Pleural tuberculosis: experiences from two centers in Brazil

Abstract Objective: This study aimed to describe the clinical and laboratory findings of patients diagnosed with pleural tuberculosis at two hospitals in southern Brazil. Methods: Patients aged < 18 years were evaluated retrospectively. The patients' medical and epidemiological history, tuberculin skin test results, radiological and pathological findings, and pleural fluid analysis results were retrieved. Results: Ninety-two patients with pleural tuberculosis were identified. The mean age was 10.9 years old. Twenty-one percent were children aged six years or less. The most common symptoms were fever (88%), cough (72%), and chest pain (70%). Unilateral pleural effusion was observed in 96% of the cases. Lymphocyte predominance was found in 90% of the pleural fluid samples. The adenosine deaminase activity of the pleural fluid was greater than 40 U/L in 85% of patients. A diagnosis of community-acquired pneumonia with antibiotic prescriptions was observed in 76% of the study population. Conclusions: Tuberculosis etiology must be considered in unilateral pleural effusion in a child with contact with a case of tuberculosis. Pleural fluid biomarkers contribute to the diagnosis of pleural tuberculosis in children and adolescents.

Post-surgical atypical mycobacteriosis in 125 patients in Rio de Janeiro

Abstract INTRODUCTION: The growing incidence of post-surgical atypical mycobacteriosis (PSAM) may be related to the increased use of low- and medium-complexity video-assisted surgery. METHODS: Between April 2007 and June 2009, 125 patients were referred from the State Health Department of Rio de Janeiro for the treatment of confirmed, probable, or suspected PSAM. RESULTS: Laparoscopic cholecystectomy was the most frequent surgical procedure (48.8%) among patients. Clarithromycin, ethambutol, and terizidone were used to treat 113 patients for a mean duration of 226 days. CONCLUSIONS: Despite the need for multidrug therapy and long treatment duration, most included patients adhered to treatment and experienced cure without relapse.

Mycobacterium avium-intracellulare and the unpredictable course of hypercalcemia in an AIDS patient

Abstract A 37-year-old man with AIDS presented with altered mental status four weeks after stopping his medications for Mycobacterium avium-intracellulare (MAI). He had low CD4 cell count and severe hypercalcemia. Bone marrow biopsy revealed bone marrow infiltration by granulomas positive for acid-fast bacilli and cultures grew MAI. His hypercalcemia continued to worsen with the initiation of MAI therapy but we were able to treat it successfully with pamidronate and calcitonin.

Detection of plasma 1,3-β-D glucan in the diagnosis of deep fungal infection / 国际检验医学杂志

Objective To evaluate the early diagnostic value of the detection of plasma 1,3-β-D glucan(G test) for deep mycobacterium infection and assess the difference of the G test and fungal culture.Methods We collected test plasma from 420 subjects from January to November 2014,including 226 cases of deep mycobacterium infection,88 cases of non-fungal infection and 106 cases of healthy controls.G-test was used to measure the concentration of 1,3-β-D glucan in the plasma.The cut-off points for 1,3-β-D glucan were determined by using receiver operator characteristics curves(ROC).Results The concentration of 1,3-β-D in plasma of paients with deep mycobacterium infection was significantly higher than that of patients with non-fungalinfection and healthy controls.There was no difference between the control groups.With the analysis of ROC curve,the best cut-off value was 25.33 pg/mL.The sensitivity,specificity,positive predictive value and negative predictive value of G test were 84.9%,70.83%,72.0%,84.1%(P<0.05).Conclusion G Test is a practical and effective method in early diagnosis of deep fungal infection.

Compromiso pulmonar en pacientes hospitalizados con infección por el virus de inmunodeficiencia humana en el Hospital Pablo Tobón Uribe (Medellín, Colombia) / Pulmonary compromise in inpatients with human immunodeficiency virus infection at Pablo Tobón Uribe Hospital, Medellín, Colombia

Más de la mitad de los pacientes con infección por virus de inmunodeficiencia humana (VIH) pueden tener compromiso pulmonar en el transcurso de su vida. Este puede ser multicausal y las infecciones oportunistas son las principales, sin embargo, las causas no infecciosas no son menos importantes. Objetivo: Describir las características del compromiso pulmonar en pacientes hospitalizados con infección por VIH. Metodología: Estudio descriptivo observacional. Resultados: Se incluyó a 63 pacientes, el 85,7% fueron hombres. La edad promedio fue 40,6 ± 12 años. El 21,4% tuvieron antecedente de promiscuidad sexual y 28,6% fueron hombres con sexo con hombres. Se identificó tabaquismo en 60,3%, alcoholismo en 52,4% y consumo de drogas en 20,6%. El 23,8% tuvo historia de tuberculosis. Al ingreso, el 79,4% tenía sida, el recuento promedio de CD4 fue 138,5 ± 17,7 células/mm3 y el 49,2% tenía CD4 < 100 células/mm3. Las principales comorbilidades fueron: enfermedad neoplásica 20,6%, diarrea crónica 19%, EPOC 6,3% y diabetes mellitus 3,2%. Los principales síntomas al ingreso fueron: respiratorios 66,7%, gastrointestinales 47,6% y neurológicos 34,9%. Los principales oportunistas documentados fueron Mycobacterium spp, H. capsulatum y P. jirovecii. El sarcoma de Kaposi, la enfermedad lifoproliferativa y la EPOC fueron causas de compromiso no infeccioso. Los principales hallazgos radiográficos fueron: infiltrados intersticiales (42,9%), compromiso pleural (23,8%) y lesiones cavitarias (7,9%). El compromiso multilobar fue evidente en el 15,9%. Las principales complicaciones fueron falla respiratoria, disfunción orgánica múltiple y falla renal aguda. El 19% requirió ingreso a UCI y, de estos, el 83,3% necesitó ventilación mecánica. La estancia hospitalariapromedio fue de 18 ± 20 días y la mortalidad del 17,5%. Discusión: Las infecciones por oportunistas son las principales causas de compromiso pulmonar y, dentro de estas, las causadas por micobacterias. Puede ocurrir más de una infección oportunista simultáneamente, pero en nuestra población fueron infrecuentes. Las causas noinfecciosas también son importantes.

More than a half of patients with HIV infection have pulmonary involvement throug-hout their lives. Opportunistic infections are the main cause; however, many patients havenoninfectious pulmonary involvement. Objective: To describe the characteristics of pulmonary involvement in inpatients with HIVinfection.Methods: Descriptive observational study. Results: A total of 63 patients were included, and 85.7% were men. The average age was40.6 ± 12 years. Some 21.4% had a history of sexual promiscuity and 28.6% were men whohad sex with men. Smoking was found in 60.3%, alcoholism in 52.4% and drug abuse in 20.6%.A tuberculosis history was documented in 23.8% of patients. At admission, 79.4% had AIDS, themean CD4 count was 138.5 ± 17.7 cells/mm3and 49.2% had CD4 counts < 100 cells/mm3. Majorcomorbidities included neoplastic disease in 20.6%, chronic diarrhea in 19%, COPD in 6.3% anddiabetes in 3.2%. Major opportunistic agents were Mycobacterium spp, H. capsulatum and P.jirovecii. Kaposi's sarcoma, lymphoproliferative disease and COPD were causes of noninfectiouspulmonary involvement. The main radiographic findings included interstitial infiltrates in 42.9%,pleural involvement in 23.8%, alveolar infiltrates in 7.9% and cavitary lesions in 7.9%. Multilobarcompromise was evident in 15.9% of the patients. The major complications were respiratoryfailure, multiple organ dysfunction and acute renal failure. Some 19% required care in the ICUand 83.3% of these required mechanical ventilation. The mean stay was 18 ± 20 days and themortality was 17.5%. Discussion: Opportunistic infections are the main causes of lung involvement and mycobacterialdiseases were most frequent. Mycobacterial diseases can occur simultaneously with an oppor-tunistic infection, but in our series this was infrequent. Non-infectious diseases are importantbut are less common.

A Case of Disseminated Skin and Soft Tissue Infection due to Mycobacterium abscessus with Metastatic Breast Cancer

Mycobacterium abscessus is a rapidly growing species of environmental mycobacteria commonly found in soil, dust, and water throughout the world. In immunocompetent patients, M. abscessus usually causes localized infection of skin and soft tissue in association with a traumatic or surgical wound. Although rare, it may cause disseminated systemic infection in patients with HIV, diabetes, or medically induced immunosuppression. Here we report a case of a 53-year-old female patient with disseminated skin and soft tissue infection due to M. abscessus who presented with multiple skin lesions on the trunk, back and four extremities. The patient had undergone salvage chemotherapy, modified radical mastectomy, and palliative chemotherapy for metastatic breast cancer. Granulomatous inflammation and acid-fast bacilli were found on skin biopsy. M. abscessus was identified via mycobacterial culture and PCR-restriction fragment length polymorphism analysis. The patient responded well to clarithromycin, cefoxitin and amikacin therapy, and was subsequently discharged on oral antimicrobial therapy. Non-tuberculous mycobacterial (NTM) infection is a rare cause of skin and soft tissue infection, and a very high index of suspicion is required to initiate an evaluation for NTM. In metastatic cancer patients with multiple skin lesions, skin infection due to NTM must be differentiated not only from cutaneous metastasis but also from bacterial or fungal infection.

Mycobacteriosis in wild birds: the potential risk of disseminating a little-known infectious disease / Micobacteriosis en aves silvestres: riesgo potencial de diseminación de una infección poco conocida en el mundo

Avian mycobacteriosis is important for animal and human health; wild birds play an important role in mycobacterial species' ecology and movement. This review was aimed at reporting the role of birds in the spread of avian mycobacteriosis in human and animal populations at risk and thus a systematic review was made of PubMed, Science Direct, Scielo and Scirus databases. Mycobacteria are classified into the Mycobacterium tuberculosis complex and non-tuberculous mycobacteria; the Mycobacterium avium complex represents the most important part of the latter because it is primarily responsible for mycobacterial infection in wild birds and is a potential pathogen for mammals, especially for immunocompromised patients. The clinical signs in birds are variable as it is a chronic and debilitating disease, involving emaciated carcasses, white nodules in different organs and microscopically it presents granulomatosous multifocal inflammation. Diagnosis begins by suspicion based on clinical signs and finishes with microbiological confirmation. New diagnostic techniques include testing with DNA-RNA probes. No effective treatment is currently available and chemoprophylaxis on suspicion of infection is not recommended at the start; these factors increase the potential risk of mycobacteriosis becoming one of the most frequently documented zoonotic diseases which is difficult to treat in birds and humans. Recent concern regarding mycobacterial infection lies in the increased frequency of these opportunistic infections occurring in immunocompromised individuals and these infections' potential impact on bird conservation, this being increased by greater contact between humans and wild and captive birds.

La micobacteriosis aviar es de importancia para la salud animal y humana. El objetivo de esta revisión fue reportar el papel de las aves en la diseminación de la micobacteriosis aviar en poblaciones vulnerables. Se realizó una revisión sistemática en las bases de datos PubMed, Science Direct, Scielo and Scirus. Las aves silvestres juegan un papel importante en la ecología y movimiento de micobacterias. Estas se clasifican en el Complejo Mycobacterium tuberculosis y las micobacterias no tuberculosas, dentro de este último grupo se destaca el Complejo Mycobacterium avium , principal responsable de micobacteriosis en aves silvestres y patógeno potencial para los mamíferos principalmente pacientes inmunosuprimidos. Los signos clínicos son variables, siendo una enfermedad debilitante y crónica, e involucra carcasas emaciadas, nódulos blanquecinos en diferentes órganos, microscópicamente presenta inflamaciones granulomatosas multifocales. El diagnóstico inicia por la sospecha basada en los síntomas clínicos y termina con la confirmación microbiológica. Adicionalmente, las nuevas técnicas diagnósticas incluyen pruebas con sondas de ADN-ARN. Actualmente, no existe un tratamiento efectivo y no se recomienda iniciar quimioprofilaxis; estos factores incrementan el riesgo potencial para convertir la micobacteriosis aviar en una enfermedad zoonótica más frecuente de lo documentado y de difícil tratamiento en aves y humanos. La reciente preocupación de las infecciones micobacterianas, radica en el aumento de la frecuencia de estas infecciones oportunistas en personas inmunocomprometidas y el impacto potencial de estas infecciones sobre la conservación de las especies de aves, favorecido por el mayor contacto entre humanos y aves tanto silvestres como cautivas.

The Usefulness of Colonoscopic Biopsy in the Diagnosis of Intestinal Tuberculosis and Pattern of Concomitant Extra-intestinal Tuberculosis / 대한소화기학회지

BACKGROUND/AIMS: Intestinal tuberculosis can be difficult to diagnose because it may mimic many other intestinal diseases. The aim of this study was to evaluate the diagnostic yield of colonoscopic biopsy and frequency of concomittent extra-intestinal tuberculosis in intestinal tuberculosis. METHODS: The medical records of 225 consecutive patients with intestinal tuberculosis (81 men, 144 women; mean age 40.6 yrs) were analyzed retrospectively. RESULTS: Histological examination of colonoscopic biopsy specimens revealed granulomas in 163 (72.4%) of the 225 patients. However, caseous necrosis was found in only 25 (11.1%) patients, and acid-fast bacilli (AFB) were noted in 39 (17.3%) of the 225 patients. Mycobacterium tuberculosis was isolated from the culture of biopsy specimens in 52 (29.3%) of 177 patients. Eighty-four patients (37.3%) had concomitant extra-intestinal tuberculosis and 67 (29.8%) showed active pulmonary tuberculosis. Histological examination of the biopsy specimens enabled the diagnosis of intestinal tuberculosis by the presence of either caseating granulomas or AFB in 52 (23.1%) patients. Combination of histological examination and Mycobacterium culture established the diagnosis in 87 (38.7%) patients. Before getting the result of Mycobacterium culture, the diagnosis could be made, by either histological examination or the presence of extra-intestinal tuberculosis in 107 (47.6%) patients. Combination of caseating granulomas, AFB staining, Mycobacterium culture, and the presence of extra-intestinal tuberculosis resulted in the diagnosis in 126 (56.0%) patients. CONCLUSIONS: To increase the diagnostic yield, AFB staining and Mycobacterium culture should be routinely performed on biopsy specimens in addition to routine histological examination for caseating granulomas.