Some selected abstract:

Afzal A, Arshad M, Ashraf O. Psoas abscess secondary to Pott's disease--an unusual presentation in a young child. J Pak Med Assoc. 2006 Apr;56(4):191-2.

Medical College, Aga Khan University, Karachi.

Psoas abscess in neonates and infants are rare. Primary psoas abscesses are said to be more common in young children. Limping, fever and abdominal pain has been described to be the way psoas abscesses usually present. The authors describe the unusual presentation and successful treatment of a young child with a unilateral psoas abscess secondary to advanced spondylodiscitis.
 

Bera S, Shende N, Kumar S, Harinath BC. Detection of antigen and antibody in childhood tuberculous                   meningitis. Indian Journal of Pediatrics, Aug 2006; 73:675-679

Department of Biochemistry & Jamnalal Bajaj Tropical Disease Research Centre, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India

Objective. Mycobacterium tuberculosis excretory secretory 31 kDa, a serine protease antigen (M. tb ES-31), prepared from Mycobacterium tuberculosis H[37]Ra culture medium has been shown to have potential in detecting tuberculosis. Precise diagnosis and management of tuberculous meningitis, in children in particular, is essential to curtail mortality and morbidity. Methods. In this study, M. tb ES-31 antigen, was used in Indirect ELISA to detect tuberculous IgG antibody, in sera and CSF samples while affinity purified anti ES-31 goat antibody was used in sandwich ELISA for detection of tuberculous antigen. In sixty-five samples each of CSF and sera from cases with neurotuberculosis and control with non-tuberculous diseases were collected from Kasturba Hospital, Sevagram. Results. Among the 20 patients suffering from neurotuberculosis the IgG antibody was detected in 17(85%) of CSF and 16(80%) of sera samples, while antigen was detected in 18 (90%) in CSF and 16 (80%) in sera. Overall specificity of the assay for both IgG antibody and antigen detection in CSF was 96% while in sera it was 94% for IgG antibody and 96% for antigen detection. Conclusion. This study showed the usefulness of mycobacterial serine protease antigen and its antibody in detecting neurotuberculosis.
 

Kalkan A, Serhatlioglu S, Ozden M, Denk A, Demirdag K, Yilmaz T, Kilic SS.  Paradoxically developed optochiasmatic tuberculoma and tuberculous lymphadenitis: a case report with 18-month follow up by MRI. South Med J. 2006 Apr;99(4):388-92.

Department of Infectious Diseases, Radiology, Immunology and Ophthalmology, Firat University Medical School, Elazig, TR23119 Turkey. akalkan61@hotmail.com

We report the first case ofextracranial tuberculous lymphadenitis which paradoxically developed during treatment of intracranial tuberculoma. Our patient, a 15-year-old girl who initially presented with meningitis and intracranial tuberculomas, developed extracranial tuberculomas during treatment for central nervous system tuberculosis. She was followed clinically with cerebrospinal fluid (CSF) studies and magnetic resonance imaging (MRI) at three monthly intervals. Within 18 months of specific antituberculous treatment, the patient had fully recovered. The course and response to therapy are discussed in light of the current literature.
 

Kim HJ, Lee HJ, Kwon SY, Yoon HI, Chung HS, Lee CT, Han SK, Shim YS, Yim JJ. The prevalence of pulmonary parenchymal tuberculosis in patients with tuberculous pleuritis. Chest. 2006 May;129(5):1253-8.

Division of Pulmonary and Critical Care Medicine, Department of Medicine and Lung Institute, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Gu, Seoul, 110-744, South Korea.

STUDY OBJECTIVE: To examine the prevalence and characteristics of parenchymal tuberculous pleuritis in adult patients. DESIGN: Prospective cohort study. SETTING: Three hospitals affiliated with Seoul National University in South Korea. PATIENTS: All patients > 15 years old with a diagnosis of tuberculous pleuritis were enrolled prospectively between January 1, 2004, and October 31, 2004. INTERVENTIONS: Diagnostic thoracocentesis and CT of the chest were done for each patient. Acid-fast bacilli (AFB) smears and cultures for Mycobacterium tuberculosis were requested if patients produced any sputum. A board-certified radiologist reviewed the chest radiographs for the presence and characteristics of any lesions. MEASUREMENTS AND RESULTS: One hundred six patients with tuberculous pleuritis were enrolled (median age, 53 years; range 16 to 89 years). Among them, 33 patients (31%) had sputum or bronchial washing findings positive for AFB smears or for M tuberculosis by culture. Lung parenchymal lesions were observed in 91 of the patients (86%) using chest CT; 39 patients (37%) with parenchymal lesions had radiographic characteristics of active pulmonary tuberculosis. In total, 62 patients (59%) had bacteriologically or radiographically active pulmonary tuberculosis. In addition, 78 patients (74%) had features of reactivated pulmonary tuberculosis. CONCLUSIONS: Lung parenchymal lesions were more common in this series of patients with tuberculous pleuritis than has been reported in previous studies. The patients mostly had radiographic features of reactivated, rather than primary, tuberculosis.
 

Marais BJ, Gie RP, Schaaf HS, Beyers N, Donald PR, Starke JR. Childhood pulmonary tuberculosis: old wisdom and new challenges. Am J Respir Crit Care Med. 2006 May 15;173(10):1078-90. Review.

Department of Paediatrics and Child Health, Desmond Tutu Tuberculosis Centre, Faculty of Health Sciences, Stellenbosch University, P.O. Box 19063, Tygerberg 7505, South Africa. bjmarais@sun.ac.za

Childhood tuberculosis is neglected in endemic areas with resource constraints, as children are considered to develop mild forms of disease and to contribute little to the maintenance of the tuberculosis epidemic. However, children contribute a significant proportion of the disease burden and suffer severe tuberculosis-related morbidity and mortality, particularly in endemic areas. This review provides an overview of well-documented concepts and principles, and demonstrates how this "old wisdom" applies to current and future challenges in the field of childhood tuberculosis; the aim was to articulate some of the most pressing issues, to provide a rational framework for discussion, and to stimulate thought and further scientific study. The prechemotherapy literature that described the natural history of disease in children identified three central concepts: (1) the need for accurate case definitions, (2) the importance of risk stratification, and (3) the diverse spectrum of disease pathology, which necessitates accurate disease classification. The relevance of these concepts and their application to pertinent issues such as the diagnosis of childhood tuberculosis are discussed. The concepts are also linked to the basic principles of antituberculosis treatment, providing a simplified approach to the diagnosis and treatment of childhood tuberculosis that is independent of resource constraints. The main challenges for future research are highlighted and in conclusion it is emphasized that the infrastructure provided by the directly observed therapy, short-course strategy, combined with well-targeted interventions, slightly improved resources, and greatly improved political commitment, may lead to a dramatic reduction in tuberculosis-related morbidity and mortality among children.
 

Sah SP, Bhadani PP, Regmi R, Tewari A, Raj GA. Fine needle aspiration cytology of tubercular epididymitis and epididymo-orchitis. Acta Cytol. 2006 May-Jun;50(3):243-9.

Department of Pathology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal. sah_sp@yahoo.com

OBJECTIVE: To study the role of fine needle aspiration cytology (FNAC) and ancillary studies in the diagnosis of tubercular epididymitis or epididymo-orchitis. STUDY DESIGN: Forty patients with tubercular epididymitis or epididymoorchitis diagnosed on FNAC underwent a detailed clinical workup, imaging and microbiologic studies before being started on antitubercular treatment (ATT). One patient underwent orchiectomy. RESULTS: Clinically, the disease presented in patients of all ages usually as a scrotal swelling or rarely as a scrotal sinus (3) or abscess (3) or as part of disseminated tuberculosis (2). Three patients gave a history of previous tuberculosis. Scrotal sonography confirmed the involvement of the epididymis, testis or spermatic cord in each case. FNAC was diagnostic in 27 aspirates (epithelioid cell granulomas with caseation) but nondiagnostic in the rest. Tubercular etiology was confirmed directly by detection of acid-fast bacilli (AFB) on FNA smears in 24 (60%) patients and urine samples in 11 and indirectly in 9 patients with negative AFB by using a combination of a positive Mantoux test (5 of 9), presence of caseating granulomas on FNA smears (7 of 9) and therapeutic response to ATT (9 of 9). CONCLUSION: FNA as a minimally invasive technique plays a prime role in the diagnosis of tubercular epididymitis and epididymoorchitis. It provides adequate material for cytologic and microbiologic examination and helps to avoid unnecesary orchiectomy.
 

Shome D, Honavar SG, Vemuganti GK, Joseph J. Orbital tuberculosis manifesting with enophthalmos and causing a diagnostic dilemma. Ophthal Plast Reconstr Surg. 2006 May-Jun;22(3):219-21.

Department of Ophthalmic Plastic Surgery, Orbit and Ocular Oncology, LV Prasad Eye Institute, Hyderabad, India.

A 60-year-old woman with no known systemic disease was referred with a hard mass in the left orbit and enophthalmos of two months duration. Differential diagnoses of metastasis from an undetected scirrhous carcinoma and sclerosing nonspecific orbital inflammatory disease were considered and a biopsy was performed. Histopathology demonstrated granulomatous inflammation with fibrosis. Subsequent polymerase chain reaction was positive for Mycobacterium tuberculosis deoxyribonucleic acid. There was no evidence of systemic tuberculosis. The patient was treated with four-drug combination anti-tubercular therapy for 6 months. The mass regressed and there was no local recurrence at two years follow-up. Orbital tuberculosis generally manifests with proptosis or osteomyelitis. However, enophthalmos may be caused by the fibrosing variant. Biopsy with histopathologic and microbioloic evaluation is essential to distinguish it from other more common causes of an orbital mass with paradoxical enophthalmos such as metastatic scirrhous carcinoma and sclerosing nonspecific orbital inflammatory disease.
 

Diagnosis, diagnostics, Immunodiagnosis & Immunodiagnostics:

14893.  Beckford-Ball J. NICE guidelines to improve TB management and prevention. Nurs Times. 2006 May 9-15;102(19):19-20.

14894.  Campbell IA, Bah-Sow O. Pulmonary tuberculosis: diagnosis and treatment. BMJ. 2006 May 20;332(7551):1194-7. Review.   

14895.  Deogaonkar M, Das S. Isolated spinal intramedullary tuberculoma in a healthy immunocompetent adult. Int J Infect Dis. 2006 May;10(3):266-7.      

14896.  Duan SY, Zhang DT, Lin QC, Wu YH. Clinical value of CT three-dimensional imaging in diagnosing gastrointestinal tract diseases. World J Gastroenterol. 2006 May 14;12(18):2945-8.

14897.  Geisinger KR. Tubercular scrotal disease. Acta Cytol. 2006 May-Jun;50(3):241-2.

14898.  Khalid SK, Jassim O. Images in clinical medicine. Scrofula. N Engl J Med. 2006 May 4;354(18):e18.   

14899.  Meyer S, Struffert T, Gottschling S. Tuberculous meningitis. Lancet 2006 20;367(9523):1682.

14900.  Pommerville PJ, Zakus P, van der Westhuizen N, Kibsey PC. Tuberculosis of the bladder without previous renal infection. Can J Urol. 2006 Apr;13(2):3044-6.

14901.  Shome D, Honavar SG, Vemuganti GK, Joseph J. Orbital tuberculosis manifesting with enophthalmos and causing a diagnostic dilemma. Ophthal Plast Reconstr Surg. 2006 May-Jun;22(3):219-21.

14902.  Street I, Gillett D, Sawyer A, Weighill J. Laryngeal tuberculosis: not the usual suspect. Br J Hosp Med (Lond). 2006 Apr;67(4):212-3. Review.   

14903.  Todd B. The QuantiFERON-TB Gold Test: a new blood assay offers a promising alternative in tuberculosis testing. Am J Nurs. 2006 Jun;106(6):33-4, 37.    

Therapy:

14904.  Brody H. Confronting a colleague who covers up a medical error. Am Fam Physician. 2006 Apr 1;73(7):1272, 1274.

14905.  Cho KD, Cho DG, Jo MS, Ahn MI, Park CB. Current surgical therapy for patients with tuberculous abscess of the chest wall. Ann Thorac Surg. 2006 Apr;81(4):1220-6.

14906.  Cho YS, Lee HS, Kim SW, Chung KH, Lee DK, Koh WJ, Kim MG.   Tuberculous otitis media: a clinical and radiologic analysis of 52 patients. Laryngoscope. 2006 Jun;116(6):921-7.

14907.  Rajapakse CD, Shingadia D. Tuberculous pyomyositis of the left quadratus lumborum. Arch Dis Child. 2006 Jun;91(6):512

14908.  Wasay M.  Central nervous system tuberculosis and paradoxical response. South Med J. 2006 Apr;99(4):331-2.  

14909.  Zasloff M.  Fighting infections with vitamin D. Nat Med. 2006 Apr;12(4):388-90.