Tuberculous encephalopathy. A rare complication of pulmonary tuberculosis

A case of tuberculous encephalopathy, a rare form of neurotuberculosis, is reported in a 16-year-old girl who had pulmonary tuberculosis and extensive cerebral demyelination. The clinical, laboratory and pathological features of this entity are highlighted and the pathogenesis discussed.(Au)

Disseminated histoplasmosis detected by lingual and tonsillar erosions in an immunocompetent patient

BACKGROUND: Histioplasmosis is a usually asymptomatic fungal infection. In the immunocompetent patient, it leads to chronic disseminated infection. Mucosal involvement is common and can provide the diagnosis. CASE REPORT: A metropolitan Frenchman with a history of alcoholism and smoking and living in Guyana consulted for lingual and tonsil erosion. Squamous cell carcinoma was suspected but not confirmed at pathology. The patient had bi-apical infiltration on the chest x-ray and was treated empirically for tuberculosis. The diagnosis of histoplasmosis was reached when rare Histoplasma capsulatum were evidenced from a buccal swab. Itraconazole led to cure in 6 months. DISCUSSION: This case illustrates the importance of mucosal signs in the diagnosis of disseminated histoplasmosis in immunocompetent subjects. Histoplasmosis is rarely the cause of active infection in immunocompetent subjects. In these patients, the fungal infection generally progresses to chronic dissemination. Mucosal signs are frequent in this from but are rare in the case of cutaneous histoplasmosis. Itraconazole (200 mg/d) is indicated for 6 months. (AU)

Tuberculosis transmission among five school bus drives and students in two New York countries

OBJECTIVE: Between November 1994 and April 1995, more than 3300 students in 49 schools in two countries in New York were potentially exposed to five school bus drivers with tuberculosis. This investigation was carried out to determine the extent of transmission of Mycobacterium tuberculosis among students. METHODS: Components of the epidemiologic investigation included tuberculin skin-test screening and collection of demographic information for students exposed to a driver with tuberculosis, chest radiography and medical evaluation of individuals with positive skin tests, and DNA fingerprinting of M tuberculosis isolates. A positive skin test was defined as >/=10 mm induration, and a converter was an individual with an increase in reaction size of >/=10 mm in the past 2 years. RESULTS: The rates of positive skin tests were 0.8 percent, 0.3 percent, 9.9 percent, 1.1 percent and 0.7 percent among US-born student exposed to drivers 1 through 5, respectively. The relative risk for a positive tuberculin skin test was significant only for student expose to driver 3 and the only secondary case identified among students was exposed to driver 3. The DNA fingerprinting patterns of isolates from drivers 3 and 4 matched. CONCLUSION: There was no clear evidence of transmission of M tuberculosis to students from driver 1, 2, 4, or 5. However, evidence suggests the driver 3 transmitted M tuberculosis to students and another driver. Routine annual tuberculin skin-test screening of drivers would not have prevented these tuberculosis exposures(AU)

Tuberculosis in children: a national survey of notifications in England and Wales in 1983. Medical Research Council Tuberculosis and Chest Diseases Unit

A survey of all notifications of tuberculosis in children (aged less than 15 years) in England and Wales in 1983 showed a decline of 35 percent in the estimated annual number if previously untreated children notified since the previous survey in 1978-9. Of the 452 children in 1983 survey, 217 (48 percent) were of white, 79 (17 percent) of Indian, and 104 (23 percent) of Pakistani or Bangladeshi ethnic origin. The decline in the number of Indian children notified (46 percent) was much greater than that for Pakistani and Bangladeshi children(16 percent). In both surveys the estimated annual notification rate was much higher for the Indian and Pakistani and Bangladeshi ethnic groups (32 and 52/100000, respectively in 1983) than for the white grop(2.4/100000 in 1983). The mean annual decline in rate between the two surveys was 14 percent for the Indian, 10 percent for the Pakistani and Bangladeshi, and 7 percent for the white children. In both surveys the rates for the children of Indian subcontinent(Indian, Pakistani, and Bangladeshi) ethnic origin born in the United Kingdom were cosiderably lower than those born abroad. Of the 452 children in the 1983 survey, 342 (76 percent) had respiratory disease (including 26.6 percent with a non-respiratory lesion as well). Less than half (134, 45 percent) had a pulmonary lesion at independent assessment of chest radiographs, a further 115 (38 percent) had only enlarged intrathoracic nodes. Only 60 (19 percent) of the children with respiratory disease only had a positive culture from a respiratory specimen, but the culture positivity rate in those tested was 45 percent. Almost two thirds of the children with non-respiratory disease had lesions of the extrathoracic nodes, nearly all cervical. There were 20 children with tuberculosis meningits in the 12 months, including 12 (6 percent) of the 217 white and six (3 percent) of the 183 children of Indian subcontinent ethnic origin. (AU)

Significance of the tuberculin skin test in pulmonary tuberculosis in Jamaica: comparisons of culture-positive, culture-negative and non-tuberculous patients

The results of tuberculin skin tests with PPD-S done on patients with pulmonary tuberculosis seen over a three-year period (1979-1981) were compared with the results of similar tests done during the same period in a group of persons without tuberculosis. Ninety per cent of patients with culture-positive tuberculosis had positive tuberculin skin tests, compared to 83 percent of positive tests in the non-tuberculous group. The presence of such a large proportion of positive tuberculin reactions in persons without active disease indicates that the skin test reaction cannot be used on its own to establish the diagnosis of tuberculosis in Jamaican adults. Eighty of 239 persons with a clinical diagnosis of pulmonary tuberculosis had negative sputum smears and cultures for acid-fast bacilli. Eighty-two percent of these patients had positive tuberculin skin tests. Invasive diagnostic tests and newer serological diagnostic methods are likely to increase the yield of confirmed positive cases of tuberculosis in the future (AU)

Intradural extramedullary tuberculoma

A case of intradural, extramedullary tuberculoma presenting 5 years after the initial infection is described. The rarity of this discrete form of the disease is indicated and the excellent result which can result from a combination of surgery and chemotherapy is emphasized (AU)

A family outbreak of tuberculosis in Barbados, 1977

An outbreak of tuberculosis affecting three young children in a family is described. The source of infection was their father (O.S.) who had advanced bilateral pulmonary lesions. Before taking up residence with M.I., the mother of the affected children, O.S. had lived for some years with his wife T.S.) who about a year prior to their marriage, had herself suffered from pulmonary tuberculosis. Her case had not been notified and she had been inadequately treated. Of the three affected children, the youngest was to have tuberculous lymphadenitis whereas the other two had relatively milder forms of the disease. The younger a child becomes infected the more likely is the source of infection to be a member of the family circle. The importance of early notification and the dangers of inadequate investigation and treatment are stressed, and significant epidemiological factors are highlighted (AU)

Routine radiographic screening of the chest in pregnant women: is it indicated?

Experience with routine antepartum chest radiographic screening from July 1, 1976, through June 30, 1977, in a city-county hospital which serves a predominantly black indigent population was reviewed. The 5422 routine screening chest radiographs produced an extremely low yield of pathology (11 cases), and only 3 of the 11 cases were not suspected from the history of physical examination. Only 2 cases of active pulmonary tuberculosis were discovered, and both patients were recent immigrants from countries with a much higher incidence of tuberculosis. This low case finding probably reflects the general decline in incidence of pulmonary tuberculosis in the United States and suggests that routine screening chest radiographs (done primarily to exclude tuberculosis) are not longer indicated in our pregnant population (AU)

A retrospective and descriptive study of pulmonary and primary tuberculosis in Clarendon 1967 - 1977

It is illustrated in the study that mortality among tuberculosis patients in Clarendon was low as only thirteen patients died over the eleven year period, and accounted for 8.7 percent of all deaths in Clarendon. It is also difficult from the data presented to be sure that the 101 new cases of tuberculosis diagnosed and notified over this period is a reflection of the magnitude of the problem. The trend towards an increase in notification every two years as shown in the study may be a reflection of a true epidemiological trend but may also represent differences in case findings. (AU)

Tuberculosis in St. Lucia - abstract

A survey was made of the total number of new cases of tuberculosis and the reativated old cases for the period 1969-1970. The associated diseases and the response to treatment was also recorded. The diagnosis in the majority of cases was made by history, clinical examination, chest X-Ray and spectum examination. In 1969 there were 53 new cases and 7 reactived ones while in 1970 there were 44 new cases and 4 reactivated ones. The patients treated in hospital received streptomycin, PAS and INAH. The usual length of hospital stay was 3 months. BCG vaccination is also a part of the programme and 2,481 children in 31 schools plus 177 pre-school children were vaccinated. 25 percent of the school population has been Heaf-tested and most were converted by the time they leave school while not more than 25 percent have positive reactions on school entrance. New teachers are screened. The large family in St. Lucia is conducive to rapid speed of tuberculosis but there are difficulties in administering prophylactic therapy to young contacts. It is hoped that with further improvement in coverage by B.C.G. vaccinations and improvement in social conditions, the incidence of tuberculos's will decline (AU)

A community survey of respiratory disease among East Indian and African adults in Guyana

The belief that chronic bronchitis is more prevalent among Indians than Africans in the Caribbean area was investigated by a community survey in Guyana. Respiratory symptoms were assessed by a standard questionnaire, ventilatory capacities were measured, and chest radiographs were taken of some 800 African and Indian men and women aged 35 to 54 years living in adjacent and similar communities. Histories of morning cough, chronic cough, morning phlegm, and chronic phlegm (chronic bronchitis) were more common in Indians than Africans. Although these respiratory symptoms were much more common in smokers than non-smokers, the higher prevalence rates in Indians could not be explained by smoking habits which were similar in the two races. Chronic bronchitis occurred in 17.3 percent of Indian and 2.4 percent of African male smokers and in 6.1 percent and 2.2 percent of Indian and African female non-smokers respectively. Judging by the history, lung infection, and clinical signs, chronic bronchitis was more severe in Indians than Africans. The condition was more common among field labourers on sugar estates but, although the majority of field labourers were Indian, this occupational difference only partially explained the difference in prevalence between Indians and Africans. Indians, for reasons unknown, appear to have a greater susceptibility than Africans to chronic bronchitis.(AU)

The results of treatment by resection of two hundred cases of pulmonary tuberculosis in Trinidad and Tobago

The pattern and treatment of pulmonary tuberculossi in Trinidad and Tobago are outlined. Two hundred cases of pulmonary tuberculosis treated by resection are analyzed and the results of treatment assessed. Indications for surgery in the cases of tuberculosis in Trinidad are outlined. The opinion is expressed that resection has a dual role in the treatment of tuberculosis: (a) to assist in the cure of tuberculosis, and (b) to remove damaged lung and bronchi, and prevent the occurrence of ill health from the sequelae of the healing process of tuberculosis. (AU)

The results of treatment by resection of two hundred cases of tuberculosis in Trinidad and Tobago

The pattern and treatment of pulmonary tuberculosis in Trinidad and Tobago are outlined. Two hundred cases of pulmonary tuberculosis treated by resection are analysed and the results of treatment assessed. Indications for surgery in the cases of tuberculosis in Trinidad are discussed. The opinion is expressed that resection has a dual role to play in the treatment of tuberculosis, in that it assists in the cure of tuberculosis, and removes damaged lung and bronchi, and prevents the occurrence of ill health from the sequelae of the healing process of tuberculosis (AU)

Results of 200 resections for pulmonary tuberculosis

Two hundred patients with pulmonary tuberculosis have been treated by pulmonary resection of varying extent in Trinidad and the first 150 have been followed up for 2 years or more. All received prior treatment with drugs. Twenty-seven died. Seventy-eight developed some post-operative complication. One hundred and sixty-six of the survivors are fit and well. Only 6 have relapsed. (AU)

Changing trends in the treatment of pulmonary tuberculosis in Jamaica

A brief review of changing concepts with regard to the treatment of tuberculosis in Jamaica has been given. Pneumothorax, once so popular, led to many difficulties as a result of too frequent and faulty application. Its popularity declined as more primary thoracoplasty was done. The advent of chemotherapy and pulmonary resection has again altered the outlook for the better. It is believed that with the present regime more patients get better more quickly, and have a better outlook than once was the case (AU)