Cases reported "Tuberculosis, Miliary"

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1/12. Clinical and genetic heterogeneity of inherited autosomal recessive susceptibility to disseminated mycobacterium bovis bacille calmette-guerin infection.

    Five patients from 4 unrelated Tunisian families who presented with disseminated neonatal infection by mycobacterium bovis bacille Calmette-Guerin strain were investigated. Two unrelated patients had different homozygous interleukin-12 receptor beta1 subunit gene splice-site mutations (64 5G-->A and 550-2A-->G). Two siblings and 1 unrelated patient, all of whom were from the same town, carried the same mutation (297del8) within the interleukin-12p40 gene. This is the first description of familial cytokine deficiency reported so far. All patients had complete lack of expression of the affected polypeptide and a profound deficiency of in vitro interferon-gamma production. The clinical severity of the mycobacterial infection was heterogeneous, even among affected members of the same family, which suggests the intervention of modifying genes.
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ranking = 1
keywords = calmette-guerin, bovis
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2/12. Miliary tuberculosis with positive acid-fast bacilli in a pediatric patient.

    CONTEXT: Tuberculosis is an important public health issue. The Brazilian government reported 78,460 new cases in 1999. Miliary tuberculosis is a severe form of this disease. OBJECTIVE: To report on an uncommon clinical presentation of miliary tuberculosis in a child. CASE REPORT: A 5-year old boy presented in the emergency room with fatigue and weight loss. He had had staphylococcus aureus pneumonia 7 months before. Chest radiography revealed lobar consolidation and miliary pattern associated with small cavities in both upper lobes. Antibiotic therapy was started. The sputum was positive for acid-fast bacilli and hence the treatment recommended for tuberculosis (rifampicin, isoniazid [INH], pyrazinamide) was started. The patient was treated for 9 months and at the end of the follow-up period he had made a complete clinical recovery. CONCLUSION: Although in some particular cases sputum can be positive for acid-fast bacilli in children, limitations to the sputum test have forced pediatricians to base tuberculosis diagnosis on epidemiological data, clinical findings and radiographic pattern. In this particular case, we hypothesize that the sputum bacillus test was positive because bacilli grew inside residual pneumatoceles that were produced during previous pneumonia.
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ranking = 0.18715504324742
keywords = bacillus
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3/12. Miliary mycobacterium bovis induced by intravesical bacille Calmette-Guerin immunotherapy.

    Intravesical instillation of bacille Calmette-Guerin (BCG), an attenuated strain of mycobacterium bovis, is the treatment of choice for many patients with bladder cancer. In a small percentage, this therapy is associated with systemic side effects including pneumonitis. It is uncertain whether these systemic manifestations are due to dissemination of infection or due to hypersensitivity, an etiologic distinction that has important therapeutic implications. We report the first case in which miliary M. bovis was proven to be the responsible mechanism, by culture of M. bovis biovar BCG from a transbronchial lung biopsy and complete resolution on anti-tuberculous chemotherapy.
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ranking = 0.12763286412986
keywords = bovis
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4/12. Enlarged cervical lymph nodes and elevated liver chemistry tests: a therapeutic dilemma.

    We describe the case of a 36-years-old male patient, originating from india, who presented with enlarged cervical lymph nodes and elevated liver chemistry tests. Histologically necrosing granulomas were observed in the lymph nodes, and PCR revealed dna from mycobacterium tuberculosis. However, in the liver biopsy granulomatous hepatitis without central necrosis was seen. With a positive PCR for mycobacteria from liver tissue and no evidence for other hepatic diseases we started drug treatment with standard quadruple regimen consisting of isoniazid, rifampicin, ethambutol, and pyrazinamide. Five days after onset of therapy, liver chemistry tests rose 10-fold, forcing us to interrupt treatment. Gradual step-wise re-exposition with the same medication after return of liver chemistry tests to baseline was well tolerated without any further side effects. liver involvement of tuberculosis can have many facets and may be treated by gradual dosing of standard drugs.
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ranking = 0.14008509260259
keywords = mycobacterium
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5/12. Miliary tuberculosis due to intravesical bacillus Calmette-Guerin therapy.

    While receiving treatment for bladder carcinoma with intravesical BCG, a 78-year-old man developed a clinical illness and roentgenographic manifestation of miliary tuberculosis. The transbronchial lung biopsy demonstrated granulomas with giant cells. Treatment with antituberculosis therapy resulted in complete resolution of the illness. The pathogenesis of this complication was considered to be due to pulmonary infection by BCG from the bladder source and differs from previously reported cases of interstitial pulmonary infiltrates which more likely represent a hypersensitivity reaction to BCG.
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ranking = 0.74862017298966
keywords = bacillus
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6/12. Disseminated mycobacterium bovis infection in an elderly patient.

    We report a fatal case of disseminated infection due to mycobacterium bovis occurring in an elderly patient. The greatest incidence of tuberculosis is in the aged, who were likely to have been infected in childhood when the disease was more prevalent. However, the clinical or radiographic presentation of tuberculosis in the older patient may be atypical or nonspecific, contributing to delay in diagnosis, and greater morbidity and mortality.
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ranking = 0.091166331521332
keywords = bovis
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7/12. Miliary tuberculosis in an in-vitro fertilization pregnancy: a case report.

    A 33-yr-old woman with primary infertility of no known cause of 10 years duration underwent in-vitro fertilization. Mild flu-like symptoms and intermittent vaginal bleeding developed, and miliary mottling was seen throughout both lung fields. At 14 weeks she aborted a normal male fetus; urine culture was positive for M. bovis. Six months later, after a course of antituberculous drugs, the patient was symptom-free.
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ranking = 0.018233266304266
keywords = bovis
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8/12. mycobacterium bovis infection of the conjunctiva.

    An elderly woman from minnesota had bilateral bulbar conjunctival nodules that proved to be caused by mycobacterium bovis. She was found to have active military tuberculosis; only pulmonary and ocular involvement was confirmed. She had a history of tuberculosis but no recent exposure or intercurrent illness. The case was unusual in that the endogenous infection caused bilateral bulbar symptoms but no palpable lymphadenopathy and no other organ involvement. This case demonstrates many of the basic tenents on the course of tuberculosis in humans. Triple chemotherapy was administered, and the patient had a slow but definite clinical response.
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ranking = 0.091166331521332
keywords = bovis
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9/12. False positive widal reaction in high-titer disseminated BCG infection.

    False-positive Widal reactions following certain non-typhoid salmonella infections may occur commonly. The case of a patient who developed miliary tuberculosis secondary to intravesical bacillus Calmette-Guerin (BCG) immunotherapy for bladder carcinoma is described. Very high titers of typhoid and paratyphoid agglutinins were obtained with the Widal test; these titers returned to normal after successful anti-tuberculous treatment. This case of high-titer, false-positive salmonella typhi and salmonella paratyphi a and B reactions to BCG infection occurred in an area non-endemic for typhoid or paratyphoid fever.
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ranking = 0.18715504324742
keywords = bacillus
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10/12. Pulmonary miliary tuberculosis and T-cell abnormalities in a severe combined immunodeficient patient reconstituted with haploidentical bone marrow transplantation.

    We report the development of miliary tuberculosis in a 7-year-old boy with severe combined immunodeficiency (SCID), whose immune system had been only partially reconstituted by haploidentical bone marrow transplantation. Although alpha beta and gamma delta T cells were of donor origin, alpha beta T cells in this patient showed defective interleukin-2 (IL-2) production, impaired IL-2 responsiveness and decreased cytolytic activity. However, gamma delta T cells could exhibit enough cytolytic activity after incubation with IL-2. Despite the presence of disseminated infection, c-reactive protein (CRP) remained negative. IL-2 therapy aggravated the disseminated tuberculosis though gamma delta T cells were supposed to be activated, and concurrently CRP became positive. These findings suggest that gamma delta T cells have no more than limited immunological roles in mycobacterium tuberculosis infection.
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ranking = 0.14008509260259
keywords = mycobacterium
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