Fibrosing Mediastinitis Associated With Tuberculosis in Children.

Two children developed fibrosing mediastinitis following past tuberculosis disease. Both were microbiologically negative for tuberculosis at presentation. One was treated with steroids and supportive therapy, but developed active tuberculosis with complications. He ultimately succumbed to healthcare-associated infection. The other recovered with steroids, administered along with antituberculosis treatment.

Catheter based treatments for fibrosing mediastinitis.

Fibrosing mediastinitis is a rare, often debilitating and potentially lethal disease characterized by an exuberant fibroinflammatory response within the mediastinum. Patients typically present with insidious symptoms related to compression of adjacent structures including the esophagus, heart, airways, and cardiac vessels. Fibrosing mediastinitis is most often triggered by Histoplasmosis infection; however, antifungal and anti-inflammatory therapies are largely ineffective. While structural interventions aimed at alleviating obstruction can provide significant palliation, surgical interventions are challenging with high mortality and clinical experience with percutaneous interventions is limited. Here, we will review the presentation, natural history, and treatment of fibrosing mediastinitis, placing particular emphasis on catheter-based therapies.

[Purulent pericarditis, an unusual complication of pneumococcal pneumonia: a case report]. / Péricardite purulente Complication inhabituelle de pneumonie à pneumocoque : à propos d'un cas chez une femme enceinte.

Purulent pericarditis has become rare since the advent of antibiotics. Among the involved germs, S. pneumoniae remains the most implicated pathogen to evoke in principle, especially that prescription of systematic antibiotics for any febrile condition can considerably mask the clinical picture. A 36-year-old pregnant woman was visiting the emergency department for dyspnea and flu-like syndrom that had been going on for a week. The chest X-ray showed a white lung on the left and the transthoracic ultrasound revealed a pericardial effusion, resulting in pericardial drainage and pleural puncture that allows the evacuation of a purulent fluid. S. pneumoniae was identified on the pericardial fluid. Antibiotic therapy and resuscitation measures have allowed a good evolution. Even if it has become exceptional, pneumococcal pericarditis must not be overlooked since the evolution is often favorable in triple conditions: early recognition, prompt institution of appropriate antibiotic therapy, and early surgical drainage.

Right Middle Lobe Collapse and Pleural Effusion in an 18-Year-Old Man.

An 18-year-old African American male subject presented to an acute care clinic with 3 days of productive cough, chills, pleuritic right chest pain, sore throat with hoarseness, congestion, and intermittent shortness of breath. He recently relocated to Texas from Georgia to undergo basic military training. He denied any other recent travel or contact with persons with pulmonary TB or other respiratory illnesses. His medical history was significant for glucose-6-phosphate dehydrogenase deficiency and sickle cell trait.

Fibrosing mediastinitis due to Aspergillus with dominant cardiac involvement: report of two autopsy cases with review of literature.

Fibrosing mediastinitis (FM) is a rare condition characterized by extensive proliferation of fibrous tissue in the mediastinum resulting in mass like lesion. Histoplasma and Mycobacterium tuberculosis are the common infective causes of fibrosing mediastinitis, but Aspergillus infection is an extremely rare cause. Fibrosing mediastinitis due to Aspergillus usually occurs following Aspergillus bronchopneumonia. Cardiac involvement due to Aspergillus-related fibrosing mediastinitis is extremely rare in immune-competent individuals and occurs following some intervention or as a part of disseminated systemic fungal infection. Here, we report two cases of Aspergillus FM with dominant cardiac involvement in immune-competent patients. Both cases presented with large mediastinal mass and large vegetation in the left atrium. Autopsy findings showed the granulomatous Aspergillus mediastinitis and extension into the heart with associated fibrosis. One case was proven to be due to Aspergillus flavus by fungal genomic sequencing. To the best of our knowledge, this is the first report of Aspergillus FM with pancarditis.

The significance of computed tomographic findings in the diagnosis of fungus ball in the paranasal sinuses.

BACKGROUND: Sinus fungus ball (SFB), previously termed mycetoma of the paranasal sinus is a type of noninvasive fungal rhinosinusitis and the treatment of choice for this condition is functional endoscopic sinus surgery. Predicting the possibility of SFB by performing preoperative computed tomography (CT) is important to ensure appropriate treatment. Various studies have reported the CT findings of SFB. We aimed to investigate the relationship between CT features and SFB to increase the preoperative diagnostic accuracy of CT. METHODS: Based on a literature review, we selected six CT features of SFB including calcification, erosion of the inner wall of the sinus, sclerosis of sinus lateral wall, heterogeneous opacification of sinus, absence of an air-fluid level, and sinus mucosal thickening. From January 2004 to February 2010, 96 SFB patients and 72 unilateral chronic rhinosinusitis (CRS) patients were enrolled in this study. Preoperative CT images of all of the patients were interpreted by a radiologist and an otolaryngologist. RESULTS: All of the CT features except mucosal thickening showed statistically significant differences between SFB and CRS group patients. After adjusting for these CT features in a multiple logistic regression model, only the two features, viz., calcification and erosion of the inner wall of the sinus, were found to have a significant positive association with SFB. CONCLUSION: We found that five CT features, particularly calcification and erosion of the inner wall of the sinus, increase the diagnostic accuracy of CT for SFB, and this ensures that the patient receives appropriate treatment.

Detection of Mycobacterium tuberculosis DNA in the sclerotic spinal wall.

Recent studies have shown that the major spinal lesion in spinal tuberculosis is predominantly sclerotic and accounts for >70% of the lesion. In this type of sclerosis, apart from spinal reactive hyperplasia and increased bone density, the most severe lesion is the formation of a hard outer osteoid shell (the sclerotic wall) around the cheese-like substances and granulated tissues. In the current study, polymerase chain reaction detection of Mycobacterium tuberculosis in the sclerotic wall was performed. Surgical specimens were obtained from 18 patients with spinal tuberculosis with peripheral sclerotic wall (as shown by computed tomography) and included the sclerotic wall, subnormal bone tissue outside the sclerotic wall, and iliac bone tissue (control). The IS986 gene in the samples was amplified by polymerase chain reaction followed by DNA sequencing. The obtained sequences were then compared with the published sequences in GenBank using DNATools version 5.1 software (International Centre for Genetic Engineering and Biotechnology, Trieste, Italy). The polymerase chain reaction results showed that 16 specimens from the sclerotic spinal wall, 3 from the subnormal bone, and 0 from the controls were positive for M tuberculosis, indicating a statistically significant difference (P<.05). These results indicated that M tuberculosis was present in the spinal sclerotic wall. Combined with our previous studies, we conclude that the sclerotic wall should be considered a lesion in patients with spinal tuberculosis.

[Clinico-morphological characteristics of pulmonary mycobacteriosis].

According to the criteria of the American Thoracal Societypulmonary mycobacteriosis has been diagnosed at 40patients without clinically important immunosupression (MAC--35%, Mkansasii--25%, M. xenopi--20%, M. fortuitum--12.5% and M. chelonae--7.5%). 95% patients have had clinically important symptomatology with polymorphic radiologic development such as a deformation of a lung pattern and focal dissemination (75%), locus and infiltration (52.5%), cavities (42.5%), marked pneumosclerosis (60%) and bronchiectasis (17.5%). 75% patients have had some changes of the bronhial tree. As opposed to tuberculosis the morphology of mycobacteriosis is more homogeneous and includes inflammation with epithelioid giant-cell granuloma and fibrosis, pneumogenic and bronchogenic cavernous cavities, mycobacterial endobronchitis. The polymorphism of clinic-radiologic developments, a similarity of lung diseases morphology caused by nontuberculous mycobacteria makes difficulties to diagnose theirs.

Measurement of the concentration of three antituberculosis drugs in the focus of spinal tuberculosis.

This is an experimental study on the distribution of antituberculosis drugs such as rifampin, isoniazid, and pyrazinamide in pathologic vertebrae of spinal tuberculosis in order to provide the regimen of chemotherapy and surgical treatment of spinal tuberculosis. The distribution of antituberculosis drugs in pathologic vertebral tissues matters greatly to the clinical effect of spinal tuberculosis' treatment. However, few pharmacokinetic studies and clinical reports about the concentrations of antituberculosis drugs in vertebral foci have been published so far. Twenty-four patients with spinal tuberculosis were divided into sclerotic group (n = 15) or non-sclerotic group (n = 9) according to radiographic features of lesion. All patients received chemotherapy with 2HRZ/2.5H(2)R(2)Z(2) for a duration of 4.5 months. Four weeks after chemotherapy all patients underwent surgery and the specimen of serum, ilium, and pathologic vertebral tissues, including sclerotic wall, subnormal osseous tissue, and foci were obtained during operation in 120-130 and 180-190 min after oral intake in the morning, respectively. The levels of three drugs in the specimen were measured using HPLC method. The concentration levels of isoniazid, rifampin and pyrazinamide varied greatly in different tissues of spinal tuberculosis, of which the bactericidal concentration values of isoniazid and rifampin and fivefold minimal inhibitory concentration (MICs) of pyrazinamide were found in subnormal vertebral bone and self-contrast ilium, the MICs of all drugs were found in sclerotic wall outside foci, and undetected level was found in foci inside the sclerotic wall. To patients without vertebral sclerotic wall around the foci, the isoniazid in foci was of bactericidal level and rifampin and pyrazinamide in foci corresponded to the MICs respectively. The sclerotic bone of affected vertebra plays an important role in blocking the antituberculosis drug's penetration into tuberculosis focus.

[Encapsulating peritoneal sclerosis]. / Umlykjandi lífhimnuhersli--tvö tilfelli og yfirlit yfir sjúkdóminn.

The incidence of encapsulating peritoneal sclerosis in patients on peritoneal dialysis seems to be increasing worldwide. In Iceland, two cases of encapsulating peritoneal sclerosis have recently been diagnosed (cumulative incidence 1.6%). The patients followed a similar course; the disease was diagnosed in the wake of a bacterial peritonitis, steroid treatment was effective during the acute phase but eventually surgical treatment was needed and a successful enterolysis performed.

[Establishment of tympanosclerosis by intratympanic injection of Staphylococcus aureus in guinea pigs].

OBJECTIVE: To establish a guinea pig model of tympanosclerosis and investigate the development and progression of tympanosclerosis in the tympanic membranes and middle ear mucosa. METHODS: Twenty-one healthy guinea pigs were subjected inoculation of 1x10(8)/L Staphylococcus aureus into the left middle ear cavities under general anaesthesia, with the right ears as the control, to establish models of chronic purulent otitis media. The animals were sacrificed by decapitation after 1, 3 and 6 months after model establishment for histological examination of the middle ear mucosa. RESULTS: The histological changes of tympanosclerosis occurred in some of the animals 3 months after model establishment, and the extent of calcium deposition and fibrosis across the mucosa were positively correlated with the duration of chronic purulent otitis media. CONCLUSION: Tympanosclerosis may occur in some guinea pigs after inoculation of Staphylococcus aureus into the middle ear cavity, and this model can be useful for study of tympanosclerosis.

Whipple disease revealed by musculocutaneous symptoms, with muscle biopsy cultures positive for Tropheryma whipplei.

A patient experienced sudden onset of musculocutaneous symptoms 3 years after being diagnosed with polyarthritis. Biopsies from the duodenum, skin, and muscle established the diagnosis of Whipple disease. Cultures of muscle biopsy specimens grew Tropheryma whipplei. Adequate antibiotic therapy ensured a favorable outcome. To our knowledge, this is the first case in which T. whipplei was recovered from muscle biopsy specimens, confirming the infectious nature of muscle involvement in Whipple disease.

Magnetic resonance imaging of nalbuphine-induced myocutaneous sclerosis.

Myocutaneous sclerosis is a known complication of intramuscular and subcutaneous injection of narcotics. We have described the MRI findings of this entity with superimposed infection in a patient addicted to intramuscular and subcutaneously administered nalbuphine. The clinical and imaging features of this disorder are sufficiently characteristic to allow confident diagnosis. This is the first report of this disorder due to nalbuphine.

Bacteriologic and serologic investigation in diffuse sclerosing osteomyelitis (DSO) of the mandible.

An attempt was made to clarify the obscure origin of diffuse sclerosing osteomyelitis (DSO) of the mandible. Bacteriologic investigations of specimens from diseased mandibles were performed with special attention to anaerobic culture technique. Propionibacterium acnes and Peptostreptococcus intermedius were in some patients found to be of etiologic importance. Sampling techniques and associated problems are discussed. An examination was made for antibodies in the patients' sera against antigens prepared from bacterial isolates. ASTA, IgM, IgG, and IgA were determined. Lymphocyte-stimulation tests were performed. The inflammatory events and chronicity of the disease could not be explained by the immunologic findings.