Search

Item does not contain fulltext

Bactericidal activity of leukocytes was investigated in 63 patients with new infiltrate pulmonary tuberculosis and 28 patients with fibrous cavernous pulmonary tuberculosis. The diverse oxygen-dependent bactericidal activity of phagocytes is typical of the patients suffering from both clinical forms of tuberculosis: reduction of nitrosative stress rates, which is more frequent in those suffering from fibrous cavernous tuberculosis, and increase of oxidative stress rates, which is more intensive in case of fibrous cavernous tuberculosis. The associated functions were detected among immune-competent cells, involved in the bactericidal function: in case of fibrous cavernous tuberculosis – between oxidative stress rates, and in case of infiltrate pulmonary tuberculosis – between nitrosative stress rates; the synergistic effect of respiratory burst was observed. In case of chronic pulmonary tuberculosis, both types of cells were equally responsible for bactericidal functions, while neutrophils were dominating in new infiltrate pulmonary tuberculosis, without prior treatment, being the cells of the first line of defense. The obtained results allowed concluding that in case of new pulmonary tuberculosis without prior treatment, nitrosative stress played the important role in the killing of tuberculous mycobacteria, while in case of chronic tuberculosis – it was oxidative stress.

The aim was to study the causes of death in HIV patients in the Novokuznetsk tuberculosis dispensary in 2016 (population is 550 thousand people; about 2% of population are HIV-positive). Materials and methods: Protocols of all autopsies of HIV-infected patients (n=221) performed in 2016 in the Novokuznetsk tuberculosis dispensary. Results: The mean age of the deceased was 37 Ѓ }6,9 years. HIV and tuberculosis (TB) co-infection was in 83,3% of patients (n=184), HIV/TB and other opportunistic or severe somatic diseases – in 10,4% (n=23), non-tuberculous opportunistic diseases – in 6,3% (n=14). The new tuberculosis cases were in 71,1% (n=147), relapses – in 7,2% (n=15), chronic tuberculosis cases – in 21,7% of patients (n=45). Disseminated form prevailed among the cases of respiratory tuberculosis; generalized tuberculosis (3 and more localizations) occurred in 87,0% (n=180), tuberculosis meningitis was found in 17,9% (n=37). Positive fluorescent sputum microscopy was in 72.5%, sputum cultures on Loewenstein-Jensen medium – in 78,3% with HIV/TB. Primary multidrug resistance was detected in 60,7% (including in 5,8% of them with primary extensively drug resistance). Severe opportunistic infections or malignancies were in 9,2% of HIV/TB (n=19) and in 78,7% of non-TB patients (n=11). Data on the CD4 level was known in 68,8% of cases (n=152): the median count was 75,5 cells/ μ l; 38,9% of new TB cases (n=46) were diagnosed with HIV in time of TB detecting. Antiretroviral therapy was performed only 13% of patients (n=29). Conclusion: There is a need for the optimization of HIV detecting approaches and early initiation of antiretroviral therapy before the appearance of incurable opportunistic diseases, as well as for comprehensive TB prevention.

Introduction: The risk of developing pulmonary tuberculosis in a silicotic is much higher than in the general population. Methods: We report in this retrospective work the clinical, paraclinical, evolutionary and therapeutic peculiarities of the silico-tuberculosis association. Forty patient files were collected between 2005 and 2018. All our patients are male, aged 29 years on average, for whom the notion of a professional exposure is often short-lived between 1 - 4 years. The notion of smoking was found in 10 patients over 15 P / A. All our patients had a respiratory discomfort with frank signs of tubercular impregnation. Chest X-ray showed diffuse and bilateral nodular lesions in all cases with images of associated excavations in 10 cases, Pseudo-tumor masses in 5 patients and ADP in 3 cases. Tuberculosis has been confirmed by bacteriology. The antibiogram revealed a multi-resistant tuberculosis in 20 patients, Atypical mycobacterium tuberculosis (avium) in two cases. All patients received antituberculous treatment for more than 6 months. The evolution was good in 10 cases, 18 patients became oxygen-requiring and Eight deaths were reported. Chronic tuberculosis in 4 patients Conclusion: The rise in the prevalence and incidence of tuberculosis in silicosis. Due to some clinical and radiological similarities between silicosis and some forms of tuberculosis, diagnosis may be delayed.

The aim of the present study is to show that non-invasive MARS imaging can differentiate between infected and healthy pulmonary tissue using an iodine-based contrast agent at high resolution. One C57BL/6J mouse with chronic tuberculosis (TB) was euthanized with CO2 and the pulmonary tissue excised. The TB lungs were incubated in 3% iodine solution. Mouse pulmonary tissue free of TB was also excised and incubated in the iodine solution for control purposes. Calibration of the MARS scanner involved scanning a phantom containing four concentrations of iodine along with water (soft tissue) and lipid (fat). The calibration phantom, control, and TB infected tissue were imaged at four threshold energy levels (20, 27, 34, 45 keV) at a constant 60 kVp tube voltage and 90 µA tube current. Following analysis of the calibration phantom, material decomposition (MD) was applied to the pulmonary tissue samples and iodine to obtain material images. MARS Vision software was used to visualize the materials to produce 3D material images. TB granulomas are visible within the lung lobes due to the iodine uptake. The amount of iodine uptake can be measured in mg by analysis of the material images using MARS Vision. MARS imaging was able to better differentiate between infected and healthy tissue. The present study demonstrated non-invasive, photon-counting CT is capable of differentiating between infected and healthy tissue. Future studies will consider development of TB markers, or drug markers labelled with gold nanoparticles, to enhance the understanding of the basic biology and mechanisms underpinning TB, and its relevance to the phenomenon of persistence in the infected host during therapy.

Results: The mean follow-up periods for patients with SCI and CTC were 98.5±31.3 and 83.2±35.3 months, respectively (p>0.05). Patients with SCI and CTC did not significantly differ with respect to the preoperative and postoperative mean bladder capacities or intravesical pressures. As additional postoperative treatments, Clean Intermittent Self-Catheterization (CISC) was performed in 5 (31.2%) SCI patients, and anticholinergic treatment was administered to 3 SCI patients (18.7%). Anticholinergic treatment was used postoperatively in only one patient with CTC (10%).

Background The incidence of nontuberculous mycobacteria is increasing, among them Mycobacterium avium complex (MAC) strains are the most frequently isolated. In countries endemic for tuberculosis, these infections pose a differential diagnosis challenge due to their clinical similarities. Patients and methods The main goal of this study was to describe the epidemiological, clinical aspects, and outcome of patients infected with MAC who met the American thoracic society (ATS) 2007 criteria for MTN disease’s definition. We conducted a 4-year retrospective evaluation from January 2009 to December 2012 at the Pneumophtisiology Department of the Point G University Teaching Hospital in Bamako. Results A total of 17 patients met the criteria for MAC disease, 16 men and one woman with a mean age of 50.4 years. All patients had at least two antituberculosis treatment courses without success. The signs and symptoms were a febrile alteration of physical condition in 41.7% (seven cases), chronic cough in 94.1% (16 cases), dyspnea in 68.7% (11 cases), and hemoptysis in 11.7% (two cases). The sputum smear was positive in 94.1% (16 cases) and the chest radiography showed constant cavitary images associated with nodular lesions in 52.9% (nine cases) or pleurisy in 11.7% (two cases). The evolution was marked by six deaths occurred within an average of 10 months and 10 were loss to follow-up. Conclusion The occurrence of MAC pulmonary disease poses diagnosis and treatment problems with less favorable outcome. Availability of early diagnosis with sputum culture will allow an accurate treatment regimen, which will improve patient outcomes.

Substitution of rifapentine (RFP) for rifampin (RIF) in the standard antituberculous regimen reduces the time required to cure chronic tuberculosis (TB) infection in mice, but not in guinea pigs. In order to gain insight into these discrepant findings, we conducted a steady-state pharmacokinetic (PK) study in healthy guinea pigs to study the metabolism and autoinduction of RIF and RFP. Both RFP and RIF 25-desacetyl metabolites (desRFP and desRIF, respectively), were detected at low concentrations in the serum of guinea pigs. The metabolite concentrations in guinea pigs are much lower than those seen in humans at steady state.

Background: BAE for massive haemoptysis is potentially life-saving with low short-to-medium term failure rates in previous studies. We aimed to characterise patients referred for BAE, to examine long-term treatment success and identify risk factors for requiring repeat BAE. Methods: We retrospectively identified all patients undergoing BAE from 1994-2007. We collated data from hospital databases and primary care on demographics, respiratory diagnoses and procedure with follow-up of up to 16 years. Outcomes were all-cause mortality and recurrence of haemoptysis requiring repeat BAE. Results: 158 patients were embolised on 208 occasions. 85 (54%) patients were male and median age was 54 (IQR: 41-67)y. The most common underlying diagnoses were aspergilloma (n=38; 24% of patients), bronchiectasis (n=24; 15%), unidentified cause (n=17; 11%) chronic tuberculosis (n=14; 9%), active tuberculosis (n=12; 8%) and cystic fibrosis (n=11; 7%). All-cause mortality at 1 month and 3 years was 5.3% and 29.7%, and need for repeat BAE was 4.7% and 30.7% respectively. Repeat BAE at 3 years was most common with aspergilloma (50%) and least common with active TB (0%). 3-year mortality was highest in cystic fibrosis (40%) and least with unknown cause (7.7%) Neither number nor location of vessels embolised predicted mortality or need for repeat BAE. No major procedural complications were noted. Conclusions: BAE by experienced operators is a safe, minimally invasive procedure for massive haemoptysis with excellent short-term success. It does not prevent late recurrence of haemoptysis nor obviate the need for repeat BAE, the risk of which is related to the underlying disease rather than to technical aspects of the procedure.

Resuscitation promoting factors (Rpf) are a family of proteins secreted by actively growing actinobacteria, including Mycobacterium tuberculosis. Experimental evidence suggests that Rpfs play a distinct role in bacterial resuscitation and re-growth as well as reactivation of chronic tuberculosis in mice. The striking similarity of the Rpfs structure to cell wall hydrolysing enzymes has provided a basis for the development of novel low molecular weight inhibitors of Rpfs activity. In particular, recently characterised nitrophenylthiocyanate compounds could be considered as a promising scaffold for generation of therapeutic agents targeting reactivation of latent tuberculosis. This review describes recent progress in understanding of molecular mechanisms of Rpf biological activity.

Chronic tuberculosis empyemae of the pleural cavity (CTEP) is one the diseases causing a lethal outcome.

On Christmas Eve 1947, Eric Blair (pen-name, George Orwell) was admitted to Hairmyres Hospital near Glasgow.2 George Orwell (Figure 1) was a journalist and novelist, and the publication in 1945 of his political fable, Animal Farm,3 had made him famous. He was 44 years old, and tests at the hospital confirmed that he had infectious chronic tuberculosis in his lungs.4 Orwell has been described as ‘a representative of truth-telling, objectivity and verification’.5 As with other events in his life, he carefully analysed and documented his experience of care for his tuberculosis, including his time in a private sanitorium. Orwell had been given treatments that were common for tuberculosis in Britain at that time: ‘collapse therapy’ and other painful surgical procedures to keep the lung disabled to ‘rest’ it, vitamins, fresh air, and being confined to bed. The hospital staff confiscated his typewriter and told him to stop working6—but they didn’t seem to advise him to stop smoking! (Figure 2) Orwell’s work, a novel he would struggle to complete in the coming year—1948, was Orwell’s ‘last great obsession’.7 He twisted the numbers of that year to give the book one of the most famous titles and powerful symbols from the 20th century: Nineteen EightyFour,8 introducing Big Brother and words like ‘doublespeak’ to the international political and social landscape (Figure 3). Orwell was hopeful

Text and Interview by Hema Bashyam By figuring out how mycobacteria survive within the very cells that try to kill them, Ehrt hopes to find a way to combat chronic tuberculosis infections. For most bacteria, getting scooped up by macrophages means a rapid death at the hands of a lethal cocktail of

Background BAE for massive haemoptysis is potentially life-saving with low short-to-medium term failure rates in previous studies. We aimed to characterise patients referred for BAE, to examine long-term treatment success and identify risk factors for requiring repeat BAE. Methods We retrospectively identified all patients undergoing BAE from 1994 to 2007. We collated data from hospital databases and primary care on demographics, respiratory diagnoses and procedure with follow-up of up to 16 years. Outcomes were all-cause mortality and recurrence of haemoptysis requiring repeat BAE. Results 158 patients were embolised on 208 occasions. 85 (54%) patients were male and median age was 54 (IQR: 41–67) y. The most common underlying diagnoses were aspergilloma (n=38; 24% of patients), bronchiectasis (n=24; 15%), unidentified cause (n=17; 11%) chronic tuberculosis (n=14; 9%), active tuberculosis (n=12; 8%) and cystic fibrosis (n=11; 7%). All-cause mortality at 1 month and 3 years was 5.3% and 29.7%, and need for repeat BAE was 4.7% and 30.7% respectively. Repeat BAE at 3 years was most common with aspergilloma (50%) and least common with active TB (0%). 3-year mortality was highest in cystic fibrosis (40%) and least with unknown cause (7.7%) Neither number nor location of vessels embolised predicted mortality or need for repeat BAE. No major procedural complications were noted. Conclusions BAE by experienced operators is a safe, minimally invasive procedure for massive haemoptysis with excellent short-term success. It does not prevent late recurrence of haemoptysis nor obviate the need for repeat BAE, the risk of which is related to the underlying disease rather than to technical aspects of the procedure.

A British author has put forward a new explanation for Joan of Arc's behaviour. This author suggests that the voices Joan of Arc heard were due to the presence of a temporal lobe tuberculoma in the context of widespread chronic tuberculosis (exposure to bovine tuberculosis, amenorrhoea, heart and intestines incombustible). We consider that some elements are incompatible with widespread tuberculosis. It is difficult to draw final conclusions, but it would seem unlikely that widespread tuberculosis, a serious disease, was present in this 'patient' whose life-style and activities would surely have been impossible had such a serious disease been present.

At the turn of the century there was little physicians could do to treat chronic tuberculosis, an illness that frequently foretold a lifetime of uncertain medical care and debilitation. During the preantibiotic era, an observant spa physician noted that consumptives who participated in lectures, social activities, and group learning experiences seemed to have a better clinical course. Though this observation was perhaps apocryphal, and certainly unproven, there was something inherent in the group process that extended the quality of life, although none thought of this as curative.

Two cases of miliary tuberculosis that were diagnosed clinically as lymphocytic leukemia are presented. Both cases had evidence of chronic tuberculosis which was of 43 years’ duration in Case 1 and of 28 years’ duration in Case 2. Both patients had granulocytopenia and anemia. Autopsy findings revealed no evidence of leukemic infiltration, but a diffuse miliary tuberculosis, involving all of the hematopoietic tissues, existed in both Cases.

A series of 63 patients (divided into 2 groups) with chronic polyresistant very extensive pulmonary tuberculosis often complicated by associated pathology were treated with Rifampicin (RMP) under supervision in a sanatorium. In group 1 (26 cases) RMP had to be used alone as the last therapeutic chance. At the end of the 1st and 2nd year the sputum was negative in 14 of 26 patients (55%) and in 10 of 20 patients (50%), respectively. Five patients died. In group 2 (37 cases, including 10 with associated pneumoconiosis) RMP could be and was combined with another drug; ethambutol (EMB) in most cases. The sputum was negative in 28 of 37 cases (75 %) after 6 months and in 14 of 22 cases (68 %) after 9 months. Only 1 patient died. As expected, the radiological results in both groups were poor because of extensive fibrosis accompanying oldstanding lesions and associated respiratory pathology including pneumoconiosis. Our findings contribute in an objective way to our notion as to what can be expected of RMP in the treatment of the type of case in question. It is stressed that better results could be obtained by the use of three-drug combinations consisting of RMP, EMB and another drug.

THORACOPLASTY for pulmonary tuberculosis, at Rutland State Sanatorium, began in 1927. By January 1, 1947, 362 patients had received that form of treatment. This is a review of the work done and of the results obtained in those twenty years. Indications The clinical indications have changed very little, if at all, throughout the whole period. The general rules established by Alexander‡ remain: "... those patients are chosen for operation who have moderately or far advanced chronic tuberculosis, with or without hemoptysis; whose lesions are of the fibroulcerative type, with or without cavitation or empyema, and are principally confined to one . . .

SummaryAerogenic tuberculous infection of mice with small numbers of tubercle bacilli resulted in chronic tuberculosis which persisted in some of the animals for over a year. The lesions produced by this infection contained a constant number (“steady state”) of culturable units of tubercle bacilli after 8 weeks, but there was enlargement and coalescence of the lesions because of an increased number of foam cell macrophages. In conse-sequence, there was an increased involvement of normal lung tissue. Thirty-six to 52 weeks after infection, the number of culturable units of tubercle bacilli had increased beyond that of the steady state; deaths continued to occur during this period.

A simple technique for the visualisation of the bronchial arteries in vivo is described and examples shown. In eight cases of fibrocystic disease in children, the bronchial arteries were found to be both dilated and tortuous radiographically. No abnormalities were noted of origin or general course. As pointed out by other investigators, the bronchial arteries are found to enlarge in emphysema, bronchiectasis, chronic tuberculosis, infarction and primary lung tumours. All of our cases had emphysematous changes of both lungs and a varying number suffered from bronchiectasis, chronic pneumonitis, and fibrotic changes. These stimuli or yet undetermined stimuli or defects in fibrocystic disease may cause the bronchial arteries to enlarge in this disease.

n/a

Dextrose (30 gms. in 250 c.c. water) given per os with acetyl salicylic acid (1 gm.) in a case of chronic tuberculosis was followed within 2 1/2 hours by a fall in rectal temperature from 38.03° C. to 36.02° C. In numerous observations upon this and other “labile” individuals under like conditions acetyl salicylic acid (1 gm. with 250 c.c.) never has produced a fall of temperature exceeding 1.1° C. in the same length of time.This observaton has led to an investigation of the action of dextrose upon the heat regulation.The preceding table shows the effects of dextrose given per os upon the temperature of three individuals, one of whom was in normal health. (Readings were taken at half hourly intervals but the curves are uniform enough for the first and last reading to suffice.)Calorimetric Observations.-In each of the above experiments also the heat production has been determined by the indirect method, using the Benedict Respiration Chamber at the New Haven Hospital. As would be expected, the CO2 excretio...

The subject of purpura in this paper is treated from the standpoint of the relationship it bears to tuberculosis. Several writers within the last two centuries have made observations on this phenomenon, endeavoring to find its cause and effect, and to discover the relation purpura has to other diseases with which it is associated. Mackenzie1 says : The great variety of supposed causes or associated conditions is sufficiently striking. Still more so is the fact that in one-third of 200 cases no explanation was offered for the purpura, though in several of the cases a necropsy was made. It will thus be seen how extremely complex is the pathology of purpura. All we can do in the present state of our knowledge is to accumulate further information and to exhaust every means—histological, bacteriological and chemical—in the investigation of cases. Osler 2 also maintains "that purpura is obscure, and is

n/a

In human pathology, the association of generalized amyloidosis with chronic tuberculosis is a well known fact. Thus, in many cases, amyloidosis has been considered an immunopathy induced by tuberculosis. In our material, necropsies of aged persons, suffering from senile mental deterioration and affected by amyloidosis, often revealed signs of lingering pulmonary and lymphonodular tuberculosis. Systematic clinical investigations of senile patients endorsed these observations, demonstrating a rather frequent occurrence of acid-fast bacilli in smears and cultures of sputa and gastric washings. Also, a causal connection between tuberculosis and amyloidosis was shown in a series of experimentally infected guinea pigs. These studies indicate the possibility of an immunobiologic connection between amyloidosis in aged persons and lingering tuberculosis.

No disease has received more attention in the literature than tuberculosis, especially pulmonary tuberculosis, yet the subject is by no means exhausted. There is a type of pulmonary tuberculosis infrequently met with in children which is often overlooked, unless constantly kept in mind. The most frequent form of tuberculosis in children, aside from tuberculous meningitis and miliary tuberculosis, is tuberculous pneumonia, either of the lobar pneumonic or bronchopneumonic type. Chronic tuberculosis as met with in adults is almost unknown in infants and children under 2 years of age. With the aid of the roentgen ray more cases of the chronic and subacute forms are being discovered. (Reuben,1Dunn,2Eisler,3and Wesler and Bass,4speak of such cases.) The type of tuberculosis to which I wish to call attention may be defined as a diffuse or parenchymatous process involving that portion of the lung immediately adjacent to

I have been studying the problems related to the pathology, diagnosis and treatment of chronic renal tuberculosis for more than a quarter of a century and, in preparing this paper, have gathered together the experience gained during these last thirty years. I have reviewed my records of the last fifteen years with considerable care and have used the data gathered in more than 300 cases. The recognition of tuberculosis of the kidney as a surgical condition has been a development of comparatively recent years. Under the influence of some of the leaders of French urology, the surgical treatment of renal tuberculosis was somewhat delayed; but at the present time chronic surgical tuberculosis limited to one kidney is universally considered as belonging in the realm of surgical therapeutic endeavor. With the development of the cystoscope and more accurate methods of diagnosis, together with the accumulated experience of clinical observation of the

The following work was undertaken for the purpose of producing an experimental chronic insufficiency of the adrenal glands. It was then our intention to study this experimental insufficiency in relation to the other glands of internal secretion, and to compare it with the clinical picture of Addison's disease. Thus far all experimental work has resulted only in an acute insufficiency of the adrenal function. Excision of the glands is followed by death in two or three days. It was accordingly necessary to devise some means of slowly but progressively injuring the function of the glands. For this purpose it was decided to try the injection of tuberculin over long periods. Tuberculin was selected because of the evidence presented by certain workers in this field that chronic tuberculosis causes a sclerosis and atrophy of the adrenal glands. Bernard and Bigard1have found, in the adrenals of the tuberculous, a

To the Editor.— Reference was recently made to chronic otitis media, from which was recovered a culture of Escherichia coli (217:826, 1971), attributed to a urinary source. In a chronic tuberculosis service of years ago, chronic otitis media (painless) was common in patients with long-standing pulmonary cavitary disease. Recovery of tubercle bacilli might be difficult, but other organisms, especially E coli , were plentiful. While bacteremia may be implicated, a simple lack of fastidiousness would be adequate to explain this colonization.

Geotrichosis, an infection rarely mentioned in the United States, is probably commoner than realized. Europe and certain South American countries have been aware of the fungus Geotrichum for many years and have reported its varying types of pathogenesis. There is increasing evidence that it will be found oftener in the United States when clinicians and laboratories become aware of its characteristics. In France, Brumpt, 1 in an excellent summary of Geotrichum infections, listed 20 species reported by various writers. Reeves, 2 in the southern United States, reported 79 cases of bronchomycoses, two of which were geotrichosis. He stated that in geotrichosis the chest roentgenogram resembles that of chronic tuberculosis, with heavy studding along the bronchi and frequent cavitation. Kunstadter and Milzer 3 consider Geotrichum of sufficient importance to include Geotrichum extract with routine skin tests for detection of mycotic infections. One of the most detailed discussions of this disease is

For the purpose of the present paper it does not especially concern us which or how many of the different tissues which together constitute a joint are affected, and I shall not attempt to discuss methods of treatment based on anatomic differentiation of the location of the lesion. It may, however, be stated that in the great majority of cases the initial lesion, so far as the joint is concerned, is in the bone; but in the purely conservative treatment the management of these cases differs hardly any from that of those which are primarily synovial. Underlying the treatment of all forms of chronic tuberculosis, of whatever tissue or wherever situated, is the gospel of rest and food. This is founded upon the fact, learned in the first place by experience, and confirmed later by the results of biologic investigations, that there is in living tissues an inherent antagonism to