ABSTRACT
Vertebral involvement is a common complication of brucellosis in adults. However psoas abscess related to brucellar spondylitis have rarely reported. The purpose of this report is to describe three cases of bilateral psoas abscess identified during workup for brucellar spondylitis. Medical imaging was helpful in confirming diagnosis of these fluid collections. Epidemiological, clinical, radiological and serological findings were consistent with melitococcal etiology. Treatment was based on a combination of antibiotics (rifampicine-doxycycline) and abscess evacuation by percutaneous drainage, needle aspiration or open surgery. Outcome was favourable. Brucellar psoas abscess is uncommon. Most caseare discovered coincidentally during investigation of melitococcal spondylitis. Management usually consists of fluid drainage and appropriate antibrucellar therapy. Prognosis is favourable.
Subject(s)
Brucellosis/diagnosis , Psoas Abscess/microbiology , Adult , Anti-Bacterial Agents/therapeutic use , Antibodies, Bacterial/blood , Brucellosis/therapy , Drainage , Female , Fluorescent Antibody Technique , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Psoas Abscess/diagnosis , Psoas Abscess/therapy , Spondylitis/diagnosis , Spondylitis/microbiology , Spondylitis/therapy , Tomography, X-Ray ComputedSubject(s)
Allopurinol/adverse effects , Drug Eruptions/etiology , Eosinophilia/chemically induced , Aged , Female , Humans , SyndromeABSTRACT
PURPOSE: Central nervous system (CNS) tuberculosis remains a public health problem, particularly in developing countries. The aim of this study is to characterize neuroradiologic findings of various intracranial lesions. METHODS: We retrospectively reviewed data of 122 patients with CNS tuberculosis, without immunosuppression. CT scan was performed in all patients, whereas 17 patients had CT scan and MRI. RESULTS: We included 74 women (61%) and 48 men (39%) with a mean age of 37 years (17 -88y). 18 patients (14,7%) had a history of tuberculosis. Tuberculous meningitis was the most frequent clinical presentation (119 cases). Mycobacterium tuberculosis was isolated in cerebrospinal fluid of 18 patients (15%). Several types of lesions were identified : hydrocephalus (35 cases), tuberculomas (29 cases), leptomeningitis (26 cases), infarction (15 cases), abcesses (2 cases). Hydrocephalus was associated to other lesions in 26 cases. Communication hydrocephalus was present in 28 cases. Multiple tuberculomas were seen in 23 cases (80%), with miliary aspects in some cases. In 3 cases, tuberculoma was present without meningitis. Patients with leptomeningitis showed thick meningeal contrast enhancement involving all basal cisterns. Infarction resulted from arterial englobement or embols, and involved the area of middle cerebral artery (12 cases). CONCLUSION: Central nervous system tuberculosis has different appearences, mostly hydrocephalus and tuberculomas. MR with contrast is necessary for diagnosis and for follow-up during treatment.
Subject(s)
Tuberculosis, Meningeal/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Hydrocephalus/cerebrospinal fluid , Hydrocephalus/diagnosis , Hydrocephalus/microbiology , Magnetic Resonance Imaging , Male , Middle Aged , Mycobacterium tuberculosis/isolation & purification , Retrospective Studies , Tomography, X-Ray Computed , Tuberculoma, Intracranial/cerebrospinal fluid , Tuberculoma, Intracranial/diagnosis , Tuberculoma, Intracranial/microbiology , Tuberculosis, Meningeal/cerebrospinal fluid , Tuberculosis, Meningeal/microbiologyABSTRACT
We retrospectively studied the epidemiological, clinical, radiological and evolutive aspects of bacterial spondylodiskitis observed in 39 patients diagnosed from January 1989 to December 1998, in order to find criteria to distinguish between pyogenic spondylodiskitis (PS) and tuberculous spondylodiskitis (TS). During the study period, we collected 13 patients (33.3%) with PS and 26 patients (66.7%) with TS. The mean age was 44 years. The delay in diagnosis was much longer in TS (8.4 months) than in PS (2 months). Diagnosis was certain in 6 cases (46%) of PS and in 12 cases (46%) of TS. Clinically, paravertebral abscesses and neurologic complications were significantly more frequent in TS. The main causative agents in PS were staphylococci. Diagnosis of spondylodiskitis is based on the imaging techniques, especially magnetic resonance imaging which is more sensitive and specific than computed tomography. Except in patients with positive blood cultures or positive urine culture in PS, and isolation of Mycobacterium tuberculosis in another visceral foci in TS, bacteriologic diagnosis was based on discovertebral needle biopsy. The yield of this technique was poor in our study (12.5%), even if bacteriologic confirmation of spondylodiskitis was made in 15 patients (38.5%). In the other cases, diagnosis rested on a set of clinical, biological and radiological criteria.
Subject(s)
Discitis/diagnosis , Discitis/microbiology , Staphylococcal Infections/complications , Tuberculosis, Spinal/complications , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Biopsy, Needle/standards , Diagnosis, Differential , Discitis/epidemiology , Discitis/therapy , Female , Humans , Magnetic Resonance Imaging/standards , Male , Middle Aged , Retrospective Studies , Sensitivity and Specificity , Staphylococcal Infections/microbiology , Suppuration , Time Factors , Tomography, X-Ray Computed/standards , Tuberculosis, Spinal/microbiology , Tunisia/epidemiologyABSTRACT
We report the case of a 70 year-old Tunisian patient who developed antimitochondrial antibodies and anti-ADN during urogenital tuberculosis with clinical and biological signs of primary biliary cirrhosis and systemic lupus erythematosus. We discuss the association of the three diseases and the etiopathogeny of the autoimmune mechanisms induced by Mycobacterium tuberculosis.
Subject(s)
Autoimmunity , Liver Cirrhosis, Biliary/complications , Tuberculosis/complications , Aged , Female , Humans , Liver Cirrhosis, Biliary/immunology , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/immunology , Mycobacterium tuberculosis/immunology , Tuberculosis/immunology , Tuberculosis/microbiology , TunisiaSubject(s)
AIDS-Related Opportunistic Infections/diagnosis , Cryptococcus neoformans/isolation & purification , Meningitis, Cryptococcal/diagnosis , AIDS-Related Opportunistic Infections/drug therapy , AIDS-Related Opportunistic Infections/pathology , Adult , Amphotericin B/therapeutic use , Anti-Bacterial Agents/therapeutic use , Antifungal Agents/therapeutic use , Diabetes Complications , Diabetes Mellitus/microbiology , Female , Fluconazole/therapeutic use , Hodgkin Disease/complications , Hodgkin Disease/microbiology , Humans , Male , Meningitis, Cryptococcal/drug therapy , Meningitis, Cryptococcal/pathology , Treatment OutcomeSubject(s)
Anti-Bacterial Agents , Drug Utilization/statistics & numerical data , Anti-Bacterial Agents/therapeutic use , Diagnosis, Differential , Drug Utilization/trends , Gram-Positive Bacterial Infections/diagnosis , Gram-Positive Bacterial Infections/drug therapy , Humans , Tunisia , Virus Diseases/diagnosis , Virus Diseases/drug therapySubject(s)
Pneumonia, Pneumocystis , Adult , Female , Humans , Male , Pneumonia, Pneumocystis/diagnosis , Pneumonia, Pneumocystis/epidemiology , TunisiaSubject(s)
Abscess/diagnostic imaging , Thoracic Vertebrae , Tomography, X-Ray Computed , Tuberculosis, Spinal/diagnostic imaging , Abscess/pathology , Abscess/therapy , Adult , Antitubercular Agents/therapeutic use , Biopsy , Drainage , Epidural Space , Humans , Male , Tuberculosis, Spinal/pathology , Tuberculosis, Spinal/therapySubject(s)
Abscess , Kidney Diseases , Staphylococcal Infections , Abscess/diagnosis , Abscess/epidemiology , Abscess/therapy , Adult , Drainage , Female , Humans , Kidney Diseases/diagnosis , Kidney Diseases/epidemiology , Kidney Diseases/therapy , Male , Staphylococcal Infections/diagnosis , Staphylococcal Infections/epidemiology , Staphylococcal Infections/therapy , Tomography, X-Ray Computed , Tunisia/epidemiology , Ultrasonography , UrographyABSTRACT
The authors report 5 cases of cerebral miliary tuberculosis studied by computerized tomography and review 5 cases of the literature. Computerized tomography can see very small tuberculomas, of several millimeters. Chest miliary tuberculosis is found in all their cases, and 3 of the 5 cases of the other authors. Because of the discretion of neurological signs and the association with chest miliary, we suggest to make a computed tomography of brain of all patients who have chest miliary tuberculosis despite the absence of neurological signs and we think that we will find out other cases of brain miliary tuberculosis.
Subject(s)
Brain Diseases/diagnostic imaging , Tuberculosis, Meningeal/diagnostic imaging , Tuberculosis, Miliary/diagnostic imaging , Adult , Brain Diseases/complications , Female , Humans , Male , Middle Aged , Tomography, X-Ray Computed , Tuberculosis, Meningeal/complications , Tuberculosis, Miliary/complications , Tuberculosis, Pulmonary/complicationsSubject(s)
Brain Abscess , Adolescent , Adrenal Cortex Hormones/therapeutic use , Adult , Anti-Bacterial Agents/therapeutic use , Brain Abscess/diagnosis , Brain Abscess/drug therapy , Brain Abscess/epidemiology , Female , Hospitals , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Retrospective Studies , Risk Factors , Suppuration , Survival Rate , Tomography, X-Ray Computed , Treatment Outcome , Tunisia/epidemiologySubject(s)
Diabetes Complications , Infections/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Drug Resistance, Microbial , Female , Hospitalization , Humans , Infections/etiology , Infections/microbiology , Male , Middle Aged , Recurrence , Retrospective Studies , Tunisia/epidemiologyABSTRACT
The evolution of immunological parameters in mediterranean visceral leishmaniasis reveal a type III mixed cryoglobulin with rhumatoid factor activity and antileishmania antibodies. This cryoglobulin follows the clinical signs of the disease and disappear under treatment. The authors insist on the transitory character of this cryoglobulin which is in relation with polyclonal stimulation of the immune system by parasitical infection.