Extrapulmonary tuberculosis in surgical specimens

Tuberculosis is a very common lesion in surgical specimen in our country. This study was designed to explore the distribution of extrapulmonary tuberculosis (EPTB) in various organs through examination of surgical specimens. A total of 103 specimens were diagnosed as tubercular lesion by histological evaluation in the department of pathology, Mymensingh Medical College and a private laboratory during the period from January 1997 to August 1998. Out of 103 cases 36 were male and 67 were female (M: F = 1:1.8) and their age ranged from 4-75 years (median age 28 years). The lesions were distributed as follows: lymphnode 86 (84.9%), intestine 9 (8.7%), bone 2 (1.9%), epididymis 2 (1.9%), fallopian tube 1 (0.97%), pharynx 1 (0.97%) tonsil 1 (0.97%) and nasal mucosa 1 (0.97%). Out of 86 cases of tubercular lymphadenitis, 61 (89.7%) were cervical, 6 (6.8%) were mesenteric and 1 (1.5%) was inguinal. Sixty nine percent clinically diagnosed cases were consistent with histological findings (18 out of 26). This study reveals, in our locality, EPTB is very common in early adulthood with female preponderance. Cervical lymph node is very common sites for EPTB.     

超声引导下穿刺活检对肺外结核的诊断价值

目的 探讨如何提高超声引导下穿刺活检对肺外结核(extrapulmonary tuberculosis,EPTB)的诊断价值.方法 对152例临床疑诊结核或诊断不明病灶的患者进行超声引导下穿刺活检,综合分析组织切片加特殊染色(病理组)、基因X-Pert MTB/RIF检测(基因组)、结核菌培养(菌培组)及涂片这4种方法...     

Extrapulmonary Tuberculosis in Human Immunodificiency Virus Infection

Background

In view of increase in incidence of exptrapulmonary tuberculosis after the epidemic of human immunodeficiency virus infection, the clinical profile of extrapulmonary tuberculosis in patients with HIV infection was studied.

Method

The study population comprised patients of HIV infection with extrapulmonary tuberculosis. Work up included history, clinical examination, sputum for acid fast bacilli, chext X-ray, ultrasonography (USG) abdomen, fine needle aspiration cytology(FNAC), transbronchial needle aspiration (TBNA) and computed tomography of chest.

Results

There were 50 cases, all males with mean age of 35 years. 24(48%) were without pulmonary tuberculosis and 26(52%) had pulmonary tuberculosis. 41(82%) had disseminated disease and 9(18%) involve one site. Fever and weight loss were the most frequent symptoms (79% and 58% respectively) in cases without pulmonary tuberculosis. The most frequent extrapulmonary site was lymph node in 46(92%), followed by spleen in 13(26%), pleura 9(18%), miliary 7(14%) and hepatic 1(2%). The diagnosis was confirmed by invasive methods in 30 out of 50(60%) cases [FNAC in 23(88%), TBNA in 2(25%) and pleural biopsy in 5(55%)].

Conclusion

In HIV infected patients, the most common extrapulmonary site is lymph mode followed by spleen.Key Words: Extrapulmonary TB, HIV Infection     

儿童结核病467例临床分析

2012年世界卫生组织首次报道,约有50万儿童结核病患者[1]。而世界卫生组织2018年的报道显示,2017年全球约有结核病患者1000万例,其中儿童100万例,占比10%,因患结核病死亡的大约有160万人,其中15%死亡病例为儿童[2]。我国是结核病高负担国家之一,全国第四次结核病流行病学调查显示,在0~14岁的儿童中,活动性肺结核的患病率为91.8/100000[3]。儿童结核病的临床表现及影像学征象不典型,病原学阳性率低,并且由于儿童免疫系统发育未完善,病灶不能被局限,易经血源传播或随淋巴系统至全身各器官,引起肺外结核,以及结核性脑膜炎、粟粒性肺结核等重症结核病,其临床表现多种多样,严重影响儿童结核病的早期诊断。本研究对温州医科大学附属育英儿童医院2000年1月—2014年12月467例住院结核病患儿的临床病例进行回顾性分析,为儿童结核病的早期诊断提供经验,降低误诊率。     

Childhood tuberculosis in Malawi: caseload,diagnostic practices and treatment outcomes

There were 22,982 cases of TB registered in Malawi in 1998, of which 2739 (11.9%) were children. Children accounted for 11.3% of all case notifications with smear-positive pulmonary TB (PTB), 21.3% with smear-negative PTB and 15.9% with extrapulmonary TB (EPTB). A significantly higher proportion of TB cases were diagnosed in central hospitals. Only 45% of children completed treatment. There were high rates of death (17%), default (13%) and unknown treatment outcomes (21%). Treatment outcomes were worse in younger children and in children with smear-negative PTB. In 2001, all 44 non-private hospitals in Malawi that register and treat children with tuberculosis (TB) were surveyed to determine actual diagnostic practice. This cross sectional study identified 150 children aged 14 years or below in hospital receiving anti-TB treatment, 98 with pulmonary TB (PTB) and 52 with extrapulmonary TB (EPTB). Median duration of illness was 8 weeks. Most patients had fever, no response to anti-malarial treatment and antibiotics, and 40% had a positive family history of TB. Nearly 45% had weight for age < 60%. Diagnosis was mainly based on clinical features and radiography, with less than 10% having tuberculin skin tests or HIV serology, and very few having other sophisticated investigations. Diagnostic difficulties make it difficult to accurately define the actual burden of childhood TB in Malawi. Diagnostic practices are poor and treatment outcomes unsatisfactory.     

Epidemiology of extra pulmonary tuberculosis in Eastern Sudan

Objective: To investigate the epidemiological factors associated with extra pulmonary tuberculosis(EPTB) in Kassala, Eastern Sudan.Methods: Patients infected with TB(pulmonary and extra-pulmonary) documented at the hospital were interviewed with a structured questionnaire used to gather socio-demographic information. The diagnosis of EPTB cases was based on presence of tuberculous granulomas in the histological samples, positive PCR to DNA of mycobacterium tuberculosis, radiological i ndings and l uid analysis suggestive of EPTB and clinical diagnosis with adequate response to anti-tuberculous therapy.Results: A total of 985 patients with TB were enrolled in the study, including 761(77.3%) with PTB and 224(22.7%) with EPTB. The mean age(SD) of patients with PTB and EPTB was 33.2(15.4) and 34.7(14.6) years respectively. The prevalence of EPTB was at(22.7%), with TB lymphadenitis 79(35.3%), marking the frequent form of EPTB followed by peritoneal TB 27(12.05%). While residence and occupation were not associated with EPTB, those with lower level of education(OR = 0.3; coni dence intervals(CI) = 0.2-0.5; P 0.001), female(OR = 8.7, CI = 4.9-15.1, P 0.001), non vaccination(OR=70.3, CI = 34.2-144.3, P 0.001), and non smoker(OR = 0.1; CI = 0.06-0.20; P 0.001), were associated with high prevalence of EPTB. Conclusions: Around one quarter of patients with TB in this study were more likely to have EPTB. Therefore, ef ective strategic plans regarding diagnostic procedures and control measures are needed to reduce the burden of the disease in Sudan.     

气管内超声引导下经支气管针吸活检在胸部恶性疾病诊断和肺癌个体化治疗中的价值

目的 评价气管内超声引导下经支气管针吸活检(endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)在胸部恶性疾病诊断和指导肺癌个体化治疗中的应用价值。 方法 回顾性分析2012年5月—2015年12月期间91例纵隔或肺门淋巴结肿大或毗邻气道的肿块的胸部恶性疾病患者EBUS-TBNA的诊断结果和24例患者EBUS标本的EGFR突变检测结果。 结果 共对227个纵隔、肺门淋巴结和23个肿块实施TBNA。4R和7组是最常受累的纵隔淋巴结;经EBUS-TBNA确诊86例,诊断恶性胸部疾病总体敏感度为94.5%,特异度为100.0%,准确度为94.5%。确诊病例中肺腺癌、小细胞癌、鳞癌和无法分型的非小细胞肺癌分别占确诊总例数的55.8%(48/86)、26.7%(23/86)、7.0%(6/86)和5.8%(5/86)。宫颈癌、结肠癌和食管癌和肾癌纵隔淋巴结转移各1例;超声图像分析表明:类圆形淋巴结[长短径之比(L/S)<1.5]、不均质回声、边界清晰、中央淋巴门结构消失和不规则血供在恶性病变中是常见征象;EBUS-TBNA标本EGFR敏感突变率为70.8%,病理标本和液基细胞标本EGFR突变阳性率差异无统计学意义(χ2=0.509 1,P=0.47);本组共17例轻微不良反应,均对症治疗后缓解或自行缓解。 结论 EBUS-TBNA操作简单、安全性高,对胸部恶性疾病的诊断和指导肺癌的个体化治疗有重要应用价值。      

210例浅表淋巴结肿大病因分析

目的:探讨浅表淋巴结肿大的病因构成特点,以提高对淋巴结肿大的病因认识。方法:回顾性分析2002年5月至2008年5月间经病理诊断淋巴结肿大病例210例。结果:在浅表淋巴结肿大患者中,良性淋巴结肿大99例,以局部病变为主,主要为淋巴结结核和非特异性淋巴结炎等。恶性淋巴结肿大111例,淋巴造血系统肿瘤68例,以淋巴瘤为主;淋巴结转移癌43例。结论:浅表淋巴结肿大存在于临床各系统疾病中,应引起临床医生的高度重视。     

多层螺旋CT对颈部淋巴结结核的诊断价值

[摘要] 目的 探讨淋巴结结核的多层螺旋CT表现及其诊断价值。方法 对经病理证实的25例淋巴结结核进行回顾性分析。结果 25例淋巴结结核共累及43个区域的淋巴结,其中累及Ⅰ区（颏下和下颌下淋巴结）6例（14.0%）,Ⅱ区（颈内静脉淋巴结上组）13例（30.2%）,Ⅲ区（颈内静脉淋巴结中组）8例（18.6%）,Ⅳ区（颈内静脉淋巴结下组）6例（14.0%）,Ⅴ区（颈后三角淋巴结）9例（20.9%）,Ⅵ区（颈前隙淋巴结）1例（2.3%）。CT表现为淋巴结肿大,平扫密度均匀,增强扫描类似于周围肌肉组织强化5例（10.2%）;淋巴结密度均匀,增强扫描呈全瘤不均匀强化,周围脂肪间隙存在11例（22.4%）;淋巴结密度不均匀,增强扫描呈周边环形强化,周围脂肪间隙存在14例（28.6%）;淋巴结密度不均匀,增强扫描成分隔状强化或环状强化,但周围脂肪间隙消失19例（38.8%）。结论 螺旋CT能够对肿大的淋巴结进行诊断,并能显示淋巴结结核的发生部位、数目、形态和周围间隙的情况,对淋巴结结核的定性诊断有较高的价值。     

基于超声造影指标颈部淋巴结穿刺活检适应证的临床研究

目的:探讨超声造影指标作为颈部淋巴结穿刺活检适应证的临床应用价值。方法: 纳入行淋巴结穿刺活检患者103例,男性47例, 女性56例,平均年龄(51.6 ± 17.9) 岁 。术前行超声造影检查,统计分析起始强化部位、强化类型两个超声造影指标作为穿刺活检适应证的统计学效能。结果:入组157枚淋巴结,炎性反应增生淋巴结 48枚,淋巴结核46枚,转移性淋巴结55枚,淋巴瘤8枚。以周边起始强化或不均匀强化超声造影指标作为穿刺活检适应证,其准确率为81.53%,敏感度为82.18%,特异度为80.35%,阳性预测值为88.30%,阴性预测值为71.4%。结论: 以周边起始强化或不均匀强化超声造影表现作为颈部淋巴结穿刺活检适应证具有较好的统计学效能,能够指导临床医师选择合适的活检方法,避免漏诊或误诊。     

γ-干扰素释放试验在肺结核和肺外结核诊断中的应用

目的:探讨γ-干扰素释放试验(IGRA)在肺结核和肺外结核诊断中的应用价值。方法:收集273例结核病患者与45例健康体检者肝素钠抗凝全血,采用国产IGRA试剂检测其血浆γ-干扰素含量,同时与结核菌素皮肤试验(TST)结果进行平行分析比较;采用抗酸染色(AFB染色)法对结核病患者痰液标本进行染色。结果:国产的IGRA试剂和TST实验的敏感性分别为85.35%和72.53%,特异性分别为86.54%和53.33%,阳性预测值分别为97.08%和90.41%,阴性预测值分别为52.94%和24.24%,准确性分别为85.22%和69.81%。两种方法对肺结核的检出率分别为85.71%(180/210)和74.76%(157/210),二者相比较,差异有统计学意义(χ2=7.943,P<0.01);两种方法对肺外结核的检出率分别为84.13%(53/63)和68.25%(43/63),二者相比较,差异也有统计学意义(χ2=4.375,P=0.036);但两种方法各自对肺结核与肺外结核的检测效果无显著差异。210例肺结核患者中AFB阳性73例,AFB阴性者137例,其中AFB阳性肺结核患者中IGRA阳性率为89.04%(65/73),AFB阴性肺结核患者阳性率为83.94%(115/137);肺外结核63例患者AFB均阴性,IGRA阳性率为84.13%(53/63)。结论:IGRA比TST对诊断结核病有较高的敏感性与特异性,尤其是对AFB阴性的肺结核和肺外结核有80%以上的检出率,有很好的临床应用前景。     

儿童肺炎支原体肺炎临床特征及肺外并发症438例分析

目的: 探讨儿童肺炎支原体(MP)肺炎临床及肺外并发症的特点。方法: 分析438例儿童MP肺炎的临床特点及肺外并发症的发生情况。结果: 438例中319例为学龄前期(3~6岁);153例肺外并发症中年龄≥ 3岁143例,3岁以下10例;并发症中以心血管、消化、神经系统多见,分别为51.0%、29.4%、17.6%;所有病例经阿奇霉素治疗14天左右好转。辅助检查:血MP-IgM均≥ 1:80,咽拭子MP培养阳性率32.6%。胸片肺间质改变238例,肺泡炎症121例,混合病变79例。结论: MP感染临床特征及胸部X线表现缺乏特异性,且易有肺外并发症,以肺外并发症为首发症状时,易造成误诊;对于治疗不理想且伴有肺外并发症的肺炎,应考虑MP感染可能,及时进行相关检测,早确诊,早治疗。     

Tubercular lymphadenitis - diagnostic evaluation

Tuberculosis is one the commonest disease affecting peripheral lymph node and cervical tubercular lymphadenitis are frequently encountered in Otolaryngological practice. Three hundred fifty six (356) cases of Fine Needle Aspiration for Cytology (FNAC) positive tubercular lymphadenitis were studied from January 2006 to December 2008. FNAC positive but histopathologically negative cases were excluded from the study. Among 356 cases of FNAC positive cervical lymphadenopathy 300 cases (84.27%) were confirmed tuberculosis on histopathological examination. Remaining 50 cases (15.73%) were diagnosed as nontubercular lymphadenitis where nonspecific lymphadenitis was the commonest finding 34(9.55%) followed by metastatic carcinoma 7(1.97%), lymphoma 6(1.08%), Kikuchiz's disease 6(1.08%), Kala-Azar 2(0.56%) & Leukemia 1(0.28%). Most of the patients presented with only multiple lymph node swelling with other symptoms, such as fever 18(5.06%), pain (15.7%), tenderness 53(14.88%), weight loss 29(8.14%), anorexia 33(9.26%). Following observations are evident from this study: i) Disease is comparatively common between 12-35 years ii) Multiple matted/discrete lymph nodes are the earliest presentation iii) Multiple lymph node is the most consistent finding for clinical diagnosis. iv) Very few patients have constitutional symptoms v) Suppuration with or without abscess formation although confirms the diagnosis even then certainty is very essential. Though the evidence of cervical tuberculosis was thought to be decreasing in developing countries the real picture seems to be different. Random survey among the whole population was not done in any country rather hospital based laboratory research was made.     

212例不明原因发热病例临床分析

目的 分析212例不明原因发热(fever of unknown origin,FUO)患者的病因构成、确诊方法,总结经验教训,不断提高FUO早期诊断及治疗水平。 方法 回顾性分析2012年1月—2015年1月在蚌埠医学院第一附属医院感染科住院且符合FUO诊断标准的212例病例,分别以性别和年龄分组,探讨FUO病因在性别和年龄中的分布。应用SPSS 19.0统计软件计算和分析,计量资料以x±s表示,计数资料采用χ2检验,P<0.05为差异有统计学意义。 结果 212例FUO患者经相关检查或诊断性治疗最终明确诊断171例,确诊率为80.66%,出院未确诊者41例(19.34%)。病因分别为:感染性疾病98例(57.31%),其中结核病占25.51%(25/98);结缔组织病(connective tissue diseases,CTD)27例(15.79%),其中成人斯蒂尔病占44.44%(12/27);肿瘤性疾病17例(9.94%),以淋巴瘤为主35.29%(6/17);其他疾病29例,以药物热最多见41.38%(12/29),坏死性淋巴结炎占24.14%(7/29)。CTD以女性多见,肿瘤性疾病以男性多见,差异有统计学意义(P<0.05),感染性疾病、其他疾病及未明确诊断疾病在不同性别中差异无统计学意义(P>0.05)。感染性疾病在各年龄组中均为首要病因,以60岁以上年龄组多见;CTD以30~59岁年龄组多见,恶性肿瘤性疾病以60~86岁组多见,差异有统计学意义(χ2=17.521,P=0.025)。 结论 FUO病因复杂,感染性疾病为其主要病因诊断,结核杆菌感染占重要地位,结核病中肺外结核是重点、难点;CTD及肿瘤性疾病在FUO病因诊断中分别居第2、3位。大多数FUO患者经过详细的询问病史及必要的实验室检查一般能够明确诊断。      

艾滋病合并结核感染233例临床分析

目的探讨艾滋病（AIDS）合并结核（TB）感染的临床特点,提高对本病的认识。方法对1990—2009年1020例AIDS住院患者的临床资料进行回顾性分析,总结AIDS合并TB感染的临床特点。结果1020例AIDS患者中共有233例发生TB感染,感染率为22．8％。TB感染部位以肺部最多见（43．8％）,其次是淋巴结（28．8％）．腹腔（12．0％）。223例（95．7％）血沉〉20mm／h,200例（85．8％）CD4^＋T细胞计数〈200个／μl。合并贫血148例（63．5％）．消化道念珠菌感染92例（39．5％）,肺炎62例（26．6％）。诊断结核病的主要方法为影像学诊断,其中CT诊断156例（67．0％）,X线片诊断56例（24．0％）。173例（74．2％）患者经抗结核治疗后预后良好。结论AIDS合并TB感染警逐年上升趋势,播散性感染及肺外感染多地,但感染部位仍以肺部最常见。合并TB感染者可同时存在其他多种合并症。早期规范抗结核治疗可获得较好疗效．     

Diagnostic evaluation of extrapulmonary tuberculosis by fine needle aspiraton (FNA) supplemented with AFB smear and culture

One hundred forty-three patients, 72 males and 71 females, with extrapulmonary tuberculosis were aspirated and subjected to cytological (Ziehl-Neelsen stain) examination and culture in Lowenstein-Jensen media. Routine haematological examination and Mantoux test were done in all the cases, x-ray chest in 112, skeletal x-ray in 3 relevant cases and sputum was examined for AFB in 16 cases where pulmonary tuberculosis was associated/suspected with extrapulmonary tuberculosis. HIV status was evaluated in 51 cases and 9 (7.64%) were seropositive. FNA cytology in 102 cases (71.3%) had caseating epithelioid granulomas while smear for AFB was positive in 57 cases (39.8%). Both culture and smear were positive in 29 (20.2%) cases. Combining both smear and culture yielded positive results in 47.5% cases. It was observed that AFB positivity was higher in untreated patients and with HIV positive cases. Further more, the triad of FNAC, AFB smear and culture were cheaper, foolproof and confirmatory than costlier tests like TB IgG, IgM, RTPCR and BACTEC.     

440例艾滋病合并结核病临床感染状况的分析

 目的探讨艾滋病合并结核病的临床感染状况。方法回顾性分析440例艾滋病合并结核病的临床感染的类型、部位、合并感染的情况。结果163例(37.05%)为多部位或全身播散性结核;肺外结核高发(143例,32.50%);48例(10.91%)直接表现为肺外结核;8例(1.82%)为成人原发型肺结核。结论结核病是艾滋病最常见及高发的机会性感染。艾滋病合并结核病临床感染状况表现为多部位或全身播散性结核、肺外结核高发,部分病例直接表现为肺外结核及成人原发型肺结核。     

结节病17例临床诊治分析

目的探讨结节病的临床特点及诊治方法,提高对该病的认识,减少误诊及漏诊。方法对17例经病理学检查确诊的结节病患者的一般资料、辅助检查、诊治经过和预后等进行回顾性分析。结果男性8例,女性9例;年龄26～73岁,平均45.7岁;临床表现以呼吸系统症状为主,其中4例有肺外表现;影像学常见双侧肺门、纵隔淋巴结肿大。经糖皮质激素治疗,临床症状和胸部影像学有不同程度的减轻或完全消失;严重患者加用甲氨蝶呤、硫唑嘌呤等治疗后,病情好转出院。结论结节病临床症状无特异性,影像学发现双侧肺门、纵膈淋巴结肿大者应考虑此病,病理检查有助于诊断。糖皮质激素治疗有一定疗效,但应采取个体化疗法。     

高频彩色多普勒超声在颈部淋巴结疾病诊断中的应用价值探讨

目的:探讨二维及彩色多普勒超声在颈部淋巴结病变检测中的应用价值。方法:用高频超声观察70例患者的92个淋巴结,将淋巴结分为4组:反应性淋巴结、结核性淋巴结、淋巴瘤和转移性淋巴结,将有血供淋巴结的血管模式分为淋巴门型、中央型、边缘型和混合型等4种类型,比较声像图表现在各种病理类型分布中的差异性。结果:恶性肿大淋巴结L/S多<1.8,92.0%的反应性淋巴结和75.6%的淋巴瘤出现淋巴门血流,有75.6%的淋巴瘤出现淋巴结边缘血流;转移性淋巴结有60.0%在淋巴结中央显示血流,57.5%在边缘出现血流;结核性淋巴结的血流分布和恶性淋巴结相似,2个反应性淋巴结、1个结核性淋巴结为无血供。结论:颈淋巴结中央血流和边缘血流主要见于恶性病变,淋巴门血流常意味着良性病变,但是这些血流分布特点在良恶性淋巴结病变中有交叉。     

Spectrum of tuberculosis in patients with HIV infection in British Columbia: report of 40 cases.

OBJECTIVE: To review the clinical features, treatment and outcome of all known cases of tuberculosis in patients with human immunodeficiency virus (HIV) infection in British Columbia between 1984 and 1990. DESIGN: Retrospective case review. SETTING: Provincial tuberculosis registry and university-affiliated HIV clinic. PATIENTS: All people with HIV infection in whom active tuberculosis was diagnosed during the study period. RESULTS: All 40 patients identified were men; their mean age was 38 years. Of the subjects 30 (75%) were homosexual, 6 (15%) were homosexual and used intravenous drugs, 2 (5%) just used intravenous drugs, and 1 (2%) had had heterosexual contact with prostitutes; for the remaining subject the risk factor for HIV infection was not established. In all cases cultures of specimens from 15 body sources yielded Mycobacterium tuberculosis. Thirty-five of the patients had acquired immunodeficiency syndrome (AIDS), and five had HIV infection uncomplicated except for tuberculosis. In 28 (70%) of the cases no AIDS-defining disease had previously been diagnosed, and in 23 (58%) extrapulmonary tuberculosis represented the AIDS-defining disease. Symptoms at presentation included weight loss (in 80% of the cases), fever (in 75%), cough (in 70%) and night sweats (in 55%). The mean CD4 lymphocyte count was 0.2 x 10(9)/L (in 15 cases). Tuberculin skin test results were positive in 8 of 16 cases. The most striking radiologic finding was intrathoracic adenopathy. All except one of the 36 patients who received appropriate treatment responded favourably at first. Adverse reactions necessitating changes in treatment occurred in 12 (33%) of the cases. Relapse occurred after completion of therapy in two cases (one at 3 weeks and the other at 9 months after treatment was stopped). Tuberculosis was the cause of death in five cases. CONCLUSIONS: Tuberculosis in people with HIV infection commonly presents as extrapulmonary disease and precedes or coincides with other AIDS-defining opportunistic infections. In most cases tuberculosis is the AIDS-defining disease. Even though radiologic findings are often unusual physicians should suspect tuberculosis. A careful examination for evidence of disease at multiple sites should be done. The duration and choice of therapy must be adequate to avoid relapse.