Difficultés diagnostiques de la tuberculose cérébrale / Diagnostic difficulties of cerebral tuberculosis

La tuberculose est une des maladies infectieuses les plus répandues dans le monde .Elle représente un problème de santé publique majeur dans les pays en voie de développe ment, y compris l'Algérie . À l'échelle mondiale et parmi tous les cas de tuberculose, l'OMS rapporte 14 % de tuberculose extra-pulmonaire (TEP) sans atteinte pulmonaire concomitante. Dans notre pays et durant ces dernières années, une recrudescence de la tuberculose extrapulmonaire a été observée. L'objectif de cet article était de présenter un cas atypique de tuberculose cérébrale dont le diagnostic a été tardif, posé par l'examen anatomopathologique avec une revue de la littérature. C'est le cas d'une jeune patiente hospitalisée dans le cadre de l'urgence pour un syn drome d'hypertension intracrânienne avec troubles neurologiques. La tomodensitomé trie cérébrale a objectivé de multiples localisations cérébrales avec une hydrocéphalie active. Le bilan d'extension était sans anomalie. La patiente avait bénéficié d'une inter vention chirurgicale, les suites opératoires ont été favorables. L'examen anatomo-pa thologique était en faveur d'une lésion inflammatoire spécifique granulomateuse faite de larges plages de nécrose caséeuse. La patiente a répondu au traitement antituber culeux. Le problème diagnosticque et les résultats seront discutés avec une revue de la littéra ture. La tuberculose cérébrale est une forme rare de la tuberculose extra-pulmonaire. Le tableau clinique ainsi que la neuro-imagerie (TDM, IRM) sont atypiques. Le diagnostic était postopératoire, reposant sur l'examen anatomopathologique. Le pronostic dépend de la précocité du diagnostic, du siège de la lésion et de la réponse au traitement antituberculeux.

Tuberculosis is one of the most widespread infectious diseases in the world. It constitutes a major public health problem, especially in developing countries, including Algeria. Globally and among all tuberculosis cases, WHO reports 14% extra-pulmonary tuberculosis (EPT) without concomitant pulmonary involvement. In our country and in recent years, an upsurge in extrapulmonary tuberculosis has been observed. The objective of this article was to present an atypical case of cerebral tuberculosis whose diagnosis was late, made by anatomopathological examination with a review of the literature. We report the case of a young patient hospitalized in emergency for an intracranial hypertension syndrome with neurological disorders. Cerebral computed tomography revealed multiple brain locations with active hydrocephalus. The extension assessment was without anomaly. The patient underwent a surgical intervention, the operative consequences were favorable. The pathological examination was in favor of a specific inflammatory granulomatous lesion made up of large areas of caseous necrosis. The patient was cured under anti-tuberculosis treatment. The diagnostic problem and the results will be discussed with a review of the literature. Cerebral tuberculosis is a rare form of extrapulmonary tuberculosis. The clinic as well as the neuroimaging (CT, MRI) are atypical. The diagnosis is postoperative, based on the pathological examination. The prognosis depends on the early diagnosis, the site of the lesion and the response to anti-tuberculosis treatment.

Breast Tuberculosis in Patients at Tertiary Care Centre: Reveiw of Six Cases

Nearly 18 % tuberculosis patients have only extrapulmonary manifestations. Tuberculosis of the breast is an uncommon disease even in countries where the incidence of pulmonary and extrapulmonary tuberculosis is high. It accounts for less than 0.1% of breast conditions in developed countries, but reaches 3–4% in regions where the disease presents with high incidence (India, Africa). The significance of mammary tuberculosis is due to very rare occurrence and usually mistaken identity with breast cancer and pyogenic breast abscess. Radiological imaging is not diagnostic. Diagnosis is based on identification of typical histological features or the tubercle bacilli under microscopy or culture. This disease can present a diagnostic problem on radiological and microbiological investigations, and thus a high index of suspicion is needed. This review is based on the discussion on the important issues relating to the diagnosis, clinical features, and management of breast tuberculosis.

Morphological analyses of caseous necrosis correlated to CD68+ and CD8+ cells in biopsies of tuberculous pleurisy / Análisis morfológico de la necrosis caseosa y su correlación con células CD68+ y CD8+ en biopsias de pleuritis tuberculosa

Tuberculosis is the most prevalent infectious disease in the world. Granuloma formation and caseous necrosis are hallmarks of M. tuberculosis infection and they represent the protective and inflammatory reactions in the infected tissues. The molecular mechanisms that mediate granuloma necrosis are still not well understood. Objectives: To immunolocalize and correlate the amounts of CD68+ macrophages and CD8+ lymphocytes to caseous necrosis extension in granulomas of tuberculous pleurisy. Methods: The study is a retrospective analysis of 30 pleural biopsies with histopathological diagnosis of chronic granulomatous pleurisy with caseous necrosis. These biopsies were classified according to necrosis intensity as minimal (N1), moderate (N2) and intense (N3). The number of granulomas was also observed and categorized as G1 (1 to 4 granulomas per section), G2 (5 to 8 granulomas per section), and G3 (more than 8 granulomas per section). Results: The means of CD68+ cells counts per mm² in N1, N2 and N3 categories of necrosis were 1,287 +/- 254, 1086 +/- 181 and 930 +/- 115 respectively. The means for CD8+ cells were 483.7 +/- 396, 366.3 +/- 43 and 558 +/- 53 cells per mm² in N1, N2 and N3 respectively. Conclusions: There were no significant statistical correlations between necrosis extension and cell counts. In analyzed biopsies, the number of CD68+ cells was significantly higher than the number of CD8+ cells.

La tuberculosis es una de las enfermedades más prevalentes en el mundo. La formación del granuloma junto con la necrosis caseosa son características propias de la infección por M. tuberculosis y representan reacciones inflamatorias y protectoras en los tejidos infectados. No se conocen bien los mecanismos moleculares que median la necrosis en el granuloma. Los objetivos fueron inmunolocalizar y correlacionar la cantidad de macrófagos CD68+ y linfocitos CD8+ con la extensión de la necrosis caseosa, en los granulomas de tuberculosis pleural. Análisis retrospectivo que incluyeron 30 biópsias con diagnóstico histopatológico de tuberculosis pleural granulomatosa crónica con necrosis caseosa. Estas biópsias fueron clasificadas según la intensidad de necrosis como mínima (N1), moderada (N2) e intensa (N3). También se determinó el número de granulomas, que fueron clasificados como G1 (1 a4 granulomas por sección), G2 (5 a 8 granulomas por sección), y G3 (más de 8 granulomas por sección). La cuantificación de células CD68+ por mm² en las categorías N1, N2 y N3 de necrosis fue de 1,287 +/- 254; 1086 +/-181 y 930 +/- 115, respectivamente. La cuantificación de las células CD68+ fue de 483,7 +/- 396; 366,3 +/- 43 y 558 +/- 53 células por mm² para N1, N2 y N3, respectivamente. No hubo correlación estadísticamente significativa entre la extensión de la necrosis y la cuantificación celular. El número de células CD68+ fue significativamente mayor que el número de células CD8+ en las biópsias analizadas.

A Case of Primary Lid Tuberculosis after Upper Lid Blepharoplasty

Primary lid tuberculosis after lid surgery is a very rare condition and is likely caused by the introduction of bacilli through epithelial injury. Secondary infection, due to direct hematogenous spread or contiguous spread from adjacent structures are more common presentations of lid tuberculosis. The authors experienced a case of primary lid tuberculosis occurring in a 19 year old female after blepharoplasty for making a eyelid crease. Her upper lid skin showed a reddish and non-tender mass lesion measured 3x1 cm, which was diagnosed as the tuberculosis through typical histopathological findings (caseous necrosis), acid-fast bacilli stain and PCR, and treated with anti-tuberculosis medications.