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PubMed1989

Frequency of Mycobacterium tuberculosis bacteremia in patients with tuberculosis in an area endemic for AIDS.

Mycobacterium tuberculosis bacteremia has recently been reported in patients infected with the human immunodeficiency virus (HIV). At our institution, tuberculosis occurs commonly among patients with and without HIV infection. We sought to determine the frequency of M. tuberculosis bacteremia among patients with newly diagnosed tuberculosis. During a 4-month period, mycobacterial blood cultures were obtained on all identifiable patients with newly diagnosed tuberculosis. Fifteen percent (9/59) of consecutive patients with tuberculosis had positive blood cultures for M. tuberculosis. Twenty-six percent (7/27) of patients known to be infected with HIV had positive mycobacterial blood cultures; two intravenous drug users who refused HIV-serologic testing also had positive mycobacterial blood cultures. M. tuberculosis bacteremia occurred at a higher rate among HIV-infected patients with an AIDS-defining opportunistic infection in addition to tuberculosis (3/3) than among HIV-infected patients without such an opportunistic infection (4/24; p less than 0.02). M. tuberculosis bacteremia occurred in 83% (5/6) of patients with disseminated tuberculosis and in 8% (4/53) of patients without disseminated tuberculosis (p less than 0.001). In all cases, tuberculosis was diagnosed in patients with M. tuberculosis bacteremia or else they died prior to the blood cultures demonstrating mycobacterial growth (mean time to detection of mycobacterial growth: 43 days). However, the frequent occurrence of M. tuberculosis bacteremia in HIV-infected patients with disseminated tuberculosis suggests that mycobacterial blood cultures may help confirm the diagnosis of tuberculosis in this group of patients.

Acquired Immunodeficiency Syndrome↗
PubMed1999

[Analysis of circumstances regarding deaths from tuberculosis in inhabitants of the Toruń Province in the years 1990-1993 as an important factor in assessing the causes of tuberculosis treatment failure].

The aim of this study was to verify the diagnoses of tuberculosis in 98 cases of death from tuberculosis (TB) in Toruń province in the years 1990-1993. The data of the official register of death were compared, with the hospital records and with the autopsy reports. Tuberculosis was accepted as the cause of death in all patients treated for sputum positive tuberculosis, and also in those in whom pathological proof of tuberculosis existed. In addition tuberculosis was accepted as the cause of death in 6 patients in whom no bacteriological examination was done, but who were tuberculosis contacts and who had the radiological picture of the lung compatible with tuberculosis. Those patients were admitted to hospital in terminal state and the permission for autopsy was refused. Tuberculosis was excluded as the cause of death in those who were treated for tuberculosis but were considered cured and also in those in whom a proof of other severe disease existed. Seventy two cases of tuberculosis death were officially registered in the above-mentioned time. In 23 of the 72 cases tuberculosis was excluded. Additionally 26 patients who died of tuberculosis were officially registered as death from other causes. After verification have found that 75 patients died of tuberculosis. In 26 of them the diagnosis was established only after death during the autopsy examination and/or positive culture for tubercle bacilli. In 27 patients tuberculosis was diagnosed very late, 15 days before death in 12 and 30 days in other 15 patients. In 19 patients the diagnosis was established 30 days or later before death. In majority of them, however, the treatment was interrupted or proceeding irregularly. It is concluded that: the real number of death from tuberculosis was similar to the registered although the errors in registered deaths from TB are in two directions; the main cause of death from TB in Toruń province in the years 1990-1993 was the late diagnosis; the late diagnoses of tuberculosis was stabilized mainly in those who died at home and also in those who were admitted to hospital in critical state and died during the first two weeks of hospitalization.

Adult↗
PubMed1983

[The development of tuberculosis control and tuberculosis epidemiology in East Germany].

The fight against tuberculosis in the German Democratic Republic was performed from the very beginning as a task of the state and the society; it was developed according to the progress of economic possibilities and the epidemiological situation. The contribution of the community and of the social-economic development on tuberculosis epidemiology has proved to be decisively important factors in tuberculosis control. The specific methods applied in tuberculosis control in the course of more than 30 years have changed in their importance effectiveness and efficiency with the reduction of the tuberculosis problem and the development of new techniques. Therefore a continuous evaluation of the tuberculosis situation is necessary to recognize the most effective approach. By reducing the estimated annual infection rate to less than 0.05%, the incidence of smear positive pulmonary tuberculosis to less than 5/100,000 and the practical disappearance of tuberculosis among children tuberculosis has become an endemic localized disease among predominantly old citizens. People's mass x-ray examinations have considerably lost their value for finding tuberculosis. Early coverage and examination of persons with respiratory symptoms (21-days-coughers), of contact persons and high risk groups will determine the future activities of the chest clinics. Their integration into the system of outpatient clinics and the system of primary health care were an important step on this way. Successful treatment of each case of tuberculosis is now possible and must be attained. Early case finding + treatment considered as an united activity has become the decisively important measure in the control of tuberculosis. The endemic foci of tuberculosis in some communities have to be surveyed and eliminated with priority. Moreover, the cooperation of all physicians of public health is necessary. Only by this way tuberculosis can be eradicated in GDR in a defined time. (Aim of WHO and IUaT: 1 case of smear positive tuberculosis among 1,000,000 inhabitants.) Up to that time tuberculosis control should remain an obligatory task of public health.

Adolescent↗
PubMed2001

A critical examination of adrenal tuberculosis and a 28-year autopsy experience of active tuberculosis.

OBJECTIVE: Tuberculosis is potentially fatal and adrenal gland involvement is uncommonly reported. The aims of the current study were to define the characteristics of tuberculosis in hospitalized patients and to analyse the features of adrenal tuberculosis. DESIGN: Retrospective analysis of autopsies and adrenalectomies. PATIENTS: 13,762 patients (13492 at autopsies and 270 at adrenalectomy). MEASUREMENTS: The presence of active tuberculosis, the predisposing factors, the pathological features and organs of involvement were examined. RESULTS: Active tuberculosis was present in 871 patients (6.5% of all 13492 autopsies). It was first diagnosed in 70% of these patients during autopsy. Cancers and a history of recent major operations were the 2 main concomitant factors in the patients with tuberculosis. Extra-pulmonary tuberculosis was seen in 261 patients (30%). The five most common extra-pulmonary sites of tuberculosis were the liver, spleen, kidney, bone and adrenal gland. Adrenal tuberculosis was seen in 52 of the 871 patients (6%) with active tuberculosis at autopsy and in 3 patients at adrenalectomy. The adrenal gland was the only organ involved by active tuberculosis in 14 of these 55 patients (25%; 35 men, 20 women). Tuberculosis was evident on macroscopic examination of the adrenal glands in 46% of the patients. On histological examination, caseous necrosis and granulomatous inflammation with Langhan's giant cells were seen in 71% and 40% of patients, respectively. Seven patients presented with signs and symptoms of Addison's disease due to bilateral adrenal involvement. Langhan's giant cells were frequently seen in histological sections and bilateral enlargement of the adrenal glands was often noted. Fine needle aspiration cytology was not useful for diagnosing adrenal tuberculosis. CONCLUSION: Unexpected and extra-pulmonary tuberculosis such as adrenal tuberculosis has been a common problem. A high index of suspicion, correct diagnosis and proper treatment are essential for the management of tuberculosis.

Addison Disease↗
PubMed2005

Tuberculosis deaths in countries with high HIV prevalence: what is their use as an indicator in tuberculosis programme monitoring and epidemiological surveillance?

Although the reduction of tuberculosis deaths is one of the aims of tuberculosis control, it has not always been a priority for National Tuberculosis Programmes (NTPs). The usual explanation is that death as a treatment outcome not associated with ongoing tuberculosis transmission is not relevant to the public health objective of cutting the cycle of disease transmission. However, death as an adverse outcome for tuberculosis patients and their families is an important indicator in NTP monitoring. Global health targets agreed as part of the Millennium Development Goals include the reduction of tuberculosis deaths. Tuberculosis deaths as an indicator of the impact of tuberculosis control measures are therefore important in the epidemiological surveillance of progress towards these targets. These considerations are particularly important in countries with high human immunodeficiency virus (HIV) prevalence where HIV has exacerbated the tuberculosis epidemic and is now the single best predictor of tuberculosis incidence. Tuberculosis deaths are also closely linked to HIV prevalence. Routine NTP data on tuberculosis cohort deaths are important in programme monitoring, and improvements in recording and reporting of deaths would help to overcome limitations in their accuracy. As routine NTP data on tuberculosis cohort deaths are insufficient as an indicator in epidemiological surveillance regarding the impact of NTPs on tuberculosis mortality, measuring progress towards targets for reduced tuberculosis deaths depends on improved national vital registration systems for a more accurate determination of tuberculosis mortality.

Environmental Monitoring↗
PubMed2007

Immunological responses and protective immunity against tuberculosis conferred by vaccination of Balb/C mice with the attenuated Mycobacterium tuberculosis (phoP) SO2 strain.

The Mycobacterium tuberculosis phoP mutant strain SO2 has been shown previously to be more attenuated than Mycobacterium bovis bacillus Calmette-Guérin (BCG) and confers protective immunity against tuberculosis in mice and guinea pig models. In this study we have investigated the survival and immunological responses of Balb/c mice infected with the M. tuberculosis SO2 strain. All Balb/C mice survived intratracheal infection with M. tuberculosis SO2 strain under conditions where all the mice infected with the parental M. tuberculosis MT103 had died after 9 weeks. Infection of Balb/c mice with M. tuberculosis SO2 was associated with comparatively lower levels of interferon (IFN)-gamma, interleukin (IL)-4 and tumour necrosis factor (TNF)-alpha and higher levels of inducible nitric oxide synthase (iNOS) during the late stage of infection, when compared with M. tuberculosis MT103 infection. The delayed-type hypersensitivity (DTH) response against M. tuberculosis culture filtrates was similar in mice infected with either the M. tuberculosis phoP SO2 strain or M. tuberculosis MT103. The protective efficacy of M. tuberculosis SO2 was compared with M. bovis BCG when delivered subcutaneously to groups of Balb/C mice. Following intratracheal challenge with M. tuberculosis H37Rv, protection was generated by 60 days post-challenge in mice vaccinated with either vaccine. At day 120 post-challenge the levels of protection were still significantly greater when compared with the non-vaccinated control group. The levels of protection conferred by vaccination with M. tuberculosis SO2 or with M. bovis BCG were similar, as measured by granuloma coalescence and pneumonia in addition to growth reduction of M. tuberculosis H37Rv.

Animals↗
PubMed2003

Incidence of cutaneous tuberculosis in patients with organ tuberculosis.

BACKGROUND: Tuberculosis continues to be a health problem in some countries. The development of resistance to antituberculitic drugs and the increase in diseases and conditions associated with immunodeficiency such as AIDS and chemotherapy have caused tuberculosis to increase recently. As a result, the incidence of cutaneous tuberculosis has been increasing as well. AIM: To detect cutaneous tuberculosis in patients with organ tuberculosis and to establish some characteristics of the relation between organ and cutaneous TB. MATERIAL AND METHODS: A total of 370 patients (145 females and 225 males), aged 2-76 years (mean age 27.5), enrolled for this screening study. These patients were hospitalized patients who already had pulmonary or extrapulmonary tuberculosis diagnosed before admission. All patients underwent a general skin examination, and, if needed, cutaneous biopsies were taken from involved skin areas. RESULTS: Three hundred and forty-seven (93.78%) out of 370 patients had pulmonary tuberculosis only or in association with one of other organ tuberculoses. Twenty-three patients had extrapulmonary TB: nine were TB adenitis, six were TB peritonitis, three were bone tuberculosis, and five were TB meningitides. Of 370 patients, only 13 (3.51%) had cutaneous TB: seven scrofuloderma (SCD; 2.16%), four lupus vulgaris (LV; 1.35%), one LV and SCD, and one Bacille Calmette-Guerin (BCG) adenitis (0.027%). Cutaneous tuberculosis was observed in seven out of 260 patients with parenchymal tuberculosis (2.96%). Four out of nine patients with TB adenitis (44.4%), one out of 12 pulmopleuretic (8.3%), and one out of 67 pleuresic patients (1.40%) had cutaneous TB as well. Mean age of the 13 patients was 32.46 years: mean age of SCD and LV was 24.8 and 48 years, respectively. The one patient with BCG adenitis was 7 months old. Five (62.5%) out of eight patients with SCD, and only one (20%) out of five patients with LV were new cases. Four patients with SCD had a positive family history, while LV patients did not. CONCLUSIONS: Organ tuberculosis is rarely associated with cutaneous tuberculosis. Scrofuloderma and LV are the most frequent forms of skin TB associated with organ TB in this population. Tuberculosis adenitis is the organ TB that causes cutaneous TB most often among other organ tuberculoses. More than one form of cutaneous TB affected only one patient with pulmonary TB; therefore, it is very rare. Tuberculids were not observed in any of the patients.

Adolescent↗