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Byline: Anish. Gandhi, Trimurti. Nadkarni, Srikant. Balasubramaniam A 39-year-old female presented with complaints of occipital headaches, diplopia, numbness over left half of face and deviation of face to the right. [...]

A 54-year-old man with an underlying AIDS experienced fever and lethargy. Magnetic resonance imaging (MRI) showed multiple small ring-enhancement lesions over pons, basal ganglion, thalami, and bilateral cerebral hemisphere. Because of the concurrent pulmonary tuberculosis (TB), presumptive diagnosis of tuberculous meningitis and brain tuberculoma was made. The patient's condition clinically improved after a 3-month anti-TB treatment coupled with highly active antiretroviral therapy (HAART), and his CD4-T lymphocyte count was increased from 17 cells/[mm.sup.3] (HIV viral load, 294,000 copies per milliliter) to 153 cells/[mm.sup.3] (HIV viral load, 5930 copies per milliliter). However, the follow-up MRI disclosed disappearance of some old brain lesions and development of some new ones; some previously identified tuberculoma became smaller in size, while some other enlarger. Of note, ring-enhanced brain lesions were found over the left frontal lobe and left posterior fossa with perifocal edema and hyperintensity in diffusion weighted MRI indicating abscess formation. Steroid was added based on the presumed paradoxical reaction of brain tuberculoma. Complete resolution of brain lesions was found on MRI 9 months later. Tuberculoma should be considered in a patient with AIDS with numerous intracranial lesions if TB involving other site(s) is definitively diagnosed, especially when the patient is receiving prophylactic trimethoprim-sulfamethoxazole and/or serologically negative for toxoplasmosis. Our report demonstrated the peculiar phenomenon of paradoxical reaction of brain tuberculoma during immune reconstitution and strengthens the belief that additional use of steroids for paradoxical reaction of brain tuberculoma is indicated after exclusion of other causes for the progressively enlarging brain lesions.

We report two cases of disseminated multidrug-resistant tuberculosis with meningitis in HIV-positive patients, who were both recent emigrants from sub-Saharan Africa. Our two cases highlight new challenges in the care of HIV and tuberculosis coinfection including early diagnosis and treatment of multidrug-resistant tuberculosis that is spreading.

Objective. We examined the feasibility and value of network analysis to complement routine tuberculosis (TB) contact investigation procedures during an outbreak. Methods. We reviewed hospital, health department, and jail records and interviewed TB patients. Mycobacterium tuberculosis isolates were genotyped. We evaluated contacts of TB patients for latent TB infection (LTBI) and TB, and analyzed routine contact investigation data, including tuberculin skin test (TST) results. Outcomes included number of contacts identified, number of contacts evaluated, and their TST status. We used network analysis visualizations and metrics (reach, degree, betweenness) to characterize the outbreak. Results. The index patient was symptomatic for 8 months and was linked to 37 secondary TB patients and more than 1200 contacts. Genotyping detected a 21-band pattern of a strain W variant. No HIV-infected patients were diagnosed. Contacts prioritized by network analysis were more likely to have LTBI than nonprioritized contacts (odds ratio = 7.8; 95% confidence interval = 1.6, 36.6). Network visualizations and metrics highlighted patients central to sustaining the outbreak and helped prioritize contacts for evaluation. Conclusions. A network-informed approach to TB contact investigations provided a novel means to examine large quantities of data and helped focus TB control. doi:10.2105/AJPH.2005.071936

OBJECTIVES. The goals were to describe the management of multidrug-resistant tuberculosis among children, to examine the tolerability of second-line antituberculosis agents among children, and to report the outcomes of children treated for multidrug-resistant tuberculosis in poor urban communities in Lima, Peru, a city with high tuberculosis prevalence. METHODS. A retrospective analysis of data for 38 children < 15 years of age with multidrug-resistant tuberculosis, either documented with drug sensitivity testing of the child&apos;s tuberculosis isolate or suspected on the basis of the presence of clinical symptoms for a child with a household contact with documented multidrug-resistant tuberculosis, was performed. All 38 children initiated a supervised individualized treatment regimen for multidrug-resistant tuberculosis between July 1999 and July 2003. Each child received 18 to 24 months of therapy with [greater than or equal to] 5 first- or second-line drugs to which their Mycobacterium tuberculosis strain was presumed to be sensitive. RESULTS. Forty-five percent of the children had malnutrition or anemia at the time of diagnosis, 29% had severe radiographic findings (defined as bilateral or cavitary disease), and 13% had extrapulmonary disease. Forty-five percent of the children were hospitalized initially because of the severity of illness. Adverse events were observed for 42% of the children, but no events required suspension of therapy for >5 days. Ninety-five percent of the children (36 of 38 children) achieved cures or probable cures, 1 child (2.5%) died, and 1 child (2.5%) defaulted from therapy. CONCLUSIONS. Multidrug-resistant tuberculosis disease among children can be treated successfully in resource-poor settings. Treatment is well tolerated by children, and severe adverse events with second-line agents are rare. Key Words tuberculosis, multidrug resistance, international child health Abbreviations MDR-TB--multidrug-resistant tuberculosis DST--drug susceptibility testing ITR--individualized treatment regimen NTP--National Tuberculosis Program DOTS--directly observed therapy, short course, DESPITE AGGRESSIVE INTERNATIONAL efforts, tuberculosis remains a leading infectious cause of death, with an estimated 8.8 million incident cases per year. (1) In 2000, an estimated 884 000 (10.7%) of [...]

We report a case of a 12-year-old girl with a mesenteric pseudoaneurysm and abdominal tuberculosis presenting with massive lower gastrointestinal hemorrhage requiring multiple blood transfusions. The pseudoaneurysm was treated successfully with transarterial microcoil embolization. Pseudoaneurysms are a rare and life-threatening complication of tuberculosis and understanding the imaging characteristics and treatment options will help to guide appropriate therapy. Keywords Tuberculosis * Lower GI bleeding * Mesenteric pseudoaneurysm * Embolization therapy

A recent analysis of global tuberculosis (TB) case notification data estimated that only 27% of new smear positive cases that arose in 2000 were detected by the current recommended strategy […]

This study assessed progress towards tuberculosis (TB) elimination in the Netherlands by using DNA finger-printing. Mycobacterium tuberculosis strains were defined as new if the IS6110 restriction fragment length polymorphism pattern [...]

A case of a 48-year-old airline mechanic from Belize with fever and altered mental status that was presented to the emergency department is discussed. Giving him required treatment of tuberculosis even though his diagnostic test showed negative results saved patient's life.

A 42-year old woman with a history of asthma and the irritable bowel syndrome presented with pain and swelling of her feet and ankles that were associated with a rash on her lower extremities. Nine months of isoniazid therapy and close clinical follow-up were important features of the patient's care and an initial diagnosis of erythema nodosum provided an early 'footprint' of tuberculosis in this case.

A case study of a twenty eight year old man who was hospitalized in the U.S. because of fever and abdominal pain and whose anatomical diagnosis reported tuberculosis lymphadenitis is presented. The case showed that the reported cases of pancreatic tuberculosis might actually represent cases of tuberculosis in the peripancreatic lymph nodes.

A 14-month-old boy with chronic abdominal distention, vomiting, and diarrhea was found to have tuberculosis (TB) in his gastrointestinal tract. TB usually affects the lungs but it can also affect other parts of the body. His mother was found to have TB in her lungs, probably because she traveled to other countries and was taking corticosteroid drugs to treat ulcerative colitis.

Code Number: is03035 ABSTRACT Duplications of the alimentary tract are a rare group of malformations often encountered in childhood. These have varying modes of presentation and can be associated with [...]

A 43-year-old man who was admitted to a hospital with fever and night sweats was diagnosed with three different types of tuberculosis: miliary, bronchiolar, and lymphangitic. He had immigrated to the US from Morocco just four months before admission.

A 59-year-old woman was diagnosed with tuberculosis in the bones of her foot and in her bladder. It took a while for the doctors to diagnose the tuberculosis because it did not appear on a chest X-ray.

Among the goals of the molecular epidemiology of infectious disease are to quantify the extent of ongoing transmission of infectious agents and to identify host- and strain-specific risk factors for [...]

An 82-year-old woman was admitted to a hospital with kidney failure and a Staphylococcus aureus infection. She had a history of diabetes, coronary artery disease, and a stroke. A chest X-ray and CT scan showed that she had lung disease. Since this could not be related to her pre-existing diseases, it was considered a new disease. Her doctors considered miliary tuberculosis, which is a form of tuberculosis that can affect other organs besides the lungs. This was confirmed by a liver biopsy.

A 10-month-old girl was admitted to a hospital with fever, a rash and peeling skin. She had been treated with antibiotics for roseola. A skin tuberculosis test was positive and a chest X-ray showed that she had pneumonia as well as fluid in her chest outside the lungs. Her peeling skin indicated a toxic reaction to a bacterial infection, such as toxic shock syndrome. A bronchoscopy revealed that she had tuberculosis. Her father was found to have active tuberculosis.

Over a period of five years, the authors made a descriptive study of 374 case histories of adult patients diagnosed with tuberculosis (TB) at the Service of Internal Medicine of the La Fe University Hospital in Valencia, Spain. The following data were gathered from the case histories: sex, age, civil status, cohabitation, and origin (rural or urban). The authors used the Z-proportions contrast test (p [less than] .01) to establish possible differences between the study population, the population served by the La Fe University Hospital, and the Valencian community at large. The odds ratios for various professions in the study group were compared with those for the same professions in the population served by the hospital. Among patients with TB, miners and construction workers were most numerous, followed by agricultural and farm workers. No cases occurred among health care workers. When the occupational distribution of the study group was compared with that of the Valencian community at large and that of the population served by the hospital, significant differences were observed for all professional sectors except industry. Likewise, comparison of the study group with the population served by the hospital revealed that the risk of TB was significantly higher among patients in the agricultural and construction sectors. It may be administratively efficient to screen at such work sites for asymptomatic infections and to provide preventive therapy in these settings - even if acquisition of TB infection is not causally linked to the work setting., Introduction The incidence of tuberculosis (TB) is increasing in nearly every region of the world (1). A number of factors have led to increased incidence in economically developed countries; these [...]

A 37-year-old man was admitted to a hospital with fever, chills, weight loss, anemia, and enlarged lymph nodes. He was homeless and had a history of alcohol and drug abuse. He tested positive for HIV although a test one month before admission had been negative. He was diagosed with acute HIV infection. Examination of a lymph node biopsy sample revealed that he also had disseminated tuberculosis. Normally, the bacterium that causes tuberculosis only infects the lungs, but it can infect other tissues. When it does, the infection is called miliary, or disseminated, tuberculosis.

The case of an 82-year-old woman illustrates that many elderly patients may present a diagnostic challege. She was hospitalized with altered mental status, enlarged lymph nodes, weight loss and a mass in her abdomen. Her physicians suspected a type of cancer called lymphoma and ordered a series of tests to confirm this. They were unable to confirm this diagnosis and two weeks after she was hospitalized she was found to have tuberculosis.

A 31-year-old woman with fever, cough, and fluid around her lungs and in her abdomen entered the hospital for care. Blood and pleural fluid cultured negative for bacteria, but a tuberculin skin test was positive. A possible history of vaccination during childhood in Cambodia complicated the diagnostic value of the skin test. Doctors treated the patient with antituberculous drugs while continuing testing. A biopsy from within the abdomen confirmed that the patient had peritoneal tuberculosis. Diagnosis of this disease is difficult because some tests may not reveal the organism.