Oral tuberculosis. Case reports.
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Tuberculous lesions of the oral cavity are rare, primary lesions in particular. Three cases of different location are reported, two of them are secondary to pulmonary disease and the third one is a primary lesion after tooth extraction. Based on these cases and the literature reviewed we analyze the differences of these clinical situations, the diagnostic procedures needed and the excellent response they shows to treatment with tuberculostatic drugs.
Two cases are hereby presented, diagnosed through clinical, laboratory radiology and histological methods. In each case, the oral involvement was associated with pulmonary tuberculosis. The trauma, particularey in the teeth, is an important deciding factor. Clinically, some ulcerous lesions in mucous membranes and tongue were observed, with definite characteristics such as quite severe pain, difficulty in swallowing and talking. The selected treatment has been chemical therapy. Looking back at hospital files, these two cases have been the only ones observed at Hospital de San Jaun de Dios of Bogotá, in the last fifteen years.
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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.
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Two cases of primary tuberculosis of the mouth are reported. Painless ulceration of long duration and enlargement of the regional lymph nodes that did not respond to conservative and antibiotic therapy were the main manifestations of the disease in both cases. In the first case the tubercle ulcer was located in the lower buccogingival sulcus of a 17-year-old girl. In the second case the lesion occurred as a chronic periodontal inflammation around the gingiva of the left lower second molar tooth. When the tooth was extracted, a painless ulceration appeared around the socket, which was filled by granulation tissue. Histopathologic examination; bacteriologic, serologic, and blood tests; and chest x-ray film confirmed the diagnosis. Predisposing factors that might favor primary inoculation of tubercle bacilli into oral mucosa are also discussed. Finally we emphasize that in such cases it is essential to attempt to locate a possible primary site elsewhere in the body before oral tuberculosis is considered the primary disease.
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According to morphological criteria, the predominant cells from human oral tuberculosis granulomas are classified as monocytes, epithelioid cells, and multinucleated giant cells. The morphology of each cell type is related to its speculated function. It is theorized that macrophages and epithelioid cells represent an in vivo line of differentiation from undifferentiated monocytes and that giant cells form from a coalescence or syncytium of macrophages. The role of these phagocytic cells and other participating inflammatory cells in granulomatous inflammation is discussed.