RESUMEN
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.
Asunto(s)
Enfermedades de la Médula Ósea/sangre , Tuberculosis Miliar/sangre , Tuberculosis Pulmonar/sangre , Adolescente , Adulto , Anciano , Anemia/complicaciones , Antituberculosos/uso terapéutico , Sedimentación Sanguínea , Enfermedades de la Médula Ósea/complicaciones , Enfermedades de la Médula Ósea/tratamiento farmacológico , Femenino , Granuloma/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Tuberculosis Miliar/complicaciones , Tuberculosis Miliar/tratamiento farmacológico , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/tratamiento farmacológico , Adulto JovenRESUMEN
BACKGROUND: Patients with end-stage renal disease undergoing chronic hemodialysis (HD) are at high risk to develop tuberculosis (TB) associated with a high mortality rate. TB diagnosis is often delayed due to non-specific symptoms, frequent extra-pulmonary manifestations, and rare microbiological confirmation. This case report illustrates the clear added value of combined interferon-γ -release assays (IGRA) in response to different mycobacterial antigens for an early diagnosis of TB in HD patients. CASE PRESENTATION: We report the case of an Egyptian patient under chronic HD treatment, who presented with recurrent episodes of fever and myalgia of unknown origin, associated with an important inflammatory syndrome. These episodes resolved partially or completely within less than 1 month without any treatment but recurred 10 times within 3 years. Chest Computed Tomography and 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18FDG PET-CT) demonstrated several active mediastinal lymphadenopathies. TB was the first suspected diagnosis but cultures and polymerase chain reaction (PCR) remained negative on a mediastinal lymph node aspiration. In contrast, the results from two different IGRA performed on blood were highly suggestive of TB disease. Several granulomas, some of them with central non-caseating necrosis, were demonstrated on a pulmonary nodule obtained by thoracoscopic resection, but PCR and culture remained negative for M. tuberculosis. Three years after the initial symptoms, a new PET-CT revealed a retro-clavicular lymphadenopathy in addition to the mediastinal lymphadenopathies, and the M. tuberculosis culture performed on the resected lymphadenopathy was positive. Antibiotic treatment for TB was started and resulted in a clear improvement of the patient's clinical condition, allowing him to successfully receive a renal graft. CONCLUSIONS: In view of the high frequency of TB in patients undergoing chronic HD and of the limitations of the classical diagnosis procedures, nephrologists have to diagnose TB mostly on clinical suspicion. We demonstrate here that the use of a combined IGRA to two different mycobacterial antigens may significantly raise the index of suspicion and help clinicians to decide starting anti-TB treatment in HD patients.
Asunto(s)
Ensayos de Liberación de Interferón gamma , Interferón gamma/sangre , Mycobacterium tuberculosis/aislamiento & purificación , Diálisis Renal , Tuberculosis Miliar/diagnóstico , Proteína C-Reactiva/análisis , Humanos , Ganglios Linfáticos/microbiología , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Tomografía de Emisión de Positrones , Tuberculosis Miliar/sangreRESUMEN
Background: Tuberculosis (TB) is prevalent worldwide and causes significant morbidity and mortality. TB is known to cause hypercalcemia. We aimed to assess the prevalence and risk factors for developing hypercalcemia among patients with TB. Methods: In this retrospective case-control study, patients with microbiological evidence of TB and an available serum calcium value were included between 2005 and 2016. The demographic, clinical, and laboratory details were recorded. Various risk factors were compared in TB patients with and without hypercalcemia. Results: A total of 129 patients fulfilled the inclusion criteria. Twenty percent were found to have an elevated serum calcium level, 65% of them had clinical features of hypercalcemia. In comparison, the odds of developing hypercalcemia in the presence of disseminated TB, diabetes and renal failure was 1.83, 1.60, and 7.33, respectively. Conclusion: One-fifth of patients with TB have hypercalcemia. Risk factors of the same are renal failure, diabetes, and disseminated TB.
Asunto(s)
Hipercalcemia/epidemiología , Hipercalcemia/etiología , Tuberculosis Miliar/complicaciones , Adulto , Estudios de Casos y Controles , Complicaciones de la Diabetes , Diabetes Mellitus , Femenino , Humanos , Hipercalcemia/microbiología , Masculino , Persona de Mediana Edad , Prevalencia , Insuficiencia Renal/complicaciones , Estudios Retrospectivos , Factores de Riesgo , Tuberculosis Miliar/sangreRESUMEN
Disseminated tuberculosis (DTB) often presents with protean clinical manifestations that often leads to potential diagnostic dilemmas. The nonspecific features may include pyrexia of unknown origin, hepatosplenomegaly, lymphadenopathy, meningitis, and a variety of hematological abnormalities, namely anemia, pancytopenia, and leukemoid reaction. Tuberculosis is one of the nonhematopoietic diseases that has been reported in conjunction with myelofibrosis. We, hereby, report a case of DTB with massive splenomegaly, severe pancytopenia, and marrow fibrosis.
Asunto(s)
Mielofibrosis Primaria/diagnóstico , Mielofibrosis Primaria/microbiología , Tuberculosis Miliar/diagnóstico por imagen , Antituberculosos/uso terapéutico , Médula Ósea/microbiología , Médula Ósea/patología , Diagnóstico Diferencial , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Pancitopenia/microbiología , Mielofibrosis Primaria/tratamiento farmacológico , Esplenomegalia/microbiología , Tomografía Computarizada por Rayos X , Tuberculosis Miliar/sangre , Tuberculosis Miliar/tratamiento farmacológicoRESUMEN
BACKGROUND: Tuberculosis (TB) is a cause of 1.2-1.5 million deaths worldwide, including deaths from TB among HIV positive people. Determining the extent of immune cells belonging to cell mediated immunity and haematological parameters is critical to maximize the potential benefit of anti-tubercular treatment and case management. MATERIALS AND METHODS: Comparative cross sectional study was conducted to determine the white blood cell (WBC) count, CD4, CD8, haemoglobin (Hgb), red blood cell (RBC) count, mean corpuscular haemoglobin (MCHC), mean corpuscular volume (MCV) between newly diagnosed TB patients and apparently healthy controls (HCs). RESULTS: From consecutively enrolled 108 TB patients, pulmonary TB (PTB) accounted for 48(44.4%), TB lymphadenitis accounted for 48(44.4%), and disseminated/miliary TB accounted for 12(11.1%). Analysis of variance revealed that mean ± SD of CD4 count of male TB patients (650 ± 224cells/µl) was significantly lower than male control group (883 ± 256 cells/µl) (p= 0.001). In a similar manner, the mean CD4 count of female TB patients (793 ± 332cells/µl) was lower than female control group (975 ± 300 cells/µl) (p=0.001). There was no statistically significant difference in CD8 counts between cases and controls for both genders. Forty (37.0%) TB patients had developed anaemia of whom 22(55%) were among PTB, 13(32.5%) from tuberculous lymphadenitis and 5(20%) from disseminated TB. Morphologically, from all anaemia among TB patients, normocytic normochromic anaemia accounted for 15(37.5%) followed by normocytic hypochromic anaemia 13(30.4%). CONCLUSION: CD4 lymphopenia was significant among TB patients. Granulocyte count was increased. Mild anaemia was found major haematological abnormality among newly diagnosed TB patients.
Asunto(s)
Anemia/complicaciones , Linfocitos T CD4-Positivos/metabolismo , Linfadenitis/etiología , Linfopenia/etiología , Tuberculosis/complicaciones , Adolescente , Adulto , Análisis de Varianza , Anemia/sangre , Anemia/epidemiología , Recuento de Linfocito CD4 , Estudios Transversales , Etiopía/epidemiología , Femenino , Granulocitos/metabolismo , Hospitales Universitarios , Humanos , Linfadenitis/epidemiología , Linfopenia/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Tuberculosis/sangre , Tuberculosis/inmunología , Tuberculosis Miliar/sangre , Tuberculosis Miliar/complicaciones , Tuberculosis Miliar/epidemiología , Tuberculosis Pulmonar/sangre , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/epidemiología , Adulto JovenAsunto(s)
Tuberculosis Hepática/diagnóstico por imagen , Tuberculosis Miliar/diagnóstico por imagen , Dolor Abdominal/etiología , Adolescente , Antituberculosos/uso terapéutico , Biopsia con Aguja , Proteína C-Reactiva/análisis , Enfermedades Funcionales del Colon/diagnóstico , Errores Diagnósticos , Hepatomegalia/diagnóstico por imagen , Hepatomegalia/etiología , Hepatomegalia/patología , Humanos , Inmunocompetencia , Masculino , Inducción de Remisión , Tuberculoma/diagnóstico por imagen , Tuberculoma/patología , Tuberculosis Hepática/sangre , Tuberculosis Hepática/complicaciones , Tuberculosis Hepática/tratamiento farmacológico , Tuberculosis Hepática/patología , Tuberculosis Miliar/sangre , Tuberculosis Miliar/complicaciones , Tuberculosis Miliar/tratamiento farmacológico , Tuberculosis Miliar/patología , Ultrasonografía IntervencionalRESUMEN
Rapid diagnosis is crucial for adequate treatment of disseminated mycobacteriosis. We conducted a retrospective cohort study to identify clinical and laboratorial features of disseminated mycobacteriosis in human immunodeficiency virus (HIV) infected patients that could help to differentiate tuberculosis (TB) from non-tuberculous mycobacteria (NTM) disease. All patients diagnosed from 1996 to 2006 were reviewed. TB was diagnosed in 65 patients and NTM in 31. Patients with TB had higher median levels of aspartate aminotransferase (AST) (69.0 vs. 45.0, P = 0.02) and lactate dehydrogenase (LDH) (725.0 vs. 569.0, P = 0.03). AST and LDH may be valuable tools in differentiating disseminated TB from NTM in HIV-infected patients.
Asunto(s)
Aspartato Aminotransferasas/sangre , Infecciones por VIH/microbiología , L-Lactato Deshidrogenasa/sangre , Infecciones por Mycobacterium/diagnóstico , Tuberculosis Miliar/diagnóstico , Adulto , Biomarcadores/sangre , Brasil , Estudios de Cohortes , Diagnóstico Diferencial , Femenino , Infecciones por VIH/sangre , Humanos , Masculino , Infecciones por Mycobacterium/sangre , Infecciones por Mycobacterium/virología , Estudios Retrospectivos , Sensibilidad y Especificidad , Factores de Tiempo , Tuberculosis Miliar/sangre , Tuberculosis Miliar/virologíaRESUMEN
The specific features of disseminated pulmonary tuberculosis were studied in patients isolating Mycobacterium tuberculosis (MBT) with a high (n = 135) and low (n = 50) viability. The degree of the pathogen's viability was shown to determine the clinical characteristics of a specific process and the efficiency of its treatment. It is speculated that there is a direct relationship between the viability ofmycobacteria and their virulence. There are differences in the nature of primary drug resistance in MBT with their varying variability.
Asunto(s)
Antituberculosos/farmacología , Mycobacterium tuberculosis/efectos de los fármacos , Mycobacterium tuberculosis/fisiología , Tuberculosis Miliar/tratamiento farmacológico , Tuberculosis Miliar/microbiología , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/microbiología , Adulto , Medios de Cultivo , Farmacorresistencia Bacteriana , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/crecimiento & desarrollo , Mycobacterium tuberculosis/aislamiento & purificación , Mycobacterium tuberculosis/patogenicidad , Población Rural , Siberia , Esputo/microbiología , Tuberculosis Miliar/sangre , Tuberculosis Miliar/diagnóstico , Tuberculosis Pulmonar/sangre , Tuberculosis Pulmonar/diagnóstico , VirulenciaRESUMEN
INTRODUCTION: Severe pulmonary tuberculosis may be complicated by deep vein thrombosis due to a state of hypercoagulability. OBSERVATION: We report a case of pulmonary miliary tuberculosis associated with cerebral venous thrombosis and multiple intracranial tuberculomas. A 65-year-old woman developed a confusional syndrome one week after starting treatment for pulmonary military tuberculosis. Neuroimaging reveals a thrombus in the right lateral sinus and multiple silent intracranial tuberculoma. CONCLUSION: The patient was given anticoagulants and fully recovered.
Asunto(s)
Trombosis del Seno Lateral/etiología , Tuberculoma Intracraneal/etiología , Tuberculosis Miliar/complicaciones , Tuberculosis Pulmonar/complicaciones , Acenocumarol/uso terapéutico , Anciano , Anticoagulantes/uso terapéutico , Antituberculosos/uso terapéutico , Confusión/etiología , Quimioterapia Combinada , Femenino , Heparina/uso terapéutico , Humanos , Huésped Inmunocomprometido , Isoniazida/uso terapéutico , Trombosis del Seno Lateral/diagnóstico por imagen , Trombosis del Seno Lateral/tratamiento farmacológico , Pirazinamida/uso terapéutico , Radiografía , Rifampin/uso terapéutico , Estreptomicina/uso terapéutico , Trombofilia/tratamiento farmacológico , Trombofilia/etiología , Tuberculoma Intracraneal/tratamiento farmacológico , Tuberculosis Miliar/sangre , Tuberculosis Miliar/tratamiento farmacológico , Tuberculosis Pulmonar/sangre , Tuberculosis Pulmonar/tratamiento farmacológicoRESUMEN
Mil cuarenta hemocultivos correspondientes a 451 enfermos uruguayos con SIDA y diagnóstico clínico de micobacteriosis diseminada fueron evaluados entre 1999 y 2003. Las muestras fueron procesadas en el Centro de Referencia Nacional para Micobacterias (Montevideo, Uruguay), utilizando el sistema de hemocultivos automatizado para micobacterias MB - BacT (BioMérieux). Se detectaron 45 muestras positivas (4,3%) correspondientes a 26 enfermos (promedio 2,3 muestras por paciente). En 10/26 casos se identificó M. avium complex (MAC) y en 13/26 el germen aislado fue M. tuberculosis. El tiempo medio de incubación fue de 12,4 días (intervalo 6-19 días) para MAC y de 22,6 días (intervalo 7-35 días) para M. tuberculosis. El hemocultivo ha demostrado ser la mejor muestra para la confirmación bacteriológica de las enfermedades micobacterianas diseminadas cuando se estudian por lo menos 2 muestras por paciente. La frecuencia de aislamientos de M. tuberculosis y MAC aislados en pacientes con SIDA en Uruguay, corresponde a la de un país con una moderada prevalencia de tuberculosis.
One thousand-forty blood cultures corresponding to 451 Uruguayan patients with AIDS and clinic diagnosis of disseminated mycobacterial infection were evaluated between 1999 and 2003. Samples were processed in the NationalReferenceCenter for Mycobacteria (Montevideo, Uruguay), using the automated blood culture system for mycobacteria MB -BacT (BioMérieux). Forty-five positive samples were detected (4.3%) corresponding to 26 patients with AIDS (average 2.3 samples per patient). In 10/26 patients M. avium complex (MAC) was identified and in 13/26 the isolated germ was M. tuberculosis. The average time of incubation was of 12.4 days (range 6-19 days) for MAC and of 22.6 days (range 7-35 days) for M. tuberculosis. Blood culture has demonstrated to be the best sample for the bacteriological confirmation of the disseminated mycobacterial infections when at least 2 samples by patient are studied. The frequency of isolates of M. tuberculosis and MAC in AIDS patients is according with a moderate prevalence of tuberculosis in Uruguay.
Asunto(s)
Humanos , Bacteriemia/epidemiología , Infecciones por VIH/complicaciones , Complejo Mycobacterium avium/aislamiento & purificación , Infección por Mycobacterium avium-intracellulare/epidemiología , Mycobacterium tuberculosis/aislamiento & purificación , Tuberculosis/epidemiología , Síndrome de Inmunodeficiencia Adquirida/sangre , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Técnicas Bacteriológicas , Bacteriemia/microbiología , Infecciones por VIH/sangre , Huésped Inmunocomprometido , Infección por Mycobacterium avium-intracellulare/sangre , Infección por Mycobacterium avium-intracellulare/complicaciones , Prevalencia , Tuberculosis Miliar/sangre , Tuberculosis Miliar/complicaciones , Tuberculosis Miliar/epidemiología , Tuberculosis/sangre , Tuberculosis/complicaciones , Uruguay/epidemiologíaRESUMEN
One thousand-forty blood cultures corresponding to 451 Uruguayan patients with AIDS and clinic diagnosis of disseminated mycobacterial infection were evaluated between 1999 and 2003. Samples were processed in the National Reference Center for Mycobacteria (Montevideo, Uruguay), using the automated blood culture system for mycobacteria MB-BacT (BioMérieux). Forty-five positive samples were detected (4.3%) corresponding to 26 patients with AIDS (average 2.3 samples per patient). In 10/26 patients M. avium complex (MAC) was identified and in 13/26 the isolated germ was M. tuberculosis. The average time of incubation was of 12.4 days (range 6-19 days) for MAC and of 22.6 days (range 7-35 days) for M. tuberculosis. Blood culture has demonstrated to be the best sample for the bacteriological confirmation of the disseminated mycobacterial infections when at least 2 samples by patient are studied. The frequency of isolates of M. tuberculosis and MAC in AIDS patients is according with a moderate prevalence of tuberculosis in Uruguay.
Asunto(s)
Bacteriemia/epidemiología , Infecciones por VIH/complicaciones , Complejo Mycobacterium avium/aislamiento & purificación , Infección por Mycobacterium avium-intracellulare/epidemiología , Mycobacterium tuberculosis/aislamiento & purificación , Tuberculosis/epidemiología , Síndrome de Inmunodeficiencia Adquirida/sangre , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Bacteriemia/microbiología , Técnicas Bacteriológicas , Infecciones por VIH/sangre , Humanos , Huésped Inmunocomprometido , Infección por Mycobacterium avium-intracellulare/sangre , Infección por Mycobacterium avium-intracellulare/complicaciones , Prevalencia , Tuberculosis/sangre , Tuberculosis/complicaciones , Tuberculosis Miliar/sangre , Tuberculosis Miliar/complicaciones , Tuberculosis Miliar/epidemiología , Uruguay/epidemiologíaRESUMEN
Cytokines were measured in patients with pleural effusion and miliary tuberculosis (TB). Patients with pleural effusion had significantly higher interferon-gamma (IFN-gamma) levels (P < 0.001) in their pleural fluid as compared to that of peripheral blood of the same patients, thus exhibiting localization of predominantly Th1-type immunity in the pleural fluid. On the contrary, patients with miliary TB had higher IFN-gamma levels in the peripheral blood as compared to their bronchoalveolar lavage fluid. Moreover, the median IFN-gamma: IL-4 ratio in the peripheral blood of miliary TB patients was two-fold higher as compared to bronchoalveolar lavage fluid, suggesting that the cytokine profile at the disease site is skewed toward a Th2-like bias. Further, flow cytometry data revealed a significantly higher (P < 0.001) percentage of CD4+ pleural fluid lymphocytes expressing IFN-gamma, whereas in the miliary TB, a nine-fold higher percentage of lymphocytes in bronchoalveolar lavage fluid expressed IL-4 in comparison with their peripheral CD4 T cells. Our data indicate, respectively, a Th1-like and Th2-like response in tuberculous pleural effusion and miliary TB, suggesting that these clinical forms of extrapulmonary tuberculosis probably reflect the extreme ends of a Th1-Th2 spectrum of the disease.
Asunto(s)
Citocinas/análisis , Tuberculosis Miliar/inmunología , Tuberculosis Pleural/inmunología , Adulto , Líquido del Lavado Bronquioalveolar/química , Líquido del Lavado Bronquioalveolar/citología , Linfocitos T CD4-Positivos/inmunología , Citocinas/sangre , Femenino , Citometría de Flujo , Humanos , Masculino , Derrame Pleural/química , Derrame Pleural/citología , Tuberculosis Miliar/sangre , Tuberculosis Pleural/sangreRESUMEN
OBJECTIVE: Tuberculosis is a major public health problem in India. Haematological changes associated with tuberculosis have been incompletely investigated. To the best of our knowledge, there is no comprehensive study assessing the haematological abnormalities in these patients from the Indian subcontinent. In the present study, we have compared peripheral blood and bone marrow findings in patients with disseminated/miliary tuberculosis (DTB/MTB) as well as pulmonary tuberculosis (PTB). An attempt has also been made to assess the effect of antituberculosis therapy on the haematologic abnormalities. MATERIAL AND METHODS: Thirty two patients with disseminated/miliary tuberculosis and 23 patients with pulmonary tuberculosis were prospectively studied to determine the various haematological manifestations in tuberculosis and the effect of antituberculosis therapy. All patients received standard antituberculosis treatment. They were subjected to a detailed haemogram including peripheral blood examination, which was repeated on completion of antituberculosis therapy. Bone marrow aspiration and biopsy was also done in all patients before starting antituberculosis treatment. RESULTS: Normocytic normochromic anaemia was the most common abnormality observed in all the groups and subgroups (DTB/MTB 84%, PTB 86%). Other haematological abnormalities of the white blood cells include leucopenia (DTB/MTB 25%, PTB 0%; p < 0.02), neutropenia (DTB/MTB 22%, PTB 0%; p < 0.04), lymphocytopenia, monocytopenia, leukocytosis, neutrophilia, lymphocytosis and monocytosis. Pancytopenia was observed only in patients with disseminated/miliary tuberculosis (p < 0.05). Thrombocytopenia was more common in patients with disseminated/miliary tuberculosis (p < 0.007), whereas thrombocytosis was more common in patients with pulmonary tuberculosis (p < 0.04). The patients of disseminated/miliary tuberculosis with granulomas in the bone marrow had certain significant differences as compared to patients without granulomas. These patients showed severe anaemia, peripheral monocytopenia and bone marrow histiomonocytosis. The haemogram reverted to normal with antituberculosis therapy in these patients. CONCLUSIONS: In view of the varied haematological abnormalities observed in patients with tuberculosis in this part of the world, it is concluded that the differential diagnosis of tuberculosis should be entertained in patients with varied haematological disorders.
Asunto(s)
Enfermedades Hematológicas/etiología , Tuberculosis Miliar/complicaciones , Tuberculosis Pulmonar/complicaciones , Adulto , Antituberculosos/uso terapéutico , Médula Ósea/efectos de los fármacos , Femenino , Enfermedades Hematológicas/sangre , Enfermedades Hematológicas/tratamiento farmacológico , Humanos , India , Masculino , Estudios Prospectivos , Tuberculosis Miliar/sangre , Tuberculosis Miliar/tratamiento farmacológico , Tuberculosis Pulmonar/sangre , Tuberculosis Pulmonar/tratamiento farmacológicoRESUMEN
OBJECTIVE: To review all cases of miliary tuberculosis (MT) over a period of 7 years in a Saudi Arabian population, to determine the clinical and laboratory characteristics and diagnostic methods, and to compare our data with others reported in the literature. DESIGN: A retrospective case review. RESULTS: Of 780 cases of active tuberculosis seen over period of 7 years, 47 (6%) had MT. The majority of the patients were aged over 60 years (68%). The most common symptoms were fever and weight loss. Risk factors were present in 70% of cases, mainly diabetes mellitus, history of prior tuberculosis, chronic liver and renal disease, immunosuppressive drug therapy and malignancy. Miliary pattern on chest radiography was seen in 89%. The most common laboratory abnormalities were anemia (66%), lymphopenia (89%), low albumin (87%), and high alkaline phosphatase (80%). Fiberoptic bronchoscopy was diagnostic in 7/10 (70%), bone marrow examination in 8/11 (73%), and liver biopsy in 14/16 (88%). High alkaline phosphatase and lymphopenia were associated with high yield of liver biopsies and bone marrow examination: 13/14 (93%) and 7/8 (88%), respectively. Death occurred in 10/47 (21%); all of these had radiological evidence of miliary pattern, and 80% had comorbid conditions. CONCLUSION: These data confirm and extend the results of other studies and suggest that MT is a disease of the elderly and immunocompromised, and is associated with high mortality. A high index of suspicion is required for diagnosis.
Asunto(s)
Tuberculosis Miliar/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Comorbilidad , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Arabia Saudita/epidemiología , Tuberculosis Miliar/sangre , Tuberculosis Miliar/diagnóstico , Tuberculosis Miliar/mortalidadAsunto(s)
Fiebre de Origen Desconocido/sangre , Enfermedades Linfáticas/sangre , Peptidil-Dipeptidasa A/sangre , Diagnóstico Diferencial , Fiebre de Origen Desconocido/etiología , Humanos , Enfermedades Linfáticas/complicaciones , Sarcoidosis/sangre , Sarcoidosis/complicaciones , Sarcoidosis/diagnóstico , Tuberculosis Miliar/sangre , Tuberculosis Miliar/complicaciones , Tuberculosis Miliar/diagnósticoRESUMEN
The authors present a case of disseminated tuberculosis in a patient under dialysis with endstage renal disease. Fever, nocturnal sweating, anorexia, asthenia, ascites, lymph node involvement and granulomatous involvement of the bone marrow were observed. In the twenty nine months of renal failure which preceded the beginning of the tuberculosis, serum calcium levels were normal or low-normal and there was a secondary hyperparathyroidism. During that period the patient was treated with calcium carbonate and calcitriol. At the onset of tuberculosis, serum calcium levels rose above normal. Treatment with calcium and calcitriol was withdrawn but hypercalcemia remained unchanged. Serum concentration of parathormone fell significantly. Antituberculosis drugs were started. The resolution of active tuberculosis was accompanied by normalization of serum calcium levels and by elevation above normal of serum concentration of parathormone.
Asunto(s)
Hipercalcemia/complicaciones , Tuberculosis Miliar/complicaciones , Adulto , Humanos , Fallo Renal Crónico/complicaciones , Masculino , Diálisis Renal , Tuberculosis Miliar/sangreRESUMEN
Apitherapy (Venom of bees and apiculture products) was included into combined treatment of 93 in-patients with pulmonary tuberculosis. Apitherapy had a beneficial effect on the organism of tuberculosis patients, manifested by enhancement of the treatment effectiveness and normalization of indices of endocrine system. It is recommended that the instruction on apitoxinotherapy be amended, in particular, by substantially supplementing the paragraph with indications and contraindications for giving it in active tuberculosis.
Asunto(s)
Abejas , Mordeduras y Picaduras de Insectos , Sistema Hipófiso-Suprarrenal/fisiopatología , Própolis/uso terapéutico , Tuberculosis Pulmonar/terapia , Adulto , Animales , Terapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tuberculosis Miliar/sangre , Tuberculosis Miliar/fisiopatología , Tuberculosis Miliar/terapia , Tuberculosis Pulmonar/sangre , Tuberculosis Pulmonar/fisiopatologíaRESUMEN
The performed studies showed that patients with active phase pulmonary tuberculosis have their T-system function suppressed, that of B-system activated, this phenomenon being the most marked in those patients with fibrocavernous tuberculosis. Increase in the activity of phagocytes was more common in patients with infiltrative tuberculosis. The immunity system state in subjects with non-active post tuberculous alterations did not depart from normal values. DNA and RNA concentrations were decreased in those patients having more pronounced immunologic disturbances (infiltrative and fibrocavernous tuberculosis), reparative capacity of RNA being altered only in patients with focal tuberculosis. Strong correlation was established between immunologic and cytogenetic indices.