Tuberculosis: experience in a low endemic area Australian tertiary hospital.

BACKGROUND: Abdominal tuberculosis (ATB) poses a significant diagnostic, management, and resource challenge. In Australia, an increasing number of tuberculosis (TB) cases are being reported, and we describe our experience of ATB in an Australian tertiary institution. METHODS: All diagnosed cases of tuberculosis (TB) at the Royal North Shore tertiary hospital campus of the University of Sydney are entered prospectively into a central registry. Cases of ATB encountered between September 1991 and November 2011 were identified and retrospectively reviewed. RESULTS: In all, 841 cases of TB were identified, of which 20 were abdominal (2.4 %). Median age at presentation was 34 years (range: 22-79 years), and 55 % of patients were women. None of the patients were born in Australia and 11 patients were of South Asian origin. The most common presenting symptom was abdominal pain (65 %). Diagnosis was based primarily on histology (90 % sensitivity), and the sensitivity of PCR analysis in this series was low (44 %). Eleven of the patients required laparoscopy or laparotomy. 40 % of cases involved the peritoneum, and disease was also seen in solid organs (liver, spleen, pancreas, adrenal gland) and bowel (esophagus, small bowel, colon). CONCLUSIONS: In our local experience ATB was seen exclusively in the immigrant population. The presentation of ATB varies greatly, necessitating a high index of suspicion within the context of abdominal symptoms in high-risk groups. The role of surgical involvement is indispensable for both diagnosis and management of ATB-related complications. Surgeons should remain mindful of the diagnosis in an age of increasing worldwide incidence.

Obstructed ileocaecal tuberculosis with splenic tuberculosis and solid pseudopapillary tumour of tail of pancreas in an immunocompetent woman.

A 22-year-old young woman presented with fever, lower abdominal pain and vomiting for 20 days. She had persistent fever and abdominal pain. Fever panel was negative. Clinical features were suggestive of subacute small bowel obstruction. Contrast-enhanced CT abdomen showed thickening of distal ileum, ileocaecal junction and caecum with conglomerate necrotic nodal mass in the ileocolic mesentry along with a lesion in the tail of pancreas. Patient was discussed with multidisciplinary team and decided to undergo a single-stage procedure after adequate nutritional optimisation. During optimisation, she underwent acute obstruction and hence taken up for emergency laparotomy proceeded to right haemicolectomy with distal pancreatectomy and splenectomy 4 weeks after the time of admission. Histopathology showed ileocaecal tuberculosis and solid pseudopapillary tumour with margins free of tumour. Approach of obstructed ileocaecal tuberculosis in the setting of incidental diagnosis of solid pseudopapillary tumour of pancreas in a moribund patient was challenging.

Splenic tuberculosis: a comprehensive review of literature.

Tuberculosis(TB) is one of the most common infections affecting the population in the developing countries. With the rising human immunodeficiency(HIV) infection its incidence is on a rise even in the developed countries. Pulmonary TB is the commonest form of infection, However, multiple extrapulmonary sites have also been reported. The spleen is thought to be a rare organ involved in this infection. Various presentations of the splenic TB have been reported in the literature. The definitive diagnosis of this is essentially formulated on the post-splenectomy specimen. A consensus statement based on the available case reports is lacking. The authors are providing an insight into this form of extrapulmonary TB after reviewing the available literature.

Tuberculous splenic abscess--a case report and review of literature.

Splenic abscess due to tuberculosis is a rare condition and is mostly diagnosed in immuno-compromised hosts. A case of tuberculous splenic abscess detected incidentally after splenectomy without any underlying disease is reported in an immuno-competent patient.

[Isolated pseudo-tumoral tuberculosis of the spleen. A case report]. / La tuberculose splénique pseudotumorale isolée. (A propos d'un cas).

INTRODUCTION: The tuberculosis isolated tumoral spleen is rare, even in the countries to strong tubercular endemic. EXEGESIS: From an observation, concerning an important, tumoral and isolated splenomegaly in 48-year-old-man. The authors put the accent on his tumorous variety by the clinic, the imagery and on macroscopic appearance of the operative piece. Are discussed the isolated character, the way of dissemination, the site of initial infestation and the deceitful character of haematological manifestations. A splenectomy to diagnostic and therapeutic goal have been realised, associated to the chemotherapy. CONCLUSION: This is an expression of the profound organ's tuberculosis rich on endothelial reticular system. It's mean a singular topography of the bacillary lesion and a great distribution of the tubercular affect.

Abscess of the spleen.

Two unusual cases are presented of splenic abscesses caused by metastatic infection with different organisms. The patients were treated with splenectomy and antibiotics.

[Clinical and radiological aspects of tuberculous splenic abscesses. Presentation of 3 cases]. / Aspects cliniques et radiologiques des abcès spléniques tuberculeux. Présentation de trois cas.

Tuberculous splenic abscess is an exceptional disease with silent presentation in disseminated tuberculosis infection. Imaging procedures allow to suspect this diagnosis in case of multilocular nodules of the spleen, or unilocular pseudotumoral macronodule. We report three cases of tuberculous splenic abscesses in two patients with acquired immunodeficiency syndromes and one with polycythemia vera. Under antituberculous treatment, clinical evolution was good with regression of the radiological features.

Isolated splenic tuberculosis.

The authors report two cases of isolated splenic tuberculosis treated since 1989 in Nizam's Institute of Medical Sciences. One case presented as pyrexia of unknown origin (PUO) and another with idiopathic thrombocytopenic purpura (ITP). Both were found to have splenic tuberculosis after splenectomy. Pre operative diagnosis could not be made in these cases. Splenectomy followed by antituberculous chemotherapy cured the condition in both the cases. The authors underline the diagnostic difficulties, essentially related to the rarity of this condition inspite of the progress in modern imaging.

Successful treatment of spleen tuberculosis in a patient with human immunodeficiency virus infection.

Tuberculosis in human immunodeficiency virus (HIV)-infected patients may act as a cofactor that accelerates the clinical course of HIV infection, and, indeed, HIV-infected patients with tuberculosis have a reduced survival rate compared to those without tuberculosis. Diagnosis of tuberculosis in HIV-positive patients can be difficult because of nonspecific symptoms and the time required for the identification of mycobacteria by means of culture techniques. Recently, antiretroviral combination therapies have improved the outcome of several acquired immune deficiency syndrome (AIDS)-associated conditions. Unfortunately, the use of antiretroviral therapy for patients coinfected with HIV and Mycobacterium tuberculosis is still to be fully evaluated. The complexity of side-effects due to antituberculosis medication and drug interaction represent important issues and combining an effective anti-HIV treatment with antituberculosis therapy is still a clinical challenge. We discuss here a case of spleen tuberculosis in a human immunodeficiency virus-positive patient who had a successful response after a diagnostic splenectomy and medical treatment that included classical antituberculosis treatment associated with antiretroviral therapy without protease inhibitors.

Pact with the devil: alemtuzumab therapy, immune suppression and infectious complications in chronic lymphocytic leukemia.

Infectious complications are an important cause of hospitalization in patients diagnosed with chronic lymphocytic leukemia. The pathogenesis of infection is complex, involving both disease-induced and treatment-related immune depression. During the last decade, the management of chronic lymphocytic leukemia (CLL) has been redefined by the approval of monoclonal antibody-based treatment, which resulted in improved therapeutic responses. Nonetheless, the profound lymphopenia induced by monoclonal agents was accompanied by increased incidence of infections caused by a new spectrum of opportunistic microorganisms. We report the case of a patient with hypercellular CLL who received Alemtuzumab as first line therapy and obtained a satisfactory therapeutic response, but developed subsequent atypical infectious complications.

Idiopathic thrombocytopenic purpura associated with splenic tuberculosis: case report.

Tuberculosis is still one of the most prevalent and fatal infectious diseases in spite of considerable improvements in medical science. Splenic tuberculosis is a rare form of extrapulmonary tuberculosis. There are limited numbers of cases in which immune thrombocytopenia is associated with splenic tuberculosis. We report a case of immune thrombocytopenic purpura due to splenic tuberculosis. Our case was a 58-year-old female with headache, gum bleeding, redness in legs, and ecchymoses on the arms for 10 days. On admission to hospital, laboratory tests were as follows: platelet count 6.000/mmc (150 000-450 000), haemoglobin: 12 g/dl, WBC: 8000/mm3, erythrocyte sedimentation rate: 58 mm/h and C-reactive protein was in normal ranges. After standard laboratory tests, the patient was diagnosed with idiopathic thrombocytopenic purpura. The patient presented abdominal lymphadenopathies and spleen in normal size in radiological examinations. Diagnostic laparotomy and splenectomy and lymph node excision was performed and splenic tuberculosis was detected in pathologic and microbiologic examination. The patient was successfully treated with apheresis platelets suspension, intravenous immunoglobulin and antituberculous therapy. In conclusion, splenic tuberculosis should be suspected in patients who have fever, abdominal lymphadenopathies and immune thrombocytopenic purpura. Histopathological examination is still an ideal method to confirm the diagnosis, suitably aided by microbiological examination.

Spontaneous rupture of tuberculous spleen in a HIV seropositive patient on maintenance hemodialysis.

Spontaneous rupture of the spleen usually occurs secondary to infection, hematological disorders or infiltrative lesions of the spleen. In patients with positive human immunodeficiency virus (HIV) antibodies and the acquired immunodeficiency syndrome (AIDS) who present with acute abdomen, splenic rupture should be considered as a possible cause and should additionally be investigated for co-infection with tuberculosis. Spontaneous rupture of spleen in asymptomatic patients requires a high index of suspicion for diagnosis. We herein report on a HIV-positive patient on maintenance hemodialysis, who presented with spontaneous rupture of a tuberculous spleen.

GLS/IL-12-modified Mycobacterium smegmatis as a novel anti-tuberculosis immunotherapeutic vaccine.

OBJECTIVE: To study the effects and mechanisms of recombinant Mycobacterium smegmatis (rMS) carrying pZM03 (a co-expression plasmid encoding human granulysin [GLS] and murine interleukin 12 [IL-12]) on murine M. tuberculosis infection. DESIGN: BALB/c mice infected with M. tuberculosis were treated with normal saline, M. smegmatis, pZM03 or rMS. The number of viable bacteria in the lungs and spleens were counted to observe the therapeutic effects. The levels of IL-12 and interferon-gamma (IFN-gamma) in serum, and IFN-gamma and tumour necrosis factor-alpha (TNF-alpha) released from spleen lymphocytes were detected to observe the T-helper 1 (Th1) response. Secretory IgA (SIgA) in bronchoalveolar lavage fluid was measured to observe the mucosal immunity. The lungs and spleens were prepared for pathological analysis. RESULTS: The rMS group showed a significantly reduced number of colony-forming units compared to the other groups. The expression of GLS in the tissue, and increased levels of IL-12, IFN-gamma, TNF-alpha and SIgA, were found in the rMS group. The pathological changes in the lungs of the rMS group were localised, while those in the control group were extensive. CONCLUSION: rMS had immunotherapeutic effects associated with a switch to the Th1 response and the antibacterial activity of GLS.

Efficacy of Mycobacterium bovis BCG vaccination in mice undergoing prior pulmonary infection with atypical mycobacteria.

The efficacy of Mycobacterium bovis BCG immunization in mice with established pulmonary infections caused by atypical mycobacteria was studied. In all four strains of Mycobacterium tested (M. kansasii, M. simiae, M. avium, and M. scrofulaceum), intravenous inoculation with 10(6) BCG had no discernible effect upon the course of atypical mycobacterial infection within the lungs; despite this, however, all BCG-vaccinated groups of mice were fully resistant to a subsequent acute aerogenic challenge with M. tuberculosis H37Rv, regardless of the presence of the pulmonary atypical mycobacterial infections. Furthermore, animals infected with M. kansasii, M. simiae, or M. avium but not vaccinated with BCG expressed considerable antituberculous resistance within the lungs, resulting in significant prolonged survival of these animals. The relevance of these findings to the expression of antituberculous resistance in human populations in areas in which atypical mycobacteria are endemic and the failure of these findings to support the hypothesis that prior contact with atypical mycobacteria might in some way jeopardize or interfere with the efficacy of subsequent BCG vaccination are discussed.

[Pathomorphology of tuberculosis after the treatment with antibacterial drugs and amniocene]. / Patomorfologiia tuberkuleza pri lechenii antibakterial'nymi preparatami i amniotsenom.

The tests on guinea pigs proved that amniocene (a tissue preparation) has a double action (antiinflammatory and potentiating repair processes in the foci of tuberculous lesions). This action manifests itself depending on the type of tuberculous inflammation and produces an effect upon the involution of experimental tuberculosis.

Acute hypersplenism and thrombocytopenia: a new presentation of disseminated mycobacterial infection in patients with acquired immunodeficiency syndrome.

We describe 2 patients with acquired immunodeficiency syndrome who presented with acute or subacute splenomegaly and thrombocytopenia secondary to disseminated Mycobacterium avium complex (MAC). The patients were treated for immune thrombocytopenic purpura without success. Thrombocytopenia may be a prominent feature of MAC. Our experience suggests that disseminated MAC may present with acute splenomegaly and thrombocytopenia in these patients and that a high index of suspicion for disseminated tuberculosis is indispensable in order to avoid delay in diagnosis and treatment in patients presenting with rapidly progressive splenomegaly and thrombocytopenia.