TUBERCULOSIS

Selected abstracts:

1.                 Hopewell PC, Pai M, Maher D, Uplekar M, Raviglione MC.  International standards for tuberculosis care. Lancet Infect Dis. 2006 Nov;6(11):710-25. Review.

Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California, San Francisco, CA 94110, USA. phopewell@medsfgh.ucsf.edu

Part of the reason for failing to bring about a more rapid reduction in tuberculosis incidence worldwide is the lack of effective involvement of all practitioners-public and private-in the provision of high quality tuberculosis care. While health-care providers who are part of national tuberculosis programmes have been trained and are expected to have adopted proper diagnosis, treatment, and public-health practices, the same is not likely to be true for non-programme providers. Studies of the performance of the private sector conducted in several different parts of the world suggest that poor quality care is common. The basic principles of care for people with, or suspected of having, tuberculosis are the same worldwide: a diagnosis should be established promptly; standardised treatment regimens should be used with appropriate treatment support and supervision; response to treatment should be monitored; and essential public-health responsibilities must be carried out. Prompt and accurate diagnosis, and effective treatment are essential for good patient care and tuberculosis control. All providers who undertake evaluation and treatment of patients with tuberculosis must recognise that not only are they delivering care to an individual, but they are also assuming an important public-health function. The International Standards for Tuberculosis Care (ISTC) describe a widely endorsed level of care that all practitioners should seek to achieve in managing individuals who have, or are suspected of having, tuberculosis. The document is intended to engage all care providers in delivering high quality care for patients of all ages, including those with smear-positive, smear-negative, and extra-pulmonary tuberculosis, tuberculosis caused by drug-resistant Mycobacterium tuberculosis complex, and tuberculosis combined with HIV infection.

2.                  Kim WS, Choi JI, Cheon JE, Kim IO, Yeon KM, Lee HJ.  Pulmonary tuberculosis in infants: radiographic and CT findings. AJR Am J Roentgenol. 2006 Oct;187(4):1024-33. 

Department of Radiology, Seoul National University College of Medicine Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.

OBJECTIVE: As complications of tuberculosis are frequent in infancy, correct diagnosis of tuberculosis in infants is important. The purposes of this study are to summarize radiographic and CT findings of pulmonary tuberculosis in infants and to determine the radiologic features frequently seen in infants with this disease. CONCLUSION: Frequent radiologic findings of pulmonary tuberculosis in infants are mediastinal or hilar lymphadenopathy with central necrosis and air-space consolidations, especially masslike consolidations with low-attenuation areas or cavities within the consolidation. Disseminated pulmonary nodules and airway complications are also frequently detected in this age group. CT is a useful diagnostic technique in infants with tuberculosis because it can show parenchymal lesions and tuberculous lymphadenopathy better than chest radiography. CT scans can also be helpful when chest radiographs are inconclusive or complications of tuberculosis are suspected.

3.                  Muzii VF, Mariottini A, Zalaffi A, Carangelo BR, Palma L.  Cervical spine epidural abscess: experience with microsurgical treatment in eight cases. J Neurosurg Spine. 2006 Nov;5(5):392-7. 

Neurosurgical Clinic, University of Siena, Policlinico Santa Maria alle Scotte, Italy. muzii@unisi.it

OBJECT: The authors report a series of eight consecutive cases in which epidural abscesses in the cervical spine were treated by microsurgery without arthrodesis, including two cases of concomitant pyogenic and tubercular infection. METHODS: The authors used a minimally invasive surgical approach consisting of single-level anterior microsurgical discectomy and drainage of the epidural abscess via a silicone catheter, and then initiated antibiotic therapy. At follow-up examination (mean duration 39 months), six patients exhibited complete recovery and two suffered from minor residual deficits. In all cases, spontaneous vertebral fusion occurred. Sagittal alignment was maintained in seven patients, and in one there was slight asymptomatic kyphosis. In two patients, tubercular and pyogenic infections were found. Prior intervention for dental infection was recorded in four cases. CONCLUSIONS: In the absence of preoperative spinal instability, microsurgical drainage of the abscess followed by specific antibiotic therapy resulted in spinal cord decompression and neurological recovery, thereby facilitating spontaneous fusion and vertebral stability. The presence of combined tubercular and pyogenic infections of the cervical spine should be considered, especially in patients whose immune systems are depressed.
 

4.                  Sharma CG, Pradeep AR, Karthikeyan BV.  Primary tuberculosis clinically presenting as gingival enlargement: a case report. J Contemp Dent Pract. 2006 Nov 1;7(5):108-14. 

Periodontics and Implantology, Government Dental College and Hospital, Bangalore, India. dileepsharmacg@rediffmail.com

Tuberculosis is a chronic systemic granulomatous disease which rarely affects the oral cavity. Oral lesions can be either primary or secondary to systemic tuberculosis, the former being rare. This is a never-before reported case of primary tuberculosis presenting as a localized diffuse gingival enlargement in an 11-year-old Indian female patient. The diagnosis was reached through identification of positive histopathological features, Tuberculin test results, presence of anti-tubercular antibodies confirmed by a polymerase chain reaction. In view of the recent increase in the incidence of tuberculosis and the prevalence of the same, it is reasonable to include tuberculosis in the differential diagnosis of gingival enlargements. This is essential to avoid any serious complications for both the clinician and patient due to a delay in the diagnosis of such a rare but plausible oral condition.

5.                  Wang JY, Hsueh PR, Jan IS, Lee LN, Liaw YS, Yang PC, Luh KT.  Empirical treatment with a fluoroquinolone delays the treatment for tuberculosis and is associated with a poor prognosis in endemic areas. Thorax. 2006 Oct;61(10):903-8.

Department of Internal Medicine, National Taiwan University Hospital, No 7, Chun Shan South Road, Taipei, 100, Taiwan.

BACKGROUND: A study was conducted to evaluate the effect of the empirical use of fluoroquinolones on the timing of antituberculous treatment and the outcome of patients with tuberculosis in an endemic area. METHODS: All patients with culture confirmed tuberculosis aged > or =14 years diagnosed between July 2002 and December 2003 were included and their medical records were reviewed. RESULTS: Seventy nine (14.4%) of the 548 tuberculosis patients identified received a fluoroquinolone (FQ group), 218 received a non-fluoroquinolone antibiotic (AB group), and 251 received no antibiotics before antituberculous treatment. Fifty two (65.8%) experienced clinical improvement after fluoroquinolone use. In the FQ group the median interval from the initial visit to starting antituberculous treatment was longer than in the AB group and in those who received no antibiotics (41 v 16 v 7 days), and the prognosis was worse (hazard ratio 6.88 (95% CI 1.84 to 25.72)). More patients in the FQ and AB groups were aged >65 years (53.2% and 61.0% v 31.5%), had underlying disease (53.2% and 46.8% v 34.3%), and were hypoalbuminaemic (67.2% and 64.9% v 35.1%). Of the nine mycobacterial isolates obtained after fluoroquinolone use from nine patients whose initial isolates were susceptible to ofloxacin, one (11.1%) was resistant to ofloxacin (after fluoroquinolone use for 7 days). Independent factors for a poor prognosis included empirical fluoroquinolone use, age >65, underlying disease, hypoalbuminaemia, and lack of early antituberculous treatment. CONCLUSIONS: 14.4% of our patients with tuberculosis received a fluoroquinolone before the diagnosis. With a 34 day delay in antituberculous treatment and more frequent coexistence of underlying disease and hypoalbuminaemia, empirical fluoroquinolone treatment was associated with a poor outcome. Mycobacterium tuberculosis isolates could obtain ofloxacin resistance within 1 week.

Diagnosis, Diagnostics, Immunodiagnosis & Immunodiagnostics:

15574.  Ammari F. Fever of unknown origin in North Jordan. Trop Doct. 2006 Oct;36(4):251-3. 

15575.  Barnes PF.  Weighing gold or counting spots: which is more sensitive to diagnose latent tuberculosis infection? Am J Respir Crit Care Med. 2006 Oct 1;174(7):731-2.

15576.  Belorgey L, Lalani I, Zakaria A.  Ischemic stroke in the setting of tuberculous meningitis. J Neuroimaging. 2006 Oct;16(4):364-6. 

15577.  De Pontual L, Balu L, Ovetchkine P, Maury-Tisseron B, Lachassinne E, Cruaud P, Jeantils V, Valeyre D, Fain O, Gaudelus J.  Tuberculosis in adolescents: A French retrospective study of 52 cases. Pediatr Infect Dis J. 2006 Oct;25(10):930-2.

15578.  Estari M, Krishna Reddy M. Enhancing of tuberculosis disease in HIV infected patients and evaluation of CD4 cell count. J Ecophysiol occup Hlth 2005, 5(3-4), 197-200.

15579.  Garbyal RS, Gupta P, Kumar S; Anshu.  Diagnosis of isolated tuberculous orchitis by fine-needle aspiration cytology. Diagn Cytopathol. 2006 Oct;34(10):698-700.  

15580.  Gopi PG, Subramani R, Kolappan C, Prasad VV, Narayanan PR. Estimation of annual risk of tuberculosis infection among children irrespective of BCG scar in the south zone of India. Indian J Tuberc 2006, 53(1), 7-11.

15581.  Gupta D, Mishra S, Faruqi S, Aggarwal AN. Aetiology and clinical profile of spontaneous pneumothorax in adults. Indian J Chest Dis Allied Sci. 2006 Oct-Dec;48(4):261-4. 

15582.  Iseman MD, Heifets LB.  Rapid detection of tuberculosis and drug-resistant tuberculosis. N Engl J Med. 2006 Oct 12;355(15):1606-8.

15583.  Kobashi Y, Obase Y, Fukuda M, Yoshida K, Miyashita N, Oka M.  Clinical reevaluation of the QuantiFERON TB-2G test as a diagnostic method for differentiating active tuberculosis from nontuberculous mycobacteriosis. Clin Infect Dis. 2006 Dec 15;43(12):1540-6.

15584.  Kumar A, Varshney MK, Trikha V, Khan SA.  Isolated tuberculosis of the coccyx. J Bone Joint Surg Br. 2006 Oct;88(10):1388-9. 

15585.  Marais BJ, Gie RP, Hesseling AC, Schaaf HS, Lombard C, Enarson DA, Beyers N. A refined symptom-based approach to diagnose pulmonary tuberculosis in children. Pediatrics. 2006 Nov;118(5):e1350-9. 

15586.  McCarthy FP, Rowlands S, Giles M.  Tuberculosis in pregnancy - case studies and a review of Australia's screening process. Aust N Z J Obstet Gynaecol. 2006 Oct;46(5):451-5. 

15587.  Murray JF, Pio A, Ottmani S.  PAL: a new and practical approach to lung health. Int J Tuberc Lung Dis. 2006 Nov;10(11):1188-91.

15588.  Oguz A, Karadeniz C, Temel EA, Citak EC, Okur FV. Evaluation of peripheral lymphadenopathy in children. Pediatr Hematol Oncol. 2006 Oct-Nov;23(7):549-61. 

15589.  Omuro AM, Leite CC, Mokhtari K, Delattre JY.  Pitfalls in the diagnosis of brain tumours. Lancet Neurol. 2006 Nov;5(11):937-48. Review. 

15590.  Otaigbe BE, Anochie IC, Gbobo I.  Spontaneous enterocutaneous fistula--A rare presentation of enteric fever. J Natl Med Assoc. 2006 Oct;98(10):1694-6. 

15591.  Polat KY, Aydinli B, Yilmaz O, Aslan S, Gursan N, Ozturk G, Onbas O. Intestinal tuberculosis and secondary liver abscess. Mt Sinai J Med. 2006 Oct;73(6):887-90. 

15592.  Radford AJ, Rothel JS, Jones SL, Sberna G.  Tuberculosis diagnostic tests: sensitivity, specificity, and comparing apples with apples. Am J Respir Crit Care Med. 2006 Oct 15;174(8):953; author reply 953-4. 

15593.  Radford AJ, Rothel JS, Sberna G.  Whole blood IFN-gamma assay for detecting TB in children. Thorax. 2006 Oct;61(10):919-20; author reply 920-1. 

15594.  Salerno D, Gottlieb J, Nguyen C.  Disseminated tuberculosis. Intern Med J. 2006 Oct;36(10):675-6.

15595.  Tsai MS, Hsieh CC, Chen HR, Chen WJ, Huang CH.  Tuberculosis mycobacterium sepsis as a rare cause of out-of-hospital cardiac arrest. Am J Emerg Med. 2006 Oct;24(6):755-6.

15596.  Venter R, Clarke DL.  A giant abdominal mass and the master of disguise - what would Hamilton Bailey have said? S Afr Med J. 2006 Oct;96(10):1046.

15597.  Vijayasekaran D, Kumar RA, Gowrishankar NC, Nedunchelian K, Sethuraman S. Mantoux and contact positivity in tuberculosis. Indian J Pediatr. 2006 Nov;73(11):989-93.

Therapy:

15598.  Ashkin D, Julien J, Lauzardo M, Hollender E.  Consider rifampin BUT be cautious. Chest. 2006 Dec;130(6):1638-40.

15599.  Dennison P, Rajakaruna G.  Cerebral tuberculoma. Thorax. 2006 Oct;61(10):922.

15600.  Gie RP.  Childhood tuberculosis mainstreamed into National Tuberculosis Programs. Int J Tuberc Lung Dis. 2006 Oct;10(10):1067.

15601.  Jubelt B.  Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. Curr Neurol Neurosci Rep. 2006 Nov;6(6):451-2.

15602.  Koc S, Beydilli G, Tulunay G, Ocalan R, Boran N, Ozgul N, Kose MF, Erdogan Z.   Peritoneal tuberculosis mimicking advanced ovarian cancer: a retrospective review of 22 cases. Gynecol Oncol. 2006 Nov;103(2):565-9.

15603.  Kong A, Koukourou A, Boyd M, Crowe G.  Metastatic adenocarcinoma mimicking 'target sign' of cerebral tuberculosis. J Clin Neurosci. 2006 Nov;13(9):955-8. 

15604.  Meher R, Singh I, Yadav SP, Gathwala G.  Tubercular otitis media in children. Otolaryngol Head Neck Surg. 2006 Oct;135(4):650-2.

15605.  Mehta S.  The treatment of ocular tuberculosis: a survey of published literature. Indian J Ophthalmol. 2006 Dec;54(4):278-80. Review. 

15606.  Ohene-Yeboah M.  Case series of acute presentation of abdominal TB in Ghana. Trop Doct. 2006 Oct;36(4):241-3. 

15607.  Olle-Goig JE.  Editorial: the treatment of multi-drug resistant tuberculosis--a return to the pre-antibiotic era? Trop Med Int Health. 2006 Nov;11(11):1625-8.

15608.  Saltini C.  Schedule or dosage? The need to perfect intermittent regimens for tuberculosis. Am J Respir Crit Care Med. 2006 Nov 15;174(10):1067-8.

15609.  Smati B, Boudaya MS, Ayadi A, Ammar J, Djilani H, El Mezni F, Kilani T.  Tuberculosis of the trachea. Ann Thorac Surg. 2006 Nov;82(5):1900-1.