Cases reported "Tuberculosis, Pulmonary"

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11/928. Tubulointerstitial nephritis associated with minimal self reexposure to rifampin.

    We report the case of a 27-year-old Asian man who self-medicated with two capsules of rifampin 1 year after completing a continuous course of chemotherapy for tuberculosis that included that drug. He developed flank pain and edema and presented with uremia requiring dialysis; despite this, he had a serum potassium of only 3.5 mEq/L. Renal biopsy showed interstitial infiltrate with inflammation of the tubules. Renal function began to improve after a 3-week course of prednisone. This case is remarkable for the severity of the renal failure despite such a minimal self-exposure.
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ranking = 1
keywords = tuberculosis
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12/928. 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.
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ranking = 5
keywords = tuberculosis
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13/928. Active tuberculosis in a deployed field hospital.

    During the deployment of U.S. troops to the former Republic of yugoslavia in support of Operation Joint Endeavor and the Dayton Peace Accords from December 1995 to December 1996, members of a deployed field hospital were exposed to a case of active tuberculosis from a local civilian worker. tuberculin skin testing of civilian contacts of the index patient revealed 76% reactivity. Testing of exposed unit members revealed a 1.3% conversion rate upon redeployment, versus a 2.0% conversion rate for redeployed soldiers as a whole. More importantly, tuberculin skin testing of locally hired civilian workers as a whole revealed a 44% background positive rate, raising significant force-protection concerns and highlighting the role of occupational medicine and the need for screening of civilian employees in operations other than war.
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ranking = 5
keywords = tuberculosis
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14/928. Transcontinental spread of multidrug-resistant mycobacterium bovis.

    Globally, the proportion of all cases of tuberculosis (TB) caused by drug-resistant strains is increasing. We report the case of a Canadian citizen who acquired a highly drug-resistant strain of mycobacterium bovis while visiting a relative with AIDS-related tuberculosis in spain. The origin of the strain was traced using spoligotyping, a polymerase chain reaction (PCR)-based fingerprint technology, and the European dna database. The level of primary drug resistance-all five first-line drugs and 19 of 21 second-line drugs-in this case was unprecedented in canada. Isolation of this strain from a Canadian citizen represents the first report of its appearance in this hemisphere. The infection was contained and combined medical-surgical treatment delivered.
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ranking = 2
keywords = tuberculosis
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15/928. Simultaneous infection with two strains of mycobacterium tuberculosis identified by restriction fragment length polymorphism analysis.

    Simultaneous infection with two different strains of mycobacterium tuberculosis has been demonstrated using phage typing. We report here the first case of mixed infection identified using IS6110-based genotyping of M. tuberculosis. The patient was diagnosed with pulmonary tuberculosis in February, 1991. The initial isolate of M. tuberculosis had two different genotype patterns (dark 7-band and light 14-band patterns). However, in a repeat isolate obtained several months later, only the 14-band pattern was visible. Exogenous reinfection and laboratory cross-contamination were unlikely because both genotype patterns were unique in the san francisco database which includes over 1300 isolates of M. tuberculosis. This case demonstrates the importance of identifying mixed infections in the study of the molecular epidemiology of tuberculosis. Mixed infections could be confused with exogenous reinfection or laboratory cross-contamination, and important epidemiologic connections could be missed.
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ranking = 10
keywords = tuberculosis
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16/928. Endobronchial actinomycosis simulating endobronchial tuberculosis: a case report.

    We report a case of a 70-year-old woman who presented with mild exertional dyspnea and cough. Fiberoptic bronchoscopic findings revealed an endobronchial polypoid lesion with stenotic bronchus. The lesion was very similar to endobronchial tuberculosis. Histologic examination of the biopsy specimen demonstrated actinomyces infection. There was a clinical response to intravenous penicillin therapy. Primary endobronchial actinomycosis must be considered in the differential diagnosis of an endobronchial lesion, especially endobronchial tuberculosis in korea.
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ranking = 6
keywords = tuberculosis
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17/928. Developing bronchial fistulas as a late complication of extraperiosteal plombage.

    A 65-year-old male, who underwent extraperiosteal plombage for pulmonary tuberculosis 46 years ago, was referred to our hospital due to relapsing hemosputa and pneumonia. A chest computed tomography scan revealed a bronchial fistula and a fluid collection in one Lucite ball. On May 20, 1996, a right-anterior thoracotomy was performed in a supine position. Five Lucite balls were removed, and the empyema space was tightly filled with an omental pedicle flap. Although the bronchial fistulas were not sutured directly, the air leakage from the drainage tube ceased 12 days later. Two years postoperatively the patient has remained well. Our simple approach of combining an anterior thoracotomy and replacement of an empyema space with an omental pedicle flap in the same posture, without closing bronchial fistulas, would be an easy procedure, and therefore exploitable in patients who have a similar problem.
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ranking = 1
keywords = tuberculosis
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18/928. Successful treatment of pulmonary mycobacterium xenopi infection in a natural killer cell-deficient patient with clarithromycin, rifabutin, and sparfloxacin.

    Isolation of mycobacterium xenopi from the respiratory tract may indicate pneumonia, often clinically indistinguishable from tuberculosis. Resistance to the classic antituberculous drugs renders the treatment of these infections problematic. We report on a case of cavernous pneumonia caused by M. xenopi in a 36-year-old male with natural killer cell deficiency but without severe immunodeficiency. He was successfully treated with a novel triple-drug combination comprising clarithromycin, sparfloxacin, and rifabutin. An impressive subsequent regression of pathological pulmonary changes was observed, and mycobacteria could no longer be detected. The therapeutic potential of clarithromycin and sparfloxacin in the treatment of M. xenopi infections is discussed.
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ranking = 1
keywords = tuberculosis
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19/928. Tuberculosis on the flight deck.

    Tuberculosis in commercial aircraft has been a concern since a 1995 incident of possible transmission from an active case of tuberculosis to passengers in the cabin of a 747. Subsequently, commercial air carriers have been vigilant in cooperating with public health authorities in tracking all known exposures to tuberculosis. In 1998, a pilot of a commercial airliner was diagnosed with active tuberculosis. Company records demonstrated that in the previous 6 mo, the pilot had flown with 48 other pilots. Every exposed pilot was contacted and evaluated by skin testing (IPPD) or chest x-ray if previously positive. There were no skin test conversions and no changes on x-rays. This study demonstrates that transmission of tuberculosis in the aircraft cabin environment, even under close and continuous exposure to an active case, is a rare event.
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ranking = 4
keywords = tuberculosis
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20/928. Tuberculosis in children undergoing continuous ambulatory peritoneal dialysis.

    The incidence of tuberculosis (TB) is increasing worldwide. Due to an impairment of cellular immunity, patients with chronic renal failure are susceptible to reactivation of TB. Seventy patients were treated by continuous ambulatory peritoneal dialysis (CAPD) in our pediatric nephrology department during the years 1989-1997. TB was diagnosed in 4 patients, representing 5.7% of all CAPD patients in our department. One patient had extrapulmonary (TB osteomyelitis) and the others had pulmonary TB. All patients were treated with antituberculous drugs.Two patients with pulmonary TB were cured. Symptoms improved in the other 2 patients but they died at home for unknown reasons. We recommend that all children in regions of high prevalence of TB should be investigated for TB, especially if they have a cough or fever of unknown etiology.
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ranking = 1
keywords = tuberculosis
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