ABSTRACT
Multifocal bone involvement is though rare but is reported from some countries where tuberculosis is endemic. Here we report a case of three years old boy was admitted in Bangabandhu Sheikh Mujib Medical University, Dhaka with the complaints of difficulty in walking ,low grade fever for six months, swelling over the back, elbow joint, knee joint and upper part of forearm and legs for two months. Family history of tuberculosis was positive. Mantoux test was 18 mm, ESR 85 mm in first hour, chest X-ray reveals right hilar lymphadenopathy, X-ray dorsolumber spine shows wedge shaped deformity in T11, L4 and with paravertebral collection from L2-L4. X-ray of legs, knee joint and forearms show multiple lytic lesions in shaft with periosteal reaction and cortical thickening. Ultrasonograph of whole abdomen shows psoas abscess. Culture of bone marrow aspirate reveals Mycobacterium tuberculosis. Patient was given an anti tubercular regimen with Rifampicin, Isoniazid, Pyrazinamide and Streptomycin for initial two months which to be followed by Rifampicin and Isoniazid for another 10 months.
Subject(s)
Mycobacterium tuberculosis/isolation & purification , Psoas Abscess/diagnosis , Tuberculosis, Osteoarticular/diagnosis , Antibiotics, Antitubercular/therapeutic use , Antitubercular Agents/therapeutic use , Child, Preschool , Humans , Isoniazid/therapeutic use , Male , Protein Synthesis Inhibitors/therapeutic use , Psoas Abscess/drug therapy , Psoas Abscess/physiopathology , Pyrazinamide/therapeutic use , Rifampin/therapeutic use , Streptomycin/therapeutic use , Tuberculosis, Osteoarticular/drug therapy , Tuberculosis, Osteoarticular/physiopathologyABSTRACT
Iron profile of 72 severely malnourished children of whom 36 children had acute respiratory infection and 36 without infection of 12-59 months of age was compared with 36 normal healthy children. Mean serum iron level in non-infected severely malnourished children was (35.91+/-0.70 microg/dl) significant lower level than normal healthy children (63.50+/-0.97 microg/dl) (p<0.001). On the other hand non-infected group had significant higher level than acute respiratory infection group (31.90+/-1.35 microg/dl) (p<0.05). In acute respiratory infection group of severely malnourished children, mean serum ferritin level (19.48+/-1.71 ng/ml) had significant higher level than non-infected malnourished children (7.02+/-0.30 ng/ml) (p<0.001). Mean serum total iron binding capacity level was reduced in severely malnourished children both in non-infected (230.00+/-1.16 microg/dl) and infected (224.64+/-3.05 microg/dl) than normal healthy children (330.86+/-2.43 microg/dl) (p<0.001). There was significant reduction of mean serum transferrin saturation level in non-infected (15.65%) and acute respiratory infection (14.53%) group of malnourished children than normal children (19.35%). It is concluded that acute respiratory infection influenced the reduction of mean serum iron, total iron binding capacity and transferring saturation level. But mean serum ferritin concentration was elevated in acute respiratory infection group as probably as acute phase protein but still lower than normal children.
