Tuberculosis revisted: classic imaging findings in childhood.

Tuberculosis (TB) remains one of the major public health threats worldwide, despite improved diagnostic and therapeutic methods. Tuberculosis is one of the main causes of infectious disease in the chest and is associated with substantial morbidity and mortality in paediatric populations, particularly in low- and middle-income countries. Due to the difficulty in obtaining microbiological confirmation of pulmonary TB in children, diagnosis often relies on a combination of clinical and radiological findings. The early diagnosis of central nervous system TB is challenging with presumptive diagnosis heavily reliant on imaging. Brain infection can present as a diffuse exudative basal leptomeningitis or as localised disease (tuberculoma, abscess, cerebritis). Spinal TB may present as radiculomyelitis, spinal tuberculoma or abscess or epidural phlegmon. Musculoskeletal manifestation accounts for 10% of extrapulmonary presentations but is easily overlooked with its insidious clinical course and non-specific imaging findings. Common musculoskeletal manifestations of TB include spondylitis, arthritis and osteomyelitis, while tenosynovitis and bursitis are less common. Abdominal TB presents with a triad of pain, fever and weight loss. Abdominal TB may occur in various forms, as tuberculous lymphadenopathy or peritoneal, gastrointestinal or visceral TB. Chest radiographs should be performed, as approximately 15% to 25% of children with abdominal TB have concomitant pulmonary infection. Urogenital TB is rare in children. This article will review the classic radiological findings in childhood TB in each of the major systems in order of clinical prevalence, namely chest, central nervous system, spine, musculoskeletal, abdomen and genitourinary system.

[Optochiasmatic tuberculomas as a paradoxical reaction to treatment for meningeal tuberculosis]. / Tuberculomas optoquiasmaticos como reaccion paradojica al tratamiento de tuberculosis meningea.

TITLE: Tuberculomas optoquiasmaticos como reaccion paradojica al tratamiento de tuberculosis meningea.

Late occurrence of bilateral tuberculous-like epididymo-orchitis after intravesical bacille Calmette-Guérin therapy for superficial bladder carcinoma.

We report a case of bilateral tuberculous-like epididymo-orchitis occurring 3 years after intravesical bacille Calmette-Guérin instillation therapy in an 83-year-old patient with proven superficial bladder carcinoma. The patient had no previous history of tuberculosis. Because of persistent inflammation and painful swelling of the epididymides and testes, the patient underwent bilateral orchiectomy. This case demonstrates the late adverse effects that can occur after intravesical BCG therapy, which in our patient ended in surgical removal of both gonads.

A novel tumor necrosis factor (TNF) mimetic peptide prevents recrudescence of Mycobacterium bovis bacillus Calmette-Guerin (BCG) infection in CD4+ T cell-depleted mice.

Tumor necrosis factor (TNF) is required to control mycobacterial infections, but its therapeutic value is limited by its in vivo instability and toxicity. The efficacy of a nontoxic TNF-mimetic peptide (TNF70-80) was tested in mice infected with Mycobacterium bovis bacillus Callette-Guerin (BCG). In vitro TNF70-80 and recombinant human TNF (hTNF) acted with interferon gamma (IFN-gamma) to reduce bacterial replication and to induce synthesis of bactericidal nitric oxide (NO) in BCG-infected, bone marrow-derived murine macrophages. The dose-dependent inhibitory effect on bacterial replication was blocked by neutralizing anti-IFN-gamma and anti-hTNF mAbs. Further, n-monomethyl-L-arginine (n-MMA) and a soluble TNF-receptor I (TNFRI-IgG) blocked bacterial growth and NO synthesis. Therefore, the peptide acted with IFN-gamma via induction of NO synthase and signaled through TNFRI receptors. Concomitant in vivo treatment with TNF70-80 or hTNF prevented reactivation of chronic BCG infection in mice depleted of CD4+ T cells by injecting anti-CD4 antibodies. Granuloma number and bacterial load were comparable in treated, T cell-depleted mice and in chronically infected, intact animals. Thus, TNF70-80 and hTNF can modulate recrudescent BCG infection in CD4+ T cell-deficient mice.

Dementia associated with dorsal midbrain lesion.

Although the dorsal midbrain has been implicated in cognitive processes in animals, its role in humans is unclear. We report the neuropsychological and postmortem neuropathological findings of a 52-yr-old university professor who developed a profound dementia in association with a focal dorsal midbrain lesion. The patient's disorder appeared to result from a tuberculous granuloma based on the clinical course and autopsy results. Neuropsychologically, he exhibited a generalized impairment across most of the cognitive domains assessed. His deficits were not explained by impaired arousal, specific sensory or motor defects, depression, or hydrocephalus. Although there are inherent limitations to a single-case investigation, our observations are consistent with animal studies that have demonstrated that focal dorsal midbrain lesions may result in cognitive impairment. We propose that the dorsal midbrain is involved in cognitive processing via modulation of thalamocortical networks.

[Changes in the granuloma in the experimental treatment of tuberculosis with a prolonged form of isoniazid]. / Izmeneniia granulemy pri lechenii tuberkuleza prolongirovannoi formoi izoniazida v éksperimente.

The main difficulties encountered in the treatment of the persistent forms of a chronic tuberculous process are associated with a difficult access to mycobacteria persisting in the vacuolar apparatus of macrophages that form granulomas as well as with a high level of toxic affections of the parenchymatous liver cells. The complex long-acting isoniazid preparation on the dextran basis and the scheme of its application prevented, to a considerable degree, the above complications under the experimental conditions and hence can be considered as promising for clinical use.

[Importance of microbiological research in correcting the antibacterial therapy of tuberculosis]. / Znachenie mikrobiologicheskikh issledovanii v korrektsii antibakterial'noi terapii tuberkuleza.

Long-term observations showed the importance of the phenomenon of the drug resistance of Mycobacterium tuberculosis in phthisiological clinical practice and its tendency in recent years. Methods for individual selection of an optimum drug combination were developed and tested, its efficacy was shown.

[Blood autotransfusion in the surgical treatment of pulmonary tuberculosis]. / Autogemotransfuziia pri khirurgicheskom lechenii tuberkuleza legkikh.

Clinical observations in 250 patients with different forms of tuberculosis have shown that blood autotransfusion during operations on the lungs is a safe and effective curative method allowing to considerably reduce the amount of donor blood and to maintain stable indices of central hemodynamics during operation and in the postoperative period.

Focal Seizure Disorder with Spontaneous Regression of Epileptogenic Lesion on Serial Computed Tomography

During a period of four years the authors experienced eighteen cases of focal seizure disorder, showing small ring or nodular enhancement with surrouding low density on CT scans. In fifteen cases, the epileptogenic lesions decreased in size or resolved completely on serial CT scans. Three cases were explored surgically. Males and famales were equally affected. Their age ranged from six to fourtyfive years and fifteen patients were under the age of thirty years. The principal symptoms and signs consisted of focal siezures (17 cases), generalized seizure during sleep (1 case), focal neurological deficits (14 cases), and intracranial hypertension (4 cases). The lesions of CT scans were found frequently in the parietal and frontal lobes. The clinical course of this self-limited disorder was variable and well correlated with the change of CT findings. The histological findings were the typical tuberculoma and the caseating gramuloma containing calcium in two cases. In one case the enhancing nodule of CT scan was not resected and the tissue specimen around the nodule revealed nonspecific inflammation. The cause of this disorder might be tuberculoma, but in some cases we could not rule out cysticercosis.

[Subthalamic tuberculoma disclosed by hemiballism. Efficacy of antituberculous treatment]. / Tuberculome sous-thalamique révélé par un hémiballisme. Efficacité du traitement antituberculeux.

The authors report a case of a 33 years old Moroccan in whom a left hemiballism has revealed a tuberculoma in the right sub-thalamic region. After a year of trial anti-tuberculosis treatment, the hemiballism had almost totally disappeared and the scan picture was significantly reduced. This case unique in its hemiballism etiology, gives way for discussing the present diagnosis as far as intra-cerebral tuberculomas are concerned. Also, this diagnosis is made difficult when one does not have the information of an active visceral tuberculosis. Nevertheless, it is important to have a scan made in order to be able to see the actual picture and particularly to follow the trial anti-tuberculosis treatment.

[Comparison of CT, scintigraphy, and angiography in the topographic and pathological diagnosis of 300 supratentorial tumors (author's transl)]. / Comparaison des tomodensitométrie, cinégammagraphie, et angiographie dans les diagnostics topographique et histologique pré-opératoires de 300 tumeurs intracrániennes sus-tentorielles.

The results of CT, scintigraphy (CSS), and angiography in 300 supratentorial cerebral tumors were compared with regard to the topographic and pathological diagnosis proposed in the initial reports. CT elucidated the topography in 98% of the cases and the pathology in variable percentages, depending on the type of tumor. The use of scintigraphy provided a high accuracy of pathological diagnosis. Except for meningiomas, arteriography was less accurate than the two other methods of examination. A radiological management of supratentorial cerebral tumors is proposed based on clinical and CT data.