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At least 379 records · Page 21Linked to original sources
PubMed1998

Splenic abscess: a diagnostic and therapeutic challenge.

The records of five patients treated in our department for splenic abscess are analysed and the literature is reviewed. Computed tomography revealed the correct diagnosis in all patients, while clinical presentation was often nonspecific. Spleen-preserving management was possible in two patients (40%). Outcome was uneventful for four patients. One patient with a splenic abscess caused by Mycobacterium tuberculosis and acquired immunodeficiency syndrome, died 4 months after splenectomy from sepsis. We discuss the clinical presentation of splenic abscess, its diagnostic approach, and treatment. Additionally, we studied whether spleen-preserving management is feasible or not.

AIDS-Related Opportunistic Infections↗
PubMed1998

Hepatosplenic tuberculosis: a cause of persistent fever during recovery from prolonged neutropenia.

SETTING: Hepatosplenic abscesses in neutropenic patients, especially during the recovery phase, are almost always attributed to fungal infections. We report similar lesions due to Mycobacterium tuberculosis in neutropenic patients in a tertiary care centre in India. OBJECTIVE: To characterize the features of hepatosplenic tuberculosis in neutropenic patients. DESIGN: Retrospective comparison of disease pattern and response to treatment of hepatosplenic tuberculosis in febrile neutropenia patients (four of 30 with severe prolonged neutropenia) and in non neutropenic patients diagnosed during the same 12-month period (n = 4, control group). RESULTS: The disease in the neutropenic patients typically presented during the recovery phase of neutropenia, with ultrasonic abnormalities similar to those seen in hepatosplenic fungal infections. In contrast to the marked organomegaly and typical granulomatous response found in the control group, the disease in the neutropenic patients was characterised by an absence of organomegaly, non-involvement of other sites, poor inflammatory response and a high bacillary load. The initial response to therapy was satisfactory in both groups. CONCLUSION: Tuberculosis needs to be considered in the diagnostic work-up of hepatosplenic abscesses that occur during the recovery phase of neutropenia.

Abscess↗
PubMed1976

[Immunobiology of tuberculosis].

R. Koch showed in 1882 in his so-called fundamental experiment that tuberculous guinea pigs exhibit a vigorous immunity against re-infection. In investigations in 1930--40 we showed that this immunity is not mediated by humoral antibodies. It is a cellular process, a local and general activation of the macrophage system (the system of mononuclear phagocytes). The tuberculous granuloma consists of activated macrophages and their descendants (epitheloid and giant cells), which inhibit the growth and spreading of tubercle bacilli. The role of the specific and unspecific activation of the macrophage system could be demonstrated in experiments on rats, infected with Bartonella muris ratti. These early results are related to the recent knowledge concerning cellular immunity and granulomatous inflammation, especially to the cooperation between the lymphatic and macrophage system.

Anaplasmataceae↗
PubMed1996

[Tuberculous hepatosplenic abscess, human immunodeficiency virus infection and multiresistant tuberculosis].

BACKGROUND: Tuberculosis (TB) with liver and/or spleen abscess (HSA) formation in HIV-positive patients is uncommon. PATIENTS AND METHODS: One hundred and thirty-seven HIV positive patients with TB were studied from January 93 to June 95. Patients with tuberculous HSA were enrolled in the study. Diagnosis was obtained by recovery of Mycobacterium tuberculosis in clinical specimens and the presence of hypoechogenic lesions in liver and/or spleen. RESULTS: M. tuberculosis isolates were resistant to some of the usual drugs in 51 patients. Twenty of these patients had HSA (39%) and in 18 patients the antibiotic sensitivity testing showed resistance to isoniazid, rifampin, ethambutol, and streptomycin. The remaining 86 patients had episodes of TB with drug-susceptible microorganism and only three patients had HSA (3%) (p < 0.001). The 23 patients with tuberculous HSA had a mean CD4+ lymphocyte count of 33 x 10(6) cells/L (2-111) and 7 had a previous episode of TB. The abdominal echography showed hepatosplenomegaly in all cases. Abscesses were located at the liver in 12 patients (52%), spleen in 18 (78%) and both organs in 7 (30%). In 16 cases a corticosteroid therapy was indicated. In the 3 patients with susceptible TB and HSA the clinical course was good. The 20 patients with resistant TB died. CONCLUSION: Abdominal TB in HIV-positive patients and HSA formation appears to be more common in severely immunosuppressed patients, with resistant TB and its mortality rate is high. The response to therapy with antituberculous drugs is slow and sometimes the administration of corticosteroids is necessary for the resolution of symptoms.

Abdominal Abscess↗
PubMed2002

[Effectiveness of the use of ultrasound irradiation of the spleen in patients with acutely progressive pulmonary tuberculosis].

Sixty-three patients with acute progressive tuberculosis (APPT) underwent splenic ultrasound radiation (SUSR) (Group 1) for evaluation of the efficiency of the procedure. A hundred and twenty five patients with APPT were treated without SUSR (Group 2, controls). An experimental study was also conducted on 290 mice. SUSR was also used in the late first month of antituberculous chemotherapy. A procedure for SUSR is described in the paper. There were most favourable clinical and X-ray changes in Group 1 than in Group 2 just after SUSR and at the end of the treatment course. After the procedure (first control) all biochemical inflammation indices (medium molecular-weight molecules, adenosine deaminase, fibrinogen, sialic acids) were significantly decreased in Group 1. Immunological indices were insignificantly changed between groups and primary investigations. A study after two months of SUSR showed no differences in biochemical indices in the groups and in this period as compared to the control one. At the same time, the levels of CD cells, especially CD8+, were found to be lower in Group 2. In Group 1, the count of CD cells and their functional activity by the blast transforming reaction on PHA were stable and significantly higher than in Group 2. The experimental study demonstrated that the levels of medium molecular-weight molecules and the index of lung damage reduced after SUSR. The decrease in the count of MBT colonies and a positive response in the murine paw test, which is indicative of T-cell immunodeficiency, were detected one month following the procedure (distant control). So SUSR should be proposed as a new effective pathogenetic treatment for APPT.

Acute Disease↗
PubMed2000

Splenic vein occlusion secondary to tuberculous lymphadenitis at the splenic hilum: report of a case.

We report a patient with splenic vein occlusion (SVO) secondary to tuberculosis. A 17-year-old male patient with mild epigastric pain and splenomegaly was found to have gastric varices by gastroscopy, and SVO by selective angiography. At operation, the splenic vein was occluded by hard fibrous tissue at the splenic hilum, and thus a splenectomy was performed. A microscopic examination of the tissue revealed caseous necrosis surrounded by epithelioid cells and Langhans-type giant cells. Although there were no other findings suggesting intestinal tuberculosis, it seemed that tuberculous lymphadenitis of the splenic hilum most likely caused the occlusion of the splenic vein. Because specific tests for tuberculosis were negative in both immunohistochemical staining for bacille Calmette-Guérin and polymerase chain reaction of DNA for Mycobacterium tuberculosis, the time of infection was assumed to have occurred a long time before. SVO can sometimes be seen in pancreatic diseases, but this patient with tuberculosis appears to be the first such reported case in the English literature.

Adolescent↗
PubMedDate not supplied

[Ultrasonographic data of the solid organs of the abdomen in stage IV human immunodeficiency virus infection. A prospective study of 101 cases in central Africa].

A systematic abdominal study of the solid organs of the abdomen (liver, spleen, pancreas, kidneys) carried out in one hundred patients from Central Africa suffering from full blown AIDS revealed disseminated hyperechoic liver in 37 cases and hypoechoic nodules of the spleen in 10 cases. The combination with abdominal adenopathy and/or serous exudates (peritoin, pleura, pericardium) suggested disseminated tuberculosis. Twenty of the 37 patients with diffusely hyperechoic liver presented within tuberculosis which was confirmed by bacteriological data (AARB present in the sputum) in 13 cases. Of the 10 patients presenting with hypoechoic nodules of the spleen, 5 presented with confirmed tuberculosis. These 10 patients were all considered to have disseminated tuberculosis. In view of the current high incidence of extrapulmonary or disseminated tuberculosis occurring in a context of AIDS and the relative infrequency of positive tests for Mycobacterium, abdominal ultrasound must be coupled with chest X-rays in screening and prompt follow-up for TB instigated in HIV-positive adult Africans.

Abdomen↗
PubMed1970

Demonstration in tissue culture of lymphocyte-mediated immunity to tuberculosis.

We have shown that splenic lymphocytes from mice immunized with viable attenuated mycobacterial cells (H37Ra) or ribonucleic acid prepared from these cells will bring about inhibition of multiplication of virulent tubercle bacilli (H37Rv) within normal mouse peritoneal macrophages in tissue culture. Apparently these lymphocytes, when stimulated with viable virulent tubercle bacilli, elaborate a filterable substance(s) which is responsible for this intracellular growth inhibitory effect.

Journal Article↗