Lingual tuberculosis revealing disseminated tuberculosis

INTRODUCTION: Tuberculous lesions of the oral cavity are uncommon. Most of cases are secondary to pulmonary disease and the primary form is rare. EXEGESIS: We report the case of a 64 year-old man, smoker, presenting a chronic ulcer of the tongue, with anorexia and important weight loss. The biopsy of this ulcer showed granulomatous inflammation and Langhans type giant cells, without necrosis. Ziehl-Nielsen stain was negative. Pulmonary lesions were subsequently detected (chest X-ray, CT-scan) and the disseminated tuberculosis was confirmed by a positive culture with acid-fast bacilli in urine, blood, and pulmonary sample. Antituberculosis treatment resulted in the complete resolution of the oral lesion. CONCLUSION: Biopsy for histopathological diagnosis, acid-fast stains and culture, is essential to determine the exact nature of chronic oral ulceration to distinguish between oral malignancy, infectious (syphilis), traumatic, or aphthous ulcers. Tuberculosis of the tongue is a difficult diagnosis. However it should be searched for because treatment usually results in a rapid recovery.     

Hypertrophic tuberculosis of vulva--a rare presentation of tuberculosis

The authors report a rare case of hypertrophic vulval tuberculosis of primary origin in a 26-year-old female patient. The diagnosis was mainly based on histopathological examination. Good outcome was obtained with antitubercular chemotherapy supplemented with surgical reduction for aesthetic concern.     

结核分枝杆菌肝素结合血凝黏附素与结核病

结核分枝杆菌肝素结合血凝黏附素是一种表面蛋白,有3个功能结构域,其C末端在翻译后进行甲基化修饰,与其免疫特性相关.可结合硫酸化糖,可通过补体C3介导与巨噬细胞的结合,与上皮细胞结合在肺外结核发病中有重要作用.通过对其细胞免疫及体液免疫作用的研究发现,其在诊断中有较好的作用,在免疫预防及免疫治疗中有广阔的应用前景.     

Present-day treatment of tuberculosis and latent tuberculosis infection

The major objectives of tuberculosis (TB) control are to reduce morbidity and mortality via an early and appropriate treatment of the disease, to prevent carriers of the Mycobacterium tuberculosis bacillus from transmitting it to others, and to prevent latent tuberculosis infection (LTB) sufferers from progressing to the disease. To achieve these objectives, it is imperative to start an appropriate, effective antituberculosis treatment as early as possible, as well as identify contacts of the infected TB patient and others at risk of LTB progressing to TB, in order to establish an appropriate treatment for them. Here we review the bases for treating TB and LTB infections, including those produced by strains resistant to anti-TB drugs.     

Hepatic tuberculosis in absence of disseminated abdominal tuberculosis

Liver involvement in tuberculosis in absence of miliary tuberculosis is rare. This study was performed to analyse the spectrum and response to treatment of hepatic tuberculosis in the absence of miliary abdominal tuberculosis. Retrospective analysis of seven cases of hepatic tuberculosis without miliary abdominal tuberculosis who presented at the single tertiary referral center were analyzed. All patients presented with fever and hepatomegaly. Five of them had pain in upper abdomen and vomiting. HIV serology was positive in one patient. All patients had normocytic normochromic anaemia, raised erythrocyte sedimentation rate (Mean 65). Mild elevation of liver enzymes and low albumin (Mean 2.4 gm%) with reversal of albumin globulin ratio (Mean 0.6) were seen in all. Two had jaundice. Prothrombin time was normal in all and lactate dehydrogenase values were elevated in all (Mean 794 IU/L). On ultrasonography, 2 had multiple hypodense lesion, 1 had coarse echotexture of liver, 1 had hyperechoic pattern and 3 had just hepatomegaly. Complete resolution of liver lesions on treatment with 4-drug anti-tuberculosis drug chemotherapy was seen. In conclusion, liver tuberculosis has protean manifestations with nonspecific alteration of liver function tests and is best diagnosed on liver biopsy. Overall response to therapy is satisfactory.     

A case of pulmonary tuberculosis preceded by skin tuberculosis

We report a case of pulmonary tuberculosis, which was preceded by skin tuberculosis. 65-year old male was admitted to our hospital complaining of skin eruption which last one year. Skin biopsy proved granuloma with acid-fast bacilli. Mycobacterium tuberculosis was detected by PCR examination using skin biopsy and skin tuberculosis was confirmed. Chest roentogenography demonstrated small nodules with bilateral infiltrates compatible with pulmonary tuberculosis. M. tuberculosis was attained by culture examination using sputa sample. In this case, skin tuberculosis was a first clinical sign to suggest pulmonary tuberculosis. Peripheral blood test showed that he has developed adult T-cell leukemia and this could be an important factor for developing skin tuberculosis. Although skin tuberculosis becomes rare disease, physician should pay attention for this disease as differential diagnosis of lasting eruption.     

Treatment of multidrug resistant tuberculosis in Santakiskes tuberculosis hospital

The authors studies 98 patients (82 males and 16 females) in 1994-1996. The patients were found sputum Mycobacteria tuberculosis (MT) resistant to two essential antituberculosous drugs: isoniazid and rifampicin. In 67 (68.4%) cases MT resistance was verified in other laboratories of the country. The examinees were 13 new cases and 17 had relapses. Sixty eight patients were diagnosed as having chronic tuberculosis. After multidrug resistant strains were identified, the patients were treated by an individual regimens by choosing adequate drugs from different groups. Twenty patients were operated on. Sputum conversion occurred in only 24 (24.5%) patients. In 14 of them clinical and X-ray lesion disappeared. In 74 (75%) good treatment outcomes were not achieved and MT remained in the sputum. There were statistically significant differences in the treatment outcomes among new, relapsing, and chronic cases (poor treatment outcomes were in 38.5, 64.7, and 85.3%, respectively). The surgical outcomes proved to be no better than those in drug-treated patients due to the incorrect definition of indications for surgery or advanced disease. The findings show that the outcomes were poor in chronic MT multidrug-resistant patients and fair results could be achieved in new cases of the disease diagnosed in time.     

三种结核抗体试剂盒在结核病诊断中的应用评价

目的 评价3种结核抗体试剂盒在结核病诊断中的应用价值。方法 收集2015年1—12月解放军第三〇九医院病理科应用聚合酶链反应反向斑点杂交法(polymerase chain reaction-reverse dot blot,PCR-RDB)进行组织标本分枝杆菌菌种鉴定(以下称“分子病理”)的601例患者资料,排除不符合纳入标准的患者,最终纳入205例患者。通过病案检索获得3种结核抗体试剂盒(TB-IgG、SD Rapid TB、TB-DOT)检测外周血结核抗体的结果。应用SPSS 20.0统计学软件,分析3种结核抗体相较于分子病理学检测的敏感度、特异度等检测效能,采用McNemar检验和Kappa值分析检测结果的差异性和一致性。结果 以分子病理检查结果为标准,TB-IgG、SD Rapid TB、TB-DOT 试剂盒的敏感度分别为26.6%(34/128)、20.3%(26/128)、97.7%(125/128);特异度分别为90.9%(70/77)、98.7%(76/77)、3.9%(3/77);阳性预测值分别为82.9%(34/41)、96.3%(26/27)、62.8%(125/199);阴性预测值分别为42.7%(70/164)、42.7%(76/178)、50.0%(3/6);正确指数分别为0.18、0.19、0.02。TB-IgG、SD Rapid TB 试剂盒检测结果分别与分子病理检查相比较,诊断差异均有统计学意义( {\chi }_{\mathit{配对}}^2 =9.17,P<0.001;矫正 {\chi }_{\mathit{配对}}^2 =13.58,P<0.001),且与分子病理检测存在微弱一致性(Kappa值分别为0.14、0.15,P值均<0.001);而TB-DOT与分子病理的诊断差异无统计学意义(矫正 {\chi }_{\mathit{配对}}^2 =0.04,P=0.833),不能肯定与分子病理检测存在一致性(Kappa值=0.02,P=0.523)。 结论 3种结核抗体试剂盒检测结果存在一定差异,SD Rapid TB在3种检测方法中相对较好;多种抗原联合检测可以提高检测的敏感度和特异度,对结核病诊断具有辅助价值。     

Delayed tuberculosis diagnosis and tuberculosis transmission.

SETTING: Tuberculosis (TB) patients and their close contacts reported to the Maryland Department of Health and Mental Hygiene from 1 June 2000 to 30 November 2001. OBJECTIVES: A recent prospective study found that 49% of pulmonary TB patients had total treatment delays > or = 90 days. This cohort was analyzed to determine the association between total treatment delay and TB transmission. DESIGN: TB patient data were collected as part of a prospective cohort study; contact data were collected from local health departments. RESULTS: Close contacts of 54 US-born patients (n = 310) and those of 70 foreign-born cases (n = 393) received tuberculin skin tests (TSTs). Among contacts of US-born patients with a total treatment delay of > or = 90 days, 40% had positive TSTs vs. 24% contacts of patients with shorter delays (aOR 2.34; P = 0.03). Other patient factors associated with TST positivity among contacts of US-born cases were black race (aOR 3.03; P = 0.05), sputum smear positive for AFB (aOR 3.29; P = 0.01) and chest radiograph with cavitation (aOR 3.11; P = 0.01). No associations were observed between foreign-born patients and risk of TST positivity among their contacts. CONCLUSION: Among US-born patients, delay in TB diagnosis is associated with greater transmission of infection to contacts and could be used independently of other index patient factors to identify contacts at greatest risk of TB infection.