1/2. Disseminated BCG infection following bone marrow transplantation for X-linked severe combined immunodeficiency.An 8-month-old boy with X-linked severe combined immunodeficiency (XSCID) developed disseminated bacille Calmette-Guerin (BCG) infection following BCG vaccination at birth. He initially presented with an abscess at the site of BCG vaccination and was begun on three-drug antituberculous treatment (rifampicin, isoniazid, and pyrazinimide). Dissemination was subclinical prior to a human leukocyte antigen (HLA)-identical bone marrow transplant (BMT) from his sister, following which he presented with an acute erythroderma. A skin biopsy specimen revealed granulomas with epithelial histiocytes and giant cells in the reticular dermis, and numerous acid-fast bacilli (AFB) were present on Ziehl-Nielsen stain. A diagnosis of disseminated BCG disease was made. Despite the addition of a fourth antituberculous agent, ethambutol, he did not recover and developed numerous skin abscesses over the following weeks. Examination of pus from these lesions demonstrated numerous AFB. clarithromycin was added as a fifth antituberculous agent. Despite five-drug antituberculous therapy and monthly intravenous immunoglobulin infusions, recurrent abscesses containing AFB developed intermittently until 7 months posttransplant. At follow-up 1 year post-BMT he showed good general physical improvement. All abscesses had healed with scarring, and no further skin lesions had occurred.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/2. Mycobacterium infection directly observed in a surgical outpatient centre.BACKGROUND: This study aims to check the presence and the role of the mycobacterium tuberculosis infection, in an Ambulatory and Day Surgery Out-Patient Centre. methods: Two periods of activity in this Centre are evaluated corresponding separately to the years 1989-1993 and 1994-1998 and the total number of patients, coming for examination, ambulatory or day surgery, hospitalization, postoperative follow-up, is considered, in order to identify the number of cases and the clinical signs of this disease. All cases were examined by the same team and the checks were completed, in the selected cases in which it was advisable, with radiological, bacteriological, bioptical, radiometrical exams and with the Elisa test (after informed consent). RESULTS: In the first period 1989-1993, 21,220 patients were examined and no case of tubercular infection was observed. In 1994-1998, 24,347 patients were examined and 4 cases of tubercular infection detected, which represent 0.016% of the patients attending the service. The clinical cases are as follows. Case 1: right sub-mammary lump, diameter 7 x 5 cm, smooth, oval, firm. Case 2: right breast swelling, diameter 5 cm, not sore, with deep attachments. The mammography and ultrasound scan indicate: the opacity is compatible with mali moris breast lesion. Case 3: coloured, immigrant, who presents back swelling, diameter 8 cm, with fluctuation. CT of the chest indicates opacity near left latissimus dorsi muscle, diameter 10 cm, without bronchopleural connections. Case 4: bleeding neoplastic ulcer of the wrist. At physical exam a right subclavear amphoric breath sound is noticed, corresponding at chest X-ray to an opacity including cavitation. In the 4 cases no lymph node in the regional effusion areas is detected. In the 4 cases surgical therapy is integrated with antituberculous chemotherapy till 6 months after operation. CONCLUSIONS: mycobacterium tuberculosis infection has been increasing in the second group of years considered, as it is observed in European industrialized countries and north america. This increase corresponds to 0.016% in 24,374 patients examined in the period 1994-98. This infection must not be connected with the classic sites and traditional primary and post-primary symptons, but must be considered and identified in a surgical hospital out-patient centre, in unusual sites, sometimes masquerading as a false positive carcinoma, in patients with predisposition, because of old age, race, immunodepression (also if hiv negatives), resistance to treatment, previous tuberculous infection. In the cases identified deep diagnostic definition, the surgical treatment and a prolonged antituberculous chemotherapy are necessary.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |