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1.
BMC Infect Dis ; 21(1): 913, 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34488670

RESUMO

BACKGROUND: While miliary tuberculosis (TB) in pregnancy is rare after in vitro fertilization and embryo transfer (IVF-ET), it poses a serious threat to the health of pregnant women and their fetuses. The present study aimed to describe the clinical features of miliary TB and pregnancy outcomes of patients after IVF-ET. METHODS: Data of infertile patients who received IVF-ET at Peking University Third Hospital between January 2012 and December 2017 were retrospectively analyzed. Patients who developed miliary TB during pregnancy were identified, and clinical characteristics of miliary TB were described. RESULTS: Out of 62,755 infertile women enrolled, 7137 (11.4 %) showed signs of prior pulmonary TB on chest X-ray (CXR). Among the 15,136 women (mean age: 33.2 ± 5.0 years) who successfully achieved clinical pregnancy, seven patients aged 28-35 years had miliary TB during pregnancy, with two patients having a complication of TB meningitis. All these patients presented with fever. Notably, old TB lesions were detected on CXR in six patients before IVF-ET; nevertheless, no anti-TB therapy was administered. Furthermore, salpingography revealed oviduct obstruction in all patients (7/7). Patients received anti-TB therapy following a diagnosis of miliary TB and were clinically cured. However, pregnancy was terminated due to spontaneous (4/7) and induced (3/7) abortion. CONCLUSIONS: TB reactivation, mostly as miliary TB and TB meningitis, is severe in pregnant women after IVF-ET and deleterious to pregnancy outcomes. Signs of prior TB on CXR may be risk factors for TB reactivation during pregnancy.


Assuntos
Infertilidade Feminina , Tuberculose Miliar , Adulto , Transferência Embrionária , Feminino , Fertilização In Vitro , Humanos , Infertilidade Feminina/terapia , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Tuberculose Miliar/diagnóstico
2.
J Assoc Physicians India ; 69(8): 11-12, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34472816

RESUMO

With global resurgence of M. tuberculosis infection, cases of extra pulmonary TB have also shown an increase. Tuberculosis is a major cause of morbidity and mortality in India. Although disseminated tuberculosis can affect most of the organs, vasculitis presenting as peripheral gangrene as a manifestation of tuberculosis is very rare. We report the case of a 70 years old male who presented with gangrene of left leg complicating disseminated tuberculosis.


Assuntos
Mycobacterium tuberculosis , Tuberculose Miliar , Tuberculose Pulmonar , Vasculite , Idoso , Gangrena/etiologia , Humanos , Masculino , Tuberculose Miliar/complicações , Tuberculose Miliar/diagnóstico
3.
Int. j. med. surg. sci. (Print) ; 8(3): 1-7, sept. 2021. ilus
Artigo em Espanhol | LILACS | ID: biblio-1292574

RESUMO

La tuberculosis es una enfermedad granulomatosa, con espectro clínico variable. El objetivo es presentar un caso con tuberculosis miliar, una de las formas clínicas menos frecuente de la enfermedad y la utilización del método clínico proporcionó el diagnóstico certero. Se presenta un paciente masculino de 54 años, no fumador, alcohólico atendido en el Hospital Clínico Quirúrgico Hermanos Ameijeiras por referir historia de tos poco productiva, cefalea, fiebre, pérdida de apetito y de peso de dos meses de evolución. En la radiografía y tomografía de tórax se evidencia un patrón miliar y la baciloscopía directa confirma la presencia del Mycobacterium tuberculosis. La TB miliar es muy poco frecuente, pero se puede sospechar ante un patrón radiológico miliar y confirmar mediante análisis microbiológico.


Tuberculosis is a granulomatous disease with a variable clinical spectrum. The objective is to present a case with miliar tuberculosis, one of the least frequent clinical forms of the disease, and the use of the clinical method provided an accurate diagnosis. We present a 54-year-old male, non-smoker, alcoholic who attended in the Ameijeiras Brothers Surgical Clinical Hospital for referring to a history of unproductive cough, headache, fever, loss of appetite, and weight two months of evolution. Chest X-ray and CT showed a miliar pattern and direct bacilloscopy confirmed the presence of Mycobacterium tuberculosis. Miliar TB is very rare but can be suspected by a miliar radiological pattern and confirmed by microbiological analysis.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Tuberculose Miliar/diagnóstico por imagem , Radiografia Torácica/métodos , Tomografia Computadorizada por Raios X/métodos
5.
Am J Case Rep ; 22: e931369, 2021 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-34404756

RESUMO

BACKGROUND Reactivation of latent tuberculosis infection (LTBI) is a recognized complication of immunosuppressive treatment. However, immunosuppressed patients are also at risk of hematogenous disseminated spread from a primary infection with Mycobacterium tuberculosis. This report presents the case of a 55-year-old Japanese man with a 12-year history of multiple sclerosis who was hospitalized with worsening neurological symptoms and was diagnosed with disseminated tuberculosis identified by abnormalities on liver function test results. CASE REPORT A 55-year-old Japanese man was admitted to our hospital for the treatment of multiple sclerosis with worsening symptoms. He showed mild liver dysfunction at the time of admission. A laparoscopy and biopsy were performed to identify the cause of the liver dysfunction, which was the only positive finding. The liver surface was studded with yellowish-white nodular lesions. Histological examination of a liver biopsy specimen revealed a granuloma without caseous necrosis. The patient was suspected of having tuberculosis. Although the results of an interferon-γ-releasing assay were indeterminate, asymptomatic disseminated tuberculosis was diagnosed from the serum adenosine deaminase levels, a caseating granuloma in the cervical lymph node, detection of acid-fast bacilli DNA in the cervical lymph nodes on polymerase chain reaction, and tuberculin skin test findings. Anti-tuberculosis treatment led to improvement in the liver function test findings. CONCLUSIONS This case has highlighted that tuberculosis may have an atypical presentation in the immunosuppressed patient. In addition to the reactivation of LTBI, hematogenous spread of primary tuberculosis may result in disseminated disease involving multiple organs and requiring emergency treatment.


Assuntos
Hepatopatias , Esclerose Múltipla , Tuberculose Miliar , Granuloma , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Esclerose Múltipla/diagnóstico
6.
BMJ Case Rep ; 14(8)2021 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-34340991

RESUMO

A 36-year-old man of central Asian origin was diagnosed with subacute disseminated tuberculosis. Initially, central nervous system involvement was suggested by an encephalopathic condition and MRI showing extensive basal and spinal meningitis. After initiation of anti-tuberculosis drugs and corticosteroid therapy, clinical and radiological deterioration of spinal damage was noted. We interpreted this in the context of a paradoxical reaction, which is suggested to be an overshooting inflammatory response after reconstitution of the immune system. Despite increased dosage of corticosteroids, a gradual worsening of gait ataxia over several weeks was noted. After administration of infliximab, the patient's condition progressively improved.


Assuntos
Síndrome Inflamatória da Reconstituição Imune , Tuberculose Miliar , Corticosteroides/uso terapêutico , Adulto , Antituberculosos/uso terapêutico , Sistema Nervoso Central , Humanos , Síndrome Inflamatória da Reconstituição Imune/tratamento farmacológico , Infliximab/efeitos adversos , Tuberculose Miliar/tratamento farmacológico
7.
Indian J Tuberc ; 68(2): 201-204, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33845952

RESUMO

BACKGROUND: Tuberculosis remains a major public health problem in various parts of the world. It leads to various haematological changes. Study of these haematological changes will help better patient management. OBJECTIVE & METHODS: It is to evaluate haematological changes in tuberculosis patients and compare the result with special emphasis to bone marrow changes as active case search is sharply decreasing the miliary tuberculosis. It is also to evaluate the patients with before and after the Intensive Phase of Anti Koch Treatment. Sputum positive and sputum negative tuberculosis patients confirmed by other ancillary techniques were included into this study. It is conducted at a tertiary level hospital in rural area. RESULT: In this study bone marrow hypercellularity was of erythroid series with only 1.92% patients showed granuloma in bone marrow aspiration. In addition to bone marrow changes, significant changes were evident in haemoglobin level, Erythrocyte Sedimentation Rate (ESR) Total White Blood Cell count and RBC count. DISCUSSION: In majority cases this study showed Erythroid Hyperplasia. It is sharp contrast with other study where myeloid hyperplasia was evident. This study also differs from other study where high number of bone marrow granuloma was reported. In this study only 1.92% cases showed bone marrow granuloma. This study also documented higher number of anaemic cases mostly because of the institute serves poor and tribal population. CONCLUSION: In our study the cases showing granuloma and hyperplasia of myeloid series were limited. With introduction of Directly Observed Treatment and house to house active case search helped to sharply decrease bone marrow granuloma by limiting multi-organ spread. This study showed, ESR level may be considered as prognostic parameters of tuberculosis.


Assuntos
Doenças da Medula Óssea/sangue , Tuberculose Miliar/sangue , Tuberculose Pulmonar/sangue , Adolescente , Adulto , Idoso , Anemia/complicações , Antituberculosos/uso terapêutico , Sedimentação Sanguínea , Doenças da Medula Óssea/complicações , Doenças da Medula Óssea/tratamento farmacológico , Feminino , Granuloma/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Tuberculose Miliar/complicações , Tuberculose Miliar/tratamento farmacológico , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/tratamento farmacológico , Adulto Jovem
9.
BMJ Case Rep ; 14(3)2021 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-33687934

RESUMO

We present a 16-year-old girl with a history of well-controlled psoriasis, on immunosuppression, who sought evaluation in the emergency department for 4 months of fever, cough and unintentional weight loss. The patient had seen multiple providers who had diagnosed her with community-acquired pneumonia, but she was unimproved after oral antibiotic therapy. On presentation, she was noted to be febrile, tachycardic and chronically ill-appearing. Her chest X-ray showed diffuse opacities and a right upper lobe cavitary lesion concerning for tuberculosis. A subsequent chest CT revealed miliary pulmonary nodules in addition to the cavitary lesion. The patient underwent subsequent brain MRI, which revealed multifocal ring-enhancing nodules consistent with parenchymal involvement. The patient was diagnosed with miliary tuberculosis and improved on quadruple therapy. Though rates of tuberculosis are increasing, rates remain low in children, though special consideration should be given to children who are immunosuppressed.


Assuntos
Psoríase , Tuberculose Miliar , Adolescente , Criança , Feminino , Humanos , Hospedeiro Imunocomprometido , Imageamento por Ressonância Magnética , Psoríase/complicações , Psoríase/tratamento farmacológico , Tomografia Computadorizada por Raios X , Tuberculose Miliar/diagnóstico , Tuberculose Miliar/diagnóstico por imagem
10.
Medicine (Baltimore) ; 100(8): e23833, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33663042

RESUMO

ABSTRACT: While chest CT provides important clue for diagnosis of miliary tuberculosis (TB), patients are occasionally missed on initial CT, which might delay the diagnosis. This study was to evaluate the clinical and radiological characteristics of radiologically missed miliary TB.Total 117 adult patients with microbiologically confirmed miliary TB in an intermediate TB-burden country were included. 'Missed miliary TB' were defined as the case in which miliary TB was not mentioned as a differential diagnosis in the initial CT reading. Clinical characteristics and radiologic findings including the predominant nodule size, demarcation of miliary nodules and disease extent on CT were retrospectively evaluated. Findings were compared between the missed and non-missed miliary TB groups. Multivariable analyses were performed to determine independent risk factors of missed miliary TB.Of 117 patients with miliary TB, 13 (11.1%) were classified as missed miliary TB; these patients were significantly older than those with non-missed miliary TB (median age, 71 vs 57 years, P = .024). There was a significant diagnostic delay in the missed miliary TB group (P < .001). On chest CT, patients with missed miliary TB had a higher prevalence of ill-defined nodules (84.6% vs 14.4%; P < .001), miliary nodule less than 2 mm showing granular appearance (69.2% vs 12.5%; P < .001), and subtle disease extent (less than 25% of whole lung field, 46.2% vs 8.7%; P < .001). Multivariable analysis revealed that only CT findings including ill-defined nodule (Odd ratios [OR], 15.64; P = .002) and miliary nodule less than 2 mm (OR, 10.08; P = .007) were independently associated with missed miliary TB.Approximately 10% of miliary TB could be missed on initial chest CT, resulting in a delayed diagnosis and treatment. Caution is required in patients with less typical CT findings showing ill-defined miliary nodules less than 2 mm showing granular appearance and follow-up CT might have a benefit.


Assuntos
Tuberculose Miliar/diagnóstico , Tuberculose Miliar/patologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Tardio , Erros de Diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Atenção Terciária , Tomografia Computadorizada por Raios X , Tuberculose Miliar/diagnóstico por imagem
13.
Pediatr Infect Dis J ; 40(2): e94-e97, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33433163

RESUMO

Pneumatoceles are rare complications of pulmonary tuberculosis in children. We present 2 cases in infants of disseminated tuberculosis complicated by pneumatoceles with different evolution. This complication should be considered if worsening of respiratory symptoms occurs after initiating anti-tuberculous treatment. Treatment of pneumatoceles is usually conservative and surgical treatment should be used in patients with giant cysts which cause respiratory distress.


Assuntos
Antituberculosos/uso terapêutico , Pneumopatias/diagnóstico por imagem , Pneumopatias/etiologia , Tuberculose Miliar/tratamento farmacológico , Tuberculose Miliar/patologia , Dexametasona/administração & dosagem , Dexametasona/uso terapêutico , Evolução Fatal , Feminino , Humanos , Lactente , Pneumopatias/patologia , Masculino , Tuberculose Miliar/diagnóstico
14.
BMC Pregnancy Childbirth ; 21(1): 27, 2021 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-33413157

RESUMO

BACKGROUND: Disseminated tuberculosis (TB) is a fatal disease resulting from hematogenous dissemination of Mycobacterium tuberculosis. Spontaneous pregnancy rate of women with TB is low; furthermore, live birth, spontaneous abortion or ectopic pregnancy may be the outcomes even if pregnancy occurs. CASE PRESENTATION: We report a case of a woman with disseminated TB who had a series of complications including preterm delivery with congenital TB and infant death of pulmonary TB, fallopian tube pregnancy. She was treated by in vitro fertilization-embryo transfer (IVF-ET), and gave birth to a healthy baby. CONCLUSION: Disseminated TB has a significant impact on female fertility. We should take more active efforts to diagnose and treat this disease in a timely fashion. Moreover, IVF treatment is a feasible approach for an infertile woman after TB.


Assuntos
Parto Obstétrico , Fertilização In Vitro/métodos , Complicações Infecciosas na Gravidez , Gravidez Tubária/etiologia , Nascimento Prematuro/etiologia , Tuberculose Miliar/complicações , Adulto , Transferência Embrionária , Feminino , Humanos , Recém-Nascido , Infertilidade Feminina/etiologia , Infertilidade Feminina/terapia , Gravidez , Tuberculose do Sistema Nervoso Central/diagnóstico por imagem , Tuberculose Miliar/diagnóstico por imagem , Tuberculose Pulmonar/congênito , Tuberculose Pulmonar/diagnóstico por imagem
16.
Intern Med ; 60(3): 445-448, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32963150

RESUMO

Miliary tuberculosis is a potentially lethal type of tuberculosis that results from the hematogenous dissemination of Mycobacterium tuberculosis bacilli. We herein describe the case of a 34-year-old man that presented with a one-month history of cough and fever, while his sputum smear results were negative. Chest computed tomography revealed bilateral centrilobular ground-glass opacification (GGO), suggestive of hypersensitivity pneumonitis; thus, bronchoscopy was performed. Cryobiopsy specimens revealed necrotic granulomas. A re-examination of sputum after bronchoscopy identified Mycobacterium tuberculosis, and miliary tuberculosis was diagnosed. A cryobiopsy might be useful for diagnosing miliary tuberculosis pathologically, particularly when miliary nodules may be masked by GGO.


Assuntos
Alveolite Alérgica Extrínseca , Mycobacterium tuberculosis , Tuberculose Miliar , Adulto , Broncoscopia , Humanos , Masculino , Escarro , Tuberculose Miliar/diagnóstico por imagem
19.
BMJ Case Rep ; 13(12)2020 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-33318245

RESUMO

Tuberculosis (TB) is an important public health problem in developing countries. In India, despite substantial efforts targeting TB and its associated risk factors, the number of cases remains high with 2.7 million new cases per year with a minimum 10% case contributed by paediatric TB. Disseminated TB has been increasingly recognised in children in recent times due to the increased prevalence of immune suppression secondary to AIDS and immunosuppressive therapies for various medical disorders and increasing awareness. Here we describe a 5-year-old girl who presented with fever of unknown cause, and her diagnosis of disseminated TB was delayed due to atypical presentation and the paucibacillary nature of paediatric TB. It was a bone marrow examination report which led us to clinch the diagnosis. The case highlights the difficulty in diagnosing disseminated TB and the importance of bone marrow examination in such cases.


Assuntos
Medula Óssea/patologia , Tuberculose Miliar/diagnóstico , Antituberculosos/uso terapêutico , Exame de Medula Óssea , Pré-Escolar , Feminino , Humanos , Tuberculose Miliar/tratamento farmacológico , Tuberculose Miliar/patologia
20.
BMC Pulm Med ; 20(1): 325, 2020 Dec 29.
Artigo em Inglês | MEDLINE | ID: mdl-33375928

RESUMO

BACKGROUND: During the ongoing pandemic of coronavirus disease 2019 (COVID-19), lockdown periods have changed the way that people and communities live, work and interact. CASE PRESENTATION: This case report describes an uncommon but important presentation of allergic bronchopulmonary aspergillosis (ABPA) in a previously healthy male, who decided to live in the basement of his house when Italy entered a nationwide lockdown during the COVID-19 pandemic. As high resolution computed tomography (HRCT) of the chest on admission showed diffuse miliary nodules, a miliary tuberculosis was initially suspected. However, further investigations provided a diagnosis of unusual presentation of ABPA. CONCLUSIONS: This case highlights the importance of maintaining awareness of Aspergillus-associated respiratory disorders during the COVID-19 pandemic, especially because lifestyle changes associated with home isolation carry an increased risk of exposure to mold spores present in some indoor environments.


Assuntos
Aspergilose Broncopulmonar Alérgica/diagnóstico , COVID-19/diagnóstico , Tuberculose Miliar/diagnóstico , Aspergilose Broncopulmonar Alérgica/diagnóstico por imagem , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis , Diagnóstico Diferencial , Humanos , Itália , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Tomografia Computadorizada por Raios X
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