Generalized tuberculosis after kidney transplantation

Tuberculosis is one of severe infectious complications in patients on hemodialysis and after kidney transplantation. Incidence of disseminated and generalized forms is high, whereas clinical symptoms are weak and nonspecific. An aggressive generalized form of tuberculosis was observed in a kidney transplant recipient. M. tuberculosis, the antigen and DNA were registered only a few days before death. Disseminated foci in the lungs were seen on CT image only in the agonal period in spite of multiple x-ray investigations. Thus, our experience and experience of other investigators evidence that if recipients of renal transplant have fever of unknown genesis and do not respond to standard antibiotic therapy, tuberculosis should be suspected and a course of specific antituberculosis therapy should be started as early as possible.     

MRI对椎旁脓肿不明显脊柱结核的诊断价值

目的 探讨椎旁脓肿不典型的脊柱结核的影像学特点及外科治疗方法.方法 对15例椎旁脓肿不典型的脊柱结核患者的病史、临床症状及体征、影像表现特点及治疗方法进行分析总结.结果 本组椎体结核病例在X线或CT上不出现典型的椎旁脓肿影像学表现,在椎体骨质弥漫性破坏且椎间隙相对完整时,给椎体结核的诊断带来一定的困难.15例中术前依病史、临床症状及专科体查,仅3例参考X线平片得出椎体结核的诊断.4例X线平片结合CT扫描得出椎体结核的正确判断,余8例辅加MRI检查得以术前确诊.结论 椎旁脓肿不典型性脊柱结核依据X线平片和CT扫描诊断困难时,MRI检查可对该病进行早期准确的诊断,MRI可清晰显示病变椎体、椎旁软组织病理及形态学改变及椎间盘变性情况.     

Current methods in diagnosis of the kidney tuberculosis

Conventional and updated medical technologies of detecting M. tuberculosis (MT) and tuberculosis antibodies (TAB) were compared. It is shown that molecular-biological and immunological methods can be used only in rapid diagnosis and screening. They should be followed by further examinations as urine MT makers and blood TAB are not criteria for final diagnosis of renal tuberculosis. Routine microbiological methods are most precise in the above diagnosis. Diagnosis of initial forms of renal tuberculosis is still unsolved problem. Low professional skills of outpatient service urologists in the field of urogenital tuberculosis explain late detection of urinary tuberculosis.     

Urogenital tuberculosis: problems of present-day diagnosis and treatment

The analysis of 4904 cases with tuberculosis admitted to the urological department of Moscow tuberculosis hospital N 7 in 1996-2002 showed increased incidence of new-onset and recurrent urogenital tuberculosis--the share has risen from 2.1 to 7.8%. Of 267 new cases, 49.4% had severe destructive forms. The disease manifested with chronic cystitis in 35 (13.11%), subacute orchoepidydimitis in 35 (13.11%), anatomofunctional alterations of the kidneys (hydronephrotic transformation, non-functioning kidney, ureteritis, etc.) in 76 (28.46%) patients. Bacterial discharge occurred in 52% of new cases. The diagnosis was based on clinical and x-ray data in 48%. Isolated genital tuberculosis, isolated nephrotuberculosis and their combination were revealed in 14.23, 59.57 and 26.2% patients, respectively. Among the patients with advanced destructive forms 75% got disabled completely. This fact indicates the importance of early diagnosis and adequate etiotropic therapy. Active urogenital tuberculosis was treated surgically in 51% patients, most of the operations were made for marked destructive processes in the kidneys. The organ-removing operations were conducted in 73% of them. Preoperative tuberculostatic therapy reduced frequency of postoperative complications. In early diagnosis, the organ was saved in operations in 9.38%. It is recommended to refer patients to the phthisiourologist to be examined for urogenital tuberculosis if they have long-standing urogenital infection, destructive lesions of the upper urinary tracts, calculous prostatitis.     

Role of polymerase chain reaction in diagnosing tuberculosis of the bladder and male sex organs

Detection of M. tuberculosis DNA by polymerase chain reaction (PCR) and standard technique was compared in 76 new cases of urogenital tuberculosis. In the urinary test PCR confirmed tuberculous etiology of the disease and corresponded to M. tuberculosis detection in 27 (60%) of 45 patients with urinary tuberculosis. M. tuberculosis DNA detection rose significantly in patients with mycobacteriuria (71%) and in examination of aspirates from isolated renal cavern, blocked kidney, epididymis, prostate and seminal vesicles. Treatment for 1 month and longer transforms the positive result into the negative one. Of 16 patients with tuberculosis of male sexual organs M. tuberculosis DNA were detected by PCR in prostatic secretion in 43.7%, in ejaculate in 93%. This did not correlate with detection of M. tuberculosis. Thus, PCR is recommended for instant diagnosis and screening before further examination and cannot be the only method in identification of urogenital tuberculosis.     

Primary Thyroid Tuberculosis

In India, it is estimated that more than 40% of the adults are infected with tuberculosis bacilli and every year 2 million people develop tuberculosis and nearly 500,000 die from it1. But, tuberculosis of the thyroid gland occurs only rarely. Since extra-pulmonary tuberculosis is now seen relatively more frequently, the existence of this condition should be recognized when goitres are being treated. We present a case of right thyroid nodule associated with low grade fever and weight loss. No signs and symptoms of hypothyroidism or hyperthyroidism were present. Patient did not have any other tuberculosis focus. Routine investigation and chest X-ray were normal. Sputum for Acid Fast Bacilli was negative. Fine Needle Aspiration Cytology and Contrast Enhanced Computed Tomography led to a diagnosis of Primary Thyroid Tuberculosis in a euthyroid patient. Patient responded well to Anti tubercular Drug Therapy along with repeated aspiration.     

Hodkgin lymphoma concomitant of tuberculosis,a therapeutic challenge for multidisciplinary management

Hodgkin lymphoma (HL) is a disease characterized by a high curability rate, and the treatment benefit-risk balance must be carefully addressed to achieve complete disease control with low risk of long-term toxicities. Most patients are treated with a combination of chemotherapy and radiotherapy, after disease staging and response to treatment evaluated by FDG PET/CT. We report the case of a 28-year-old patient concomitantly diagnosed of a Hodgkin lymphoma and active tuberculosis. Initial staging was difficult due to pulmonary and abdominal tuberculosis localization that induced FDG PET/CT hypermetabolism. Anti-tuberculosis treatment was first started, allowing secondary an early accurate Hodgkin lymphoma staging by FDG PET/CT. The patient was then treated by chemotherapy and radiotherapy. Helical TomoTherapy® was used with involved site (IS) irradiation volume was performed to decrease the high doses to organs-at-risk (OAR), especially lungs in this context of tuberculosis.     

Analysis of 27 patients with lung cancer misdiagnosed as tuberculosis

Because lung cancer is similar to tuberculosis not only in clinical symptoms but also in X-ray manifestation, it is occasionally misdiagnosed. Currently, as the incidence of tuberculosis in the elders tends to increase and lung cancer is not rare in the youth patient's age is no more a good reference in differential diagnosis. Accurate diagnosis should be based, besides X-ray examination, on sputum cytology, bronchoscopy and biopsy.     

髋关节结核人工关节置换长期效果观察

目的 探讨髋关节结核行人工关节置换的可行性。方法 1986—1997年间收治髋关节结核30例，26例行全髋关节置换、4例单纯股骨头置换，并进行长期随访。结果26例全髋关节置换者，早期感染2例，其中1例单纯应用抗生素治愈，1例手术清创治愈。1例术后7年X线片示髋臼内陷，但无症状，已5年。1例术后2年窦道复发，手术证实为混合感染，无结核复发；髋臼内陷1例，再手术，亦无结核复发。4例股骨头置换效果良好。结论 髋关节结核选择良好的手术时机，可行人工关节置换。     

Treatment of renal tuberculosis

Three groups of parameters of 4 tuberculostatics effects on tuberculosis of the kidneys and general condition were singled out basing on comparative efficacy of 3 and 4 mycobacterial drugs: more effective, equally effective and negative. Higher efficacy manifested with greater number of cases of leukocyturia elimination and conversion of cultivable mycobacteria into uncultivable ones, more obvious morphological signs of tuberculous inflammation involution. Equal efficacy of 3 and 4 drugs was characterized by the same rate of mycobacteriuria continuation and detection of mycobacteria in caverns from the removed tuberculous kidney. The negative effect of medication consisted in increased intolerance of the drugs, involvement of the liver and kidneys, toxico-allergic reactions. Indications for initial use of 4 mycobacterial drugs in new cases of tuberculosis are early forms of tuberculosis of the kidneys in normal nitrogen-excretory function and absence of hepatic insufficiency. This treatment must be recommended with caution for old patients. The conclusion is made that WHO recommendation to use initially four drugs for treatment of urogenital tuberculosis is not well grounded and physicians should decide on the treatment regimen after consideration individual characteristics of the patients.     

Dysphagia: A rare presentation of tuberculous mediastinal lymphadenitis

Mediastinal lymphadenitis as the only presentation of adult tuberculosis is rare. Rarer still is dysphagia as the only presenting symptom of mediastinal tuberculous lymphadenitis. Here is the report of such a case.     

98例肺部单发小结节的临床分析

目的：研究肺部单发小结节良恶性患者的临床表现和胸部CT特点。方法：分析98例肺部单发小结节患者的资料,对其临床表现和胸部CT特点进行数据资料统计,采用卡方分析,两组率的差异采用两组率比较的方法。结果：98例患者中,肺癌46例（46．9％）,良性肿瘤14例（14．3％）,结核球38例（38．8％）,无任何症状查体发现小结节和仅伴有咳嗽咯痰症状者56例（57．1％）,其中50％为I期肺癌患者。年轻,有长期发热、盗汗,胸背痛症状者提示结核;无任何症状、仅有咳嗽咳痰,痰中带血或咯血提示恶性肿瘤;胸部CT影像中良性肿瘤发生于中叶或舌叶的比率高（42．3％）,结节边界清,密度均匀,恶性肿瘤多边界不清,密度不均,有毛刺,分叶,胸膜皱缩;结核出现于下叶的比率高,钙化多见。结论：加强肺癌高危人群的普查,筛查和监测是发现早期肺癌患者的途径,对发现的肺部小结节,结合临床表现和CT特点可以作出初步诊断,当结节直径＞1cm,且不能判定良恶性时,可考虑手术探查。     

MRI in ankle tuberculosis: Review of 14 cases

We reviewed the MR imaging features of ankle tuberculosis and determined the role of MR in its diagnosis. A retrospective analysis of 14 cases of ankle tuberculosis imaged with MRI was performed. Plain radiographs were also reviewed where available, and the imaging characteristics were noted. We also reviewed the medical records in order to assess the impact of the imaging findings on management of these patients. Magnetic resonance imaging is extremely helpful for detection, mapping the extent and resolution of the disease. It can identify cases, enables early institution of antituberculous chemotherapy and might obviate the need for surgery.     

Rapid susceptibility test for Mycobacterium tuberculosis to isoniazid and rifampin with resazurin method in screw-cap tubes

Multi-drug resistant (MDR) Mycobacterium tuberculosis is still a serious public health problem all over the world. MDR tuberculosis (MDR-TB) caused by these strains has emerged within the last decade and rapid detection is critical for the effective treatment of patients. Recently, a resazurin microtiter assay plate for detecting MDR strains was developed. In this study, it was adapted to screw-cap tubes and the activity of isoniazid (INH) and rifampin (RIF) to 50 M. tuberculosis clinical isolates was tested by this method for the first time. Results were compared with the radiometric reference method for the susceptibility testing of M. tuberculosis complex. The results of both methods were in 100% and 96% agreement for RIF and INH, respectively. Specificity, sensitivity, positive predictive value and negative predictive value were 91.7%, 100%, 92.8% and 100% for INH, respectively. All of these values were 100% for RIF. Susceptibility testing results were obtained on the 8th day of incubation for 42 isolates and on the 9th day for the other eight strains. Our results indicate that this method is suitable for the early determination of INH and RIF resistance in developing countries because it is inexpensive, rapid and easy to perform.     

Glottic tuberculosis masquerading as early multifocal carcinoma

The incidence of tuberculosis has progressively decreased in developed countries after the advent of antituberculous chemotherapy, but has recently been increasing again mainly due to migratory flows. Although common in the past and considered to be a prelethal event, laryngeal involvement has become a rarity. We report the case of a 52-year-old female smoker who complained of persistent aphonia. Videostroboscopy showed bilateral vocal fold erythroleukoplakias. A chest X-ray and CT scan aroused the suspicion of lung tuberculosis, which was confirmed by Ziehl-Neelsen staining for acid-alcohol-fast bacilli on bronchoalveolar lavage. Antituberculous chemotherapy rapidly improved the quality of her voice and led to complete disappearance of the vocal fold lesions. In conclusion, laryngeal tuberculosis may mimic an early glottic multifocal carcinoma and should therefore, despite its rarity, always be considered in the differential diagnosis of erythroleukoplakia-like lesions in order to avoid improper surgical treatment and voice damage.     

Extrapulmonary tuberculosis active infection misdiagnosed as cancer: Mycobacterium tuberculosis disease in patients at a Comprehensive Cancer Center (2001-2005)

BACKGROUND: Extrapulmonary tuberculosis is an uncommon disease in the U.S., even in immunosuppressed cancer patients. This study evaluated characteristics and frequency of extrapulmonary tuberculosis in patients at a tertiary care referral cancer center. METHODS: The records of all consecutive patients with Mycobacterium tuberculosis diagnosed during January 2001 through April 2005 at the M. D. Anderson Cancer Center were reviewed after obtaining institutional review board approval. RESULTS: There were 26 patients with active tuberculosis during the period studied; 18 of them were cancer patients and the others had been referred for a presumed cancer but did not have cancer. The overall rate of active tuberculosis during this period was 0.2 in 1000 new cancer diagnoses. There were 18 men (69%), the median age was 54 years (range, 3-84 yrs), and 16 patients (62%) were born in the U.S. Thirteen (72%) of the 18 cancer patients had solid-organ tumors; 3 of the 5 patients with a hematologic malignancy had non-Hodgkin lymphoma. Three patients (12%) had diabetes mellitus, and 2 patients (8%) had received high-dose (>1 mg/kg of prednisone daily) corticosteroids in the previous week. No patient had a recent history (within the past 4 wks) of chemotherapy; 4 patients had neutropenia. Cough was a prominent symptom (31%), followed by bone pain (19%), dyspnea (15%), and fever (12%). Fifteen patients (58%) had extrapulmonary infection, including 5 patients with concurrent pulmonary involvement; 7 noncancer patients (88%) and 8 cancer patients (44%, P = 0.22) had extrapulmonary disease. In 11 patients (42%), the lungs were the only site of active tuberculosis. Cavitary pneumonia was seen radiographically in 3 of 16 patients (19%) with pulmonary tuberculosis. All M. tuberculosis isolates were susceptible to isoniazid, rifampin, ethambutol, and pyrazinamide; streptomycin resistance was noted in 1 of 22 (5%) isolates tested. Twenty-two patients (85%) received appropriate antituberculosis treatment; all had a clinical and radiographic response. In 3 patients (12%) the cause of death was attributed to M. tuberculosis disease; 2 of 18 cancer patients (11%) died of progressive M. tuberculosis, and they had advanced solid-organ cancer, whereas 1 of 8 patients (13%) without cancer died and the tuberculosis diagnosis was made only on postmortem examination. Univariate analysis showed no significant differences in patients or disease characteristics between non-U.S.-born and U.S.-born patients, whereas noncancer patients (age 52 yrs) and those with extrapulmonary tuberculosis (age 53 yrs) were younger compared with cancer patients (63 yrs; P < 0.007) and those with pulmonary disease (age 60 yrs; P = 0.09). CONCLUSIONS: Extrapulmonary tuberculosis was relatively common in younger patients with active M. tuberculosis infection, and was often initially misdiagnosed as cancer.     

Early detection of tubercular otitis media: A clinicopathological study

Four out of 80 cases admitted for ear surgery had tubercular otitis media. Associated pulmonary tuberculosis and tuberculosis cervical lymphadenitis were present in one case only. Rest three cases had primary tuberculosis of ear. All the four cases were diagnosed by histopathology. Radical mastoidectomy followd by antitubercular treatment was given in all the four cases. Post aural abscess and facial paralysis were present only in one case.In three months follow up, all the four cases had dry ear, facial paralysis recovered but hearing did not improve as tympanoplasty was not attempted in any case. There was no further deterioration of hearing after surgery in any case.     

血浆 MAL 基因甲基化检测对于肺癌早期诊断的意义

目的：研究肺癌患者、肺结核患者及健康人群 T 淋巴细胞相关蛋白（T －lymphocyte maturation －asso-ciated protein,MAL）基因启动子区的甲基化状态,进一步探讨血浆 MAL 基因甲基化检测对于肺癌早期诊断及鉴别肺癌与肺结核疾病的意义。方法：采用甲基化特异性 PCR（methylation special PCR,MSP）方法,检测75例肺癌组织标本、癌旁组织标本和对应的血浆标本及58例肺结核组织标本及对应的血浆标本的 MAL 基因启动子区甲基化状态;同时检测30例正常人群的血浆标本 MAL 甲基化状态作为对照。结果：肺癌组织和癌旁组织中 MAL 基因甲基化发生率分别为78．7％（59／75）和2．7％（2／75）,差别具有统计学意义（P ＜0．001）;肺癌和肺结核组织中 MAL 基因甲基化发生率分别为78．7％（59／75）和3．4％（2／58）,差别具有统计学意义（P＜0．001）;肺癌患者与肺结核患者对应的血浆中 MAL 基因甲基化发生率分别73．3％（55／75）和1．7％（1／58）,差别也具有统计学意义（P ＜0．001）。正常健康人群的血浆标本中未发现 MAL 基因甲基化改变;肺癌组和肺结核组分别与健康人群组比较,肺癌组明显高于健康人群（P ＜0．001）,而肺结核组患者与健康人群比较无明显差异（P ＝0．47）。组织标本和血浆标本的检出率具有一致性（P ＞0．05）。根据病理类型、TNM分期、性别、吸烟史等对肺癌患者进行分组,各组之间均无明显差异（P ＞0．05）。结论：MSP 法检测血浆 MAL 基因甲基化状态,可以作为一种有潜力的肺癌早期诊断方法,对于鉴别肺癌和肺结核也有一定的帮助。     

Implications of beta 2-microglobulin in the detection of associated urinary tract diseases in patients with infiltrative pulmonary tuberculosis

The addition of radioimmunoassay of beta 2-microglobulin (beta 2-MG) from the sera of patients with infiltrative pulmonary tuberculosis to the complex of clinical, x-ray, ultrasound, cytological and biochemical examinations contributes to early detection of renal dysfunction which is important in phthisiology. Changes in urinary and blood serum values of beta 2-MG may serve as a screening test for different nephropathies.     

DR联合支气管镜检查对肺结核与小叶性肺癌的临床诊断价值

目的 探讨数字X射线机(DR)联合支气管镜检查诊断肺结核与小叶性肺癌的临床价值.方法 分析150例疑似肺结核与小叶性肺癌患者的病例资料,疑似小叶性肺癌患者48例,疑似肺结核患者102例,以临床表现及手术病理活检结果为依据,比较观察常规检查和DR联合支气管镜检查的特异度、敏感度和准确度.结果 DR联合支气管镜检查诊断小叶性肺癌的灵敏度、特异度和准确度分别为74.19%、70.59%和72.92%,高于常规检查的51.61%、52.94%和52.08%(P<0.05);DR联合支气管镜检查诊断肺结核的灵敏度、特异度和准确度分别为71.79%、70.83%和71.57%,高于常规检查的55.13%、54.17%和54.90%(P<0.05).结论 DR联合支气管镜检查对肺结核和小叶性肺癌的诊断效果好,有利于患者及早得到确诊和治疗,值得临床推广.