivation or postprimary tuberculosis. In a series of 56 adult patients with documented postprimary disease due to M tuberculosis, we found hilar or mediastinal lymphadenopathy in three cases (5%). Although intrathoracic lymphadenopathy was more common in primary tuberculosis, we do not believe that intrathoracic lymphadenopathy is as specific for primary tuberculosis, particularly in the adult, as was once thought. For this reason, we believe that the roentgenographic demonstration of intrathoracic lymphadenopathy should not be used as a definitive research or clinical criterion for primary tuberculosis in an adult.
A multiorgan donor cancer screening protocol: the Italian Emilia-Romagna region experience.
BACKGROUND: We describe the Emilia-Romagna screening protocol for all multiorgan donors within this region of Italy and report on the first 2 years of implementation. SETTING: Setting is a 24-hour multidisciplinary call service covering the 16 intensive care units in Emilia-Romagna (3,969,000 inhabitants) and a centralised pathology center, directed by a transplant coordination center. STUDY POPULATION AND PERIOD: All 271 effective donor candidates presenting in Emilia-Romagna in 2001-2002. PROTOCOL: Anamnesis, external examination, and thorough laboratory and instrumental screening is followed by sampling of internal effusions and evaluation of all internal organs. All suspect findings are then investigated by extemporary pathologic evaluation. To fit national legal requirements, candidates are classified as standard risk (no transmissible risk); nonstandard risk (low-risk of transmission, eligibility restricted to certified clinical emergencies pending informed consent); and unacceptable risk (unconditional exclusion because of high-risk pathologies). RESULTS: The protocol was successfully implemented for all 271 candidates. In addition to 14 independent exclusions, clinical suspicion of cancer was raised for 61 donors presenting with 82 lesions or effusions. Along with one case of lymph-node tuberculosis (unacceptable risk), histocytologic screening revealed eight cases of malignancy (5 prostate, 1 papillary-thyroid, 1 follicular-thyroid, and 1 renal cell, all nonstandard risk); the remainder were benign (standard risk). Protocol implementation led to exclusion of 8 (3.0%) candidates (1 nonstandard risk transplantation was performed). CONCLUSIONS: This stringent protocol-now adopted with some modifications at a national level-provides an initial example of a feasible intervention aimed at maximising donation safety while rationalizing use of marginal donors.
Bilateral inguinal scrofuloderma during steroid therapy in a patient with bullous pemphigoid.
This report described a case of scrofuloderma that developed in the bilateral inguinal regions during treatment of bullous pemphigoid with systemic corticosteroid. Analysis of the literature on scrofuloderma between 1978-1993 disclosed that the number of cases with extracervical involvement are increasing. Immunosuppression could disseminate tuberculous focuses, resulting in extracervical involvement of SD connected with the underlying extrapulmonary tuberculous lesions.
Tuberculosis and blood disorders.
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Lichen scrofulosorum in a patient with AIDS.
A patient with AIDs who presented with pulmonary tuberculosis and cervical scrofuloderma developed a widespread eruption of lichenoid papules shortly after commencing antituberculous therapy. The clinical and histological features in this case were consistent with lichen scrofulosorum even though the tuberculin test was negative. To our knowledge this is the first reported case of lichen scrofulosorum in an HIV positive patient. The lesions cleared following 8 weeks of antituberculous therapy.