Duodenal ulcers preceding cervical tuberculous lymphadenitis

Lymphadenitis is the most common presentation of extra pulmonary tuberculosis, whereas gastrointestinal localization, particularly duodenal involvement, is rare. We report a case of extra pulmonary tuberculosis with association between cervical lymphadenitis and duodenitis with multiple ulcers, not responsive to treatment with protonic pump inhibitors, in a human immunodeficiency virus-seronegative adult woman of Eritrean origin. Clinical patterns of duodenal TB, diagnostic difficulties and aetiopathogenesis are discussed according to the literature. In this case report it is suggested that tuberculous infection must be considered when duodenal ulcers fail to respond to proton pump inhibitors, especially when the patient comes from an endemic area.     

Diagnosis of tuberculous lymphadenitis using fine needle aspiration biopsy

Background: Tuberculous lymphadenitis is the commonest form of extrapulmonary tuberculosis. However, the optimal approach to diagnosis, employing biopsy by either fine needle aspiration (FNA) or surgical excision, remains uncertain. Aims: To evaluate the diagnostic value of biopsy using each of the component diagnostic modalities of FNA (microscopy, cytology and culture), and compare these with excision biopsy in the diagnosis of tuberculous lymphadenitis in a predominantly migrant population in Melbourne. Methods: A retrospective examination of tuberculous lymphadenitis cases presenting to Western Health over 12 years was conducted. Using a reference method of positive culture of Mycobacterium tuberculosis, the diagnostic sensitivities of each modality employed in FNA were determined. Results: Forty‐two subjects having FNA and 30 having excision biopsy as the initial investigation were compared. Among specimens obtained by FNA, sensitivity of microscopy was 18% (95% confidence interval (CI): 5–40%) and sensitivity of cytology was 38% (95% CI: 20–59%). For specimens obtained by excision biopsies, sensitivities for microscopy and histology were 17% (95% CI: 2–32%) and 96% (95% CI: 88–100%) respectively. Sensitivity of culture performed on FNA specimens was 86% (95% CI: 65–97%). Conclusions: Given the relatively high sensitivity of mycobacterial cultures from FNA, this study supports its routine use as the initial investigation in most patients with suspected tuberculous lymphadenitis. Microscopy and cytology add relatively little to the clinical utility of FNA.     

颈部淋巴结结核外科治疗并发症的危险因素分析

目的对颈部淋巴结结核外科治疗并发症的危险因素进行分析。方法回顾分析我院外科收治的179例颈部淋巴结结核患者,分析年龄、体重指数、病灶大小、受累淋巴结的分区、是否并发糖尿病以及是否存在耐多药等临床资料与手术并发症的相关性。结果性别、年龄、体重指数、糖尿病与手术并发症无相关性(P0.05),病灶CT横截面直径≥3cm手术并发症发生率是3 cm的4.641倍,淋巴结受累达到2组及以上手术并发症发生率是受累1组的4.060倍,耐多药(+)手术并发症是耐多药(-)组的5.594倍;结论病灶直径≥3cm、受累淋巴结区域≥2个及耐多药(+)显著增加颈部淋巴结结核手术并发症发生率,是手术并发症的危险因素。     

二维图像及多普勒超声血管模式在颈部淋巴结病变诊断应用

目的探讨二维图像及彩色多普勒超声血管模式在颈部淋巴结结核诊断中的应用价值,为临床诊断提供参考。方法分析我院149例颈部淋巴结肿大患者,分析指标包括淋巴结的长径/短径、边界清楚与否、淋巴门有无、淋巴结的内部回声等,同时结合彩色多普勒超声淋巴结血管模式。结果 79例经病理证实为淋巴结结核,55例经病理证实为良性淋巴结(其中淋巴结炎37例,反应性增生淋巴结18例),15例经病理证实为恶性淋巴结(其中淋巴瘤3例,转移性淋巴结12例),恶性肿大淋巴结长短径比1.5,良性肿大淋巴结长短径比2,结核性肿大淋巴结1.5。结核性肿大淋巴结内部多见无回声区及钙化,77.2%的结核性肿大淋巴结可见边缘型或中央型血管模式,常出现无血供淋巴结。结论根据二维图像及血管模式特征,颈部淋巴结结核大多都能做出明确诊断。     

立复欣与利福平治疗颈淋巴结核的临床对照研究

目的　发析比较静脉应用立复欣和口服利福平方案在颈淋巴结核治疗中的作用。方法　选择经病理和 /或细胞学确诊的颈淋巴结核患者 72例 ,随机将其分成对照组和实验组 ,实验组 37例用含静脉制剂立复欣全身加局部治疗 ,对照组 35例选用含口服利福平全身治疗加局部治疗的方案作为对照。结果　实验组和对照组有效率 1个月分别为 4 3.2 %、2 2 .9% ,3个月分别为 6 4 .9%、4 0 % ,治愈率 9个月分别为 86 .5 %、6 2 .9% ,两组比较差异有显著性 (P<0 .0 5 ) ,实验组 9个月与对照组 12个月治愈率分别为 86 .5 %、88.6 % ,两组比较差异无显著性 (P>0 .0 5 ) ,而且实验组在疗程、肝功能损害、体温恢复正常的时间等方面都具有明显的优越性。结论　应用含立复欣的方案在颈淋巴结核的治疗中具有局部药物浓度高、作用快、副作用小的特点 ,其治愈率高 ,有良好的临床应用价值。     

Clinical review of 23 patients with tuberculous peritonitis: presenting features and diagnosis

OBJECTIVE: To better identify which clinical, laboratory, radiological and invasive procedures were most useful in diagnosing tuberculous peritonitis and to assess the methods in order to reach the diagnosis in future cases. METHODS: Tuberculous peritonitis cases diagnosed between 2000 and 2006 were reviewed retrospectively. Their clinical presentation, physical examination, laboratory and diagnostic methods were evaluated. RESULTS: Twenty‐three cases of tuberculous peritonitis were diagnosed. The mean age of the patients were 30 ± 11 years and 16 were women. The mean duration of symptoms prior to diagnosis was 3.6 months. All patients presented with abdominal pain. Abdominal swelling (91.3%), loss of appetite (87%) and weight loss (82.6%) were the other commonest symptoms. The major physical findings were ascites (78.3%) and fever (60.9%). The serum ascites albumin gradient was <1.1 g/dL in all. An ascites fast bacilli smear was positive in 12 (52.2%) patients. Skin tests with purified protein derivative, adenosine deaminase and polymerase chain reaction were performed in seven, four and five patients, respectively. The tuberculous culture was positive in only two. The most common radiological findings were ascites (100%) and omental involvement (65.2%). A laparoscopy was performed in nine of 23 patients. A total of 22 patients completed anti‐tuberculous therapy successfully and were cured, except one with cirrhosis. CONCLUSION: Tuberculous peritonitis may be fatal but is medically cured if diagnosed in a timely fashion. Although both non‐invasive and invasive tests have additional benefits, clinician suspicion is still the first step for the diagnosis of tuberculous peritonitis.     

Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of peripancreatic tuberculous lymphadenitis

The percentage of patients with atypical extrapulmonary forms of tuberculosis has been increasing. Among extrapulmonary tuberculosis cases, tuberculosis of the pancreas and peripancreatic lymph nodes is a rare clinical entity. Here, we present a case of peripancreatic tuberculous lymphadenitis diagnosed by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) both cytologically and microbiologically. A 23-year-old man had a 1-week history of epigastralgia and low-grade fever. Subsequently, he was found to have an abnormality on abdominal ultrasound. A computed tomography scan of the abdomen showed a solitary mass consisting of multiple cystic components with rim enhancement in the peripancreatic portion contiguous to the gall bladder. Endoscopic ultrasound-guided fine-needle aspiration was performed to confirm the diagnosis. The cytological examination revealed epithelioid cells with caseous necrosis, indicating tuberculosis. The aspirated fluid was positive by polymerase chain reaction (PCR) analysis and culture for Mycobacterium tuberculosis. Antituberculosis therapy with isoniazid, rifampicin, ethambutol, and pyrazinamide was started based on the PCR and cytology results, and a good response to the treatment was noted. Endoscopic ultrasound-guided fine-needle aspiration cytology with PCR analysis is very useful for the diagnosis of peripancreatic tuberculosis.     

Mycobacterial lymphadenitis in eastern Sydney

Background: There has been a resurgence of tuberculosis (TB) in the developed world, especially extrapulmonary manifestations, of which lymphadenitis is the most common. We reviewed all cases of mycobacterial lymphadenitis notified in the eastern suburbs of Sydney from 1989 to 1996. Aims: To review all cases of mycobacterial adenitis in eastern Sydney. Methods: This was a retrospective review of the medical records of 54 patients (aged 1.2 to 84 years), recruited from all notifications of TB presenting as lymphadenitis at Prince of Wales, Sydney Children's and St Vincent's Hospitals. Results: There were two distinct groups: Group 1, patients with Mycobacterium tuberculosis (MTB), n=37 (68.5%), Group 2, patients with atypical mycobacteria, n=17 (31.5%). For Group 1, 83.3% were foreign born and 18.9% were positive for the human immunodeficiency virus (HIV). Disease involved single node groups in 73% (the cervical chain was involved in 70.1%). Complete resolution of lymphadenopathy at conclusion of treatment occurred in 73.1%. Outcome was not documented in 13.5%, of the rest; 83.8% completed treatment; 2.7% were lost to follow up before treatment concluded; 2.7% were still being seen at the time of writing and 10.8% died within six months of treatment starting (all were HIV positive). HIV positive patients had more diffuse disease. Group 2 were all Australian born. They comprised children less than six years who were all HIV negative and adults (aged 30–55 years) who were all HIV positive. The children were all treated surgically with 80% having complete resolution of their modes. Those adults with HIV had a mortality of 83.3% during treatment. Conclusions: In eastern Sydney lymphadenitis caused by MTB in the HIV negative population is mostly seen in those who are immigrants. Our large proportion of HIV positive patients tended to have diffuse disease and a high mortality. The reporting of outcomes was poor and in a greater than expected number of outcome and follow up were inadequately documented.     

Tuberculous mediastinal lymphadenitis that evolved into pulmonary tuberculosis following transbronchial needle aspiration

This case report describes a patient with multi‐drug‐resistant mediastinal lymph node tuberculosis that evolved to smear‐positive pulmonary tuberculosis following transbronchial needle aspiration. This is the first report of this complication, and bronchoscopists should be vigilant for its occurrence.     

淋巴结结核脓液病原学诊断特点

目的 分析首次诊断为淋巴结结核病例的脓液病原学诊断特点,为临床医生提供选择诊断方法的理论依据.方法 收集我中心结核临床实验室2016年1月—2017年12月所有淋巴结结核脓液标本的病例资料,从中选出首诊时在超声引导下或无超声引导下用注射器穿刺抽脓的初诊淋巴结结核病例51例.分析病例的相关临床资料,包括性别、年龄、病原学...     

组织细胞坏死性淋巴结炎

目的提高对少见病组织细胞坏死性淋巴结炎的认识。方法对我科诊治的患者进行分析,并结合文献复习。结果组织细胞坏死性淋巴结炎是一种具有特殊临床病理过程的自限性淋巴结疾病,病因及发病机制不明,以顽固性发热、区域性淋巴结肿大和一过性白细胞减少为特征。结论临床表现具有非特异性,组织学形态较复杂,容易误诊。抗生素治疗对本病无效,而糖皮质激素是最有效的治疗药物。     

肺结核和肺外结核患者外周血淋巴细胞亚群的检测意义探讨

目的探讨肺结核与肺外结核患者外周血淋巴细胞亚群的检测意义。方法选择72例结核病患者,其中肺结核患者41例(A组),肺外结核患者31例(B组),同期选择32例健康体检者作为对照组(C组),应用流式细胞术即(FCM)进行检测。结果三组外周血淋巴细胞亚群的表达率比较,有统计学意义(P0.05),三组在CD+3CD+4/CD+3CD+8比值比较,差异无统计学意义(P0.05)。结论肺结核与肺外结核患者行外周血淋巴细胞亚群的检测对分析免疫状态有重要意义。     

颈部淋巴结结核发生结核性脓肿的危险因素分析

目的 探讨颈部淋巴结结核患者发生结核性脓肿的相关危险因素。方法 分析2013年7月至2016年6月于同济大学附属上海市肺科医院住院确诊的符合纳入标准的280例颈部淋巴结结核患者临床资料,分析颈部结核性淋巴结脓肿发生的危险因素。结果 280例颈部淋巴结结核患者中有52例(18.6%)患者在治疗中出现淋巴结脓肿、自行破溃或需要淋巴结切开引流。发生脓肿者中不规范治疗者占38.5%(20/52)、肿大淋巴结直径≥2cm者占76.9%(40/52)、年龄≤45岁者占90.4%(47/52);未发生脓肿者中不规范治疗者占24.6%(56/228)、肿大淋巴结直径≥2cm者占55.3%(126/228)、年龄≤45岁者占77.6%(177/228);差异均有统计学意义(χ²值分别为4.14、8.23、4.30,P值均<0.05)。多因素logistic回归分析显示,不规范治疗(OR=2.53,95%CI:1.31~4.89)、肿大淋巴结直径≥2cm(OR=2.29,95%CI:1.12~4.66)和年龄≤45岁(OR=3.68,95%CI:1.21~11.17)为发生颈部结核性淋巴结脓肿的危险因素。结论颈部淋巴结结核患者治疗不规范、肿大淋巴结直径≥2cm及年龄≤45岁为发生结核性脓肿的独立危险因素,当颈部淋巴结结核患者出现上述危险因素时要警惕发生结核性脓肿的可能。     

肺结核住院患者的营养状况与肺功能的相关性分析

目的探讨肺结核住院患者的营养状况对肺功能的影响,为加强营养治疗提供参考依据。方法随机选择2005年7—9月在我院住院的确诊肺结核患者95例,分别接受了身体质量指数（BMI）和白蛋白（ALB）等营养指标调查和肺功能评估。按BMI值分为A组（BMI≤18．5）和B组（BMI〉18．5）,按ALB值分为I组（ALB≤35）和Ⅱ组（ALB〉35）,分别比较两组肺功能指标的差异。并将BMI、ALB与各项肺功能指标做相关分析。结果按BMI和ALB判断的营养不良的发生率。BMI与FVC％、FEVI％呈显著正相关,（r=0．303,0．321,P〈0．01）,ALB与FVC％、MMF％、MVV％等呈显著正相关,（r=0．271,0．269,0．251,P值分别〈0．01、0．01、0．05）。结论肺结核住院患者的营养状况与肺功能关系密切,营养不良可影响肺的通气功能,提高营养水平将有助于改善患者呼吸功能指标。     

颈部淋巴结核96例诊断分析

目的 分析探讨颈部淋巴结核(CTL)的诊断方法.方法 回顾性分析青岛市胸科医院2012年4月至2013年12月收治的128例颈部肿块患者(其中96例确诊为颈部淋巴结核,作为观察组;32例为非颈部淋巴结核患者,作为对照组)的诊断过程,比较128例患者PPD试验、结核抗体检测、标本浓缩集菌抗酸杆菌检测、颈部CT增强扫描检查、结核感染T淋巴细胞斑点试验(T-SPOT.TB)(其中观察组60例进行了检测)、结核分枝杆菌DNA-PCR共6种方法的诊断阳性率.采用SPSS 13.0统计软件进行处理,对组间和观察组样本率采用x2检验进行比较,P＜0.05为差异有统计学意义.结果 对照组与观察组结核抗体检查阳性率分别为46.88％(15/32)、56.25％(54/96),两组比较差异无统计学意义(x2=0.849,P=0.357).对照组PPD试验、浓缩集菌抗酸杆菌检测、CT增强扫描、T-SPOT.TB、结核分枝杆菌DNA-PCR检查阳性率分别为25.00％(8/32)、0％(0/32)、15.63％(5/32)、9.38％(3/32)、0％(0/32),观察组各阳性率分别为84.38％(81/96)、13.54％(13/96)、92.71％(89/96)、98.33％(59/60)、97.92％(94/96),5项组间比较差异均有统计学意义(分别为x2=39.938,P＜0.01;x2=4.823,P=0.028;x2=73.105,P＜0.01;x2=75.154,P＜0.01;x2=117.961,P＜0.01).结论 CT增强扫描、血清T-SPOT.TB和结核分枝杆菌DNA-PCR在临床上对于颈部淋巴结核的检查阳性率较高;结合多种检查方法有助于辅助诊断颈部淋巴结核,同时有助于颈部肿块的鉴别诊断.