Epididymal tuberculosis: report of a case with particular color Doppler ultrasonography finding

Isolated tuberculous epididymitis is a rare entity. Because of the increase of this pathology, tuberculosis should be considered in the differential diagnosis of a scrotal swelling even in the absence of a history of previous tuberculosis. We report a case of isolated tuberculous epididymitis, diagnosed in an early stage, with color Doppler ultrasound findings.     

Tuberculous pericarditis in Birmingham.

Forty-one patients with acute tuberculous pericarditis were studied retrospectively. Anti-tuberculosis chemotherapy alone was effective in thirty. Five patients died, two from unrelated causes, two due to delayed diagnosis, and one after pericardiectomy. Constrictive pericarditis developed in seven patients, six of whom had successful pericardiectomy. Corticosteroids could not be shown to have reduced the risk of developing constriction. When constriction occurred it did so within the first six months of illness in all cases in contrast to a separate series of 15 patients who presented with constrictive pericarditis. These had had no previous history of tuberculosis, and in 10 cases where pericardiectomy was done, no histological evidence of tuberculosis was found. They were European with an average age of 49 years whereas in the group with acute tuberculous pericarditis 33 were Asian and the average age was 36 years.     

Total hip replacement infected with Mycobacterium tuberculosis. A case report with review of literature

Mycobacterium Tuberculosis infection of a total joint prosthesis in patients with previous pulmonary or osteoarticular tuberculosis is well recorded in literature. We describe the case of a 59-year-old woman with tuberculous infection complicating a total hip arthroplasty 15 months after surgery for osteoarthritis. The patient had no prior history of exposure to tuberculosis and no evidence of pulmonary or osteoarticular tuberculosis. She was treated with four-drug antituberculous chemotherapy for 12 months with retention of the prosthesis. The purpose of this case report and literature review is to highlight to the Western Orthopaedic surgeon the importance of keeping in mind a differential diagnosis of tuberculosis while dealing with prosthetic joint infections. The infection of a joint with Mycobacterium Tuberculosis in patients without previous tuberculosis is very uncommon. We have reviewed the surgical and medical management of the cases reported in literature.     

Inflammatory pseudotumour of the spleen associated with splenic tuberculosis

Inflammatory pseudotumor (IPT) of the spleen is an uncommon entity with an uncertain aetiology. Inflammatory pseudotumors present diagnostic difficulties because the clinical and radiological findings tend to suggest a malignancy. The symptoms include weight loss, fever, and abdominal pain. Most cases of splenic IPT present solitary relatively large well circumscribed masses on imaging. The diagnosis in the majority of the cases is made after histopathologic study of splenectomy specimens. The IPTs that occur in the spleen and liver are typically associated with Epstein-Barr virus. Thirty-seven percent of all new cases of active tuberculosis infection are extrapulmonary tuberculosis and tuberculous lymphadenitis the most commonly occurring form of extrapulmonary tuberculosis. We report the case of an inflammatory pseudotumor of the spleen associated with splenic tuberculous lymphadenitis in a 50-year-old female patient who was preoperatively diagnosed with a malignant spleen tumour based on her history of breast of carcinoma.     

肾结核的超声诊断与分型

目的：探讨肾结核超声诊断、分型及其临床价值。方法：回顾性分析资料完整的150例肾结核患者的超声声像图特点。结果：超声诊断肾结核的符合率为79．3％(119／150)，根据肾结核B超声像图特点，将肾结核分析归纳为6型，即囊肿型18例，积水型10例，积脓型6例，炎症萎缩型16例，钙化型31例，混合型38例。结论：超声检查具有价廉、无创等优点，对肾结核声像图的分型，有助于肾结核的诊断及鉴别诊断。     

Use of the 1 tuberculin unit (TU) Mantoux test in the assessment of tuberculous infection in children following neonatal BCG vaccination.

BACKGROUND--BCG vaccination alters the response to tuberculin testing and influences the potential validity of the Heaf test in the diagnosis of tuberculosis. This study used a purified protein derivative 1 tuberculin unit (TU) Mantoux test with a cut off of 5 mm induration as an indicator of tuberculous infection in high risk children to determine whether this would distinguish infection from previous neonatal BCG vaccination. METHODS--Children at high risk of tuberculosis on chest radiography, Heaf test, or contact history who had been screened in the contact tracing clinic and referred for further assessment were included in the study. After clinical examination, chest radiography, and Mantoux testing they were assigned to three groups (tuberculous disease, chemoprophylaxis, or no treatment) and followed up for 6-24 months in the outpatient clinic and subsequently by postal questionnaire. RESULTS--Comparison of the Heaf and Mantoux tests showed a difference in the results with 82% of cases positive by the Heaf test and 59% positive by the Mantoux test. Using the Mantoux test result in combination with clinical and radiographic findings 194 children were allocated to the three groups as follows: primary tuberculosis (5), chemoprophylaxis (101), no treatment (88). During follow up for a mean (range) time of 46 (11-102) months four additional cases received treatment for primary tuberculosis, two in the chemoprophylaxis group and two in the untreated group. CONCLUSIONS--The use of the 1 TU Mantoux test after neonatal BCG vaccination reduced the number of children receiving treatment from 129 to 93-that is, by 36%. Although the numbers are small, there was no increase in the later development of tuberculosis.     

Value of adenosine deaminase in the diagnosis of tuberculous pleural effusions in young patients in a region of high prevalence of tuberculosis.

BACKGROUND--Pleural biopsy is usually considered important for the diagnosis of pleural effusions, especially for distinguishing between tuberculosis and neoplasia, even though tuberculous pleural fluid contains sensitive biochemical markers. In regions with a high prevalence of tuberculosis, and in patient groups with a low risk of other causes of pleurisy, the positive predictive value of these markers is increased. The criteria for performing a pleural biopsy under these circumstances have been investigated, using adenosine deaminase (ADA) as a pleural fluid marker for tuberculosis. METHODS--One hundred and twenty nine patients with a pleural effusion aged < or = 35 years (mean (SD) 25.2 (4.9) years) were studied. Seventy three were men. Eighty one effusions (62.8%) were tuberculous, 12 (9.3%) parapneumonic, and 10 (7.7%) neoplastic, five were caused by pulmonary thromboembolism, four by systemic lupus erythematosus, seven by empyema, three following surgery, one was the result of asbestosis, and one of nephrotic syndrome. In five cases no definitive diagnosis was reached. ADA levels were determined by the method of Galanti and Giusti. RESULTS--The diagnostic yield of procedures not involving biopsy was 94.5% (122/129). Pleural biopsy provided a diagnosis in a further two cases, but not in the remaining five. All tuberculous cases had pleural fluid levels of ADA of > 47 U/l (mean (SD) 111.1 (36.6) U/l). The only other cases in which ADA exceeded this level were six of the seven patients with empyema. Cytological examination of the pleural fluid diagnosed eight of the 10 neoplastic cases, compared with six diagnosed by pleural biopsy. CONCLUSIONS--In a region with a high prevalence of tuberculosis procedures not involving pleural biopsy have a very high diagnostic yield in patients with a pleural effusion aged < or = 35 years, making biopsy necessary only in cases in which pleural levels of ADA are below 47 U/l, pleural fluid cytology is negative and, in the absence of a positive basis for some other diagnosis, neoplasia is suspected.     

The prevalence and clinical features of tuberculous peritonitis in CAPD patients in Turkey, report of ten cases from multi-centers

OBJECTIVE: To determine the rate, risk factors and outcome of Tuberculous Peritonitis (TBP) in patients treated with continuous ambulatory peritoneal dialysis (CAPD) in our units. DESIGN: Retrospectively, we reviewed the medical data of all CAPD patients from 12 centers for TBP, covering the period between 1986 and December 2002. SETTING: All patients were from 12 renal clinics at tertiary-care university hospitals. RESULTS: Ten cases of TBP were identified among the CAPD patients in our centers. There were five male and five female patients with a mean age of 37.2 years. None of the patients had tuberculosis history, 6 patients had predominance of PNL. One patient had coincidental bacterial peritonitis. Two patients were successfully treated without the removal of the Tenckhoff catheter. CONCLUSION: TBP in CAPD patients is a very rare complication. In contrast to predominance of lymphocytes in nonuremic patients with tuberculous peritonitis, CAPD patients with tuberculous peritonitis may have predominance of PNL on examination of the peritoneal fluid. Since TBP has high morbidity and mortality, early diagnosis and treatment of disease are extremely important for improving outcome.     

Intrathoracic tuberculous lymphadenopathy: clinical and bronchoscopic features in 17 adults without parenchymal lesions.

BACKGROUND: Whilst intrathoracic lymphadenitis is a characteristic sign of primary tuberculosis in children, its presence without parenchymal lesions in adults is unusual and makes the diagnosis using noninvasive techniques difficult. The diagnostic role of bronchoscopy in adults with intrathoracic tuberculous lymphadenitis is reported. METHODS: Seventeen patients with intrathoracic lymphadenopathy seen during 1993 who had all undergone bronchoscopy and had been found to have tuberculosis in the absence of any parenchymal lung lesions were evaluated retrospectively. RESULTS: Right paratracheal lymphadenopathy was observed on the plain chest radiograph in all the patients. Fifteen of the 17 patients had an endobronchial abnormality and samples taken at bronchoscopy gave a definitive diagnosis in nine (53%) of the 17. Four patients had ulcerating endobronchial granuloma and all had biopsy samples positive for tuberculosis. Transbronchial or transcarinal needle aspiration samples were diagnostic in five of 11 patients (45%) subjected to the procedure. Peripheral lymph node biopsy diagnosed tuberculosis in two cases and in the remaining six patients the diagnosis wa achieved by mediastinoscopy or thoracotomy. CONCLUSIONS: Bronchoscopy has an important role in the diagnosis of intrathoracic tuberculous lymphadenopathy in adults and should be considered before other invasive procedures.     

踝关节镜下微创治疗踝关节结核的临床疗效

目的探讨踝关节镜技术微创治疗踝关节结核的临床疗效。方法从2009年4月至2010年4月,本组采用踝关节牵引状态下使用关节镜检查及手术28例,其中15例行关节镜下结核病灶清除术,13例因关节破坏较重而行关节融合术,术后继续联合、规范、适量和全程抗痨治疗并注意营养支持。结果术后患者恢复快,一般情况可,平均随访12个月以上,28例患者的术后踝关节未肿胀,血沉下降,无窦道形成,无结核复发。按Baird评分标准,优16例,良7例,可5例,优良率为82%。术前McGuire踝关节评分（58±6.1）分,术后（88.9±5.4）分,提高（30.9±1.7）分（t=18.5,P〈0.01）。结论踝关节镜可直接观察和处理踝关节内病变情况,明确诊断,处理病灶。选择镜下手术创伤小,术后康复快,疗效肯定。     

An unusual case of genito-urinary tuberculosis. Case report

We represent and discuss etiology, diagnosis as well as differential diagnoses of tuberculous orchtitis referring to an actual case of this rare disease. In the least of all cases one can conclude from the clinical symptoms on the tuberculous origin of the disease. Other differential diagnoses will set more frequently due to rarity of this disease. Quite a lot of cases a bacterial superinfection veils the sterile leucocyturia as main characteristic of genitourinary tuberculosis. Imaging diagnostics frequently fails to give indications of tuberculous origin of the lesion. As before the evidence of Mycobacteria tuberculosis is the most important parameter to proof a tuberculosis. Despite required microbiological cultivation to make a resistogram the polymerase chain reaction is a high sensitive and comparable fast method for detection of Mycobacteria even from tissue. In such dubious cases we recommend to perform an operative denudation due to frequently difficult delimitation from malignant testicular tumours.     

New features in the pathogenesis of renal tuberculosis and their significance for its detection.

The study of 1,464 cases of renal tuberculosis in 1946-1971 shows that the incidence of this illness has not diminished. The percentage of aged patients and of women has increased. The frequency of previous tuberculosis has decreased and the interval between tuberculosis and renal tuberculosis has increased. These new features show that the role of general pathogenic factors regresses whereas that of local factors progresses. Among the latter, the main factor is a disturbance of the urine outflow from the kidneys. This factor is of particular importance in women who had pathologic pregnancies and deliveries, gynecological diseases and surgery. While the connection of renal tuberculosis with tuberculous diseases diminishes its connection with urogenital conditions is rising. Accordingly, it is necessary to suspect and search for renal tuberculosis in new groups of persons: in older persons, in patients without a history of previous tuberculosis, in patients cured from tuberculosis, in women after obstetrical and gynecological complications, in patients with renal diseases, malformations, etc. Our preventive examinations indicated that nephrotuberculosis can be actively and earlier detected not only in patients with extrarenal tuberculosis but in persons cured from it, and in patients with local urogenital lesions.     

二代测序技术应用于脑脊液检测在结核性脑膜炎中的早期诊断价值

目的评价二代测序技术应用于脑脊液检测在结核性脑膜炎（TBM）患者中的早期诊断价值。 方法前瞻性纳入2018年2月2日至2018年8月2日于山东省胸科医院就诊的临床怀疑TBM的患者共50例,并跟踪随访其诊疗结局。送检脑脊液标本均进行二代测序,测序所得原始序列与病原微生物数据库进行对比得到最终结果。二代测序结果以检测到结核分枝杆菌复合群唯一比对序列为阳性,未检测到唯一比对序列为阴性。以符合脑脊液结核分枝杆菌培养阳性、涂片阳性、Xpert MTB/RIF检测阳性及结核分枝杆菌核酸检测阳性等4项中至少1项即为确诊TBM患者;临床可疑TBM且抗结核治疗有效为临床诊断患者;有其他病原学依据或临床排除TBM者为非TBM患者。分析二代测序在TBM早期诊断中的敏感性和特异度。 结果确诊为TBM患者22例中Xpert MTB/RIF检测阳性13例,培养阳性6例,结核分枝杆菌核酸PCR检测阳性5例,临床诊断为TBM患者12例,非TBM患者16例。在确诊及临床诊断患者中,二代测序技术检测到结核分枝杆菌复合群系列20例,敏感性为58.8%（20/34）,特异度为100%（16/16）。在确诊患者中,二代测序的敏感性为63.6%（14/22）;在同步进行结核分枝杆菌培养、Xpert MTB/RIF检测与二代测序的50例标本中,以临床诊断为标准,3种方法的特异度均为100%（16/16）;传统方法、Xpert MTB/RIF检测及二代测序的敏感性分别为29.4%（10/34）、38.2（13/24）和58.8（20/34）,前两种检测方法与二代测序敏感性差异均有统计学意义（McNemar检验：χ² = 8.333、P = 0.013,χ² = 8.333、P = 0.065）。传统方法与二代测序联合检测的敏感性高达82.4%（28/34）。 结论二代测序技术能够较快速地检测脑脊液中的结核分枝杆菌复合群,且其敏感性和特异度均较高,可作为TBM的早期诊断指标。二代测序联合传统检测方法可提高检出率。     

表现为腹部肿块的大肠结核诊断和鉴别诊断

目的　探讨以腹块为临床表现的大肠结核的诊断和鉴别诊断。方法　报告 1987～2 0 0 0年收治的以腹部肿块为临床表现的大肠结核 15例 ,并结合文献进行回顾性分析。结果　 15例肠结核均以腹块为主诉就诊 ,其中 9例行纤维结肠镜检查 ,3例行钡灌肠。仅 3例诊断为肠结核 ,其余 12例经手术活检确诊 ;所有病例均经抗结核治疗 ,1例复发。结论　纤维结肠镜下活检和手术活检是肠结核确诊的重要手段 ,利用多聚酶链反应 (PCR)技术检测活检组织中的结核杆菌 ,以及手术时常规行肠系膜淋巴结活检 ,有助于肠结核的诊断和鉴别诊断     

Scottish national survey of tuberculosis notifications 1993 with special reference to the prevalence of HIV seropositivity.

BACKGROUND: The study sought to determine the contribution of HIV seropositivity to the arrest of decline in tuberculosis notifications in Scotland. METHODS: Survey forms relating to each tuberculosis notification in 1993 were completed by the notifying consultant. Voluntary anonymous HIV testing of tuberculosis cases aged under 65 was requested. Age, sex, ethnic status, country of birth, employment status, occupation, previous tuberculosis, contact status, risk factors for HIV infection, HIV serostatus of cases aged under 65, site, radiological extent, and bacteriological status of tuberculous disease were determined. RESULTS: Five hundred and seventy four cases of tuberculosis were originally notified, of which 77 (14%) subsequently proved to be non-tuberculous and were therefore denotified. Of the 497 cases 423 (85%) were white and 58 (12%) were from the Indian subcontinent. Eighty five per cent of patients from the Indian subcontinent were aged < 55 years whereas 64% of white patients were aged > 55 years. Pulmonary disease was found in 74%, non-pulmonary in 22%, and combined disease in 4% of patients. Of 242 HIV tests performed, three were positive and five other HIV positive patients were known, giving an HIV positivity rate of 1.6% of all tuberculosis notifications in 1993. Annual notification rates for Scotland were 9.7 per 10(5) before and 8.7 per 10(5) after exclusion of previously treated cases; rates were 8.4 per 10(5) for the white population and 179 per 10(5) for those from the Indian subcontinent. CONCLUSIONS: The study documents the distribution of tuberculous disease in Scotland by age, sex, site, and ethnic group for the first time. Notification practices, with respect to denotification, need to be improved. Infection with HIV is presently uncommon in cases of tuberculosis in Scotland but continued vigilance is essential.     

Tuberculous spondylitis: analysis of 69 cases from Saudi Arabia.

DESIGN: Retrospective chart and radiographic review of all cases admitted to the authors' hospital and diagnosed to have tuberculous spondylitis. OBJECTIVE: To identify the frequency, presenting features, utility of diagnostic tests, and treatment outcome of spinal tuberculosis in a tertiary care center. METHODS: All cases of spinal tuberculosis treated in the authors' hospital over 14 years were reviewed. Only those with histologic or microbiologic confirmation or those who responded to antituberculous spondylitis therapy were included. Outcome was assessed according to predefined criteria. RESULTS: Between 1985 and 1998, 69 cases of tuberculous spondylitis were found, i.e., 5% of all tuberculous spondylitis cases diagnosed. The mean age was 52.8 years (range, 15-80 years), and 37 (53.6%) were male. Only five patients had a history of tuberculosis. The most frequent symptoms were backache (84%) and fever (32%), and the most frequent sign was spinal tenderness (45%). Nineteen (28%) patients had paraparesis and 12 (17%) had kyphosis. Except for elevated sedimentation rate (94.5%), the laboratory workup was not helpful. Both computed tomography and magnetic resonance imaging were found to be helpful in diagnosis, often with complementary information. Thirty-eight patients (55%) had thoracic spine involvement and 55 patients (80%) had paraspinal abscesses. Tissue aspirates had a yield of 70%, 35%, and 57% for granulomas, acid-fast bacilli smear, and culture, respectively. Medical therapy alone was given in 37 cases (54%), whereas 32 patients (46%) required additional surgical intervention, mainly those with spinal cord compression, spinal deformity, or risk of spinal instability. There was definite improvement in 63 cases (91%). The best outcome was in those patients presenting early before the occurrence of spinal deformity or neurologic symptoms. CONCLUSION: Tuberculous spondylitis is prevalent in the authors' hospital. Both computed tomography and magnetic resonance imaging are extremely helpful for diagnosis, and tissue aspirate is a good confirmatory method. A good outcome is expected if the diagnosis is made in early stages before the appearance of spinal deformity and neurologic symptoms. Surgical intervention can be avoided in these cases regardless of the presence or absence of paraspinal abscesses.     

Deep sepsis from Mycobacterium tuberculosis after total hip replacement. Case report

One case of deep sepsis from Mycobacterium tuberculosis occurring two years after total hip replacement is reported. The patient had no history of previous tuberculous infection nor showed any sign of systemic disease at the time of surgery. The clinical and pathogenic implications are discussed.     

Tuberculosis of the breast: Report of eight cases

In the 8 cases here reported (Table II), the average age was thirty-two years; youngest twenty years, oldest forty-six years. The nodular type was present in 7, the sclerosing type in one. The left breast was involved in 4, the right in 4. The upper outer quadrant alone was the seat of disease in 2, the inner lower quadrant alone in one, the outer lower quadrant alone in 2, the inner lower quadrant in one, and the outer lower and outer upper quadrants together in 2. The tuberculous mass was fixed in all 8 cases. The overlying skin was attached to the mass in 7 cases and not attached in one case. Pig-skin appearance was present in 6, including the mixed case (II) of carcinoma and tuberculosis, and not present in 2. Retraction of the nipple was present in 5 and not in 3. No case gave a history of discharge from the nipple. The breast was fixed to the chest wall in 5 cases and not so in 3 cases. A sinus was present in 4 cases and absent in 4. Axillary nodes were palpable in 7 cases. Clinical evidence of tuberculosis elsewhere in the body was present in only one case of the 8. The initial symptom was a lump in 6 cases, painful in 2 and not painful in 4 cases of the 6. An acute abscess was the initial symptom in 2 of the 8 cases. Only one case gave a positive past history of tuberculosis and possibly one other (V) who reported adenitis of neck nine years previously. Family history was negative in all cases. Only one case gave a history (VIII) of previous acute inflammation of breast. Five of the 8 cases gave a history of lactation, 6 of the 8 of pregnancy and 2 had never been pregnant. The shortest time from onset to admission to hospital was four weeks: the longest time one and onehalf years. The Wassermann reaction was positive in 3 cases, negative in 4, not recorded in one. The clinical diagnosis was tuberculosis in 2, carcinoma in 6. Tubercle bacilli were demonstrated in none. The diagnosis of tuberculosis of the breast was made by microscopic study of the tissues in all 8 cases. Six of the 8 patients were reported living and well; 1 eight years, 1 four years, 1 two years, and 3 one year each, after the operation. One patient died of shock within twenty-four hours after operation and one (II) died of metastatic cancer fifteen months after operation.     

The Prevalence and Clinical Features of Tuberculous Peritonitis in CAPD Patients in Turkey,Report of Ten Cases from Multi-centers

Objective.?To determine the rate, risk factors and outcome of Tuberculous Peritonitis (TBP) in patients treated with continuous ambulatory peritoneal dialysis (CAPD) in our units. Design.?Retrospectively, we reviewed the medical data of all CAPD patients from 12 centers for TBP, covering the period between 1986 and 12 2002. Setting.?All patients were from 12 renal clinics at tertiary-care university hospitals. Results.?Ten cases of TBP were identified among the CAPD patients in our centers. There were five male and five female patients with a mean age of 37.2 years. None of the patients had tuberculosis history, 6 patients had predominance of PNL. One patient had coincidental bacterial peritonitis. Two patients were successfully treated without the removal of the Tenckhoff catheter. Conclusion.?TBP in CAPD patients is a very rare complication. In contrast to predominance of lymphocytes in nonuremic patients with tuberculous peritonitis, CAPD patients with tuberculous peritonitis may have predominance of PNL on examination of the peritoneal fluid. Since TBP has high morbidity and mortality, early diagnosis and treatment of disease are extremely important for improving outcome.     

An open technique of pleural biopsy in the diagnosis of tuberculous effusions.

To assess an open technique of pleural biopsy as an aid to diagnosis in pleural disease 107 African patients with radiological evidence of pleural effusion underwent biopsy. In 87 there was radiological evidence of an effusion but not of underlying lung disease; 73 patients (84%) in this group were ultimately diagnosed as suffering from tuberculosis and of these 56 (77%) had a positive pleural biopsy. There was a heavy male predominance of tuberculous infection (male:female ratio approximately 5:1) and half of the patients were aged 21 to 30 years. In the 20 patients with radiological changes in the lung a diagnosis was established by biopsy in 13 cases. Four of these were tuberculous and a further two cases of tuberculosis were established on clinical grounds.