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Infection and immunology
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
5.9. Which of the following statements about primary tuberculosis is/are correct?The primary focus in the lung usually cavitates.Symptoms from primary tuberculosis mostly arise from enlargement of the draining lymph nodes.Some degree of blood-borne dissemination occurs with most cases of primary tuberculosis.Sputum positive for acid-fast bacilli (AFB) is required before making a diagnosis of primary tuberculosis.Most cases of miliary tuberculosis and tuberculous meningitis occur within 1 year of initial infection with tuberculosis.
Tuberculosis in Childhood and Pregnancy
Published in Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies, Clinical Tuberculosis, 2020
Lindsay H. Cameron, Jeffrey R. Starke
The most common clinically significant form of disseminated tuberculosis is miliary disease, which occurs when massive numbers of tubercle bacilli are released into the bloodstream, leading to disease in two or more organs.44,63,64 Miliary tuberculosis is most often a complication of primary infection, occurring within 2–6 months of the primary inoculation. While this form of disease is most common in those who are immunosuppressed or in infants and young children, it also occurs in adolescents and older adults, resulting from the breakdown of a previously healed or calcified primary pulmonary lesion.
The respiratory system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
In adult secondary pulmonary tuberculosis, there is tiredness, anorexia, weight loss, cough, pleural effusion, and fever but drenching night sweats are now uncommon. The chest radiograph shows patchy or nodular upper lobe shadowing as well as fibrosis with/without cavitation. Miliary tuberculosis presents in a non-specific manner with weight loss, fever, and few physical signs. The chest radiograph may show normal findings, because tubercles are only 1–2 mm in diameter. A Mantoux skin test is usually positive, but may be occasionally negative in severe disease. Diagnosis is by the identification of tubercle bacilli, either in tissue or on microbiological culture, the latter enabling testing for drug sensitivities. PCR assays may facilitate rapid diagnosis and speciation.
Safety and effectiveness of conventional systemic therapy and biological drugs in patients with moderate to severe psoriasis and HIV infection: a retrospective multicenter study
Published in Journal of Dermatological Treatment, 2019
Andrea Montes-Torres, Gloria Aparicio, Raquel Rivera, Eva Vilarrasa, María Marcellán, Jaume Notario, Caridad Soria, Isabel Belinchón, Pablo de la Cueva, Marta Ferrán, Jose Manuel Carrascosa, Francisco J. Gómez, Laura Salgado, Manuel Velasco, Miguel Ángel Descalzo, Ignacio García-Doval, Esteban Daudén
With regard to safety, six (26.1%) patients presented serious adverse events during follow-up, not necessarily related to the therapy. Four of them were in the AIDS stage. One case died because of an acute peritonitis 2 years after starting ETN. A miliary tuberculosis was diagnosed in a second case during treatment with IFX leading to the withdrawal of the drug despite the good clinical response. A third case developed an acute respiratory insufficiency secondary to a decompensation of its obstructive pulmonary disease after a pulmonary infection during treatment with MTX. A fourth case developed transaminitis one month after MTX initiation, and esophageal candidiasis and prostate adenocarcinoma under treatment with ETN. A fifth case developed severe hypertension during CsA therapy, and finally, in the last case MTX treatment had to be interrupted because of a paraplegia secondary to a complicated aortic aneurysm. A supplementary table with individualized information of the cases is included.
Tuberculous cellulitis in an immunocompetent patient
Published in Baylor University Medical Center Proceedings, 2019
Pejman Rabiei, Merve Hasanov, Bobak Akhavan, Gabriel M. Aisenberg
Microbiological confirmation of tuberculous cellulitis remains challenging.8 The diagnostic yield depends on the selected method; on whether the form of cutaneous tuberculosis is paucibacillary or multibacillary; and on site selection, technique, and choice of transport media.8 Tuberculous cellulitis is considered a form of miliary tuberculosis and is usually multibacillary. Deep tissue biopsy and swab cultures have concordant results in 50% to 60% of samples in chronic skin infections.9–11 Though highly recommended in the assessment of chronic skin infections, deep tissue biopsy is relatively invasive, expensive, and may not be available in all settings.12 Though caseating granulomas are characteristic of tuberculous infection, they may be absent in some cases.13
Management of complex tuberculosis cases: a focus on drug-resistant tuberculous meningitis
Published in Expert Review of Anti-infective Therapy, 2018
Ravindra Kumar Garg, Imran Rizvi, Hardeep Singh Malhotra, Ravi Uniyal, Neeraj Kumar
Extra-CNS involvement is frequently observed in meningeal tuberculosis. Lung and lymph node involvement is common either as a part of miliary or disseminated tuberculosis [41](Table 3). The latter is characterized by the presence of M. tuberculosis in two or more noncontiguous body parts [42]. Miliary tuberculosis, on the other hand, is characterized by the presence of diffuse miliary infiltrates in chest radiograph or high-resolution computed tomography (CT) or miliary tubercles in multiple organs. Abnormalities in chest radiographs (10/33) and abnormal thorax CT (15/22) are common in tuberculous meningitis [43]. Thoracic imaging of patients has shown various pulmonary lesions like cavitation, mediastinal or hilar lymphadenopathy, pulmonary nodularity, consolidation, pleural effusions, and tuberculous spondylodiscitis [44]. Invasive respiratory sampling consisting of bronchoscopy with bronchoalveolar lavage yields a higher number of microbiologically confirmed tuberculous meningitis cases. Thus, the workup should include thorax CT, bronchoscopy, and bronchoalveolar lavage [45].