Tuberculosis abdominal en pediatría: presentación de un caso / Abdominal tuberculosis in pediatrics: A case report

La tuberculosis es una enfermedad infectocontagiosa cuya forma de presentación más frecuente es la pulmonar; la afectación abdominal es poco frecuente, por lo que su diagnóstico continúa siendo un desafío. Las manifestaciones clínicas de la tuberculosis abdominal así como sus hallazgos en el examen físico suelen ser inespecíficos y, en muchas ocasiones, similares a los de otras patologías, por lo que es fundamental considerarla entre los diagnósticos diferenciales. Se presenta el caso clínico de un paciente de sexo masculino, de 15 años de edad, hospitalizado por un síndrome febril prolongado asociado a dolor abdominal, diarrea, sudoración nocturna y pérdida de peso

Tuberculosis is an infectious disease which most commonly compromises the respiratory system, whereas abdominal involvement is rare, thus its diagnosis is a challenge. The clinical manifestations of abdominal tuberculosis as well as its physical examination findings are usually non-specific and, frequently, similar to those of other diseases, so it is critical to consider abdominal tuberculosis among the differential diagnoses. Here we report the clinical case of a 15-year-old male patient hospitalized for a prolonged febrile syndrome associated with abdominal pain, diarrhea, night sweats, and weight loss.

The rules of acupoint selection of acupuncture and moxibustion for scrofula in ancient times / 中国针灸

Based on data mining technology, the rules of acupoint selection of acupuncture-moxibustion for scrofula in ancient times were analyzed. The relevant articles of acupuncture and moxibustion for scrofula were searched in the Chinese Medical Code, and the original article, acupoint name, acupoint characteristic, and acupoint meridian tropism, etc. were screened and extracted. The Microsoft Excel 2019 was used to establish a acupoint prescription database, and the frequency of acupoints as well as their meridian tropism and characteristics were analyzed. The SPSS21.0 was applied to perform cluster analysis of acupuncture prescriptions; the SPSS Modeler 18.0 was used to perform the association rules analysis of the neck and the chest-armpit acupoints, respectively. As a result, 314 acupuncture prescriptions were extracted, including 236 single-acupoint prescriptions and 78 multiple-acupoints prescriptions (53 for neck and 25 for chest-armpit). A total of 54 acupoints were involved, with a total frequency of 530. The top 3 commonly-used acupoints were Tianjing (TE 10), Zulinqi (GB 41) and Taichong (LR 3); the most commonly-used meridians were hand shaoyang meridian, foot shaoyang meridian, hand yangming meridian and foot yangming meridian; the most commonly-used special acupoints were he-sea points and shu-stream points. The cluster analysis obtained 6 clusters, and the association rule analysis obtained that the core prescriptions of the neck were Quchi (LI 11), Jianyu (LI 15), Tianjing (TE 10) and Jianjing (GB 21), while the core prescriptions of the chest-armpit were Daling (PC 7), Yanglingquan (GB 34), Danzhong (CV 17), Jianjing (GB 21), Waiguan (TE 5), Zhigou (TE 6), Yuanye (GB 22) and Zhangmen (LR 13). The core prescriptions obtained from association rule analysis by difference areas were basically consistent with those by cluster analysis of total prescriptions.

Comparison of different diagnostic modalities for isolation of Mycobacterium Tuberculosis among suspected tuberculous lymphadenitis patients / Comparação de diferentes modalidades de diagnóstico para isolamento de Mycobacterium tuberculosis entre pacientes com suspeita de linfadenite tuberculosa

Abstract Tuberculosis is a communicable disease with high morbidity and mortality rates in developing countries. The study's primary objective is to compare conventional methods such as acid-fast bacillus (AFB) culture and microscopy with rapid diagnostic methods. The secondary objective is to compare histopathological and microbiological findings in suspected patients with tubercular lymphadenitis. A total of 111 samples (August 2018 to September 2019) of lymph nodes were processed for AFB microscopy, AFB cultures, drug-susceptibility testing (DST), histopathology, and Xpert Mycobacterium Tuberculosis (MTB)/resistance to Rifampin (RIF) assays. Out of 111 lymph node samples, 6 (5.4%) were positive for AFB smear microscopy, 84 (75.6%) were positive for AFB culture, 80 (70.7%) were positive on Gene Xpert, and 102 (91.8%) were indicative of tuberculosis for histopathology studies. Mycobacteria growth indicator tube (MGIT) culture positivity was 84 (75.6%) higher than solid Lowenstein-Jensen (LJ) culture 74 (66.6%). Positive cultures underwent phenotypic DST. Two cases were Multidrug-resistant (MDR) on DST, while three cases were Rifampicin resistant on Gene Xpert. The sensitivity of Genexpert was (62%) against the conventional AFB culture method. The poor performance of conventional lymphadenitis diagnostic methods requires early and accurate diagnostic methodology. Xpert MTB/RIF test can help in the treatment of multidrug-resistant TB cases. Nonetheless, rapid and conventional methods should be used for complete isolation of Mycobacterium tuberculosis.

Resumo A tuberculose é uma doença transmissível com altas taxas de morbimortalidade nos países em desenvolvimento. O objetivo principal do estudo é comparar métodos convencionais, como cultura de bacilo álcool-ácido resistente (BAAR) e microscopia, com métodos de diagnóstico rápido. O objetivo secundário é comparar os achados histopatológicos e microbiológicos em pacientes com suspeita de linfadenite tubercular. Um total de 111 amostras (agosto de 2018 a setembro de 2019) de gânglios linfáticos foi processado ​​para microscopia de AFB, culturas de AFB, teste de susceptibilidade a drogas (DST), histopatologia e Xpert Mycobacterium tuberculosis (MTB)/ensaios de resistência à rifampicina (RIF). Das 111 amostras de linfonodos, 6 (5,4%) foram positivas para baciloscopia de AFB, 84 (75,6%) foram positivas para cultura de AFB, 80 (70,7%) foram positivas para o GeneXpert e 102 (91,8%) foram indicativas de tuberculose para estudos histopatológicos. A positividade da cultura do tubo indicador de crescimento de micobactérias (MGIT) foi 84 (75,6%), maior que a cultura sólida de Lowenstein-Jensen (LJ), 74 (66,6%). As culturas positivas foram submetidas a DST fenotípico. Dois casos eram multirresistentes (MDR) ao DST, enquanto três casos eram resistentes à rifampicina no GeneXpert. A sensibilidade do GeneXpert foi 62% contra o método convencional de cultura AFB. O fraco desempenho dos métodos convencionais de diagnóstico de linfadenite requer metodologia de diagnóstico precoce e precisa. O teste Xpert MTB/RIF pode ajudar no tratamento de casos de tuberculose multirresistente. No entanto, métodos rápidos e convencionais devem ser usados ​​para o isolamento completo do Mycobacterium tuberculosis.

Comparison of different diagnostic modalities for isolation of Mycobacterium Tuberculosis among suspected tuberculous lymphadenitis patients / Comparação de diferentes modalidades de diagnóstico para isolamento de Mycobacterium tuberculosis entre pacientes com suspeita de linfadenite tuberculosa

Tuberculosis is a communicable disease with high morbidity and mortality rates in developing countries. The study's primary objective is to compare conventional methods such as acid-fast bacillus (AFB) culture and microscopy with rapid diagnostic methods. The secondary objective is to compare histopathological and microbiological findings in suspected patients with tubercular lymphadenitis. A total of 111 samples (August 2018 to September 2019) of lymph nodes were processed for AFB microscopy, AFB cultures, drug-susceptibility testing (DST), histopathology, and Xpert Mycobacterium Tuberculosis (MTB)/resistance to Rifampin (RIF) assays. Out of 111 lymph node samples, 6 (5.4%) were positive for AFB smear microscopy, 84 (75.6%) were positive for AFB culture, 80 (70.7%) were positive on Gene Xpert, and 102 (91.8%) were indicative of tuberculosis for histopathology studies. Mycobacteria growth indicator tube (MGIT) culture positivity was 84 (75.6%) higher than solid Lowenstein-Jensen (LJ) culture 74 (66.6%). Positive cultures underwent phenotypic DST. Two cases were Multidrug-resistant (MDR) on DST, while three cases were Rifampicin resistant on Gene Xpert. The sensitivity of Genexpert was (62%) against the conventional AFB culture method. The poor performance of conventional lymphadenitis diagnostic methods requires early and accurate diagnostic methodology. Xpert MTB/RIF test can help in the treatment of multidrug-resistant TB cases. Nonetheless, rapid and conventional methods should be used for complete isolation of Mycobacterium tuberculosis.

A tuberculose é uma doença transmissível com altas taxas de morbimortalidade nos países em desenvolvimento. O objetivo principal do estudo é comparar métodos convencionais, como cultura de bacilo álcool-ácido resistente (BAAR) e microscopia, com métodos de diagnóstico rápido. O objetivo secundário é comparar os achados histopatológicos e microbiológicos em pacientes com suspeita de linfadenite tubercular. Um total de 111 amostras (agosto de 2018 a setembro de 2019) de gânglios linfáticos foi processado para microscopia de AFB, culturas de AFB, teste de susceptibilidade a drogas (DST), histopatologia e Xpert Mycobacterium tuberculosis (MTB)/ensaios de resistência à rifampicina (RIF). Das 111 amostras de linfonodos, 6 (5,4%) foram positivas para baciloscopia de AFB, 84 (75,6%) foram positivas para cultura de AFB, 80 (70,7%) foram positivas para o GeneXpert e 102 (91,8%) foram indicativas de tuberculose para estudos histopatológicos. A positividade da cultura do tubo indicador de crescimento de micobactérias (MGIT) foi 84 (75,6%), maior que a cultura sólida de Lowenstein-Jensen (LJ), 74 (66,6%). As culturas positivas foram submetidas a DST fenotípico. Dois casos eram multirresistentes (MDR) ao DST, enquanto três casos eram resistentes à rifampicina no GeneXpert. A sensibilidade do GeneXpert foi 62% contra o método convencional de cultura AFB. O fraco desempenho dos métodos convencionais de diagnóstico de linfadenite requer metodologia de diagnóstico precoce e precisa. O teste Xpert MTB/RIF pode ajudar no tratamento de casos de tuberculose multirresistente. No entanto, métodos rápidos e convencionais devem ser usados para o isolamento completo do Mycobacterium tuberculosis.

Masa pulmonar como manifestación primaria de tuberculosis en pediatría: reporte de un caso / Pulmonary tuberculosis presenting as a lung mass in children: case report

La tuberculosis es una de las principales causas infecciosas de muerte en el mundo y es endémica en Argentina. La mayoría de los casos de tuberculosis son de localización pulmonar; el tuberculoma una complicación infrecuente. Se describe un caso clínico de presentación pulmonar atípica de tuberculosis. Se trata de una niña de 15 meses, previamente sana, derivada a neumología por fiebre, mal progreso de peso e imagen persistente por 2 meses en la radiografía de tórax a pesar de haber recibido antibioticoterapia. Antecedente de contacto estrecho con persona sintomática respiratoria. Se internó para estudio, mostró una PPD de 13 mm y una masa voluminosa heterogénea en el lóbulo superior izquierdo en la tomografía computada de tórax. Se realizaron tres lavados gástricos y toracoscopia exploratoria con biopsia pulmonar con rescate de Mycobacterium tuberculosis en cultivos. Se diagnosticó tuberculoma pulmonar y realizó tratamiento estándar con fármacos antituberculosos con evolución favorable.

Tuberculosis is one of the main causes of death due to infection around the world. Although tuberculosis frequently involves lung parenchyma, tuberculoma is a rare complication. We describe an atypical pulmonary presentation of tuberculosis. A 15-month-old girl, previously healthy, was referred to the pulmonology department due to fever, poor weight gain, and a 2-months persistent lung image on chest x-ray despite antibiotic therapy. She had been in frequent contact with a respiratory symptomatic subject. She was admitted to the hospital with a TST of 13 mm and a heterogeneous bulky mass in the left upper lobe at chest computed tomography. Three gastric lavages were done and the patient underwent exploratory thoracoscopy and lung biopsy, with positive cultures for Mycobacterium tuberculosis. The diagnosis of pulmonary tuberculoma was confirmed, and the patient received standard anti- tuberculosis therapy with a favorable evolution.

A Case of Eosinophilic Granulomatosis with Polyangiitis Mimicking Cutaneous Tuberculosis and Tuberculous Lymphadenitis

Summary@#Eosinophilic granulomatosis with polyangiitis (EGPA), or Churg-Strauss Syndrome (CSS) is a rare granulomatous necrotizing vasculitic disease characterized by the presence of asthma, sinusitis, and hypereosinophilia. We describe a patient who was initially diagnosed with tuberculous lymphadenitis and later diagnosed with EGPA.

Analysis on specific effect of acupoints at the upper arms in treatment of scrofula and goiter / 中国针灸

Through analyzing the indication distribution of the different acupoints located at the upper limbs recorded in

Caracterización clínica epidemiológica de tuberculosis infantil, Región Sanitaria Metropolitana del Distrito Central, Honduras / Epidemiological and clinical characteristics of tuberculosis in children, Central District Metropolitan Health Region, Honduras

En 2015, la tasa global de incidencia de tuberculosis por 100,000 habitantes fue 43 en Honduras y 29 en el Municipio del Distrito Central. Objetivo: Caracterizar clínica y epidemiológicamente los casos de tuberculosis infantil, Región Sanitaria Metropolitana del Distrito Central (RSMDC), 2016. Métodos: Estudio descriptivo transversal. Se revisaron las Fichas de Notificación de Casos de Tuberculosis en pacientes menor o igual a18 años, registrados durante 2016. Se analizaron variables sociodemográficas y clínicas. Se diseñó una base de datos en EpiInfo 7.2.1. Se obtuvo autorización institucional. La información personal de los casos se manejó confidencialmente. Resultados: Del total de 400 fichas registradas, 13 (3.2%) contenían información completa. La caracterización se realizó a partir de estos 13 casos, 53.8% eran niñas, 46.2% entre 15 y 18 años. En 67% el diagnóstico fue clínico, 27% tenía tuberculosis pulmonar y 16.7% extrapulmonar. El método de diagnóstico más utilizado fue baciloscopía (38.5%). Todosrecibieron tratamiento básico primario, sin comorbilidades, no vivían en condición de riesgo o pertenecían a grupo de riesgo; no presentaron recaídas ni co-infección VIH. Discusión: El sistema de notificación de casos en RSMDC denota un déficit extraordinario e inaceptable en el registro de la información. Aunque la caracterización realizada puede estar sesgada por el número reducido de casos, sus características son similares a lo descrito para la tuberculosis infantil. Es imperativo fortalecer la vigilancia epidemiológica de la tuberculosis en Honduras con énfasis en la tuberculosis infantil y la detección y tratamiento de los contactos...(AU)

Respuesta paradojal al tratamiento antituberculoso en una paciente con SIDA / PARODOXICAL RESPONSE TO ANTITUBERCULOSE TREATMENT IN A PATIENT WITH AIDS

La tuberculosis (TB) es una enfermedad infectocontagiosa de gran importancia en la salud pública y representa una de las 10 principales causas de muerte a nivel mundial. Una de las complicaciones del tratamiento antituberculoso es la respuesta paradojal, que se define como un empeoramiento clínico o la aparición de nuevas lesiones en un paciente que comienza un tratamiento antifímico. Esta reacción está mediada por una respuesta de hipersensibilidad a los antígenos de Mycobacterium tuberculosis. Suele aparecer entre 2 y 4 meses luego de iniciado el tratamiento antituberculoso, generalmente precedida por una mejoría inicial del cuadro. Se presenta una mujer con sida y tuberculosis ganglionar con respuesta paradojal a la terapéutica antimicobacteriana y se realiza una revisión bibliográfica del tema.

Tuberculosis (TB) is an infectious disease of great importance in public health and represent one of the 10 leading causes of death worldwide. One of the complication of the antituberculous treatment is the paradoxical reaction, which is defined as a worsening or the appearance of new lesions in a patient receiving antimicobacterial treatment. This paradoxical response is mediated by a hypersensitivity reaction to mycobacterial antigens. It usually appears between 2 and 4 months after initiation of tuberculosis treatment and is preceded by an initial improvement of the clinical condition. Here, we describe a woman with AIDS and lymph node tuberculosis with a paradoxical reaction to antimycobacterial therapy and the subject is reviewed.

Tuberculosis abdominal en niños de un hospital público de tercer nivel en México / Abdominal tuberculosis in children of a public tertiary hospital in Mexico

INTRODUCCIÓN. A nivel mundial la tuberculosis es una de las diez causas de muerte, con una incidencia de 7 920 pacientes entre 0 ­ 14 años en la región de América; siendo el abdomen el sitio extrapulmonar más común. OBJETIVOS. Describir las características etarias, clínicas, microbio-lógicas, complicaciones y comorbilidades asociadas en los pacientes pediátricos con tuberculosis abdominal. MATERIALES Y MÉTODOS. Estudio retrospectivo, base de datos de 23 pacientes y edades de 0 meses a 17 años 11 meses y 29 días de edad con evidencia confirmatoria de la presencia del microorganismo; de los servicios de Gastroenterología y Epidemiología en el Nuevo Hospital Civil de Guadalajara "Dr. Juan I. Menchaca ", período 2007 a 2018. RESULTADOS. Se informaron 47,8% (11; 23) de sexo masculino y 52,2% (12; 23) de sexo femenino; 26,1% (6; 23) con antecedente de ingesta de lácteos no pasteurizados. Los tres datos clínicos más frecuentes fueron dolor abdominal, fiebre y pérdida de peso. El 8,7% (2;23) tuvieron convivencia con personas con tuberculosis activa positivo; 30,4% (7; 23) registraron prueba cutánea de derivado proteico pu-rificado positiva; 30,4% (7; 23) identificación de bacterias ácido-alcohol resistentes positivo; 43,5% (10; 23) estudios de imagen compatibles; 8,7% (2; 23) proteína C reactiva de mucosa intestinal po-sitivo; 4,3% (1; 36) cultivo positivo y 8,7% (2; 23) pacientes con inmunodeficiencia. CONCLUSIÓN. La tuberculosis abdominal, se presentó en menores de edad con síntomas inespecíficos de dolor abdominal, fiebre y pérdida de peso, expuestos a ingesta de productos lácteos no pasteurizados, combe positivo e inmunodeficiencia.

INTRODUCTION. Worldwide, tuberculosis is one of the ten causes of death, with an incidence of 7 920 patients between 0 - 14 years in the Americas region; the abdomen being the most common extrapulmonary site. OBJECTIVES. Describe the age, clinical, microbiological, complications and associated comorbidities in pediatric patients with abdominal tuberculosis. MATERIALS AND ME-THODS. Retrospective study, database of 23 patients and ages from 0 months of age to 17 years 11 months and 29 days of age with confirmatory evidence of the presence of the microorganism; of the Gastroenterology and Epidemiology services at the New Civil Hospital of Guadalajara "Dr. Juan I. Menchaca ", period 2 007 to 2 018. RESULTS. 47,8% (11; 23) men and 52,2% (12; 23) women were reported; 26,1% (6; 23) with a history of unpasteurized dairy intake. The three most frequent clinical data were abdominal pain, fever and weight loss. 8,7% (2; 23) lived together with people with positive active tuberculosis; 30,4% (7; 23) recorded a positive purified protein derivative skin test; 30,4% (7; 23) positive acid-alcohol resistant bacteria identification; 43,5% (10; 23) compatible imaging studies; 8,7% (2; 23) positive intestinal mucosal C-reactive protein; 4,3% (1; 36) positive culture and 8,7% (2; 23) patients with immunodeficiency. CONCLUSION. Abdominal tuberculosis occurred in minors with nonspecific symptoms of abdominal pain, fever and weight loss, exposed to intake of unpasteurized dairy products, positive combe and immunodeficiency

Fine needle non-aspiration cytology for the diagnosis of cervical lymph node tuberculosis: a single center experience / Punção não aspirativa com agulha fina para o diagnóstico de tuberculose linfonodal cervical: experiência de centro único

Abstract Introduction: The fine-needle cytology is being used as a first line of investigation in the diagnosis of head and neck swellings, as it is simple, cost effective and less invasive as compared to biopsy. Objective: The aims of this study were to evaluate the results of the fine-needle non-aspiration cytology of cervical lymphadenopathy and to study the factors influencing the rate of non-diagnosis results. Methods: This retrospective study was conducted on selected patients with cervical lymphadenopathy that had undergone a fine-needle non-aspiration cytology followed by a histological biopsy. The sensitivity, specificity, positive predictive value and negative predictive value of fine-needle non-aspiration cytology for diagnosing tuberculosis were estimated. The risk factors of non-diagnosis results were evaluated. Results: The sensitivity, specificity, positive predictive value rates of fine-needle non-aspiration cytology for tuberculosis were 83.3%, 83.3%, 78.9% and 86.9% respectively. In total, 47 out of the 131 samples (35.8%) were considered non-diagnosis. Of the non-diagnosis samples, 84.2% (38 out of 47) were benign mostly due to tuberculosis (30 cases). Among the studied factors, only tuberculosis (confirmed by histopathological examination) was significantly associated with non-diagnosis cytology (p = 0.02, Odds-Ratio = 2.35). Conclusion: Tuberculosis is currently the commonest cause of cervical lymphadenopathy in North Africa. Fine-needle non-aspiration cytology is safe and accurate in the diagnosis of cervical tuberculous lymph node that is associated with the risk of non-diagnosis cytology.

Resumo Introdução: A punção não aspirativa com agulha fina tem sido utilizada como primeira linha de investigação no diagnóstico de tumores de cabeça e pescoço, por ser uma técnica simples, custo-efetiva e menos invasiva quando comparada à biópsia. Objetivo: Os objetivos deste estudo foram avaliar os resultados de citologia por punção não-aspirativa com agulha fina de linfadenopatias cervicais e estudar os fatores que influenciam a taxa de falha diagnóstica. Método: Este estudo retrospectivo foi realizado em pacientes selecionados com linfadenopatia cervical submetidos a punção não aspirativa com agulha fina, seguida por biópsia histológica. Foram estimadas a sensibilidade, especificidade, o valor preditivo positivo e valor preditivo negativo da punção não aspirativa com agulha fina para o diagnóstico de tuberculose. Os fatores de risco dos resultados com falha diagnóstica foram avaliados. Resultados: As taxas de sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo da punção não aspirativa com agulha fina para tuberculose foram de 83,3%, 83,3%, 78,9% e 86,9%, respectivamente. Das 131 amostras, 47 (35,8%) foram consideradas como falha diagnóstica. Das amostras não diagnosticadas, 84,2% (38 de 47) eram benignas, principalmente devido à tuberculose (30 casos). Entre os fatores estudados, apenas a tuberculose (confirmada pelo exame histopatológico) estava significativamente associada à citologia com falha diagnóstica (p = 0,02, odds ratio = 2,35). Conclusão: A tuberculose é atualmente a causa mais comum de linfadenopatia cervical no norte da África. A punção não aspirativa com agulha fina é uma técnica segura e precisa no diagnóstico de linfonodos cervicais associados ao risco de citologia com falha diagnóstica.

Causas de condenações em bovinos em um abatedouro com inspeção municipal de Minas Gerais / Causes of bovine condemnation in an slaughter under municipal inspection services in the Minas Gerais staction

A identificação de condenações em frigoríficos é importante para fornecer melhorias no processo produtivo e dados de possíveis fontes de contaminação na linha de abate. O objetivo foi identificar as causas de condenação de carcaças e vísceras bovinas, em um frigorífico de inspeção municipal em Minas Gerais, e discutir fatores que favorecem a ocorrência das mesmas. Foram analisados os registros de condenações no período de julho de 2017 a setembro de 2018. Do total de 3.723 animais abatidos, 101 (2,71%) apresentaram algum tipo de condenação. Foram condenados principalmente fígado, coração, fragmentos de caraças e carcaças inteiras. Abscessos hepáticos foram a causa mais frequente de condenação. Observamos que a frequência de descarte de carcaças e vísceras variaram entre os Serviços de Inspeção e estão relacionadas com a região estudada.

Aspects épidémiologiques et histologiques des tuberculoses extra-pulmonaires au Bénin

Les tuberculoses extra-pulmonaires (TEP) représentent une proportion élevée de toutes les formes de tuberculose et leurs manifestations cliniques polymorphes rendent le diagnostic souvent difficile. L'objectif de notre étude était de décrire les caractéristiques épidémiologiques et histologiques des TEP diagnostiquées dans deux laboratoires d'anatomie pathologique de Cotonou. Nous avons mené une étude transversale descriptive portant sur 53 dossiers de patients atteints de tuberculose extra-pulmonaire dans les laboratoires d'anatomie pathologique de la Faculté des Sciences de la Santé et de la Cité Houéyiho à Cotonou sur une période de 10 ans (juin 2007 - juin 2018). L'âge moyen était de 46,5 ans avec une prédominance féminine (54,7 %). Les principales localisations étaient : la tuberculose ganglionnaire à 71,7 %, suivie par la tuberculose digestive (17 %) et de la tuberculose urogénitale (9,4%). Dans les différentes formes, le type histologique le plus fréquent était le type caséo-folliculaire. Notre travail a montré une fréquence élevée de l'atteinte ganglionnaire avec le type caséo-folliculaire comme le type histologique dominant

Aspects épidémiologiques et histologiques des tuberculoses extra-pulmonaires au Bénin

Les tuberculoses extra-pulmonaires (TEP) représentent une proportion élevée de toutes les formes de tuberculose et leurs manifestations cliniques polymorphes rendent le diagnostic souvent difficile. L'objectif de notre étude était de décrire les caractéristiques épidémiologiques et histologiques des TEP diagnostiquées dans deux laboratoires d'anatomie pathologique de Cotonou. Nous avons mené une étude transversale descriptive portant sur 53 dossiers de patients atteints de tuberculose extra-pulmonaire dans les laboratoires d'anatomie pathologique de la Faculté des Sciences de la Santé et de la Cité Houéyiho à Cotonou sur une période de 10 ans (juin 2007 - juin 2018). L'âge moyen était de 46,5 ans avec une prédominance féminine (54,7 %). Les principales localisations étaient : la tuberculose ganglionnaire à 71,7 %, suivie par la tuberculose digestive (17 %) et de la tuberculose urogénitale (9,4%). Dans les différentes formes, le type histologique le plus fréquent était le type caséo-folliculaire. Notre travail a montré une fréquence élevée de l'atteinte ganglionnaire avec le type caséo-folliculaire comme le type histologique dominant

Cluster of Lymphadenitis due to Nontuberculous Mycobacterium in Children and Adolescents 8–15 Years of Age

BACKGROUND: Nontuberculous mycobacteria (NTM) lymphadenitis is an under-recognized entity, and data of the true burden in children are limited. Without a high index of suspicion, diagnosis may be delayed and microbiological detection is challenging. Here, we report a cluster of NTM lymphadenitis experienced in Korean children. METHODS: Subjects under 19 years of age diagnosed with NTM lymphadenitis during November 2016–April 2017 and April 2018 were included. Electronic medical records were reviewed for clinical, laboratory and pathological findings. Information regarding underlying health conditions and environmental exposure factors was obtained through interview and questionnaires. RESULTS: A total of ten subjects were diagnosed during 18 months. All subjects were 8–15 years of age, previously healthy, male and had unilateral, nontender, cervicofacial lymphadenitis for more than 3 weeks with no significant systemic symptoms and no response to empirical antibiotics. Lymph nodes involved were submandibular (n = 8), preauricular (n = 6) and submental (n = 1). Five patients had two infected nodes and violaceous discoloration was seen in seven subjects. Biopsy specimens revealed chronic granulomatous inflammation and acid-fast bacteria culture identified Mycobacterium haemophilum in two cases and NTM polymerase chain reaction was positive in two cases. Survey revealed various common exposure sources. CONCLUSION: NTM lymphadenitis is rare but increasing in detection and it may occur in children and adolescents. Diagnosis requires high index of suspicion and communication between clinicians and the laboratory is essential for identification of NTM.

Tuberculosis ganglionar periférica en pediatría: 16 años de experiencia en un centro pediátrico de tercer nivel de Buenos Aires, Argentina / Peripheral tuberculous lymphadenitis in pediatrics: 16 years of experience in a tertiary care pediatric hospital of Buenos Aires, Argentina

La tuberculosis extrapulmonar representa el 1520 % de todas las formas de presentación. La tuberculosis ganglionar periférica es la segunda forma extrapulmonar más frecuente en niños de Argentina, luego de la pleural. En el Servicio de Tisiología del Hospital de Niños "Dr. Ricardo Gutiérrez", se analizaron en forma retrospectiva 92 casos de tuberculosis ganglionar periférica asistidos entre agosto, 2000-septiembre, 2015. La edad media fue 8,7 ± 5 años. Las adenopatías fueron periféricas únicas (31,5 %), periféricas múltiples (20,6 %) y periféricas asociadas a profundas (47,8 %). Predominó la localización cervical (80 %). El 80 % recibió antibioticoterapia previa, sin respuesta. El 56 % tenía foco de contagio conocido; 69 %, prueba cutánea de tuberculina positiva y 54 %, radiografía de tórax patológica. Todos iniciaron tratamiento antifímico por clínica compatible, exposición y/o prueba cutánea de tuberculina positiva, antes de la confirmación microbiológica o histológica. La evolución fue curación (81,5 %), derivación cercana al domicilio (8,7 %), abandono (8,7 %). Un paciente falleció.

Extrapulmonary tuberculosis accounts for 15-20 % of all clinical presentations of tuberculosis. Peripheral tuberculous lymphadenitis is the second most common presentation of extrapulmonary tuberculosis in children, after pleural tuberculosis, in Argentina. We analyzed 92 patients with peripheral tuberculous lymphadenitis seen at the Department of Tisiology of Hospital de Niños "Dr. Ricardo Gutiérrez" between August 2000 and September 2015. The patients' mean age was 8.7 ± 5 years. Nodal sites corresponded to single peripheral (31.5 %), multiple peripheral (20.6 %), and peripheral associated with deep nodes (47.8 %). Cervical lymph nodes were the most common site of involvement (80 %). In 80 % of patients previous antibiotic therapy had been administered, without response. The tuberculosis source was known in 56 %; 69 % had a positive tuberculin skin test; and 54 %, a pathological chest X-ray. Tuberculosis treatment was started on all patients based on clinical criteria, exposure and/or positive tuberculin skin test, prior to microbiological or histological confirmation. The clinical course was either healing (81.5 %), referral to a facility near home (8.7 %) or dropout (8.7 %). One patient died.

Sensibilidade in vitro a antimicrobianos de Corynebacterium pseudotuberculosis isolados de pequenos ruminantes da região Centro- Norte do Estado da Bahia / In vitro antimicrobial susceptibility of Corynebacterium pseudotuberculosis isolated from small ruminants from the North-Central region of the State of Bahia

Introdução: corynebacterium pseudotuberculosis é uma bactéria com importância em medicina veterinária por ser o agente etiológico da Linfadenite Caseosa (LC) em pequenos ruminantes. A doença leva a perdas econômicas devido a condenação de carcaças, diminuição de produtividade e redução do valor comercial do couro dos animais acometidos. O tratamento da doença é pouco eficaz, pois os agentes antimicrobianos não conseguem atravessar a barreira dos granulomas, mas tem sido proposta a inoculação intracapsular de antibióticos como tratamento e como medida de prevenção de contaminação ambiental. Objetivo: devido a esse fato, o presente estudo teve como objetivo avaliar a sensibilidade in vitro de isolados clínicos de Corynebacterium pseudotuberculosis isolados de animais da região Centro-Norte do estado da Bahia. Metodologia: foram retirados material de granulomas de 11 animais de uma fazenda na região acima mencionada, e as bactérias foram isoladas a partir desse material. Esses isolados então foram submetidos a metodologia de difusão em disco de ágar utilizando-se discos impregnados com doze antibióticos diferentes. Resultados: 90,9% (10/11) dos isolados foram resistentes a oxacilina. Com relação à sensibilidade, 100% dos isolados foram sensíveis a ampicilina, amicacina, amoxicilina, cefalotina, ceftriaxona, ciprofloxacina, enrofloxacina, neomicina e penicilina, enquanto 90,9% destes apresentaram sensibilidade a bactericina e doxiciclina. Conclusão: pode-se concluir que os isolados de C. pseudotuberculosis da região estudada apresentam sensibilidade a diversos antibióticos, o que pode facilitar na escolha de um antimicrobiano com menor toxicidade para fins de tratamento com inoculação intracapsular do medicamento.

Background: corynebacterium pseudotuberculosisis important bacteria in veterinary medicine because it is the Etiologic Agent of Caseous Lymphadenitis (CL) in small ruminants. The disease leads to economic losses due to condemnation of carcasses, productivity decrease and leather commercial value reduction of affected animals affected. The treatment of the disease is not very effective, because antimicrobial agents cannot cross the barrier of granulomas, but it has been proposed the intracapsular inoculation of antibiotics as treatment and as a measure of prevention of environmental contamination. Objective: due to this fact, the present study aimed to evaluate the in vitro susceptibility of clinical isolates of Corynebacterium pseudotuberculosis isolated from animals in the North Central region of the State of Bahia. Methodology: granuloma material were removed from 11 animals from a farm in the above mentioned area, and the bacteria were isolated from this material. These isolated bacteria were then subjected to disk diffusion method of agar using disks impregnated with twelve different antibiotics. Results: 90,9% (10/11) the isolated bacteria were resistant to oxacillin.With respect to sensitivity, 100% of the isolates bacteria were susceptible to amikacin, ampicillin, amoxicillin, cephalotin, ceftriaxone, ciprofloxacin, enrofloxacin, neomycin and penicillin, while 90.9% of these showed sensitivity to bacitracin and doxycycline. Conclusion: it can be concluded that the isolated bacteria of C. pseudotuberculosis from the region studied present sensitivity to different antibiotics, which can facilitate the choice of a less toxic antimicrobial for treating with intracapsular inoculation of the medicine.

Coinfección por lepra y tuberculosis ganglionar en un adulto / Leprosy and ganglionar tuberculosis coinfection in an adult

Se describe el caso clínico de un paciente de 34 años de edad, quien acudió a consulta de Dermatología por presentar máculas eritematosas pruriginosas generalizadas. A los 3 meses con tratamiento específico comenzó a presentar febrículas vespertinas y adenopatías cervicales dolorosas, por lo que se indicó una baciloscopia en ambos codos y pabellones auriculares, pero no se halló el Mycobacterium leprae; además se realizó biopsia por aspiración con aguja fina de un ganglio cervical, cuyo resultado reveló una tuberculosis ganglionar. Finalmente se diagnosticó una coinfección por lepra y tuberculosis ganglionar, dos enfermedades producidas por el Mycobacterium, cuya coexistencia es rara.

The case report of a 34 year-old patient is described who came to the Dermatology Service due to disseminated pruritic erythematous stains. After 3 months with specific treatment he began to present evening low fevers and painful cervical adenopathies, reason why a baciloscopy was indicated in both elbows and ear pavilions, but the Mycobacterium leprae was not found; besides aspiration biopsy with fine needle of a cervical ganglion was also carried out, which result revealed a ganglionar tuberculosis. Finally a leprosy and tuberculosis ganglionar coinfection was diagnosed, two diseases emerging due to the Mycobacterium, which coexistence is strange.