Thyroid tuberculosis

Thyroid tuberculosis is a rare disease. Its incidence is low even in countries where prevalence of pulmonary tuberculosis is high (0.1–0.4%). In literature, there are only a few cases which were diagnosed as thyroid tuberculosis. It can be explained by a high resistance of the thyroid gland to infectious processes. However, the prevalence of tuberculosis has increased worldwide and thyroid involvement can be a primary manifestation of the disease. The incidence of extrapulmonary tuberculosis has been showing a progressive increase in the recent years(Barnes and Weatherstone, 1979). The most frequent clinical presentation is a solitary thyroid nodule that may present as a cystic nodule. It may also present as thyroid abscess with pain, fever and other non-specific signs and symptoms. ATT results in complete cure therefore it is important to differentiate it from other form of thyroiditis. Patients are usually euthyroid, but cases of hypothyroidism and hyperthyroidism are described. For accurate diagnosis of thyroid tuberculosis, clinical and radiological features are nonspecific and histological examination is required for confirmation of diagnosis. PCR may help in diagnosis. The authors encounter 3 cases of thyroid tuberculosis in last 5 year which are described in this article. The aim of this study is to review all the cases published in literature to describe clinical presentation, appropriate diagnostic method and possible treatment options of the disease.     

Acromioclavicular joint tuberculosis: A report of two cases

Acromioclavicular joint tuberculosis is an extremely rare presentation with only 16 cases reported so far and has a relatively high propensity to be misdiagnosed. India being a tuberculosis endemic region accounts for almost 27% of cases worldwide (global index of 2018 was 10 million). With a higher index of suspicion an earlier diagnosis can be made. We report two patients of AC joint tuberculosis, treated with multidrug chemotherapy resulting in a good functional outcome.     

肾上腺结核合并Addison''''s病42例临床分析

目的　探讨肾上腺结核合并Addison’s病的临床特点。方法 回顾性分析42例肾上腺结核合并Addison’s病的临床资料。结果 42例肾上腺结核合并Addison’s病病例中,30例(714%)伴有肾上腺外结核;39例化验红细胞沉降率,26例增快;27例行PPD试验,20例阳性;25例行CT扫描,20例(80%)有肾上腺钙化,18例(72%)肾上腺增大。结论 肾上腺结核是我国Addison’s病的常见原因,且常伴有肾上腺外结核,CT扫描显示肾上腺钙化、增大对结核性Addison’s病的诊断具有特征性。     

Localized tuberculosis of the oesophagus: a rare condition

Abstract. This report describes the case of a male patient with progressive dysphagia, epigastric pain, odynophagia, generalized weakness and a mid-oesophagus ulceration in which biopsies showed acid-fast bacilli and histological evidence of tuberculosis. Culture of the biopsies and the sputum revealed mycobacterium tuberculosis. There were no respiratory symptoms, and radiographs did not reveal evidence of pulmonary tuberculosis. The patient responded well to antituberculous therapy and he is alive and well 7 years later, without any signs of relapse. The involvement of the oesophagus as the only demonstrable localization of tuberculosis is an extremely rare condition, which should always be considered as differential diagnosis in dyspepsia of unknown origin.     

Tuberculous involvement of the oesophagus with oesophagobroncheal fistula

Tuberculous involvement of the oesophagus is a rare disease. Even if it is suspected, diagnosis is often difficult though dysphagia and chest pain are the most common symptoms without any other specific signs of tuberculosis. The diagnosis is based on oesophagography, oesophagoscopy, bronchoscopy, and computed tomographic scan. Suspected tuberculosis can be confirmed with histology, smear, and culture. The two most common differential diagnoses are Crohn's disease and carcinoma. The case is reported of a female patient with tuberculous involvement of the oesophagus, who developed an oesophagobroncheal fistula during steroid treatment started for suspicion of Crohn's disease. The patient was immunocompromised due to treatment with azathioprine that she was receiving for multiple sclerosis. The fistula was successfully treated by antituberculous chemotherapy alone.     

Gastric tuberculosis in the past and present

The paper presents a historical review of the literature on the rare form of extrapulmonary tuberculosis--gastric tuberculosis. It is more frequently associated with tuberculosis of other organs and observes as an isolated form. The disease has no specific clinical signs. It is diagnosed as gastric carcinoma or ulcer by X-ray and in most cases endoscopic studies. The diagnosis of gastric tuberculosis can be made only by histological study of the resected stomach or its biopsy specimen. Antibiotic treatment for tuberculosis yields a good effect.     

Appendicular tuberculosis:The resurgence of an old disease with difficult diagnosis

Gastrointestinal tuberculosis(TB) is quite rare,representing only 3% of all extra-pulmonary cases.Blind gut and ileum are the most common gastrointestinal localizations,while appendix involvement is infrequent.Appendix involvement is usually related to symptoms of acute appendicitis since the caseous necrosis may lead to adhesions and surgical complications such as perforation.For this reason patients with suspected appendicular TB usually undergo surgery even without a secure diagnosis.In these cases,due t...     

食管结核合并结核性腹膜炎1例

食管结核是结核杆菌侵及食管壁导致的一种少见的炎性肉芽肿性病变,其发病率低,易误诊.最容易混淆的疾病是食管癌和食管平滑肌瘤.食管结核常见症状为吞咽困难,胸骨后疼痛,消瘦和发热等,这些症状与食管平滑肌瘤、食管癌比较无特异性,术前诊断较困难.尤其是食管结核合并结合性腹膜炎更是少见.本文报道1例食管结核合并结核性腹膜炎,并结合文献,就诊断及治疗进行复习.     

腹膜活检对结核性腹膜炎的诊断价值

目的评价经皮腹腔穿刺腹膜活检对结核性腹膜炎的诊断价值。方法使用自动弹簧活检针对34例临床上考虑为结核性腹膜炎患者进行腹膜活检,并进行病理诊断。结果34例患者均经一次穿刺取出腹膜壁层组织,经病理证实结核性腹膜炎26例、转移性腺癌3例、恶性淋巴瘤1例和大致正常腹膜组织4例,一次穿刺活检成功率为100％,经活检明确腹水病因的诊断率为88．2％。结论腹膜活检对结核性腹膜炎诊断及鉴别诊断,有重要的临床诊断价值。     

ELISPOT检测在老年肺结核诊断中的应用价值

目的评价结核分枝杆菌特异性IFN-γ酶联免疫斑点(Elispot)检测技术对老年人肺结核的诊断价值。方法对46例老年肺结核、85例中青年肺结核、22例老年非肺结核、97例健康对照,进行Elispot检测并分析该技术诊断老年肺结核的可靠性。结果老年和中青年肺结核Elispot检测的敏感度分别为76.19%和87.5%,特异度分别为84.47%和85.29%。中青年和老年肺结核组Elispot检测阳性率显著高于其它两组(P<0.05)。结论 Elispot检测技术在诊断老年肺结核中显示出较好的敏感性和特异性,阳性率高,可用作老年肺结核的辅助诊断。     

肺吸虫病并发肺结核52例临床分析

目的探讨肺吸虫病并发肺结核的临床表现及治疗,提高对肺吸虫病并发肺结核的认识。方法对1995—2002年收治的52例肺吸虫病并发肺结核患者的临床资料进行回顾性分析。结果肺吸虫病并发肺结核均为青年和成年人,男性(67.3%)多于女性,大多数是在疫区居住的农民(76.9%);临床表现呈复杂性、多样性,误诊11例(21.1%);全部病例在流行区均有食半生石蟹或饮溪流生水史,肺结核和肺吸虫病均通过病原学检查确诊。结论肺吸虫病并发肺结核时,两病的临床症状和体征有许多相似之处,影像学有时也难分辨,必须结合病史及病原学检查可确诊。     

Imaging features of intrasellar tuberculoma: two cases

Hypophyseal tuberculoma is extremely rare. It may be confused with other more common sellar tumors such as adenomas. Characteristic, but not specific, radiological features are in the majority of cases: intense enhancement on contrast CT and thickening of the pituitary stalk better visible on MRI. We describe imaging findings in two patients with pituitary tuberculosis. In these cases an accurate non-invasive diagnosis was found to be important as antituberculous chemotherapy is curative.     

肺结核并发肺曲菌球47例外科治疗

目的　探讨肺曲菌球与肺结核的关系及其诊断和治疗;方法 对13年经外科手术治疗的47例肺结核合并曲菌球病人进行回顾性分析;结果 男性31例,占66.0%,病程>5年27例。咯血症状突出,41例,占87.2%。47例肺结核合并曲菌球中,术前明确诊断32例,占68.1%,漏误诊率31.8%。45例治愈,占95.7%,死亡2例,占4.2%。术后并发症10例,分别为胸腔感染、支气管胸膜瘘、肺炎、肺不张、支气管哮喘、呼吸衰竭和失血性休克。结论 肺曲菌球病见于肺结核空洞患者,在长期规律抗结核治疗后仍反复咯血,漏诊率较高,手术治疗为首选,效果较好。     

结核感染T细胞斑点实验临床检测研究

目的探讨结核感染T细胞斑点实验（T-SPOT.TB）在临床快速诊断结核病中的应用价值。方法利用T-SPOT.TB方法检测外周血中结核感染特异的效应T淋巴细胞的频率。同时与涂片抗酸染色、BACTEC960培养及实时定量PCR方法做比对。结果164例结核病患者中,155例T-SPOT.TB阳性,提示方法敏感度为94.5％（155/164）,显著高于其他方法。60例非结核呼吸道疾病对照组中有5例阳性,20例健康对照均为阴性,方法的特异度为93.8％（75/80）。结论T-SPOT.TB方法敏感度和特异度均非常高,可用于结核病的快速诊断,尤其是对于结核病和非结核分枝杆菌病的早期鉴别。     

18例脾结核临床分析

目的探讨脾结核的诊断及治疗措施。方法对18例脾结核患者的临床资料进行回顾性分析。结果18例病人中表现为发热14例(占77.7%),腹痛9例(占50.0%),发热病程为1周至12个月,平均热程为2个月。其他较常见症状体征为腹胀4例(占22.2%)、盗汗4例(22.2%)、乏力5例(占27.8%)、纳差7例(38.9%)、贫血7例(38.9%)、脾肿大9例(占50%)。手术及病理诊断12例,1例胃液发现抗酸杆菌确诊,5例经试验性抗结核治疗有效确诊。18例病人中10例合并脾外结核。确诊前误诊9例(50%)。2例病人死亡,余16例均经手术及或1年以上的抗结核治疗,经随访预后良好。结论脾结核以长程发热和腹痛为突出表现,误诊率高,诊断主要依靠脾切除病理学检查及诊断性治疗,选择性手术治疗及系统性抗结核治疗是脾结核的主要有效治疗手段。     

Anoperineal tuberculosis: diagnostic and management considerations in seven cases

PURPOSE: Anoperineal tuberculosis is a rare extrapulmonary form of the disease that we must learn to recognize because it requires specific treatment. METHODS: Data from seven patients with anoperineal tuberculosis observed in a Parisian proctology unit between 1982 and 1999 were reviewed. RESULTS: All the patients were male (median age, 55 years); five were born in underdeveloped countries, and two were still living there. The average length of time between first manifestation of the disease and diagnosis was three years (range, 3 months to 9 years); all patients had undergone surgery previously. There were six recurring anal fistulas (complex in 5 cases) and one recurring abscess. In every case, the diagnosis had been suspected or confirmed by systematic histologic study of the surgically excised tissue. An association with pulmonary tuberculosis was found in each case. Treatment included two parts: conventional surgical treatment of anal sepsis and specific medical antituberculosis treatment. Evolution was favorable in all cases, with no recurrence of disease. Human immunodeficiency virus infection did not increase the incidence of anoperineal tuberculosis. CONCLUSION: Tuberculosis should be suspected in all recurrent fistulas. Histologic examination of the excised tissue and a lung x-ray should be performed to avoid delay in diagnosing an easily curable disease.     

Intestinal tuberculosis as a cause of chronic diarrhoea among patients with human immunodeficiency virus infection: report of two cases

In Western countries human immunodeficiency virus infection is considered the main risk factor of tuberculous disease, its incidence being 500 times higher in HIV-infected patients than in the general population. Despite the disease frequently present in these patients with extraintestinal manifestations, intestinal localization is rarely observed and often as a consequence of complications such as acute gastrointestinal bleeding or perforation. The diagnosis of intestinal tuberculosis is difficult and is often delayed due to the lack of specific signs and symptoms as well as the low sensitivity of routine methods. A review of the literature is made and personal experience in the diagnosis of two cases is reported.     

FQ-PCR技术在肺外结核中的诊断价值

目的探讨FQ-PCR技术对活动性骨关节结核和泌尿系结核的诊断价值。方法选择118例疑似结核病患者,其中关节炎患者52例,泌尿系感染患者66例,应用FQ-PCR技术分别检测患者关节腔积液和尿液中的TB-DNA,并与抗酸染色法的检出率比较。结果 52例关节炎患者中,确诊结核性关节炎患者36例,TB-DNA阳性22例,22例全部为确诊病例,阳性率61.1%。抗酸染色的阳性数为2,均为TB-DNA阳性者,阳性率5.6%;66例泌尿系统疾病患者中,确诊泌尿系结核患者52例,TB-DNA阳性32例,32例全部为确诊病例,阳性率为61.5%,抗酸染色的阳性数为4,均为TB-DNA阳性者,阳性率7.7%。结论应用FQ-PCR技术检测患者关节腔积液和尿液中的TB-DNA,具有高度敏感性和特异性,可作为结核性关节炎和泌尿系统结核早期诊断的一个可靠指标。     

不同方法收集胃液进行结核分支杆菌培养对儿童肺结核的诊断价值

目的探讨胃液的结核分支杆菌培养对儿童肺结核的诊断价值。方法对４６例儿童肺结核患者选取痰、胃腔内直接吸取液、清晨呕吐液及其他时段呕吐液４种标本进行结核分支杆菌培养，并对其培养阳性率进行比较。结果上述４种标本的结核分支杆菌培养阳性率分别为９％、３３％、２６％和４％。结论酌情选用不同方法收集胃液进行培养，是诊断儿童肺结核的特异性方法之一     

78例肺结核合并喉结核临床分析

目的 探讨肺结核合并喉结核的临床特征,提高肺结核合并喉结核的诊疗水平.方法 回顾性分析2016年4月至2019年8月入住我院的78例肺结核合并喉结核患者的临床资料,包括:电子支气管镜、胸部CT、活检病理、抗酸染色涂片、结核菌培养、结核菌分子检测等结果,同时了解是否合并其他部位结核、诊疗经过是否存在误诊,并对抗结核方案及...