Epidemiological and clinical patterns of intrathoracic lymph node tuberculosis in 60 human immunodeficiency virus-negative adult patients.

We retrospectively evaluated a group of human immunodeficiency virus (HIV)-negative adult patients with hilar and/or mediastinal tubercular adenopathy to assess their epidemiological, clinical and radiological features. Out of 3,003 intrathoracic tuberculosis (TB) cases (of which 745 were immigrants from various developing countries) observed in our Institute from 1986-1996, 8 Italians and 52 immigrants were selected. Case history analysis, and standard chest radiography were performed in all cases, while other investigations such as a tuberculin test, sputum and culture examination for Mycobacterium tuberculosis, computed tomography (CT) scanning and biopsy were performed in the majority of patients. Less frequently, bronchoscopy, mediastinoscopy, and echography were also performed. Right paratracheal adenopathy was found most frequently (29 cases), as previously described. CT scanning showed a central necrosis pattern in 31 cases, while normo/hyperdensity occurred in 11 cases. M. tuberculosis was detected in sputum smear and/or culture in only 16 patients. Our study confirms that, when HIV-positive patients are excluded, this peculiar TB location occurs more frequently in immigrants than in the indigenous Italian population (7.0 versus 0.3%, p < 0.001). People from the Indian subcontinent and Senegal are the most frequently involved nationalities among the immigrants present in Milan.

Anti-mycobacterial activity of amikacin.

We have tested in the IUTM egg medium the susceptibility against amikacin (AKC) of 147 strains of Mycobacterium tuberculosis (M.t.) isolated from the sputum of patients affected with pulmonary Tb. Only five strains showed resistance at 5 and 10 mcg/ml: they were also resistant to other main anti-tubercular drugs (MATD). The other 59 strains resistant to MATD and the 82 ones without any resistance to MATD were found normally susceptible to AKC at 5 mcg/ml in IUTM m. The parallel test performed on a synthetic medium (7H10) with 10 firstly-observed strains, allowed us to define that AKC undergoes a 60% inactivation in the egg medium. Two patients suffering from chronic pulmonary Tb, with M.t. constantly isolable in their sputum, assumed a twice-weekly treatment (TWT) with AKC alone (total 26 gr). This management induced in them improvement of the radiological and bacteriological findings, without alteration of the checking parameters.

Diagnostic value of the paracoagulation protamine sulphate test (PSt) in the pulmonary diseases more frequently encountered in the clinical practice.

A single diluted protamine sulphate test has been employed by the Authors in several respiratory diseases in order to define its diagnostic usefulness. Such a test, easily performed in all clinical chemistry laboratories and very cheap, has resulted to be positive mostly in the pleuropulmonary pathology following microembolic spread to the lung (pulmonary infarction), with a higher significance the earlier the test has been made. The test has appeared to be also able to differentiate infarctual active pleurites (positive) from tubercular eudates and transudates (negative).