Tuberculous epididymo-orchitis. A review of 20 cases

Twenty cases of tuberculous epididymo-orchitis, occurring in Glasgow from 1970 to 1979, were reviewed. Five gave a history of previous tuberculosis and 10 showed no evidence of tuberculous infection in their urine. In half of the cases the diagnosis was made from histological material. Only five patients had normal intravenous urograms and five required subsequent major surgery for upper urinary tract disease. Tuberculosis should be considered in the differential diagnosis of a scrotal swelling even in the absence of a history of previous tuberculosis.     

Gallenblasentuberkulose

We report a case of gall bladder tuberculosis in a 64-year-old male. The gall bladder is an extremely rare localization of an infectious disease seen frequently worldwide--tuberculosis. The reason for this special resistance against the mycobacteria is not clear and is controversial. In imaging, the disease can mimic acute or chronic cholecystitis or carcinoma of the gall bladder. It is important to consider tuberculous cholecystitis in differential diagnosis and to do tuberculin skin tests in case of suspicion. This test is technically easy and cost-effective. Since 1968, isolated tuberculosis of the gall bladder has not been reported in western civilization. This case study was done because of the rareness of the disease,and we review the literature on this topic.     

Spontaneous choledochoduodenal fistula with tuberculous duodenal ulceration

Spontaneous choledochoduodenal fistulas (CDFs) are rare. The most common aetiology is penetrating duodenal ulcers, observed in 80% of cases. Even in areas where acid peptic disease is common, tuberculosis should be considered as a cause, especially in developing countries like India, where tuberculosis is common. The management of CDF due to acid peptic disease is predominantly surgical while healing of tuberculous CDF has been reported with antitubercular treatment. A preoperative diagnosis of tuberculous CDF by endoscopic biopsy from the duodenal ulcer or image guided fine needle aspiration if abdominal lymph nodes are present can eliminate the need for surgery and achieve a cure with antitubercular treatment. The CDF in this case was due to caseation of periduodenal lymph nodes rupturing into the duodenum and the bile duct.     

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.     

Peripheral tuberculous lymphadenopathy: a review of 67 cases.

Peripheral tuberculous lymphadenopathy is the commonest form of extrapulmonary tuberculosis. Sixty-seven patients with peripheral tuberculous lymphadenopathy who presented to general surgeons and underwent lymph node biopsy between 1979 and 1989 are reviewed. Fifty-four patients (81 per cent) were of Indian subcontinent ethnic origin and 13 (19 per cent) were of white ethnic origin. The sites most commonly affected were the cervical lymph nodes. Biopsy specimens obtained by open operation were sent for microbiological examination in all but 13 cases, of whom seven were patients of white ethnic origin. Tuberculous lymphadenopathy remains an important differential diagnosis of cervical lymphadenopathy and it is essential that peripheral lymph node biopsies are examined both histologically and microbiologically.     

骨科感染偶发分枝杆菌的临床案例分析一例

［摘要］ 目的 偶发分枝杆菌属于快速生长的分枝杆菌,在自然界分布广泛,但其导致的骨科感染病例少见报道,现分析我院骨科感染偶发分枝杆菌病例一例,为临床治疗提供参考。方法 回顾分析其实验室检查过程、临床特点及治疗过程,并随访其治疗效果。结果 非结核分枝杆菌容易漏诊、误诊,常规细菌培养不易检出,其导致的感染难以控制,且治疗过程较长。结论 非结核分枝杆菌导致的感染报道越来越多,但是治疗过程较复杂,治疗时间较长,其分离、培养及鉴定对临床有着极其重要的意义。     

Diagnostic dilemma of tuberculosis in the foot and ankle

BACKGROUND: Isolated involvement of bone in tuberculous infection is uncommon, and the variable clinical and radiological features may mimic pyogenic osteomyelitis, bone tumor or other inflammatory and neoplastic processes of the synovium. We have reported our experiences with the diagnosis of tuberculosis infection in the ankle and foot with the hope of providing sufficient information about these cases to lead to early diagnosis. MATERIALS AND METHODS: We treated 15 patients with tuberculosis involving the foot and ankle between 1995 and 2005. They were followed for a minimum of 24 months, and the average duration of symptoms was 23 months. All patients underwent a physical examination, routine laboratory tests, plain radiographs, and a biopsy of the infection site. MRI studies were performed in 10 patients and a CT scan was done in one patient. RESULTS: The lesions were located in the forefoot (2), midfoot (3) and ankle (10). From the imaging studies, the presumptive preoperative diagnoses were tuberculous osteomyelitis (7), pyogenic osteomyelitis (4), pigmented villonodular synovitis (2), amyloidosis (1), and avascular necrosis of the talus (1). These diagnoses were verified by granulomatous inflammation with or without caseous necrosis on histology and tubercle bacilli were cultured in four cases. In three cases the diagnosis was made by polymerase chain reaction (PCR). CONCLUSION: When a patient presents with a localized, painful swelling and a persistent draining sinus of the foot and ankle, tuberculosis should be considered in the differential diagnosis. Additionally, we highly recommend taking a biopsy of the site of suspected infection because an early diagnosis is the key to successful treatment.     

Difficulties in the differential diagnosis of tuberculosis of the breast

An analysis of the own material and of literature data permits to note alterations in the clinical course of mammary gland tuberculosis, which is the manifestation of tuberculosis pathomorphism under modern conditions. The lesion of the mammary gland is most commonly an isolated disease. This interferes with the differential diagnosis between tuberculous mastitis and tumors of the mammary gland and supports the opinion that the spreading of infection from other old tuberculous foci via hematogenic path plays the main part in the pathogenesis of tuberculosis of the mammary gland.     

Isolated tuberculous tenosynovitis of the flexor carpi ulnaris: a case report and review of literature

Musculoskeletal involvement is seen in only about 1.3% of all patients with tuberculosis. Very few cases of isolated tuberculous synovitis have been reported. The rarity of this condition often leads to the failure to consider tuberculosis in the differential diagnosis, resulting in delayed therapy. We present one such case of isolated tuberculous tenosynovitis of the flexor carpi ulnaris in an otherwise healthy, 17-year-old female, which healed completely on conservative treatment.     

Duodenal tuberculosis

Duodenal tuberculosis is an uncommon disease. It may be either extrinsic or intrinsic or both. In the extrinsic type there can either be primary duodenal involvement or compression due to enlarged paraduodenal lymph nodes. The clinical presentation can be dyspeptic or obstructive symptoms. The dyspeptic symptoms include epigastric pain, nausea, and occasional vomiting and obstructive symptoms include bilious vomiting frequently after meals, epigastric pain, and generalized abdominal pain. This report describes a young lady presenting with gastric outlet obstruction symptoms due to tuberculous adhesion involving the proximal duodenum.     

Membranous nephropathy and granulomatous interstitial nephritis due to tuberculosis

Tuberculous involvement of the genitourinary tract is well reported in the literature. However, reports of glomerular lesions of the kidney due to tuberculosis are rare. Tuberculosis has been identified as the most common infectious cause of granulomatous interstitial nephritis (GIN). We report a 23-year-old female patient with a membranous nephropathy and GIN due to tuberculosis. She presented with renal failure and nephrotic-range proteinuria, both of which resolved with the treatment of tuberculosis. There is only one report, from Japan, of a patient with membranous nephropathy and tuberculous granulomatous nephritis. Our patient is the second with tuberculous GIN and membranous nephropathy. In our patient, the close temporal relationship between the infection and glomerulonephritis, an ulcerated tuberculin skin test, the response to the treatment and the absence of any other systemic disease that might cause the glomerulonephritis suggested an association between tuberculosis and membranous nephropathy. However, a causal association can only be speculation, because membranous nephropathy could remit spontaneously. It is also possible that it might relapse at a later date when the tuberculosis is inactive. Therefore, the association might be either coincidental or causal, and could become clearer as similar patients are reported.     

Relationship of urogenital tuberculosis to tuberculosis of other organs,in old and new autopsy material

Based on more than 32 thousand autopsies performed at the János Hospital, Budapest, during the first sixty years of this century, in 835 cases attention has been focussed on the place of urogenital tuberculosis among other kinds of tuberculosis, on the kind of constellation and immunobiological condition it represents, as well as on its relationship to other forms of tuberculosis. These problems have been approached from several angles. p ]The observations tend to indicate that at least in postmortem material urogenital tuberculosis is one of the worst forms of organ tuberculoses and represents an unfavourable constellation in tuberculous disease.     

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.     

Diagnosis and Treatment of Skipped Multifocal Spinal Tuberculosis Lesions

Spinal tuberculosis, also known as Pott's disease or tuberculous spondylitis, is usually secondary to primary infection in the lungs or other systems, and in most instances, is thought to be transmitted via blood. Typical manifestations of infection include narrowing of the intervertebral disc by erosion and bone destruction of adjacent vertebrae. Atypical spinal tuberculosis is a specific type of spinal tuberculosis. It mainly consists of single vertebral lesions, single posterior structure lesions, multiple vertebral lesions, and intra-spinal lesions. Skipped multifocal spinal tuberculosis is one of these types and is characterized by two or more vertebral lesions without the involvement of the adjoining intervertebral discs, regardless of their location. To date, only a few cases have been reported. Upon clinical admission, it can be treated conservatively or surgically, depending on the patient's symptoms. In addition, gene or biological therapies are being investigated. However, because of the exceptional imaging findings and insidious symptoms, it is often misdiagnosed as a neoplastic lesion, osteoporotic fracture, or other infectious spondylitis, increasing the risk of neurological deficit and kyphotic deformity, and delaying the optimal treatment window. In this study, we review the diagnosis and treatment strategies for skipped multifocal spinal tuberculosis lesions and enumerate the common differential diagnoses, to provide reference and guidance for clinical treatment and diagnosis direction.     

Non-surgical renal tuberculosis

We wish especially to call the attention of practitioners and urologists to the extreme and progressive frequency of this malady, both unilateral and bilateral, and to the fact that there are certain instances of this disease in which surgery as a therapeutic procedure should not be applied. We would emphasize the fact that combined medical and urological treatment in a select group of cases yields the most profitable and satisfactory results.In the three cases reported, the first one shows the incidence of an excretory renal tuberculous bacilluria without demonstrable pathological lesion in the kidney. The clinical value of this fact speaks for itself in the misleading interpretation of many diagnoses.The second case illustrates early bilateral renal tuberculosis when surgery must be applied as the best and most reasonable treatment arresting or curing the disease.The third case reported illustrates the advanced stage of bilateral renal tuberculosis, when both sides are equally involved with greatly diminished function, and when surgical treatment should not be recommended.There is no definite rule governing the solution of the clinical problem, but no kidney should be removed, particularly in doubtful cases, until after the three elements of the triangle, pointed out in this paper, are present to a marked degree and associated also with positive microscopic findings or guinea pig inoculation.Repeated urological investigations in many instances are entirely justified in an effort to discover the earliest tuberculous lesion of the upper urinary tract, and also to prevent the involvement of the second kidney. However, it is of great value to recall that genitourinary tuberculosis is a syndrome of a general body process localized in one or more of the genitourinary organs, demanding immediate attention in regard to hygienic and antituberculous treatment, i.e., the use of tuberculin, sunlight, forced diet, rest, plenty of fresh air and a peaceful life.In the light of modern urology, two distinct types of renal tuberculosis must be differentiated, the one that requires only medical treatment and the one requiring surgical treatment, when nephrectomy as a rule is indicated. But there are still certain cases in the early stage of the disease when the process is localized, involving only isolated zones of the cortical parenchyma or the medullary substance and when the lesion is walled off and does not communicate with the papillae, the calices or the pelvis, and therefore is a closed or isolated process, as we can readily see in the three distinct types shown in Figure 6. In these cases the diagnosis is most difficult, and nephrectomy should not be performed until the process is well established, i.e., after the tuberculous nodules or abscesses have broken through into the excretory apparatus producing pyuria and other marked urinary symptoms. We should not forget that not until that stage is reached can pyelographic data reveal the condition. These cases evidently require most active and efficient medical and urological treatment in order to attain a cure. But if the disease can not be arrested or cured, and the symptoms progress, the permanent cure may be obtained in from 80 to 90 per cent of the cases by early nephrectomy.On the other hand we should not wait for the incidence of an occluded renal tuberculosis, as occurs in autonephrectomy for blocking of the ureter, nor should we depend upon body resistance that the disease may continue for a long period of time. Logically it is assumed that the focus of infection is bound to develop further infection in the other kidney or in the lower urinary tract at a most serious risk. The damage that nature may cause insidiously in destroying the whole kidney parenchyma, by the tuberculous process alone, is undoubtedly worse than the traumatism of a simple nephrectomy in order to remove an organ deeply involved and functionless (Fig. 7).However, medical and urological routine treatment, as administered by the newly formed Tuberculosis Division of the Brady Urological Foundation at the New York Hospital, should be used systematically not only in postoperative or inoperable cases, but more especially in the earlier stages of the disease, for it is at this period that results are most gratifying.     

54例非结核分枝杆菌感染者对二线抗结核药的耐药分析

目的：观察分析非结核分枝杆菌（NTM）的耐药情况。方法收集本院分枝杆菌培养阳性并鉴定为非结核分枝杆菌的病例,并对其药效结果进行分析。结果320例分枝杆菌培养阳性病例中,54例为非结核分枝杆菌,占16.9%,对二线抗结核药物阿米卡星（AK）,卷曲霉素（CPM）,对氨基水杨酸钠（PAS）,莫西沙星（MFX）,左氧氟沙星（LFX）和丙硫异烟胺（TH1321）均有不同程度的耐药,耐药率高达87.0%,且大多数呈现多耐药。结论非结核分枝杆菌对抗结核药呈现耐药现象,故临床用药困难,对临床抗结核治疗效果不佳或疑似NTM肺病的患者应及早做痰培养、菌型鉴定及药物敏感试验并寻求其他有效的治疗方法。     

Infection as a Cause of Spinal Cord Compression: A Review of 36 Spinal Epidural Abscess Cases

A retrospective survey of 36 cases treated in the Department of Neurosurgery, Hacettepe University Hospitals since 1970 was performed. Clinical presentation, aetiology and outcome of this rare disease compared to recently published series. All cases were admitted with signs of neural compression. Clinical and laboratory data suggesting an infectious origin were present only in 4 cases. Radiological investigation including magnetic resonance imaging in 10 patients, were not confirmative for an epidural abscess except for two cases. All cases underwent urgent surgical decompression and tuberculous abscess either in granulation or pus form was found in the majority. Overall mortality rate was 5.8%. Outcome was closely related to the neurological condition on admission rather than the underlying infectious origin. When compared with recently reported series, our cases demonstrated a significant divergence in terms of clinical presentation, pathogenesis and outcome. The most probable reason for this discrepancy is that risk factors for compromised immunity or systemic infection were much less than the other series and mycobacterium tuberculosis is the responsible agent in the majority which has a much more favourable outcome than non-spesific infections.     

Rupture of tuberculous spinal abscess resulting in tuberculous empyema and chylothorax

STUDY DESIGN: Case report with a review of scientific literature. OBJECTIVE: To describe the course of tuberculous spinal disease (Pott's disease) complicated by pyogenic and tuberculous empyema, and chylothorax as there has been an increase in the numbers of notified cases of tuberculosis in the UK(1). To the best of our knowledge, a similar case has not been reported previously in the UK, although there has been a report of bilateral chylothorax associated with Pott's disease. SETTING: A national spinal injuries unit in a Scottish university teaching hospital. METHODS: Review of literature on the chemotherapy of spinal tuberculosis and the role of streptokinase in the treatment of empyema and the relation between spinal tuberculosis, empyema and chylothorax. RESULTS: Although spinal tuberculosis was recognised and treated appropriately with chemotherapy, the patient sustained pleural involvement with later development of both empyema and chylothorax. CONCLUSION: The case highlights the difficulties in the treatment of tuberculosis of the spine inspite of the presence of fully sensitive organisms and early institution of appropriate chemotherapy. In the absence of surgical debridement, the duration and dosage of chemotherapy as practised in the initial period may have to be prolonged into the continuation phase. The thoracic duct can be damaged either because of extension of the tuberculosis itself or because of instillation of intrapleural streptokinase for treatment of pleural empyema leading to chylothorax. There is a need for randomised trials of intrapleural streptokinase treatment in tuberculous empyema.     

Intracranial tuberculoma with difficult preoperative diagnosis. Case report]

Intracranial tuberculoma is a relatively rare tumor in developed countries. A 41-year-old Japanese male with a personal history of pulmonary tuberculosis at the age of 20 was referred because of continuous headache. Computed tomography scan revealed multilocular ring-like enhancement in the right deep temporal region with massive brain edema. Angiography showed an avascular mass with narrowing of the carotid bifurcation. The preoperative diagnosis was glioblastoma. This mass was successfully removed and the histological diagnosis was tuberculoma. This case suggested that tuberculoma is still one of the differential diagnoses of an enhanced mass lesion even without any active extracranial tuberculous lesion.     

Inactive Fibrotic Lesions Versus Pulmonary Tuberculosis With Negative Bacteriology

This article analyzes the concept of inactive fibrotic lesions of presumed tuberculous origin (old healed tuberculosis), defined by radiological characteristics and a positive tuberculin skin test (TST), and we examine the evidence-based foundation for the indication of treatment of latent tuberculosis infection in these cases. We explore the risk of reactivation in older and recent literature, and the problems raised by the differential diagnosis with active tuberculosis with negative bacteriology. We also analyze data on the prevalence of fibrotic lesions in the recent literature. We examine the possible role of Interferon Gamma Release Assays (IGRAs) versus TST and other molecular antigen detection techniques in sputum that can aid in establishing the diagnosis and we discuss the current indications for chemoprophylaxis and the different options available. We propose diagnostic guidelines and therapeutic algorithms based on risk stratification by age and other factors in the management of radiological lesions that raise a differential diagnosis between fibrotic lesions and active pulmonary tuberculosis with negative bacteriology.