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PubMed1993

A comparative study on the reliability of the fluorescence microscopy and Ziehl-Neelsen method in the diagnosis of pulmonary tuberculosis.

Pulmonary tuberculosis (PTB) is the most common presentation of tuberculosis (TB) in Kenya. For the diagnosis of PTB the sputum smear is used because it is technically simple, non-invasive and cheap. The reliability of direct smear examination for the diagnosis of TB has however frequently been questioned. To address this problem, a study comparing the reliability of fluorescence microscopy (FM) and Ziehl-Neelsen (ZN) staining method for examination of direct smear in the diagnosis of PTB was carried out at the Respiratory Disease Research Unit Laboratory, Nairobi, Kenya. A total of 1480 sputum specimens collected from patients with suspected PTB were analyzed. Two direct smears were prepared from each specimen, one stained using FM and the other using the ZN method. Culture results were used as the gold standard for assessment. Specificity was 97% and 96% for FM and ZN methods, respectively. The sensitivity of the FM method was 80% and that of the ZN method 65% (p < 0.001). Overall agreement was 86.8%. Positive smears which were missed on the ZN stained smears (15%) contained low density bacilli on both FM stained smears and on culture. The use of FM greatly improves the diagnostic value of the sputum smear especially in patients with a low density of bacilli who are likely to be missed on ZN stained smears. The method is economical in both time and expense and is recommended for laboratories handling large numbers of sputum specimens.

Colony Count, Microbial↗
PubMedDate not supplied

Radiology of pulmonary tuberculosis.

Pulmonary tuberculosis (TB) is a considerable health problem throughout the world, and has increased in incidence over the past 10 years. This article reviews the typical radiographical findings in post-primary TB and reactivation, and describes the less common manifestations of the disease in nonimmuno-compromised and immuno-compromised individuals. Indications for plain radiography, computed tomography and high-resolution computed tomography are also discussed.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Diagnostic imaging of pulmonary tuberculosis.

Pulmonary tuberculosis in its primary and postprimary form is a widespread disease. Radiologic and CT findings in the acute phase of the disease, its many different aspects, as well as the alterations observed following the outcomes of tuberculosis at the parenchymal and pleural level, are examined.

AIDS-Related Opportunistic Infections↗
PubMed1983

Apical localization of pulmonary tuberculosis, chronic pulmonary histoplasmosis, and progressive massive fibrosis of the lung.

We have reviewed the accumulated evidence for the explanation of the apical localization of pulmonary tuberculosis, chronic pulmonary histoplasmosis, and massive fibrosis of the lung due to silicosis and coal-workers pneumoconiosis. The effect of gravity on the erect human lung results in greatly diminished pulmonary artery blood flow in the apical and subapical areas. This in turn results in higher oxygen tensions but also impairment of tissue clearance mechanisms in these areas. Analysis of the accumulated evidence better supports the theory of lymph stasis and impaired clearance of antigenic substances as the major determinant of the apical localization of pulmonary tuberculosis rather than the presently favored oxygen tension theory. The impaired clearance theory also best explains the apical localization of chronic pulmonary histoplasmosis and progressive massive fibrosis of the lung.

Animals↗
PubMed1978

The air-fluid level in cavitary pulmonary tuberculosis.

Pulmonary tuberculosis has long been associated with the formation of cavities in the lung. Many reports in the literature indicate that the occurrence of air-fluid levels in tuberculosis is unusual. The authors present 18 cases of proved active cavitary tuberculosis where air-fluid levels occurred during the active phase of the disease. The consideration of tuberculosis in the differential diagnosis of an air-fluid containing pulmonary cavity is emphasized and the pathogenesis of cavity formation is discussed.

Adult↗
PubMed1996

[Four cases of pulmonary tuberculosis resembling pulmonary abscess with a so-called niveau-like shadow in a medical school hospital: discussion concerning the formation mechanism of niveau-like shadows].

Four cases of pulmonary tuberculosis resembling pulmonary abscess radiographically were reviewed from their clinical features, chest X-ray and chest CT, and the mechanism of formation of so-called niveau-like shadows was discussed. Only one case showed a newly formed tuberculous cavity with air fluid level on chest X-ray, however, even in this case, the possibility of the infection with tubercle bacilli of an emphysematous bulla of the lung could not be completely excluded as several bulla were found on chest CT. The remaining three cases showed a slightly different mechanism of the formation of niveau-like shadows. Namely, mycobacterium tuberculosis spread into an existed bulla and a tubercle bacilli infected bulla was formed. Regarding the clinical features, no remarkable findings were detected and we could find no differences with common tuberculosis. Based on these experiences, the presence of pulmonary tuberculosis resembling the shadow of pulmonary abscess should be emphasized.

Aged↗
PubMed1986

Update: the radiographic features of pulmonary tuberculosis.

Pulmonary tuberculosis produces a broad spectrum of radiographic abnormalities. During the primary phase of the disease these include pulmonary consolidation (50%), which often involves the middle or lower lobes or the anterior segment of an upper lobe; cavitation (29%) or pneumatocele formation (12%); segmental or lobar atelectasis (18%); pleural effusion (24%); hilar and mediastinal lymphadenopathy (35%); disseminated miliary disease (6%); and a normal chest radiograph (15%). During the postprimary phase of the disease, common abnormalities include exudative and/or fibroproductive parenchymal densities (100%), predominantly in the apical and posterior segments of the upper lobes (91%); cavitation (45%) with bronchogenic spread of disease (21%); marked fibrotic response in the lungs (29%); and pleural effusion, empyema, and fibrosis (18%, 4%, and 41%, respectively). Upper-lobe masslike lesions are seen occasionally (7%); spontaneous pneumothorax and intrathoracic lymphadenopathy are rare (5% each). Common causes of a missed diagnosis of tuberculosis are (1) failure to recognize hilar and mediastinal lymphadenopathy as a manifestation of primary disease in adults, (2) exclusion of tuberculosis because disease predominates in or is limited to the anterior segment of an upper lobe or the basilar segment of a lower lobe, (3) overlooking of minimal fibroproductive lesions or reporting them as inactive, (4) failure to recognize that an upper-lobe mass surrounded by satellite fibroproductive lesions might be tuberculous, and (5) failure to consider healed sequelae of primary disease or a positive purified protein derivative skin test as contributory to identifying the patient's pulmonary disease.

Adolescent↗
PubMed1994

[Home oxygen therapy in pulmonary tuberculosis and pulmonary atypical mycobacteriosis during chemotherapy].

During the period of eight years from 1985 to 1992 we had sixteen patients (pulmonary tuberculosis: 6, atypical mycobacteriosis: 10) who had been under the treatment for tuberculosis and on whom home oxygen therapy (HOT) was started. Of sixteen patients twelve had history of antituberculous therapy in the past. There were nine chronic active or persistently sputum positive patients of whom three were pulmonary tuberculosis and six atypical mycobacteriosis. The duration of illness was long in these patients and it was more than ten years in tuberculosis patients. Four cases died, two cases of pulmonary tuberculosis died from hemoptysis, and two cases of atypical mycobacteriosis died from respiratory failure.

Adult↗
PubMed2006

Unique transcriptome signature of Mycobacterium tuberculosis in pulmonary tuberculosis.

Although tuberculosis remains a substantial global threat, the mechanisms that enable mycobacterial persistence and replication within the human host are ill defined. This study represents the first genome-wide expression analysis of Mycobacterium tuberculosis from clinical lung samples, which has enabled the identification of M. tuberculosis genes actively expressed during pulmonary tuberculosis. To obtain optimal information from our DNA array analyses, we analyzed the differentially expressed genes within the context of computationally inferred protein networks. Protein networks were constructed using functional linkages established by the Rosetta stone, phylogenetic profile, conserved gene neighbor, and operon computational methods. This combined approach revealed that during pulmonary tuberculosis, M. tuberculosis actively transcribes a number of genes involved in active fortification and evasion from host defense systems. These genes may provide targets for novel intervention strategies.

Bacterial Proteins↗
PubMed1989

[Clinical value of serum copper, zinc and copper/zinc ratio in the differentiation of sarcoidosis from pulmonary tuberculosis and pulmonary carcinoma].

Serum Cu, SZn and SCu/Zn ratio were studied in 14 patients with sarcoidosis, 72 patients with pulmonary tuberculosis, 15 patients with pulmonary carcinoma and 50 healthy persons as control. The results were: no significant differences were found between control group and sarcoidosis group in SCu, SZn and SCu/Zn ratio. In tuberculosis group and carcinoma group SCu increased and SZn decreased. Therefore, the SCu/Zn ratio increased significantly. The results suggested that SCu less than 1.2 ppm (means + 2 s), SZn greater than 0.8 ppm (means - 2 s) and SCu/Zn ratio less than 1.5 were helpful for the differential diagnosis of sarcoidosis from pulmonary tuberculosis and pulmonary carcinoma.

Adult↗
PubMed1998

[The causes of death of pulmonary tuberculosis: late sequelae of pulmonary tuberculosis].

We investigated the causes of death of late sequelae of pulmonary tuberculosis. Chronic respiratory failure is one of the most frequent cause of death in the patients of late sequelae of pulmonary tuberculosis. We compared the long term prognosis of chronic respiratory failure in case of emphysema and pulmonary tuberculosis. In the patients with chronic respiratory failure by pulmonary emphysema, the prognosis was poor in those with pulmonary hypertension. But in case of late sequelae of pulmonary tuberculosis, prognosis was not affected by presence or absence of pulmonary hypertension. The determinants of prognosis of late sequelae of pulmonary tuberculosis are the indication of home oxygen therapy, malnutrition, and hypoxemia. Fungal infection, especially aspergilloma, is a common secondary infection of late sequelae of pulmonary tuberculosis. We investigated forty-two cases of aspergilloma as late sequelae of pulmonary tuberculosis, and of those 15 patients died. The causes of death were pneumonia and respiratory failure. Measurement of galactomannan antigen of aspergillus in serum using ELISA or PCR, it was apparent that the outcome was poor in the patients positive for antigen. It suggested that the prognosis of the patients with aspergilloma related with some degree of invasion of Aspergillus in parenchyma. It was reported that neoplasm is closely related to chronic tuberculous empyema. Lymphoma is most frequently complicated with chronic tuberculous empyema, and squamous cell carcinoma, adenocarcinoma, sarcoma and carcinoid were reported as complication of chronic empyema. We reported the case of angiosarcoma, originated from chronic empyema in left thoracic cavity formed after being treated for tuberculosis with artificial pneumothorax. Recently, the number of patients with late sequelae of pulmonary tuberculosis have been decreased, but some severe cases of patients of pulmonary tuberculosis will suffer from late sequelae of pulmonary tuberculosis, and that is still a great problem of the clinical course of pulmonary tuberculosis.

Aspergillosis↗
PubMedDate not supplied

[Association of active pulmonary tuberculosis and pulmonary neoplasms].

Six cases are presented (out of a total of 11) with sputum positive pulmonary tuberculosis associated with bronchopulmonary carcinoma. The carcinoma developed during the evolution of 9 cases of active tuberculosis that had received a long discontinous treatment with tuberculostatic drugs. Only two of the 11 patients could be operated because the other 9 were hospitalized in the terminal stage of the disease, with invasive tumors. These had neither been suspected nor investigated for neoplasia. The use of all available means of investigation in the early stages of cancer can be of considerable help in the early detection of this disease and may allow for the application of surgical methods. Exploratory thoracotomy, together with extemporaneous histological investigation, are much more useful for the diagnosis than the expectative attitudes, which lead to theloss of the patient. Positive sputum should not eliminate the possibility of the association of tuberculosis with cancer.

Aged↗
PubMed2006

Role of mannose binding lectin gene variants on its protein levels and macrophage phagocytosis with live Mycobacterium tuberculosis in pulmonary tuberculosis.

Mannose-binding lectin (MBL) plays an important role in innate immunity. Functional mutant homozygotes of the MBL gene affect the serum MBL levels and have been correlated with disease susceptibility. We have studied the regulatory role of variant MBL genotypes on serum MBL level and macrophage phagocytosis with live Mycobacterium tuberculosis, and the lymphoproliferative response to M. tuberculosis culture filtrate antigen in pulmonary tuberculosis (PTB) patients (n = 48) and normal healthy subjects (NHS) (n = 58). The total serum MBL level was higher in PTB patients than in NHS (P = 0.0085). Patients and NHS with AA genotype (homozygotes of MBL - common alleles) showed a very high serum MBL level, and those with OO genotype (functional mutant homozygotes of MBL - less frequent alleles) showed a very low MBL level (AA vs. OO: NHS, P = 3.3 x 10(-9); PTB, P = 3.1 x 10(-9)). A significantly lower phagocytosis was observed in NHS with AA genotype than in NHS with AO (heterozygotes) genotype (P = 0.046). In PTB patients, no such difference was observed. A negative correlation of macrophage phagocytosis with MBL level was seen in patients and NHS (P = 0.019). Antigen-induced lymphoproliferative response was significantly decreased in PTB patients with AA genotype as compared with NHS with AA genotype (P = 0.036). The present study suggests that AA genotype with its associated higher serum MBL levels plays a regulatory role in immunity to tuberculosis than functional mutant homozygotes (OO genotype) with its associated lower level of MBL.

Adult↗