1/60. mycobacterium tuberculosis infection in allogeneic bone marrow transplantation patients.Bone marrow transplant (BMT) recipients are prone to bacterial, viral and fungal infections. mycobacterium tuberculosis infection can occur in these patients, but the incidence is lower than that of other infections. This report describes four patients with mycobacterium tuberculosis infection identified from 641 adult patients who received a BMT over a 12-year period (prevalence 0.6%). The pre-transplant diagnosis was AML in two patients and CML in the other two. Pre-transplant conditioning consisted of BU/CY in three patients and CY/TBI in one. Graft-versus-host disease (GVHD) prophylaxis was MTX/CsA in three patients and T cell depletion of the graft in one patient. Sites of infection were lung (two), spine (one) and central nervous system (one). Onset of infection ranged from 120 days to 20 months post BMT. Two patients had co-existing CMV infection. One patient had graft failure. The two patients who received anti-tuberculous (TB) therapy recovered from the infection. Although the incidence of tuberculosis in BMT patients is not as high as in patients with solid organ transplants, late diagnosis due to the slow growth of the bacterium can lead to delay in instituting anti-TB therapy. A high index of suspicion should be maintained, particularly in endemic areas.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
2/60. Miliary hepatic tuberculosis not associated with splenic or lung involvement. A case report.Miliary hepatic involvement is a frequent finding on autopsy in patients with disseminated tuberculosis. Imaging studies may reveal hepatosplenomegaly and/or parenchymal inhomogeneity and, in a minority of cases, focal lesions, invariably associated with miliary lung disease. An unusual case of disseminated tuberculosis with manifestations of miliary hepatic involvement, abdominal and neck lymphadenopathy on US and CT without any evidence of active disease in the lungs, spleen or other organ, is described.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
3/60. Renal amyloidosis following tuberculosis.amyloidosis, either primary or secondary, may be defined as a group of chronic infiltrative disorders that have in common a beta-pleated sheet configuration on x-ray diffraction examination, a fine fibrillar nonbranching appearance on electron microscopy and an apple-green birefringence when examined under polarised light after staining with congo-red. Renal amyloidosis is a rare entity in the pediatric age group and is almost always secondary in nature, related to chronic infections and inflammatory conditions. It occurs 2-7 years after a chronic inflammatory process; however an onset as early as 9 months of life is known. The diagnosis of amyloidosis is suspected on the basis of clinical features and is established by obtaining an appropriate tissue biopsy and demonstrating amyloid with appropriate stains. All the tissues obtained must be stained with congo-red stain which is the singlemost useful diagnostic test to define amyloidosis. In order to differentiate the primary from secondary variety, the deposits may be treated with potassium permanganate before congo-red staining. In secondary amyloidosis, the green birefringence seen under polarized light is abolished. Therapeutic approaches include specific measures to reduce the amyloid deposition and general measures to relieve symptoms related to involvement of specific organs. The prognosis in renal amyloidosis is relatively poor, with a median survival of 9-13 months in primary amyloidosis complicated by renal involvement, and more than 50 months in secondary amyloidosis. We have reported a case of secondary amyloidosis following tuberculosis and have discussed the clinical features, diagnosis and management of amyloidosis.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
4/60. Second episode of tuberculosis in an HIV-infected child: relapse or reinfection?We report a case of an HIV-infected child with a second episode of tuberculosis 22 months after completing antituberculosis treatment. dna fingerprinting of organisms from both episodes showed an identical strain of mycobacterium tuberculosis. We believe this to be the first case of confirmed relapsed tuberculosis in an HIV-infected child, and suggest that a longer course of antituberculosis treatment be given to such children. inverted question mark 2000 The British infection Society.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
5/60. rhodococcus equi and hiv-1 infection in uganda.OBJECTIVES: To describe three cases of rhodococcus equi infection in a cohort of hiv-1 infected adults in Entebbe, uganda and to compare this to the rates and presentation of tuberculosis in this cohort. methods: Consecutive hiv-1 infected adults registering with a community HIV/AIDS clinic in Entebbe were enrolled in a cohort between October 1995 and June 1998 as part of an intervention trial of pneumococcal polysaccharide vaccine. Participants were routinely reviewed every 6 months and had open access to the clinic when unwell. Standard protocols were followed for investigation and management of illness. Microbiological investigations followed standard procedures. RESULTS: 1372 (71% female) study participants were followed for 2141 person years of observation (pyo). rhodococcus equi was isolated from three study participants from blood, a lymph node aspirate and stool. The individuals were undergoing investigation of acute pneumonia, acute cough with cervical lymphadenopathy and chronic fever with wasting, respectively. The clinical features of these cases are described. All had a CD4 T-cell count of <300/ml. The rate of R. equi infection in the cohort was 1.4/1000 pyo. There were 132 cases of pulmonary and extrapulmonary tuberculosis in the cohort which were diagnosed either microbiologically or clinically. The rate of laboratory confirmed mycobacterial disease was 50.1/1000 pyo. The ratio of mycobacterial disease to R. equi disease was 36:1 (95% CI 11-113:1). CONCLUSIONS: rhodococcus equi infection occurs in hiv-1 infected adults in africa. The infection is clinically indistinguishable from pulmonary and extra-pulmonary tuberculosis in the cohort described here. Although the rate of R. equi disease is much less than that of tuberculosis, it is important to consider it in the differential diagnosis of tuberculous infection in cases which are smear negative. rhodococcus equi infection is probably underdiagnosed in africa due to a lack of microbiological facilities and its resemblance to common commensal organisms.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
6/60. Fatal sepsis due to mycobacterium tuberculosis after allogeneic bone marrow transplantation.mycobacterium tuberculosis is a serious, but rare infectious complication after allogeneic bone marrow transplantation. We describe a case of fatal sepsis due to mycobacterium tuberculosis after allogeneic bone marrow transplantation for philadelphia chromosome-positive ALL. The diagnosis was made after BAL. Although broad-spectrum antituberculous therapy was started immediately after diagnosis, blood cultures became positive for mycobacterium tuberculosis. The patient developed severe pyrexias and finally died of multi-organ failure. Rapid progression of mycobacterial infection should be considered in patients post BMT with unexplained fever, particularly in patients from endemic areas.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
7/60. Tuberculous otitis media: a difficult diagnosis and report of four cases.Tuberculous otitis media is a rare disease. Due to the condition's rarity and its usually indolent course, the diagnosis is often delayed. This can lead to irreversible complications, such as permanent hearing loss or facial nerve paralysis. Tuberculosis of the middle ear cleft, as this disease's first presentation, is indeed very rare. Surgery may be carried out prior to diagnosis occasionally, i.e., middle ear exploration for chronic middle ear disease. We present four cases of tuberculous otitis media which occurred as the first presentation of the disease. The patients did not present with the classic symptoms of middle ear tuberculosis. The diagnosis was based on the histology following middle ear exploration for chronic middle ear disease. None of the patients presented any other systemic involvement. We present a review of this disease's clinical symptoms and the diagnostic tests available.- - - - - - - - - - ranking = 0.076896019321341keywords = nerve (Clic here for more details about this article) |
8/60. Tuberculosis transmitted through transplantation.Tuberculosis in solid organ transplant recipients is associated with relatively high morbidity and mortality and is often extra-pulmonary. Reactivation of dormant infection is the usual mode of acquisition with donor and nosocomial transmission occurring infrequently. We report two cases of probable donor transmitted extra-pulmonary infection where both isolates of mycobacterium tuberculosis proved to be indistinguishable using hemi-nested inverse PCR of the IS 6110 region.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
9/60. Congenital tuberculosis proven by percutaneous liver biopsy: report of a case.A female term neonate with congenital tuberculosis presented with clinical manifestations of cough, respiratory distress and bilateral reticulonodular infiltration on chest radiograph. Her Indonesian mother had extrapulmonary tuberculosis. The neonate's tuberculosis symptoms were characterized by multi-organ involvement including lung, liver, gall bladder and kidneys, suggesting a spreading hematogenous transmission. pathology of the liver biopsy revealed scattered miliary granuloma. After anti-tuberculosis treatment, significant improvement was seen on chest radiogram and in her clinical condition. Congenital tuberculosis should be suspected in infants who are unresponsive to empirical antibiotics. Transcutaneous liver biopsy may help confirm its prenatal origin.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
10/60. Multiple drug-resistant mycobacterium tuberculosis: evidence for changing fitness following passage through human hosts.Recent studies have shown a difference in the genotype of resistant bacteria following passage in animals compared to those passaged in vitro. This suggests that organisms rapidly adapt to their environment of growth. We sought to investigate whether this phenomenon occurred in human infection and whether changes could be detected in the fitness (growth velocity) of isolates transmitted between human hosts. Isogenic strains of mycobacterium tuberculosis were obtained from a well-documented hospital outbreak. The subjects included those who were HIV seropositive and immunocompromised. The relative fitness of each sample was measured using growth competition in vitro. The results confirmed that our method of measuring fitness was not influenced by the storage conditions of the isolates, and demonstrated that the fitness of genetically similar isolates obtained from different patients in the outbreak differed significantly, as reflected in the growth velocity of the strains. This study provides the first evidence that multiple drug resistant M. tuberculosis strains adapt to the environment of their human host.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
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