A review of peripheral tuberculous arthritis

There is a clear difference between TB infection and TB. Transition from the former to the latter involves host factors and perhaps environmental elements. Currently, more individuals with immunosuppressive situations caused by aging, debilitating diseases, immunosuppressive therapies, and HIV-III infection are predisposed to secondary forms of TB. Different patterns of clinical presentation, at variance with those previously described, could result from these changes in the host. PTBA is a good example. In the present review of 52 patients, we found that patient age is rising, as has been reported in other western countries. We also found that oligoarthritis and involvement of non-weight-bearing joints is becoming more common. From the diagnostic point of view, histological studies and cultures of synovial tissue remain the most reliable tests. Awareness of these factors, recognition of changing patterns, proper use of diagnostic procedures, and early treatment should improve the outcome of patients.     

A case of tuberculous peritonitis

We report a case of a 73-year-old man with tuberculous peritonitis. He had sought treatment at a clinic near his house for his fever and abdominal distension. Massive ascites were found and he was referred to our hospital. The endoscopy and abdominal CT scan performed on admission revealed no abnormal findings except the massive ascites. Mycobacterium tuberculosis (MT) DNA was detected in the ascitic fluid by polymerase chain reaction (PCR) and ascitic adenosine deaminase (ADA) activity was 127.6 U/l. He was diagnosed as tuberculous peritonitis and transferred to the Department of Respiratory Medicine. A chest CT scan showed predominant right pleural effusion with no other abnormal findings in bilateral lung fields. His sputum were all positive by smear acid-fast staining, MT DNA and culture on MT. His final diagnosis was tuberculous peritonitis, pulmonary tuberculosis, and tuberculous pleuritis. Treatment was started by anti-tuberculosis drugs with combined use of isoniazid, rifampicin, ethambutol, and pyrazinamide. The therapy was continued for 6 months. The culture for MT (Mycobacteria Growth Indicator Tube) converted to negative after 2 weeks of treatment and the C-reactive protein level became normal after a month. The pleural effusion and ascites disappeared after 2 and 3 months, respectively. Tuberculous peritonitis is a relatively rare disease, however when we encounter unexplained ascites, MT PCR and the measurement of ADA should be done considering a rapid diagnosis of tuberculous peritonitis, before invasive diagnostic laparoscopy.     

A case of tuberculous pericarditis

A case of tuberculous pericarditis successfully managed with medical treatment alone was reported. A 78-year-old male was admitted because of cough, dyspnea and fever. Chest X-P and echocardiogram revealed massive pericardial effusion. His clinical symptoms and signs suggested cardiac tamponade. Mycobacterium tuberculosis was detected from pericardial fluid. ADA activity in pericardial fluid was high. Thoracic CT scan showed tracheobronchial, pretracheal, paratracheal and superior mediastinal lymph-node swelling. The diagnosis of tuberculous pericarditis was confirmed. Anti-tuberculous therapy consisting of INH, RFP, EB in combination with prednisolone was started. One month later pericardial effusion was controlled and six months later he was in good clinical condition without surgical treatment.     

A case of tuberculous pyometrium concurrent with tuberculous pleurisy

An 84-year-old woman began to have low fever below 38 degrees C with slight lassitude from June 19, 2002. Despite oral administration of Clarithromycin for 3 days, the fever did not subside and the lassitude increased, so she was admitted to our department. While inflammatory findings were noticed, the cause was not identified by blood and imaging examinations (thoracoabdominal CT, etc.). Although her tuberculin reaction was positive, symptoms indicative of pulmonary tuberculosis were absent. Administration of Cefotiam and Imipenem Cilastatin sodium was ineffective. Pyometra was diagnosed. After drainage, the uterine cavity was washed every day. On the basis of culture of fluid retained a few colonies of Gram-negative bacteria were isolated, but were not identified, Cefpirome was administered, whereupon the fever subsided gradually, but mild inflammatory findings remained. Even after discharge on July 24, the retention increased, so drainage and washing were done repeatedly. However, mild inflammatory findings persisted. She began to have a fever from September 17 and was readmitted. After admission, administration of Flomoxef sodium was started, but no improvement was seen. A small amount of hydrothorax appeared on the left. Thoracocentesis yielded a bloody, slightly turbid exudative. Acid-fast staining and Mycobacterium tuberculosis specific PCR of pleural effusion were negative, but adenosindeaminase was 87.4 U/l. Therefore, a diagnosis of tuberculous pleurisy was made. DNA/PCR of tubercle bacilli in the fluid retained in the uterus was positive, and re-retention was prevented by administration of anti-tuberculosis drugs. These findings suggest a strong possibility of tubercle bacillus having been the causative bacteria. Particularly in the case of the elderly, it appears important that pyometra be included in differential diagnosis as the cause of fever even without gynecological symptoms and that tubercle bacillus be considered the causative bacterium.     

旅游者感染黑热病1例

1临床资料患者,女,20岁,学生,四川省德阳市人。因反复不规则发热4个月,脾脏切除术后1个月入院。患者4个月前无明显诱因出现发热,体温38·5℃。自行服用3~4 d感冒药后症状无明显缓解。在当地市级医院按“感冒”输液治疗后有所缓解。数天后再次发热,不伴咳嗽、咳痰等症状。抗感冒     

A case of tuberculous pericardial effusion

We report a case of an 80-year-old caucasian female in the UK who presented with weight loss and was found to have a pericardial effusion. There was neither previous exposure to tuberculosis nor any suggestion of immunosuppression. Repeated analysis of pericardial fluid established a tuberculous origin. Search of medical literature did not reveal any similar cases in the elderly in the UK.     

A case of pulmonary actinomycosis, who expectorated sulfur granules, caused by Actinomyces odontolyticus and Actinomyces meyeri]

A 51-year-old man complaining of cough and bloody sputum, was admitted to our hospital because of antibiotic-resistant chronic pneumonia in the right upper lobe. Initially, bronchoscopic examination and sputum culture revealed no evidence of malignancy or any specific infection, either pathologically or microbiologically. However, pathological examination of a solid body expectorated with sputum revealed typical sulfur granules, indicating pulmonary actinomycosis. Two actinomyceses named Actinomyces odontolyticus and Actinomyces meyeri were detected later. Pulmonary infection caused by these types of actinomyceses is rare, and the diagnostic procedure seemed to be unusual.     

A case of tuberculous peritonitis diagnosed by ultrasonography-guide peritoneal biopsy

The diagnosis of tuberculous peritonitis is quite difficult because the symptoms are not specific for the disease and the incidence of occurrence are relatively rare. We report a case of tuberculous peritonitis diagnosed by ultrasonography-guided peritoneal biopsy. A 64-year-old male was admitted to our hospital because of fever, dyspnea and abdominal pain. Laboratory findings revealed an elevated ESR (53 mm/1 hr.) and positive CRP. The tuberculin skin test was negative. The chest radiograph revealed bilateral pleural effusion. Abdominal ultrasonographic examination and computed tomography showed ascitic fluid, thickening of the mesentery and peritoneum, and inflammatory pseudotumor of the omentum. Ascitic fluid was exudate with a high lymphocyte count and elevated ADA (184 IU/l). Microbiological studies with the fluid were negative. Peritoneal biopsy guided by ultrasonography was performed, and the specimens showed central caseous necrosis surrounded by epitheloid cells and acid-fast bacilli were demonstrated. The size of the pseudotumor, pleural effusion and ascites decreased after antituberculous chemotherapy with corticosteroid was given. Diagnosis of tuberculous peritonitis has often been made by laparotomy or laparoscopy. In a case of this kind, percutaneous peritoneal biopsy guided by ultrasonography is safe and useful.     

婴儿感染人芽囊原虫1例报告

患儿,女性,4月龄,湖南省常德市临澧城关镇人。因无明显诱因血样便,于2006年5月8日来广西医科大学一附院儿科就诊。大便3次/d,有腥臭味,较稀烂,伴少许黏液,无浓性物,量中等,同时伴呕吐(非喷射状),无咖啡样物,进食即吐,无明显烦躁和哭闹。患儿为顺产第1胎,新法接生,出生时体重3.1     

Early detection of Rickettsia tsutsugamushi in peripheral monocyte cultures derived from experimentally infected monkeys and dogs.

Rickettsia tsutsugamushi organisms were identified in Giemsa and fluorescent antibody stained monocyte cell cultures derived from experimentally infected monkeys and dogs. The identification of organisms in monocyte cell cultures compared favorably with the standard technique of mouse inoculation.     

输血感染间日疟1例

患者 ,男 ,8岁 ,在某院作心脏手术 ,输注血液1 2 0 0 ml,术后住院 1个月出院。两月后 ,患者突然发烧、头痛、胸闷 ,即护送至涪陵区第二人民医院住院治疗。查体 :T 39.8℃ ,R 2 8次 /min,心率 1 2 8次 /min,BP 1 1 /8k Pa。实验室检查 :RBC 4 .8× 1 0 1 2 /L,WBC 3.9× 1 0 9/L,Hb 1 1 5g/L。X线检查双肺 ( -) ,B超检查 ,肝脏稍增大。大便检查无RBC、WBC和脓细胞 ,诊断为发热原因待查 (病毒感染 )。给青霉素 1 60万 U、庆大霉素 8万 U、病毒唑 0 .2 g静注2 d,仍持续发热不退。继请我站协助采血镜检疟原虫。经染色镜检查见间日疟原…