ABSTRACT
Mycobacterium kansasii extrapulmonary infections are infrequent in immunocompetent adults. Rifampin (RIF), clarithromycin (CLR), isoniazid (INH) and ethambutol (EMB) are included in all the standard regimens against M.kansasii. We report a case of a healthy 65-year-old male farmer who presented with isolated right supraclavicular lymphadenopathy. The lymph node FNA showed acid-fast-bacilli and granulomatous inflammation. Quantiferon TB Gold test, HIV serology, and functional immunological studies were all negative or normal. He was put on a standard 4 drugs anti-tuberculous regimen that was switched to RIF + CLR+ INH after the Microbiology lab demonstrated an EMB-resistant Mycobacterium kansasii isotype I strain. The patient was cured after 12 months of therapy. This is the 6th reported case of M. kansasii extrapulmonary lymphadenitis in an immunocompetent adult and the 2nd showing EMB resistance in the world literature. Antimycobacterial regimens against M. kansasii, classically resistant to pyrazinamide (PZA) might also exclude EMB due to its increasing resistance in Europe. A 612 months therapy with at least 2 effective antimycobacterial drugs including RIF + CLR might be enough to treat extrapulmonary M. kansasii infections in immunocompetents.
ABSTRACT
PURPOSE: We sought to evaluate clinical-epidemiologic aspects, pathologic characteristics, and treatment of sclerosing polycystic adenosis (SPA) of the parotid gland and to report 2 new cases. MATERIALS AND METHODS: We conducted a systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for studies published in or before June 2016. The inclusion criteria were as follows: final diagnosis of SPA affecting the parotid gland and articles published in Spanish or English. The exclusion criteria were as follows: unclear diagnosis after pathologic analysis and patients affected by other conditions in the major salivary glands. We added 2 new cases. RESULTS: Our review ultimately included 21 articles and 45 cases. The mean patient age was 41 years (range, 7-84 years). The female-to-male ratio was 2:1. In all patients the tumor showed progressive growth. The evolution range was 7 days to 11 years. In 17.7% of cases, the tumor was associated with pain. The average tumor size was 30.3 mm (range, 12-60 mm). Fine needle aspiration biopsy (FNAB) was unable to diagnose 30 cases. Benign tumors comprised 58% of tumors (18), whereas malignancy was present in 25.8% (8). Thirty-five tumors were well circumscribed. There were 8 multinodular or lobed cases. The tumor was described as encapsulated in 1 case, partially encapsulated or pseudo-encapsulated in 16, and not encapsulated in 12. Five cases showed different degrees of degenerative changes, ranging from dysplasia to invasive carcinoma. All cases underwent surgical treatment. Superficial parotidectomy with preservation of the facial nerve was performed in 22 cases (61.1%), total parotidectomy in 8 (22.2%), and tumor enucleation in 6 (16.6%). The mean follow-up period was 51.5 months (range, 5-276 months). Of documented cases, 74.2% had 2 or more years of follow-up. Recurrences occurred in 6 cases (16.6%). CONCLUSIONS: We consider SPA a benign tumor with progressive growth, which is occasionally painful. It occurs around age 40 years and occurs more often in female patients. Fine needle aspiration biopsy does not provide an adequate preoperative diagnosis. Recurrences are infrequent. Follow-up should be customized according to the pathologic findings. Malignant transformation may occur. Superficial parotidectomy with facial nerve preservation is the treatment of choice.
Subject(s)
Salivary Gland Diseases , Aged , Female , Humans , Middle Aged , Parotid Gland/pathology , Salivary Gland Diseases/diagnosis , Salivary Gland Diseases/surgery , SclerosisABSTRACT
BACKGROUND AND OBJECTIVE: To evaluate the performance and the usefulness of an in vitro interferon gamma release assay in the diagnosis of latent tuberculosis infection in immunocompromised hospital-based population. PATIENTS AND METHOD: A cohort of 445 high-risk adults from a hospital located in an intermediate tuberculosis burden area were prospectively evaluated for latent tuberculosis by means of the whole blood in vitro QuantiFERON-TB Gold assay (QTF), measuring tuberculosis-specific interferon gamma release by memory-effector T lymphocytes. RESULTS: Overall the test displayed a positive result in 15.43% patients. Among the different risk groups, hemodialysis patients revealed the highest positive rates (30.23%). Indeterminate results (10.19% on the whole) were more often seen in neoplastic (18.03%) patients and in patients with autoimmune disease (17%). In 291 patients in whom QTF and Mantoux were simultaneously performed, concordance was moderate (kappa = 0.4520) with a 76.8% agreement when Mantoux was negative (179/233) but reaching only 50% (29/58) when Mantoux positive patients were selected. CONCLUSIONS: QFT test is suitable for routine latent tuberculosis diagnosis in hospital-based immunocompromised patients. At least in some of them, i.e. hemodialysis and patients with autoimmune suppression, QFT adds valuable information for therapeutical decision-making. In Mantoux positive patients, it is very useful for ruling-out false positives due to BCG-vaccination and/or non-tuberculous mycobacterial infection.
Subject(s)
Interferon-alpha/analysis , Interferon-alpha/biosynthesis , Lymphocytes/immunology , Tuberculosis/diagnosis , Tuberculosis/immunology , Adolescent , Adult , Aged , Aged, 80 and over , Child , Cohort Studies , Female , Humans , Male , Middle Aged , Risk Factors , Serologic Tests/methodsABSTRACT
FUNDAMENTO Y OBJETIVO: Evaluar la aplicabilidad en el medio hospitalario de una prueba de interferóngamma in vitro en respuesta a antígenos específicos, así como valorar su utilidad en el diagnóstico de tuberculosis latente en pacientes con alto riesgo de reactivación tuberculosa.PACIENTES Y MÉTODO: Estudio descriptivo y prospectivo realizado en una cohorte de pacientes hospitalariosformada por 445 adultos seleccionados por pertenecer a grupos de riesgo para el desarrollo de enfermedad tuberculosa activa, procedentes de una región con una incidencia intermedia de tuberculosis activa declarada en la población general. Se realizó una prueba deproducción de interferón gamma in vitro en sangre total tras estimulación específica de antígeno, denominada QuantiFERON-TB Gold assay (QTF), que valora la respuesta de los linfocitos T efectores de memoria, específicos de tuberculosis.RESULTADOS: La prueba fue positiva en el 15,43% de los casos. El mayor número de positivos (30,23%) se observó entre los pacientes en hemodiálisis. Los resultados indeterminados (un 10,19% en total) fueron más frecuentes en pacientes con enfermedades neoplásicas y autoinmunitarias (el 18,03 y el 17%, respectivamente). En 291 casos en que se realizó simultáneamente la intradermorreacción de Mantoux, la concordancia fue moderada (kappa = 0,4520), con un 76,8% de acuerdo en caso de Mantoux negativo (179/233), pero sólo del 50% (29/58) cuando el Mantoux fue positivo.CONCLUSIONES: La prueba QTF puede aplicarse habitualmente en el medio hospitalario para eldiagnóstico de tuberculosis latente en pacientes inmunodeprimidos. Al menos en algunos de éstos (pacientes en hemodiálisis, con enfermedades autoinmunitarias) aporta información adicionalmuy valiosa a la hora de tomar decisiones terapéuticas. En pacientes con Mantoux positivo es muy útil para descartar falsos positivos debidos a vacunación antituberculosa y/o infección por micobacterias atípicas
BACKGROUND AND OBJECTIVE: To evaluate the performance and the usefulness of an in vitro interferon gamma release assay in the diagnosis of latent tuberculosis infection in immunocompromisedhospital-based population.PATIENTS AND METHOD: A cohort of 445 high-risk adults from a hospital located in an intermediatetuberculosis burden area were prospectively evaluated for latent tuberculosis by means of the whole blood in vitro QuantiFERON-TB Gold assay (QTF), measuring tuberculosis-specific interferon gamma release by memory-effector T lymphocytes.RESULTS: Overall the test displayed a positive result in 15.43% patients. Among the different risk groups, hemodialysis patients revealed the highest positive rates (30.23%). Indeterminate results (10.19% on the whole) were more often seen in neoplastic (18.03%) patients and in patients with autoimmune disease (17%). In 291 patients in whom QTF and Mantoux were simultaneously performed, concordance was moderate (kappa = 0.4520) with a 76.8% agreement when Mantoux was negative (179/233) but reaching only 50% (29/58) when Mantoux positive patients were selected.CONCLUSIONS: QFT test is suitable for routine latent tuberculosis diagnosis in hospital-based immunocompromised patients. At least in some of them, i.e. hemodialysis and patients with autoimmunesuppression, QFT adds valuable information for therapeutical decision-making. In Mantoux positive patients, it is very useful for ruling-out false positives due to BCG-vaccination and/or non-tuberculous mycobacterial infection
