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PubMed2006

Oral tuberculosis associated with a treatment with anti-rheumatic drugs.

BACKGROUND: The use of immunosuppressive medication is a dominant risk factor for infection in patients with rheumatoid arthritis (RA). Methotrexate (MTX) is one of the traditional disease-modifying antirheumatic drugs. Adalimumab [a human anti-tumor necrosis factor-alpha (anti-TNF-alpha) monoclonal antibody] represent an important advance in the treatment of RA and has been recently come in use. TNF-alpha plays a role in the host defense against Mycobacterium tuberculosis and notably in granuloma formation. Infections occur at a high rate among those who use one or the combination of the two medications. METHOD: We examined a female patient that was referred to our department for evaluation and treatment of a granular lesion on the soft palate and uvula, complaining of mild dysphagia. The patient was treated for 4 months with MTX and adalimumab for RA before the oral lesion appeared. RESULTS: The histopathological examination of a specimen of the oral lesion, taken by biopsy, showed a chronic inflammation characterized by tuberculous granulomas. Polymerase chain reaction test and culture of a new specimen was positive for M. tuberculosis. CONCLUSIONS: The therapeutic use of MTX or/and adalimumab for the treatment of RA or few others diseases, can cause oral tuberculosis.

Adalimumab↗
PubMed1996

Oral tuberculosis following autologous bone marrow transplantation for Hodgkin's disease with interleukin-2 and alpha-interferon immunotherapy.

A patient with Hodgkin's disease (HD) underwent autologous bone marrow transplantation (ABMT). Six months later while receiving interleukin (IL)-2 and alpha-interferon immunotherapy, he developed a painful lesion in his oral cavity with a fistula in the buccal area. Excision biopsy disclosed necrotizing granulomatous inflammation with acid-fast bacillus. The patient received a 9-month course of isoniazide, rifampin and pyrazinamide, and recovered. The possible pathophysiological mechanism is discussed.

Adjuvants, Immunologic↗
PubMed2000

Oral tuberculosis: a clinical evaluation of 42 cases.

OBJECTIVES: A retrospective review of a large series of oro-facial cases of tuberculosis to analyse clinical, histopathological, and radiological aspects, as well as those of chemotherapy. MATERIALS AND METHODS: A total of 42 cases of tuberculosis of the oro-facial region were examined. Thirteen patients had a primary form and 29 a secondary form of the disease. Diagnosis was based on careful clinical examination, Mantoux reaction, histopathological examination, microbiological cultures and immunological investigation with the detection of antibodies against Mycobacteria in the patients' serum (ELISA). RESULTS: Cases examined consisted of 27 males and 15 females. The age range was 3 to 73 years (mean age 31 years). Clinical manifestations comprised oral ulcers in 69.1%, bone involvement in 21.4%, and salivary gland and/or lymph node involvement in 14.3%. A total of 79.4% patients with secondary disease had pulmonary lesions, 15 of whom showed clinical and radiological signs of activity; there was one case of bilateral renal lesions and two of skin lesions. CONCLUSIONS: Oro-facial tuberculosis is often difficult to diagnose and it should be an important consideration in the differential diagnosis of lesions that appear in the oral cavity. The most important diagnostic tools remain a careful clinical evaluation, biopsy for histologic study, as well as acid-fast stains, culture, and immunological assays, and skin testing.

Adolescent↗
PubMed2003

PCR method is essential for detecting Mycobacterium tuberculosis in oral cavity samples.

Tuberculosis is a re-emerging infectious disease, and infection by Mycobacterium tuberculosis has been increasing in immunocompromised hosts, including elderly persons. M. tuberculosis-infected persons may receive dental treatment. To evaluate the risk of M. tuberculosis infection in dental clinics, we examined the detection rates of M. tuberculosis in sample of mixed saliva, dental plaque, extracted teeth, caries lesions, and denture plaque by nested polymerase chain reaction (PCR). The detection rates by PCR in samples from mixed saliva, dental plaque, caries lesions and denture plaque obtained from tuberculosis patients were 98.0%, 92.0%, 89.0%, and 100%, respectively. The detection rates by the culture method were 17.3%, 2.0%, 0%, and 0%, respectively. M. tuberculosis also was detected from the nontuberculous mycobacteria-infected group. Strains of Actinomyces naeslundii, Porphyromonas gingivalis, and Fusobacterium nucleatum inhibited the growth of clinical strains of M. tuberculosis, but strains of Streptococcus mutans, Streptococcus sanguinis, and Actinobacillus actinomycetemcomitans did not. The present study concludes that the PCR method is essential for detecting M. tuberculosis in oral samples.

Aerosols↗
PubMed2005

Primary tuberculosis of the oral cavity.

Tuberculosis is one of the major causes of ill health and death worldwide. Nevertheless, tuberculous lesions of the oral cavity are rare and can be a diagnostic challenge, particularly in young immunocompetent patients. Most of the cases are secondary to pulmonary disease and the primary form is uncommon. In this paper, we present a case of primary oral tuberculosis, affecting the floor of mouth in a 13-year-old Brazilian male patient.

Adolescent↗
PubMed2001

Tuberculosis of oral mucosa.

In secondary tuberculosis, lesions of the oral cavity may accompany lesions of the pharynx, lungs, lymph nodes or miliary tuberculosis. A 35-year-old male was suffering from swelling of his right cheek, cough, weakness and weight loss. There were local hyperemia and irregular oral mucous in the inner part of the right cheek. Chest x-ray showed bilateral nodular opacifications and a cavity of 2 cm. Acid-fast bacteria were present in sputum and Lowenstein-Jensen culture was positive. The pathological signs of the biopsy taken from the buccal mucosa including multistratified squamous epithelium were: tubercle structure, Langhans' giant cells and minimal cazeation necrosis. After anti-tuberculous chemotherapy oral and pulmonary lesions were almost in remission. Following this case report of lung tuberculosis accompanied by tuberculosis of oral mucosa, the literature related is reviewed.

Adult↗
PubMed1996

[Primary tuberculosis of the oral cavity].

Primary tuberculosis in the oral cavity is a rare entity. Usually, the microorganisms need a disruption of the oral mucosa to become pathogenic. In this article the authors describe a clinical case of primary oral tuberculosis, on a female of 52 years-old who suffered an exodontia 20 days before. The bacteria identificated was Mycobacterium tuberculosis hominis. The microbiologic identification is essential to assure the efficacy of the treatment.

Antibiotics, Antitubercular↗
PubMed1975

[Injection therapy of the prostate in prostatic tuberculosis].

Oral therapy of prostatic tuberculosis so far has only been able to achieve conversion in one-fifth of the cases. Since 1970 we have practiced the transcutaneous injection of the prostate and have achieved conversion in all cases within a short time. Injection of 1 g Streptomycin and 0.1 g INH twice a week over a period of four to five weeks was carried out in 90 patients. Complications contraindicating the treatment was not seen. The transcutaneous injection treatment of the prostate is indicated in all patients where cavernous changes in the prostate have been demonstrated by urethrography.

Drug Therapy, Combination↗
PubMed1995

[Pulmonary tuberculosis complicated with tuberculosis of oral mucosa, mandible and cervical lymph nodes].

A case of pulmonary tuberculosis complicated with tuberculous of oral mucosa, mandible and cervical lymph nodes in 53-year-old man is reported. He was firstly treated for right side dental caries. He also received routinely an empiric antibiotic therapy, but discharge of pus continued. Then, pain of oral cavities spread to the right shoulder. The diagnosis of oral mucosa, osteomyelitis of mandible and lymph node tuberculosis was made by the histological examination of biopsy specimens and positive smear test for M. tuberculosis in granulation. The chest X-ray film showed multiple nodular shadows in bilateral lungs. The combination of INH, RFP and SM was applied initially and then SM was replaced by CS due to its side effect. Negative smear test for M. tuberculosis of oral mucosa was achieved five months after the initiation of treatment.

Humans↗