1/60. Fulminant lethal tuberculous pneumonia (sepsis tuberculosis gravissima) with ARDS in a non-immunocompromised western European middle-aged man.We report the case of a 42 years old, non-immunocompromised native Austrian living in Vienna. He presented at home with severe dyspnea and had to be intubated immediately. Shortly after hospital admission, he developed severe adult respiratory distress syndrome (ARDS) and septic shock with massive, bilobar patchy to confluent infiltrations and a need for norepinephrine. A CT-scan revealed severe loss of functional lung tissue with areas of consolidation and multiple communicating cystic spaces. air leaking into the mediastinum through fistulas produced pneumomediastinum, pneumoperitoneum, and a massive soft tissue emphysema. bronchoalveolar lavage performed within the first 24 hours of admission revealed of acid-fast bacilli. Even though appropriate tuberculostatic medication was started immediately, the patient succumbed the next day to ARDS due to massive tuberculous pneumonia and miliary disease (sepsis tuberculosis gravissima).- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
2/60. mycobacterium tuberculosis infection masquerading as diffuse alveolar hemorrhage after autologous stem cell transplant.We report a fatal case of pulmonary tuberculosis masquerading as diffuse alveolar hemorrhage after autologous stem cell transplant.- - - - - - - - - - ranking = 5keywords = alveolar (Clic here for more details about this article) |
3/60. pneumocystis carinii pneumonia (PCP) at Ga-Rankuwa Hospital.pneumocystis carinii is recognized as one of the leading causes of death in AIDS patients in developed countries but its role in this regard in developing countries appears to be less prominent. Sub-Saharan African countries, in spite of their high hiv prevalence, have hardly recorded any cases. We report the first microbiologically proven case of PCP in an adult patient at Ga-Rankuwa Hospital. A 37 year old African woman was referred to Ga-Rankuwa Hospital from the local clinic for chest infection with a non productive cough that had not responded to conventional treatment. On admission, she was febrile, emaciated and in respiratory distress with oral thrush. Chest radiography showed diffuse bilateral infiltrations and a preliminary diagnosis of atypical pneumonia and tuberculosis was made. The patient was begun on penicillin, gentamicin, contrimoxazole and anti-tuberculosis therapy. Laboratory investigations revealed a low haemoglobin, positive hiv test (after counselling) and pneumocystis carinii trophozoites and cytes in the bronchoalveolar larvage specimen. In spite of appropriate treatment the patient died within three days. One wonders whether the outcome for this middle aged woman with advanced hiv infection would have been different had appropriate cotrimoxazole therapy been administered at the primary health care centre. It must be noted that PCP may no longer be a rare disease in sub-Saharan countries and intensive investigations should be carried out to avoid losing patients with treatable infectious diseases.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
4/60. Persistent tuberculosis or specimen contamination?Cross-contamination during sequential processing of sputum specimens from different patients causes false-positive growth of mycobacterium tuberculosis in culture. We describe an unusual case of cross-contamination in a 36-year-old man with acquired immunodeficiency syndrome and possible persistent tuberculosis. culture with 1 of 3 sputum specimens was positive for rifampin-susceptible M tuberculosis. review of processing revealed that his single culture-positive sputum specimen had followed a sputum specimen from another patient with active pulmonary tuberculosis that was positive in culture for M tuberculosis resistant to rifampin. Molecular strain typing by restriction fragment length polymorphism demonstrated the 2 isolates to be an identical strain of M tuberculosis. agar proportion susceptibility testing of the rifampin-resistant isolate revealed low numbers of resistant organisms in a range of 1.5% to 3.3%. It was concluded that rifampin-susceptible organisms that constituted approximately 98% of the resistant isolate contaminated sputum from the patient with possible persistent tuberculosis. His culture result was, therefore, considered false positive, not an indication of tuberculosis.- - - - - - - - - - ranking = 0.018952814643701keywords = process (Clic here for more details about this article) |
5/60. Tuberculous pneumonia complicating lung transplantation: case report and review of the literature.Although tuberculosis is more common in transplant recipients than in the general population, most centres report that mycobacterial infection is very rare in comparison with the extreme variety of transplant-associated infections. Only 18 previous cases of tuberculosis-complicated lung or heart-lung transplants have been published. An unusual case is reported of mycobacterium tuberculosis infection in a double-lung recipient who presented a radiographic feature of segmental pneumonia, mimicking a bacterial infection. bronchoalveolar lavage revealed lymphocytosis (> 30% of isolated cells). Data regarding optimal treatment for tuberculosis in lung transplant recipients are limited. Nevertheless, therapy should not be different from that in other immunocompromised patients and should include an aggressive initial four-drug regimen (until the sputum cultures become negative) or a 6-month conventional therapy with two agents to which the organism is susceptible. Close follow-up is required to confirm the bacteriological response and minimize the likelihood of relapse. In this patient, treatment with a four-drug antituberculous regimen for 3 months followed by isoniazide and rifampicin for an additional 9 months was curative.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
6/60. Pulmonary tuberculosis with unusual cystic change in an immunocompromised host.We present a rare case of upper zone cystic change of the lung with disseminated tuberculosis of a non-smoking 30-year-old immunocompromised male. He suffered from repeated pneumothorax. The basic pathological feature of video-assisted thoracoscopic lung biopsy revealed granulomatous involvement in the respiratory bronchioles with poorly developed epithelioid cells and disruption of elastic fibers. Electron microscopy demonstrated a decrease in elastic fibers and disruption of the epithelial basement membrane of the respiratory bronchiole and no langerhans cells in the lesion. autopsy of the lung revealed centroacinar distribution of multiple cystic lesions in the bilateral upper lobe. Almost all cystic walls showed loss of elastic fibers and cysts frequently involved the respiratory and terminal bronchioles, alveolar ducts and, occasionally, alveoli. Some larger cystic lesions revealed communication to the bronchi. The cystic changes in this case of pulmonary tuberculosis may be caused by a check-valve mechanism due to granulomatous involvement of the bronchioles and also by excavation of caseous necrotic material by draining bronchi.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
7/60. Transmission of mycobacterium tuberculosis from medical waste.CONTEXT: washington State has a relatively low incidence rate of tuberculosis (TB) infection. However, from May to September 1997, 3 cases of pulmonary TB were reported among medical waste treatment workers at 1 facility in washington. There is no previous documentation of mycobacterium tuberculosis transmission as a result of processing medical waste. OBJECTIVE: To identify the source(s) of these 3 TB infections. DESIGN, SETTING, AND PARTICIPANTS: Interviews of the 3 infected patient-workers and their contacts, review of patient-worker medical records and the state TB registry, and collection of all multidrug-resistant TB (MDR-TB) isolates identified after January 1, 1995, from the facility's catchment area; dna fingerprinting of all isolates; polymerase chain reaction and automated DNA sequencing to determine genetic mutations associated with drug resistance; and occupational safety and environmental evaluations of the facility. MAIN OUTCOME MEASURES: Previous exposures of patient-workers to TB; verification of patient-worker tuberculin skin test histories; identification of other cases of TB in the community and at the facility; drug susceptibility of patient-worker isolates; and potential for worker exposure to live M tuberculosis cultures. RESULTS: All 3 patient-workers were younger than 55 years, were born in the united states, and reported no known exposures to TB. We did not identify other TB cases. The 3 patient-workers' isolates had different DNA fingerprints. One of 10 MDR-TB catchment-area isolates matched an MDR-TB patient-worker isolate by DNA fingerprint pattern. DNA sequencing demonstrated the same rare mutation in these isolates. There was no evidence of personal contact between these 2 individuals. The laboratory that initially processed the matching isolate sent contaminated waste to the treatment facility. The facility accepted contaminated medical waste where it was shredded, blown, compacted, and finally deactivated. Equipment failures, insufficient employee training, and respiratory protective equipment inadequacies were identified at the facility. CONCLUSION: Processing contaminated medical waste resulted in transmission of M tuberculosis to at least 1 medical waste treatment facility worker. JAMA. 2000;284:1683-1688.- - - - - - - - - - ranking = 0.018952814643701keywords = process (Clic here for more details about this article) |
8/60. Hard metal lung disease--the first case in singapore.INTRODUCTION: We report the first case of hard metal lung disease in singapore and the occupational investigative work and control measures that were undertaken. CLINICAL PICTURE: A 38-year-old machinist in the tool manufacturing industry presented with exertional dyspnoea and cough. Chest X-ray revealed bilateral reticulonodular infiltrates with honeycombing. High resolution computed tomography scan of the thorax confirmed the presence of interstitial fibrosis. Open biopsy of the lung showed features of pneumoconiosis. Particle induced X-ray emission (PIXE) analysis, a relatively new elemental analysis technique, performed on the lung biopsy specimen confirmed the presence of tungsten and titanium; and he was diagnosed to have hard metal lung disease. Microbiologic, serologic and histologic investigations excluded an infective cause. Serial pulmonary function tests on follow-up showed no progression. He presented with haemoptysis 10 months later and was diagnosed to have tuberculosis on the basis of positive sputum and bronchoalveolar lavage cultures for mycobacterium tuberculosis complex. TREATMENT: Preventive measures and permanent transfer to non-cobalt work were instituted. OUTCOME: The interstitial fibrosis appears to have stabilised. CONCLUSION: The diagnosis of hard metal lung disease must be considered in a worker exposed to cobalt presenting with interstitial fibrosis.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
9/60. The rapid diagnosis of smear-negative pulmonary tuberculosis: a cost-effectiveness analysis.OBJECTIVE: The prompt diagnosis of smear-negative pulmonary tuberculosis (PTB) is a clinical challenge. It may be achieved by a number of tests which have varying accuracies, costs and degrees of invasiveness. The objective of this study was to compare the cost-effectiveness of clinical judgement (empirical), the Roche Cobas amplicor assay for mycobacterium tuberculosis (amplicor), acid-fast staining of bronchoalveolar lavage specimens (BAL), nucleic acid amplification tests of bronchoalveloar lavage specimens for M. tuberculosis (BAL NAA), computed tomography (CT) and amplicor assay followed by BAL. METHODOLOGY: The range of predictive values of the various strategies were derived from published data and a new study of 441 consecutive adult patients with suspected smear-negative PTB prospectively stratified into three pretest risk groups: low, intermediate and high. The cost-effectiveness was evaluated with a decision tree model (DATA software). RESULTS: The incidence of PTB was 5.7% (4% culture positive) for the whole group, 95% in the high-risk group, 0.9% in the low-risk group and 3.4% in the intermediate-risk group. The sensitivity of the empirical approach was 49% and of the amplicor assay was 44%. Patient outcomes were expressed as life expectancy for the base case of a 58-year-old man with a pretest probability of 5.7%. At this low pretest risk the differences in life expectancies between tests was < 0.1 years and the empirical approach incurred the lowest cost. Sensitivity analysis at increasing pretest risks showed better life expectancies (approximately 1 years) for CT scan and test combinations than empirical and amplicor for additional costs of US$243-US$309. bronchoalveolar lavage had the worst overall cost-effectiveness. CONCLUSIONS: We conclude that the pretest risk of active PTB was a key determinant of test utility; that the AMPLICOR assay was comparable to clinical judgement; that BAL was the least useful test; and that with increasing risks, CT scan and test combinations performed better. Further studies are needed to better define patients with intermediate risk for PTB and to directly compare the cost-effectiveness of more sensitive nucleic acid amplification tests such as the enhanced Gen Probe, CT scan and test combinations/sequences in these patients.- - - - - - - - - - ranking = 2keywords = alveolar (Clic here for more details about this article) |
10/60. Epiglottic tuberculosis: differential diagnosis and treatment. Case report and review of the literature.A case of a 40-year-old man with tuberculous involvement of the epiglottis suffering from unsuspected pulmonary tuberculosis is described. The laryngeal lesions were primarily considered to be highly suspicious for a neoplastic process rather than an infectious one. After diagnosis, the patient was treated according a standard protocol and followed up for a period of 2 years. He is still free of disease. The clinical presentation, diagnosis, pathological findings, and therapy of the condition are described. The differential diagnosis and management of epiglottic tuberculosis are reviewed and discussed. Even though these cases are rare, otorhinolaryngologists should keep in mind the possibility of tuberculosis in the differential diagnosis of laryngeal tumors, as the incidence of tuberculosis in developed countries is steadily increasing.- - - - - - - - - - ranking = 0.0094764073218504keywords = process (Clic here for more details about this article) |
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