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PubMed2000

[Carbohydrate metabolism impairment and specific features of the course of tuberculosis in adolescents with diabetes mellitus].

The paper deals with the detection of carbohydrate metabolic disturbances in adolescents with tuberculosis and analyzes their impact on the course of a specific process. Borderline carbohydrate metabolic disorders were identified in 10.8% of the 130 patients examined. A trend for tuberculosis to run less favourably was found in patients with carbohydrate metabolic disturbances than in those without these disorders; however, there was no significant difference between the groups. Fourteen tuberculosis adolescents with diabetes mellitus were followed up. Their concurrence showed a severe course. In 33.2% of patients, the course of tuberculosis was poor, by progressing to fibro-cavernous tuberculosis.

Adolescent↗
PubMed2000

Brain tuberculomas.

Although brain tuberculomas have become rare in developed countries, diagnosis should be kept in mind when confronted with brain space-occupying lesion(s), particularly in immigrants from endemic countries. Surprisingly, Human Immunodeficiency Virus (HIV) infection does not seem to have affected the incidence of this tuberculous lesion. Clinical, biological and radiological signs are only suggestive. Thus, when no other active extracranial tuberculous process is found, the diagnosis should be confirmed by a biopsy before beginning antituberculous treatment which is rapidly effective. Adjunction of steroids may be warranted owing to the common paradoxical enlargement of lesions during the first weeks of therapy, as is now well described in lymph node tuberculosis. Cure can be obtained in more than 85% of the cases, but neurological sequelae are not rare.

AIDS-Related Opportunistic Infections↗
PubMed2000

Surgery in tuberculosis.

Tuberculosis in children involves many organs and systems including lymphatics, lungs, CNS, GIT and genitourinary. Although the mainstay of treatment is medical, surgery has a definite role under specific circumstances. It is important to differentiate atypical mycobacterial infection wherein surgery is the primary modality of treatment. The lung is most commonly involved in tuberculosis and besides bronchoscopy, thoracic procedures range from tube thoracostomy to decortication and lung resection. Neurotuberculosis constitutes almost half the cases of extrapulmonary tuberculosis and tuberculous meningitis (TBM) is the commonest type of CNS involvement. Hydrocephalus is a late complication of TBM and shunt surgery is indicated when signs and symptoms of raised intracranial pressure persist despite adequate medical therapy. Abdominal tuberculosis could be peritoneal or gastrointestinal. Either form can complicate the other and each can present in acute, subacute or chronic form. Surgical therapy is reserved for complications like strictures, fistulae and GI bleed. Genitourinary tuberculosis constitutes 15-20% of all extrapulmonary disease and epididymitis is the most common manifestation in the males. Surgery is generally reserved for management of complications such as ureteral strictures, perinephric abscesses and nonfunctioning kidneys.

Child↗
PubMed1975

[Epidemiology of Tuberculosis in Children from 1968 til 1973 in Schleswig-Holstein (author's transl)].

In Schleswig-Holstein 271 children (131 boys, 140 girls) were treated for tuberculosis between january 1968 and June 1973; 84% were aged 5--14 years, 14% between 1--4 years and 29% between 0--1 year. Each year, nearly the same number of infections occurred in the various districts of the country. In 246 children a primary form of tuberculosis was diagnosed (in 11 cases with pleurisy). 11 patients tuberculous meningitis, 3 patients miliary tuberculosis and 5 patients another form of the disease, 18 of 271 patients (7%) had been vaccinated against tuberculosis as newborns; in 4 of these children tubercle bacilli could be isolated. BCG vaccination had been done 8--12 years before disease in 11 cases and 1--5 years before disease in 7 cases. None of these vaccinated children had a hematogenous tuberculosis or died. Of the non-vaccinated children two patients had meninogencephalitis and died. The other children were cured by chemotherapy, 12 children by additional surgery. The morbidity of tuberculosis in Schleswig-Holstein was 7--10 per 100000 children. Therefore, further BCG vaccination, chemoprophylaxis or preventive chemotherapy seems necessary. Early recognition of tuberculosis in old persons may be of practical value to prevent infections in children.

Adolescent↗
PubMed2000

[Mental confusion and multifocal lymphatic and pulmonary tuberculosis. A case report].

This report describes a case of mental confusion associated with ongoing adenitis and pulmonary tuberculosis in a 20-year-old man with no history of psychiatric disorders. Diagnosis was based on clinical and laboratory findings. Tranquillizers improved mental status and antituberculosis treatment was administered before referring the patient to an internal medicine department. The authors emphasize the rarity of these cases in the Senegalese medical literature and discuss possible diagnostic pitfalls.

Acute Disease↗
PubMed2001

[Extrapulmonary tuberculosis in children in Russia (epidemiology, clinical forms and their study)].

The paper provides the data of comprehensive epidemiological and clinical studies made at the Clinic of Tuberculosis in Children and Adolescents. Research Institute of Phthisiopulmonology, I. M. Sechenov Moscow Medical Academy, Ministry of Health of the Russian Federation, in the past 15 years and dedicated to extrapulmonary tuberculosis in children and adolescents with tuberculosis. Due to the specific features of manifestations of extrapulmonary tuberculosis in childhood and adolescence and to the existing system of prevention and early detection of the disease in children and teenagers in the Russian Federation, the number of children with severe generalized extrapulmonary tuberculosis is not on the rise despite that the epidemiological situation has aggravated in the past 15 years. The clinical features of most common forms of extrapulmonary tuberculosis are shown and measures for their monitoring proposed.

Adolescent↗
PubMed2001

[Clinical and radiographic manifestations of tuberculous spondylitis in adults].

Data on 348 adult patients with tuberculous spondylitis treated in 1994-1999 are analyzed. The radiation manifestations of spondylitis first occurring in maturity, which amount to 82.3% in the clinical setting were studied in 112 patients. In 50% of cases, spondylitis was a manifestation of multiorgan tuberculosis. The proportion of those with onset in youth increased (27.9). Isolated lesions of the corpus vertebrae were more frequently detected. The processes involving 2 vertebrae were predominant (61.2%), but complicated by foci at new levels. There was a drastic increase in the proportion of disseminated and multi-levelled spondylitis involving 3-9 vertebrae (36.9%). The exudative component of the inflammation was much pronounced, abscesses were extensive in all forms of spondylitis. Spinal cord deficit was noted in 68% of cases of thoracic and cervical spondylitis. MRI should be used for early diagnosis and determination of the extent of a process.

Adolescent↗
PubMed2001

[Effectiveness of chemotherapy of intrathoracic tuberculosis in children: late follow-up data].

Clinical and X-ray studies were made in 148 children 2-10 years after hospital treatment to evaluate the stability of clinical recovery by the frequency of relapses in relation to the use of different drug treatment regimens. Children from an experimental group (n = 75) received shorter chemotherapy with 3-4 drugs (isoniazid, rifampicin, pyrazinamide in uncomplicated tuberculosis plus streptomycin in complicated one) in the intensive phase of chemotherapy. Pyrazinamide was not used in the intensive phase in the control group (n = 73). Long-term follow-ups showed a high efficiency of shorter chemotherapy regimens in treating intrathoracic tuberculosis in children since they do not lead to the higher incidence of recurrences--2.7% in both groups. The latter occurred in adolescents who had severe residual changes, who had been irregularly followed up at the tuberculosis control dispensary after hospital discharge, who had not received seasonal preventive chemotherapy courses, and who had experienced complicated, generalized or acute tuberculosis.

Adolescent↗