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PubMedDate not supplied

CT appearances in abdominal tuberculosis. A pictorial essay.

Abdominal tuberculosis continues to be endemic in the developing world and has shown a resurgence in the West. Computed tomography (CT) evaluation is singularly informative as it demonstrates involvement of the bowel, peritoneum, lymph nodes, and solid organs in a single examination. A spectrum of CT findings in an immunocompetent population is presented, ranging from subtle to advanced and common to rare. Genitourinary tuberculosis and tuberculosis in AIDS are excluded as they merit separate discussions.

Humans↗
PubMed1988

Incidence and nature of human tuberculosis due to bovine tubercle bacilli in South-East England: 1977-1987.

A total of 201 new cases of tuberculosis due to bovine tubercle bacilli was confirmed in South-East England between 1977 and 1987 inclusive. This represents about 1% of all cases of tuberculosis in this region. Most cases occurred amongst older individuals of indigenous white British origin, although some younger patients of Southern European and Indian subcontinent ethnic origin were also diagnosed. The lung was the most frequent site of disease, followed by the genito-urinary tract. In view of the known risk of transmission of disease from man to cattle via the respiratory and urinary tracts, continued surveillance of this relatively uncommon form of tuberculosis is still indicated.

Adolescent↗
PubMed2001

Safety of an ofloxacin-based antitubercular regimen for the treatment of tuberculosis in patients with underlying chronic liver disease: a preliminary report.

BACKGROUND AND AIMS: Hepatotoxicity is a major side-effect of antitubercular drugs (ATD). As these drugs are metabolized in the liver, there is a theoretical risk of increased hepatotoxicity in patients with underlying chronic liver disease (CLD). Ofloxacin has antitubercular activity and has exclusive renal clearance. The aim was to study the efficacy and safety of an ofloxacin-based antitubercular regimen for treating tuberculosis in patients with underlying CLD. METHODS: Thirty-one cases were randomly assigned to two drug regimens using WHO dosage schedules: (i) regimen A (n = 15): isoniazid, rifampicin and ethambutol for 2 months, followed by isoniazid and rifampicin for a further 7 months; and (ii) regimen B (n = 16): isoniazid, pyrazinamide, ethambutol and ofloxacin for 2 months, followed by isoniazid, ethambutol and ofloxacin for a further 10 months. Hepatotoxicity was diagnosed if alanine aminotransferase/aspartate aminotransferase increased > fivefold from the baseline or to > 400 IU/L, or if bilirubin increased by > 2.5 mg/dL from the baseline. RESULTS: The response to ATD was achieved in all the patients who completed the therapy. Four (26.6%) patients on regimen A developed hepatotoxicity as compared to none on regimen B (P = 0.043). None of these patients could be restarted on ATD using the same regimen A because of the persistently deranged liver functions. CONCLUSIONS: In patients with tuberculosis who have underlying CLD: (i) an ofloxacin-based antitubercular regimen without rifampicin is as effective as a rifampicin-based regimen; and (ii) a combination of isoniazid with rifampicin is more hepatotoxic than a combination with ofloxacin and pyrazinamide.

Adolescent↗
PubMed2002

Milk containing Mycobacterium bovis as a source of infection for white-tailed deer fawns (Odocoileus virginianus).

SETTING: White-tailed deer represent the first wildlife reservoir of Mycobacterium bovis in the United States. The behavior of does with nursing fawns provides several potential mechanisms for disease transmission. Little information exists concerning transmission between doe and fawn, specifically transmammary transmission. OBJECTIVE: Determine if fawns can become infected by ingestion of milk replacer containing M. bovis, thus simulating transmission from doe to fawn through contaminated milk. DESIGN: Seventeen, 21-day-old white-tailed deer fawns were inoculated orally with 2 x 10(8) CFU (high dose, n=5), 2.5 x 10(5) to 2.5 x 10(6) CFU (medium dose, n=5), and 1 x 10(4) CFU (low dose, n=5) of M. bovis in milk replacer. Dosages were divided equally and fed daily over a 5-day period. Positive control fawns (n=2) received 1 x 10(5) CFU of M. bovis instilled in the tonsillar crypts. Fawns were euthanized and examined 35-115 days after inoculation and various tissues collected for bacteriologic and microscopic analysis. RESULTS: All fawns in the tonsillar, high oral and medium oral dose groups developed generalized tuberculosis involving numerous organs and tissues by 35-84 days after inoculation. Three of five fawns in the low-dose oral group had tuberculous lesions in the mandibular lymph node, and one of five had lesions in the medial retropharyngeal lymph node when examined 115 days after inoculation. CONCLUSION: White-tailed deer fawns can become infected through oral exposure to M. bovis. Therefore, the potential exists for fawns to acquire M. bovis while nursing tuberculous does.

Animals↗
PubMed2001

[Intestinal tuberculosis: Easier overlooked than diagnosed].

Intestinal tuberculosis: Easier overlooked than diagnosed. The medical history of two Asian immigrants suffering from intestinal tuberculosis demonstrates the difficulties in finding the correct diagnosis. Intestinal tuberculosis resembles Crohn's disease with regard to clinical symptoms, macroscopic and microscopic intestinal findings. Sonographic, radiologic, endoscopic, and histological examinations facilitate distinguishing both entities. Diagnosis of intestinal tuberculosis is made by identification of the causative microorganism in tissue specimens. As this may be difficult and time-consuming, a therapeutic trial with anti-tuberculous agents may be warranted.

Adult↗
PubMedDate not supplied

[BCG-induced inflammation during childhood and in pregnancy. Additionally a contribution to BCG-induced necrotising cerebral arteritis].

In the third year of life of a girl vaccinated neonatally against tuberculosis an abscess of the associated lymph nodes appeared which contained acid-fast bacilli. After extirpation of the lymph nodes weeks later an intestinal BCG-dissemination was observed which seemed to be cured under a brief tuberculostatic therapy. At the age of 22 years a left sided hemiplegia due to aneurysms and thrombosis of 2 cerebral arteries was seen. At autopsy in the adventitia of the arteria basilaris macrophages were discovered which showed intracellular acid-fast bacilli. A paralysis of the oculomotor nerve appearing later was also caused by this brain lesion. Towards the end of a pregnancy a serious BCG-dissemination in the intestines relapsed. A healthy premature child was born. Massive tuberculostatic therapy was inefficient. The woman died in her 27th year of life. A defective function of the macrophages is suggested for the immunological abnormality.

Adult↗
PubMed1985

[Role of computed tomography in extrapulmonary tuberculosis].

A retrospective evaluation of 65 computed tomographic investigations on 27 patients with proven disseminated extrapulmonary tuberculosis showed no CT changes characteristic for tuberculosis, except for a higher density of tubercular abscesses. In the majority of cases the extent of tubercular manifestations could only be exactly established after the CT investigation. With the aid of this information together with the clinical course of the disease, the timing, type and extent of operative measures could be determined. Finally, in comparison with conventional X-ray and sonography, computed tomography has proved to be superior for control of therapeutic procedures.

Adult↗
PubMed2003

Ten years of extrapulmonary tuberculosis in a Danish university clinic.

The objective of this study was to describe the symptoms, diagnostic measures and outcomes of extrapulmonary tuberculosis (ex-TB) in a Danish university clinic from 1990 to 1999. 48 patients with ex-TB were identified retrospectively and clinical and laboratory data extracted from the patient files. The majority were immigrants from Africa (71%). A direct connection between symptoms on admission and anatomical localization of TB was found in 83%. The main localizations of ex-TB were peripheral lymph nodes (n = 15) and the abdomen (n = 19). In 73% Mycobacterium tuberculosis could be cultured. One culture was resistant to isoniazide and 1 had decreased sensitivity to isoniazide and etambutol. Two patients relapsed with TB. Some pitfalls in diagnosing TB were found, as 13% had a normal erythrocyte sedimentation rate at presentation, 9% had a negative tuberculin skin test and fever was absent in 31% of the cases. The patients' subjective complaints on admission should guide the diagnostic procedures.

Adolescent↗
PubMed1988

Clinical features of abdominal tuberculosis.

The clinical features of 81 cases of abdominal tuberculosis (TB) are presented. The peritoneum was involved in 41 patients, the ileocecal area in 17, the anorectal area in 16, and mesenteric glands in 8. There was one case each involving the liver and sigmoid colon. Most patients were young women. The tuberculin reaction was significant in 83% of patients tested, and 54% had evidence of TB elsewhere. Tuberculous peritonitis was more common in native North American Indians and presented as an acute abdomen, abdominal tumor, or cirrhosis. Asians developed the majority of ileocecal and mesenteric lymph node disease and were frequently diagnosed as having Crohn's disease, appendicitis, or cancer. Anorectal cases presented with fistulae or abscesses and usually had concomitant pulmonary TB. The disease was fatal in five patients (6%), four of whom were diagnosed only after death. One noncompliant patient had a relapse. All other patients were cured after receiving treatment.

Adult↗