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The incidence of urine cultures positive for Mycobacterium tuberculosis in a general tuberculosis patient population.

When urine specimens from a general tuberculosis patient population of 328 were submitted routinely for mycobacterial cultures, 33 patients (10 per cent) a positive turine cultures for Mycobacterium tuberculosis. In 22 patients (7 per cent) a positive urine culture for M. tuberculosis was unanticipated. Review of these 22 patients revealed that all had denied current genitourinary symptoms, 58 per cent had urinalyses within normal limits, and 58 per cent had normal intravenous pyelograms. Thus, lack of symptoms and normal tests do not necessarily exclude the possibility of genitourinary tuberculosis. Only 4.7 per cent of patients with pulmonary tuberculosis but 21 per cent of those with extrapulmonary tuberculosis had unanticipated positive urine cultures for M. tuberculosis. This suggests that routine submission of urine specimens for mycobacterial cultures can be a valuable adjunct to the bacteriologic confirmation of the diagnosis of extrapulmonary tuberculosis.

Bacteriological Techniques↗

Non-respiratory tuberculosis with Mycobacterium tuberculosis after penetrating lesions of the skin: five case histories.

Tuberculosis is primarily transmitted from person to person via the respiratory route. We describe five cases of patients who developed tuberculosis at the site of a skin injury: three after being treated repeatedly with local corticosteroids via intramuscular injections, and two who cut themselves accidentally with a knife. All cultures yielded normal-sensitive Mycobacterium tuberculosis, and all patients responded well to anti-tuberculosis treatment. These unusual manifestations of non-respiratory tuberculosis may support the assumption that persistent, painful, reddish and/or fistulous areas of the skin might also indicate an infection caused by M. tuberculosis, via either reactivation of pulmonary tuberculosis or primary infection with M. tuberculosis by cutaneous transmission.

Administration, Topical↗

[Meningoencephalitis tuberculosis--primary isolation of resistant M. tuberculosis].

Tuberculosis is one of the main causes of serious diseases in developing countries. Despite of decreasing tuberculosis in industrial countries, diseases is not eradicated. In last fifth years the picture of diseases is changed with large number atypical cases. Factor that is responsible for this are variable and includes primary infection in old ages, or problems that are in relation with immigration of populations. Tuberculosis meningitis disease witch appears mostly in childhood with high incidence in first three years of life. Most cases tuberculosis meningitis are caused with human types of tuberculosis bacillus, while bovines type is responsible for less than 5% of cases, but there are also reported cases of tuberculosis meningitis caused 3% atypical mycobacterium. In report is described a girl in age of two years sick of tuberculosis meningitis, she come from Kosovo, with positive epidemiological anamnesis. When she came to the hospital diseases had all clinical manifestation of serious meningoencefalitis. Very soon signs of decompensate hydrocephalus are developed. In the culture of cerebrospinalis fluid isolated Mycobacterium tuberculosis primary resistant on etambutol and rifampicin.

Child, Preschool↗

[Evaluation of detection of M. tuberculosis in clinical specimens of tuberculosis by DNA amplification].

The sensitivity of detection of M. tuberculosis genomic DNA were 1pg or 10-100 bacterial cell by PCR. Only M. tuberculosis, M. bovis and BCG were positive with 165 b.p band, but all other 14 mycobacterium and 10 bacteria of non-mycobacterial tested, were negative. Of 75 sputum specimens of pulmonary tuberculosis, the positive rate of PCR were 53.3%, culture method showed only 21.3%, fast-acid staining were 25.3%. 17 non-tuberculosis lung disease were negative in three methods. Of 58 tuberculosis meningitis, the positive rate of PCR, the fast-acid staining and culture in cerebrospinal fluid were 51.7%, 8.6%, 1.7% respectively. 30 non-tuberculosis meningitis were negative in three methods. The results showed that DNA amplification is a superior method with high degree of sensitivity and specificity for rapid diagnosis of pulmonary tuberculosis and tuberculosis meningitis.

Cerebrospinal Fluid↗

[Mycobacterium tuberculosis drug resistance in patients with HIV and pulmonary tuberculosis infections in Rome: 1987-1996].

A retrospective chart review was performed on 118 HIV infected patients with pulmonary tuberculosis hospitalized between 1987 and 1996 in a tertiary care center for Infectious Diseases in Rome. The aims of this study were: a) to evaluate global prevalence of and risk factors for drug-resistant Mycobacterium tuberculosis and multidrug resistant tuberculosis; b) to assess trends in prevalence of drug-resistant tuberculosis over the 10-year study period. Prevalence of drug resistance of first Mycobacterium tuberculosis isolates was tested on Lowenstein-Jensen medium with the proportional method. Of the 118 patients studied, 83 had never been treated for tuberculosis and 35 had already been treated for at least 1 month. The overall prevalence of resistance to one or more drugs was 25% (17% in never treated patients vs 46% in already treated patients; p = 0.002). Five percent of isolates were resistant to both isoniazid and rifampin (1% in never treated patients vs 14% in already treated patients; p = 0.008). Resistance rates to individual drugs were: isoniazid 14%, rifampin 8%, ethambutol 0%, streptomycin 13%. During the study period no significant variations in prevalence of drug-resistant tuberculosis were found. In our area, empiric therapy should include 4 drugs: as well as isoniazid, rifampin and pyrazinamide, we recommend ethambutol. Surveillance of drug-resistant tuberculosis is needed. Directly observed therapy should be considered for HIV patients in order to prevent increases in drug resistance, relapses, and treatment failures.

Adult↗

[The role of bacteriologic tests for diagnosis of tuberculosis in clinics other than tuberculosis control clinics (preliminary evaluation of test methods and their results)].

Broadening of bacteriological testing for tubercle bacilli presence concerns patients with chronic cough treated in out-patients clinics and in hospital wards excluding tuberculosis control wards. Bacteriological tests have been carried out in tuberculosis laboratories as ordered by doctors of out-patient clinics and hospitals. From 05.11.1993 to 30.09.1994, 3917 tests were carried out on various specimens supplied to laboratories: sputum, urine, pleural fluid, peritoneal fluid, pus from lymph nodes. In 60 specimens positive results were obtained with the use of direct method or the mycobacterial culture. Pulmonary tuberculosis was diagnosed in 23 patients, renal tuberculosis--in 2 patients, tuberculosis of bones--in 1 case, tuberculosis of the peripheral lymph nodes--in 1 case, peritoneal tuberculosis--in 1 case. All the patients underwent specialized treatment. The above presented results justify the continuation of the tests.

Body Fluids↗

Guidance for national tuberculosis programmes on the management of tuberculosis in children. Chapter 2: anti-tuberculosis treatment in children.

The management of children with TB should be in line with the Stop TB Strategy, taking into consideration the particular epidemiology and clinical presentation of TB in children. Obtaining good treatment outcomes depends on the application of standardised treatment regimens according to the relevant diagnostic category, with support for the child and carer that maximises adherence to treatment. A recent development in treatment recommendations is that, following a comprehensive literature review, ethambutol is now considered safe in children at a dose of 20 mg/kg (range 15-25 mg/kg) daily. Critical areas for further research include the optimal formulations and dosing of first- and second-line TB drugs and new drug development.

Antitubercular Agents↗