RESUMEN
An association of autoimmune hemolytic anemia with disseminated tuberculosis is an exceedingly rare entity. We describe herein a case of cold hemolytic autoimmune anemia associated with miliary tuberculosis resolved with blood transfusions, therapeutic plasma exchange, and antituberculous agents. We discuss the advantages of therapeutic plasma exchange at an early stage in the management of this condition.
Asunto(s)
Anemia Hemolítica Autoinmune , Tuberculosis Miliar , Anemia Hemolítica Autoinmune/complicaciones , Anemia Hemolítica Autoinmune/terapia , Humanos , Intercambio Plasmático , Tuberculosis Miliar/complicaciones , Tuberculosis Miliar/terapiaRESUMEN
This article reports the fulminant course of a pneumogenic sepsis with severe ARDS (acute respiratory failure) in a 36-year-old female Indian patient, who died within 14â¯h after admission to the intensive care unit due to a multiorgan failure. During treatment the diagnosis of a miliary tuberculosis was suspected but was only confirmed by the autopsy. Due to high hygiene standards, miliary tuberculosis as the cause of septic shock is rare in Europe. Only 1-2% of the patients with pulmonary miliary tuberculosis develop an ARDS with a mortality of 60-90%. Based on this case the diagnostics as well as treatment of the patient are described. Furthermore, the management of an open tuberculosis on an intensive care unit is explained.
Asunto(s)
Choque Séptico/microbiología , Tuberculosis Miliar/complicaciones , Adulto , Femenino , Humanos , Unidades de Cuidados Intensivos , Insuficiencia Multiorgánica/diagnóstico , Insuficiencia Multiorgánica/etiología , Insuficiencia Multiorgánica/microbiología , Insuficiencia Multiorgánica/terapia , Choque Séptico/diagnóstico , Choque Séptico/terapia , Tuberculosis Miliar/diagnóstico , Tuberculosis Miliar/terapiaRESUMEN
BACKGROUND: Untreated, miliary tuberculosis (TB) has a mortality approaching 100%. As it is uncommon there is little specific data to guide its management. We report detailed data from a UK cohort of patients with miliary tuberculosis and the associations and predictive ability of admission blood tests with clinical outcomes. METHODS: Routinely collected demographic, clinical, blood, imaging, histopathological and microbiological data were assessed for all patients with miliary TB identified from the London TB register from 2008 to 2012 from Northwest London Hospitals NHS Trust. Multivariable logistic regression was used to assess factors independently associated with the need for critical care intervention. Receiver operator characteristics (ROC) were calculated to assess the discriminatory ability of admission blood tests to predict clinical outcomes. RESULTS: Fifty-two patients were identified with miliary tuberculosis, of whom 29% had confirmed central nervous system (CNS) involvement. Magnetic resonance imaging (MRI) was more sensitive than computed tomography (CT) or lumbar puncture for detecting CNS disease. Severe complications were frequent, with 15% requiring critical care intervention with mechanical ventilation. This was independently associated with admission hyponatraemia and elevated alanine aminotransferase (ALT). Having an admission sodium ≥125 mmol/L and an ALT <180 IU/L had 82% sensitivity and 100% specificity for predicting a favourable outcome with an area under the ROC curve (AUC) of 0.91. Despite the frequency of severe complications, one-year mortality was low at 2%. CONCLUSIONS: Although severe complications of miliary tuberculosis were frequent, mortality was low with timely access to critical care intervention, anti-tuberculous therapy and possibly corticosteroid use. Clinical outcomes could accurately be predicted using routinely collected biochemistry data.
Asunto(s)
Enfermedades del Sistema Nervioso Central/mortalidad , Tuberculosis Miliar/complicaciones , Tuberculosis Miliar/mortalidad , Adolescente , Adulto , Anciano , Alanina Transaminasa/sangre , Biomarcadores/análisis , Enfermedades del Sistema Nervioso Central/diagnóstico por imagen , Enfermedades del Sistema Nervioso Central/etiología , Enfermedades del Sistema Nervioso Central/terapia , Niño , Estudios de Cohortes , Femenino , Humanos , Londres/epidemiología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Respiración Artificial , Tomografía Computarizada por Rayos X , Tuberculosis Miliar/terapia , Adulto JovenAsunto(s)
Antituberculosos/administración & dosificación , COVID-19/complicaciones , Neumotórax , Toracocentesis/métodos , Tuberculosis Miliar , COVID-19/diagnóstico , COVID-19/epidemiología , COVID-19/fisiopatología , Niño , Humanos , India , Masculino , Neumotórax/diagnóstico por imagen , Neumotórax/etiología , Neumotórax/fisiopatología , Neumotórax/terapia , Radiografía Torácica/métodos , Respiración Artificial/métodos , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , SARS-CoV-2/aislamiento & purificación , Resultado del Tratamiento , Tuberculosis Miliar/complicaciones , Tuberculosis Miliar/diagnóstico , Tuberculosis Miliar/fisiopatología , Tuberculosis Miliar/terapia , Síndrome Post Agudo de COVID-19RESUMEN
The management and therapy of miliary tuberculosis: Nobuharu OHSHIMA (Asthma and Allergy Center, National Hospital Organization Tokyo National Hospital). Treatment and management of severe pulmonary tuberculosis: Yuta HAYASHI, Kenji OGAWA (Department of Respiratory Medicine, National Hospital Organization Higashi Nagoya National Hospital). Death of a young (non-elderly) patient may become a large psychological burden not only for patient's family but also for medical staff. We analyzed non-elderly cases with severe pulmonary tuberculosis by comparing 13 patients who died of tuberculosis in the hospital (death group) and 31 patients who survived and were discharged from hospital (survivor group). The mean age was older and there were more patients who were out of employment in the death group compared to the survivor group. Among the factors related to the general condition evaluated on the admission, disturbance of consciousness, respiratory insufficiency, impairment in the ADL, poor dietary intake, and decubitus ulcer were more observed in the death group. Chest X-ray finding was not a predictive factor of poor prognosis. Among the laboratory findings, the numbers of peripheral blood lymphocytes, red blood cells, and thrombocytes significantly decreased in the death group. Serum level of total cholesterol, cholinesterase, and albumin were also significantly lower in the death group, indicating that malnutrition was related to the death of severe tuberculosis. Further studies are needed to establish the optimal nutritional management and evaluate the effectiveness of adjunctive use of steroid for severe tuberculosis patients. Invasive fungal infection complicated with pulmonary tuberculosis: Akira WATANABE, Katsuhiko KAMEI (Division of Clinical Research, Medical Mycology Research Center, Chiba University). Among the invasive mycoses, chronic pulmonary aspergillosis (CPA) is the most frequent disease as a sequel to pulmonary tuberculosis. However, identifying CPA early in patient with persistent pulmonary shadows from pulmonary tuberculosis is difficult. Serum microbiological tests such as Aspergillus precipitans (principally for Aspergillus IgG antibodies) are useful but sensitivity and specificity of this test are not high. Even treated, CPA has a case mortality rate of 50% over a span of 5 years. Morbidity is marked by both systemic and respiratory symptom and hemoptysis. Loss of lung function and life-threatening hemoptysis are common. As invasive pulmonary aspergillosis, early diagnosis and treatment of CPA might improve the outcome. Regarding the treatment, concomitant use of some anti-tubercular agents and antifungals is contradicted. Treatment and management for pulmonary tuberculosis complicated with COPD and interstitial pneumonia: Shinji TAMAKI, Takashi KUGE, Midori TAMURA, Sayuri TANAKA, Eiko YOSHINO, Mouka TAMURA (National Hospital Organization Nara Medical Center), Hiroshi KIMURA (Second Department of Internal Medicine and Respiratory Medicine, Nara Medical University) Recently, patients of pulmonary tuberculosis have many complications especially in the elderly population. It is recognized that patients with COPD and interstitial pneumonia (IP) have an increased risk for developing active tuberculosis. The aim of this report is to describe the clinical findings of pulmonary tuberculosis complicated with COPD and IP. We reviewed 327 patients who were diagnosed as pulmonary tuberculosis. Twenty-six cases were complicated with COPD. All patients were male, and had smoking history. Cavitary lesions were observed only in 5 cases. Acute exacerbation of COPD occurred in one fatal case. Ten cases were complicated with IP. Cavitary lesions were observed in 3 cases. Acute exacerbation of IP were observed in 7 cases, and 4 patients died during the anti-tuberculosis treatment. Careful evaluation and treatment are necessary for tuberculosis patients complicated with COPD and IP.
Asunto(s)
Enfermedades Pulmonares Fúngicas/complicaciones , Enfermedades Pulmonares Intersticiales/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Tuberculosis Miliar/terapia , Tuberculosis Pulmonar/terapia , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Mycobacterium tuberculosis infection in patients with autosomal dominant polycystic kidney disease (ADPKD) is rare, and its diagnosis and treatment are difficult because numerous cysts are exposed to infection and antibiotics do not easily penetrate infected cysts. Here, we report the case of a 43-year-old Japanese man with disseminated urogenital tuberculosis (TB) and ADPKD without human immunodeficiency virus (HIV) infection. Delayed diagnosis and ineffective anti-TB chemotherapy worsened his condition. Finally, he underwent bilateral nephrectomy but experienced postoperative complications. In conclusion, kidney TB should be recognized as a cause of renal infection in ADPKD, and surgical treatment should be instituted without delay. The importance of early diagnosis and treatment cannot be overemphasized to prevent kidney TB deterioration.
Asunto(s)
Mycobacterium tuberculosis/aislamiento & purificación , Riñón Poliquístico Autosómico Dominante/complicaciones , Tuberculosis de los Genitales Masculinos/microbiología , Tuberculosis Miliar/microbiología , Tuberculosis Pulmonar/microbiología , Tuberculosis Renal/microbiología , Adulto , Antituberculosos/uso terapéutico , Técnicas Bacteriológicas , Diagnóstico Tardío , Humanos , Masculino , Nefrectomía , Orquiectomía , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Tuberculosis de los Genitales Masculinos/diagnóstico , Tuberculosis de los Genitales Masculinos/terapia , Tuberculosis Miliar/diagnóstico , Tuberculosis Miliar/terapia , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/terapia , Tuberculosis Renal/diagnóstico , Tuberculosis Renal/terapiaRESUMEN
Purpose: Miliary pulmonary tuberculosis (TB) among pregnant women after in vitro fertilization embryo transfer (IVF-ET) causes poor outcomes but is rarely reported. This study analyzed the clinical characteristics and risk factors of these patients to provide hints for further studies. Method: The demographic characteristics, clinical manifestations, radiologic features, treatment, and outcomes of six patients diagnosed from May 2012 to August 2021 in Xiangya Hospital and 69 patients that were reported in English or Chinese literature from January 1980 to August 2021 were retrospectively analyzed. Continuous variables were compared between groups by t-test or Mann-Whitney U test, and categorical variables were compared between groups by chi-square test or Fisher exact test. Univariate and multiple logistic regression analyses were used to determine the predictors of respiratory failure. Results: A total of 75 patients were included. The average age of patients was about 30 years. All patients had tubal obstruction; 5 of them were diagnosed with pelvic TB before. Thirteen cases had a history of pulmonary or extrapulmonary TB, six out of them without any antituberculosis treatment history. All patients were in their first or second trimester during the onset of symptoms. The average interval between onset of symptoms and radiologic examination was about 21 days. The most common abnormalities on chest computed tomography scan were multiple nodules, pulmonary infiltrate, and consolidation. Merely 10 patients obtained bacteriological diagnosis by Mycobacterium tuberculosis culture or polymerase chain reaction test. The other patients were clinically diagnosed. All the patients received antituberculosis treatment. Although 44% of patients had fatal complications, all cases were cured or improved after antituberculosis treatment. Unfortunately, only eight fetuses survived (10.6%). The most frequent and severe complication was type I respiratory failure (20%). Patients with expectoration, dyspnea, coarse breath sounds, ground-glass opacity, and pulmonary infiltrate or consolidation were more likely to have respiratory failure (P < 0.05). Ground-glass opacity (OR = 48.545, 95% CI = 2.366-995.974, P = 0.012) and pulmonary infiltrate or consolidation (OR = 19.943, 95% CI = 2.159-184.213, P = 0.008) were independent predictors for respiratory failure. Conclusion: Tube infertility with underscreened or untreated TB is a risk factor for miliary TB during pregnancy after IVF-ET. Ground-glass opacity and pulmonary infiltrate or consolidation are predictors of respiratory failure. We demonstrate risk factors for incidence and complications to supply clues for future intervention and improve patient prognosis.
Asunto(s)
Insuficiencia Respiratoria , Tuberculosis Miliar , Tuberculosis Pulmonar , Adulto , Antituberculosos/uso terapéutico , Transferencia de Embrión/efectos adversos , Femenino , Fertilización In Vitro/efectos adversos , Humanos , Embarazo , Mujeres Embarazadas , Insuficiencia Respiratoria/complicaciones , Estudios Retrospectivos , Factores de Riesgo , Tuberculosis Miliar/diagnóstico , Tuberculosis Miliar/etiología , Tuberculosis Miliar/terapia , Tuberculosis Pulmonar/complicacionesRESUMEN
Acute respiratory distress syndrome (ARDS) represents a rare complication of miliary tuberculosis (TB) in the adult setting, and it is even less common in the pediatric population. The presence of comorbidities and the possibility of a delayed diagnosis may further impair the clinical prognosis of critically ill patients with disseminated TB and acute respiratory failure. In this report, we present a case series of five pediatric patients with miliary TB and ARDS, where rescue and multimodal respiratory support strategies have been applied with a favorable outcome in more than half of them. The burden of miliary TB over time on a general pediatric intensive care unit-including two ARDS patients-is also illustrated.
Asunto(s)
Síndrome de Dificultad Respiratoria/etiología , Tuberculosis Miliar/complicaciones , Niño , Comorbilidad , Cuidados Críticos , Femenino , Humanos , Unidades de Cuidado Intensivo Pediátrico , Masculino , Pronóstico , Síndrome de Dificultad Respiratoria/diagnóstico , Síndrome de Dificultad Respiratoria/terapia , Tuberculosis Miliar/diagnóstico , Tuberculosis Miliar/terapiaRESUMEN
OBJECTIVE: To analyse the clinical characteristics of miliary tuberculosis (TB) in pregnant women after in vitro fertilisation and embryo transfer (IVF-ET). METHODS: Six pregnant women with miliary TB after IVF-ET between October 2010 and July 2015 were retrospectively analysed. RESULTS: The patients were aged between 29 and 39 years. Fever, cough and dyspnoea were the main symptoms, and started during the first and second trimesters of pregnancy. Erythrocyte sedimentation rate and C-reactive protein were increased. White blood cell count was normal or slightly increased. Tuberculin purified protein derivative and acid-fast smear of sputum tests were negative. T-SPOT®.TB was performed in two cases and the results were positive. Chest computed tomography showed typical miliary nodules. One patient had tuberculous meningitis. Although all patients were cured, the foetuses died. CONCLUSIONS: The principal symptoms of miliary TB in pregnant women after IVF-ET were fever and dyspnoea. Physicians should consider the occurrence of miliary TB, particularly in the case of fever of long duration, respiratory symptoms and no response to antibiotic treatment.
Asunto(s)
Complicaciones Infecciosas del Embarazo/diagnóstico , Resultado del Embarazo , Tuberculosis Meníngea/diagnóstico , Tuberculosis Miliar/diagnóstico , Adulto , Disnea/etiología , Transferencia de Embrión , Femenino , Fertilización In Vitro , Fiebre/etiología , Humanos , Embarazo , Complicaciones Infecciosas del Embarazo/terapia , Estudios Retrospectivos , Tuberculosis Meníngea/etiología , Tuberculosis Meníngea/terapia , Tuberculosis Miliar/etiología , Tuberculosis Miliar/terapiaRESUMEN
Tuberculosis (TB) affecting a prosthetic knee is an unusual and diagnostically challenging presentation of this disease. This study reported a case of an 80-year-old man with a left total knee arthroplasty (TKA) performed eight years before his presentation. He presented with left knee swelling and pain for one month. Knee X-rays showed a normal joint space with no loosening of his prosthesis. His chest X-ray showed miliary disease, and microbiological studies of his sputum and synovial fluid aspirate grew Mycobacteria tuberculosis complex. He was successfully medically treated with anti-tuberculous therapy alone for one year. His knee hardware was retained, and he did not require debridement, resection, or revision. It is believed that this is the first reported case of miliary TB with delayed-onset TKA prosthetic joint infection (PJI) in which the prosthesis was successfully retained. Thirty-eight published TB TKA PJI cases in medical literature were also reviewed.
Asunto(s)
Antituberculosos/uso terapéutico , Artritis Infecciosa/transmisión , Artroplastia de Reemplazo de Rodilla/efectos adversos , Articulación de la Rodilla/diagnóstico por imagen , Prótesis de la Rodilla/efectos adversos , Infecciones Relacionadas con Prótesis/terapia , Tuberculosis Miliar/terapia , Anciano de 80 o más Años , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/microbiología , Humanos , Articulación de la Rodilla/microbiología , Articulación de la Rodilla/cirugía , Prótesis de la Rodilla/microbiología , Masculino , Mycobacterium tuberculosis/aislamiento & purificación , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/microbiología , Radiografía , Tuberculosis Miliar/diagnóstico , Tuberculosis Miliar/microbiologíaRESUMEN
Pneumothorax as a complication of adult cavitary pulmonary tuberculosis is well known and not at all rare, but its occurrence as a complication of miliary tuberculosis is extremely rare. We report a 22-year-old woman who had nonproductive cough and fever for 3 days. Chest radiography showed diffuse, symmetrical miliary nodulation throughout both lung fields. The patient was treated for a presumed diagnosis of miliary tuberculosis with standard antituberculous regimen. Bilateral pneumothorax occurred simultaneously during hospitalization and chest tube thoracostomy was performed. Three days later, recurrent right pneumothorax developed. Video-assisted thoracoscopic surgery (VATS) lung biopsy of the right lung was performed and pathology showed granulomatous interstitial pneumonia with acid-fast positive bacilli. Lung tissue culture was positive for Mycobacterium tuberculosis. In the following 2 months, bilateral pneumothorax recurred twice and chemical pleurodesis with minocycline was performed on both sides, but air leakage persisted. VATS pleurodesis was performed on both sides successfully without recurrence of pneumothorax on either side. Our experience highlights the fact that pneumothorax should be suspected in an adult with miliary tuberculosis who suddenly develops acute respiratory distress. Recurrent pneumothorax can be managed, apart from medical therapy of miliary tuberculosis, with surgical intervention.
Asunto(s)
Neumotórax/microbiología , Tuberculosis Miliar/complicaciones , Tuberculosis Miliar/diagnóstico , Femenino , Humanos , Recurrencia , Tuberculosis Miliar/terapia , Adulto JovenAsunto(s)
Emigrantes e Inmigrantes , Absceso del Psoas/diagnóstico , Rasgo Drepanocítico/diagnóstico , Rasgo Drepanocítico/genética , Tuberculosis Ganglionar/diagnóstico , Tuberculosis Miliar/diagnóstico , Antituberculosos/uso terapéutico , Niño , Terapia Combinada , República Democrática del Congo/etnología , Femenino , Estudios de Seguimiento , Alemania , Humanos , Escisión del Ganglio Linfático , Imagen por Resonancia Magnética , Absceso del Psoas/terapia , Tuberculosis Ganglionar/terapia , Tuberculosis Miliar/terapia , UltrasonografíaRESUMEN
OBJECTIVE: To analyze the clinical characteristics of haematogenous disseminated tuberculosis in pregnant women after in vitro fertilization and embryo transfer (IVF-ET). METHODS: Six cases of haematogenous disseminated tuberculosis after in vitro fertilization pregnancy from January 2001 to December 2005 were retrospectively analyzed. RESULTS: The clinical manifestations of pulmonary miliary tuberculosis were non-specific. All cases presented with fever for several weeks, but typical respiratory manifestations were lacking. Chest X-ray showed typical miliary and infiltrate lesions. The onset of fever was at an average of 53.2 days after embryo transfer. Miscarriage occurred in 5 patients within 2 to 4 weeks after the onset of fever. CONCLUSION: The main symptom of miliary tuberculosis in pregnant women after IVF-ET was fever, and the prognosis of the pregnancy was poor. Physician should be alert to the occurrence of haematogenous disseminated tuberculosis, especially in pregnant women with long-term fever.
Asunto(s)
Complicaciones Infecciosas del Embarazo , Tuberculosis Miliar , Adulto , Transferencia de Embrión , Femenino , Fertilización In Vitro , Humanos , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/terapia , Tuberculosis Miliar/diagnóstico , Tuberculosis Miliar/terapiaRESUMEN
A 36-year-old Philippine woman had had fever and general fatigue from September, 2006 (11th week of pregnancy). She was admitted with high fever, general fatigue and dyspnea on October 16, 2006 (13th week of pregnancy). A chest radiograph on admission showed bilateral miliary shadows and ground glass shadows. She already had severe hypoxia on admission. As acid-fast bacilli were positive in urine (Gaffky 8) and sputum (Gaffky 1), we diagnosed as miliary tuberculosis and pulmonary tuberculosis complicated with acute respiratory distress syndrome (ARDS). We treated her with antituberculosis chemotherapy, corticosteroid, sivelestat sodium hydrate, direct hemoperfusion using a polymyxin B immobilized column, and mechanical ventilation, but she died due to respiratory failure. We emphasize that in this case pregnancy has the risk of to causing disease progression of miliary tuberculosis and we should treat immediately and intensively for miliary tuberculosis complicated with ARDS.
Asunto(s)
Complicaciones Infecciosas del Embarazo , Síndrome de Dificultad Respiratoria/etiología , Tuberculosis Miliar/complicaciones , Adulto , Femenino , Humanos , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/terapia , Tuberculosis Miliar/diagnóstico , Tuberculosis Miliar/terapiaAsunto(s)
Sudunidad beta 1 del Receptor de Interleucina-12/deficiencia , Tuberculosis Miliar/genética , Tuberculosis Miliar/inmunología , Tuberculosis Resistente a Múltiples Medicamentos/genética , Antibacterianos/uso terapéutico , Antituberculosos/uso terapéutico , Pueblo Asiatico/genética , Vacuna BCG/efectos adversos , Preescolar , Consanguinidad , Predisposición Genética a la Enfermedad , Humanos , Masculino , Tuberculosis Miliar/etiología , Tuberculosis Miliar/terapia , Tuberculosis Resistente a Múltiples Medicamentos/etiología , Tuberculosis Resistente a Múltiples Medicamentos/inmunología , Tuberculosis Resistente a Múltiples Medicamentos/terapiaRESUMEN
A 23-year-old woman had dry cough, fever and chest tightness for 1 months. Through thoracic CT scan and serological examination, the patient was clinically diagnosed as disseminated tuberculosis. she was given anti-tuberculosis therapy combined with autologous cytokine-induced killer (CIK) immunotherapy. Through the close follow-ups we found that after immunotherapy Her condition would have a swift improvement and she do not appear liver damage after a large doses of antibiotic therapy. In conclusion, adjuvant autologous CIK immunotherapy is an effective approach for disseminated tuberculosis.
Asunto(s)
Células Asesinas Inducidas por Citocinas/trasplante , Inmunoterapia Adoptiva/métodos , Calidad de Vida , Tuberculosis Miliar/diagnóstico por imagen , Tuberculosis Miliar/terapia , Autoinjertos , Células Asesinas Inducidas por Citocinas/inmunología , Femenino , Estudios de Seguimiento , Humanos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Tuberculosis Miliar/fisiopatología , Adulto JovenRESUMEN
An unusual case of miliary tuberculosis which presented as fever and a tubo-ovarian abscess in a postpartum patient is described. Fatal congenital tuberculosis was also diagnosed in the mother's premature infant. The difficulties encountered in diagnosing the tuberculosis in these patients are summarized, and the need for early recognition and therapy is emphasized. Epidemiologic follow-up of the premature infant's exposed contacts was thorough and revealed no new cases of tuberculosis among the infants or the personnel who were exposed to the infected baby.
Asunto(s)
Complicaciones Infecciosas del Embarazo/diagnóstico , Tuberculosis Miliar/congénito , Absceso/diagnóstico , Adulto , Enfermedades de las Trompas Uterinas/diagnóstico , Femenino , Humanos , Recién Nacido , Enfermedades del Ovario/diagnóstico , Embarazo , Tuberculosis de los Genitales Femeninos/diagnóstico , Tuberculosis Miliar/diagnóstico , Tuberculosis Miliar/terapiaRESUMEN
Tuberculosis of the middle ear and mastoid is currently a rare disease in developed countries, but this disease still occurs and may cause serious consequences. We report a case of disseminated tuberculosis involving the middle ear, mastoid, lung and central nervous system. Tuberculosis should be considered in the differential diagnosis of chronic ear drainage, especially in young children.
Asunto(s)
Mastoiditis/microbiología , Mycobacterium tuberculosis/aislamiento & purificación , Otitis Media Supurativa/microbiología , Tuberculosis del Sistema Nervioso Central/diagnóstico , Tuberculosis Miliar/diagnóstico , Antituberculosos/administración & dosificación , Preescolar , Terapia Combinada , Países Desarrollados , Femenino , Estudios de Seguimiento , Humanos , Mastoiditis/complicaciones , Mastoiditis/terapia , Otitis Media Supurativa/complicaciones , Otitis Media Supurativa/terapia , Enfermedades Raras , Medición de Riesgo , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Tuberculosis del Sistema Nervioso Central/complicaciones , Tuberculosis del Sistema Nervioso Central/terapia , Tuberculosis Miliar/complicaciones , Tuberculosis Miliar/terapiaRESUMEN
SETTING: A tertiary care hospital in northern India. OBJECTIVE: To study the patterns of clinical presentation of cutaneous tuberculosis, to correlate them with Mantoux reactivity and BCG vaccination status, and to suggest a clinical classification based on these factors. DESIGN: Analysis of the records of patients with cutaneous tuberculosis who attended the hospital between 1975 and 1995. RESULTS: A total of 0.1% of dermatology patients had cutaneous tuberculosis. Lupus vulgaris was the commonest form, seen in 154 (55%) of these patients, followed by scrofuloderma in 75 (26.8%), tuberculosis verrucosa cutis in 17 (6%), tuberculous gumma(s) in 15 (5.4%) and tuberculids in 19 (6.8%). No correlation was found between Mantoux reactivity and the extent of disease (localised disease 63.6%, disseminated disease 67.9%). The presence of regional lymphadenopathy was an indication of dissemination of the disease (localised disease 34.7%, disseminated disease 71.7%). Dissemination of the disease was observed in the whole of the spectrum of cutaneous tuberculosis (22.1%), but was seen more often in the presence of gumma and scrofuloderma. There were more unvaccinated individuals in the group with disseminated disease (80.3%) than in those with localised disease (65.5%). CONCLUSIONS: Lupus vulgaris was the most common clinical presentation, followed by scrofuloderma, tuberculids, tuberculosis verrucosa cutis and tuberculous gumma. Some patients presented more than one clinical form of the disease. Classification of cutaneous tuberculosis needs to be modified to include smear-positive and smear-negative scrofuloderma apart from the inclusion of disseminated disease. The presence of regional lymphadenopathy serves as a clinical indicator of disseminated disease. Patients with disseminated disease were less likely to have been BCG-vaccinated than those with localised disease.