Displacement of gold marker in immunoelectron microscopy of human respiratory cilia

The incidence of tuberculosis is rising in the United States. Similarly, the incidence of pulmonary tuberculosis in Taiwan is increasing, but that of large bowel tuberculosis in this region has not been reported. The purpose of this study was to investigate the changing disease pattern and to determine some possible surgical prognostic factors for large bowel tuberculosis. Seventy cases of large bowel tuberculosis treated at our institute during the period 1965-1995 were reviewed and analyzed. A steady decline in the case number of large bowel tuberculosis were noted from 1975, but there seems to be a slight increase in cases since 1990. The average age of these patients was 65.1 years, and none had human immunodeficiency virus infection. The ileocecum is the most common region of involvement. Of these 70 patients, 59 had not been definitively diagnosed until surgery. Active pulmonary tuberculosis was found in 18 patients (25.7%). The incidence of postoperative pulmonary complications was higher in patients with active pulmonary tuberculosis or disseminating large bowel tuberculosis. Postoperative abdominal complications, including intestinal obstruction, abdominal cutaneous fistula, and wound infection, were seen in 13 patients, none of whom had active pulmonary tuberculosis. Although the incidence of tuberculosis has been reduced for years, it is now rising. Physicians should bear in mind the possibility of large bowel tuberculosis in patients with intestinal obstruction without specific origin. Postoperative respiratory care is important for patients with pulmonary tuberculosis, with either active or disseminating lesions.     

Tuberculosis of the esophagus

A case of tuberculosis of the esophagus is presented in a patient with pulmonary tuberculosis. The patient, complaining of dysphagia, had esophagoscopic examination which showed a submucosal tumor with central ulceration. Tissue biopsy, under direct vision from the tumor mass, confirmed the diagnosis of tuberculosis. The patient has been asymptomatic under treatment. Both esophageal and pulmonary lesions are largely improved.     

The coexistence of pulmonary tuberculosis and lung cancer

For appropriate approach to diagnosis of pulmonary tuberculosis, it is necessary to understand the pathological processes from primary infection and acquisition of cellular immunity to reactivation, progression and cure of the tuberculous lesions. The outlines for roentgenological diagnosis are reviewed, which are the process of primary infection and cure after acquisition of cellular immunity, the process of reactivation and progress of postprimary pulmonary tuberculosis, and roentgenological characteristics of primary and postprimary pulmonary tuberculosis. The outlines of roentgenological aspects of pulmonary mycobacteriosis due to M. avium complex and M. kansasii are reviewed, which are increasing in Japan.     

Pulmonary tuberculosis in the elderly

Clinical problems of pulmonary tuberculosis in the elderly patients were discussed. As for diagnosing tests, chest X ray sometimes shows atypical findings in patients with pre-existing pulmonary diseases (i.e. pulmonary emphysema, interstitial pneumonia and etc). It is most important to get bacteriologic evidence from suspected patients of pulmonary tuberculosis. Elderly patients have co-existing diseases except pulmonary tuberculosis. Controlling co-existing diseases is essential for treatment of pulmonary tuberculosis in the elderly patients. Treatment with standard chemotherapy leads to good result even in the elderly. However, we have to investigate the mechanism of rush cases, who dies in a few months in spite of adequate chemotherapy.     

The present situation, treatment and prognosis of drug-resistant pulmonary tuberculosis. Cooperative Study Unit of Chemotherapy of Tuberculosis of the National Sanitoria in Japan

We studied 266 patients with drug-resistant pulmonary tuberculosis at national sanatoria in Japan. The patients included 218 men (mean age, 58 years) and 48 women (mean age, 62 years). The levels of isoniazid and rifampicin resistance were determined at 1 mcg/mL and 50 mcg/mL, respectively. The results were as follows. (1) Most patients with drug-resistant pulmonary tuberculosis were middle-aged or past middle-aged. (2) There were many cases of drug-resistant pulmonary tuberculosis in previously treated tuberculosis patients with active disease and several cases in previously untreated pulmonary tuberculosis patients. However, in some previously untreated patients active tuberculosis was convert relatively easily to inactive tuberculosis. (3) Concerning life style, bachelors who drank heavily were more likely to develop drug-resistant pulmonary tuberculosis. (4) Most cases of drug-resistant pulmonary tuberculosis had at least one cavity on chest radiographs. (5) Several patients with drug-resistant tuberculosis left the hospital against the advice of their attending doctors; therefore, it was difficult to treat their illnesses. (6) In more than half the cases in which Mycobacterium tuberculosis was resistant to isoniazid and rifampicin, tolerance to streptomycin and ethanbutol was also seen. (7) When patients with drug-resistant pulmonary tuberculosis continued to have tuberculous bacilli in their sputum after 3 months of chemotherapy, there was a tendency for them to expectorate tuberculous bacilli in their sputum. For these drug-resistant tuberculosis patients, we must pay attention not only to the medical aspects but also to the social aspects of their disease.     

The significance of isolating low numbers of mycobacterium tuberculosis in culture of sputum specimens

Because fewer than five Mycobacterium tuberculosis colonies were isolated from single sputum specimens from several patients with little clinical evidence of pulmonary tuberculosis, we reviewed all of our low colony isolates (LCIs) from an 18-month period. Thirty-one patients had 35 LCIs and were separated easily into groups that either appeared to have tuberculosis by clinical criteria or appeared to be uninfected. Patients in the "tuberculosis likely" group reasons such as concurrent antituberculosis therapy or an interstitial location of their pulmonary lesion to account for their LCIs. In contrast, patients in the "tuberculosis unlikely" group were all culture-negative when reevaluated two to four months after their first culture, and they had no evidence of tuberculosis on chest x-ray film despite having received no antituberculosis therapy. Half had negative tuberculin reactions, without generalized anergy. Epidemiologic study showed that most had been cultured the same day as patients with smear-positive tuberculosis, and the possibility of cross-contamination was investigated.     

The use of sputum induction for establishing a diagnosis in patients with suspected pulmonary tuberculosis in Malawi

SETTING: There has been a marked increase in notified cases of smear-negative pulmonary tuberculosis in Malawi since 1986. One reason for this may be related to the difficulties of getting adequate samples of expectorated sputum from patients. Sputum induction with nebulized hypertonic saline may be a simple way of obtaining a better specimen. OBJECTIVE: To examine the value of sputum induction for detecting cases of smear-positive tuberculosis. DESIGN: Sputum induction was performed on 82 adults presenting to the Queen Elizabeth Central Hospital, Blantyre, Malawi with clinically suspected pulmonary tuberculosis who were expectorated sputum smear-negative or unproductive of sputum. The induced sputum smear was examined for acid-fast bacilli and cultured for mycobacteria. RESULTS: Sputum was successfully induced from 73 of the 82 patients (26 previously smear-negative and 47 previously unproductive). The induced sputum was smear-positive in 18 patients (5 previously smear-negative and 13 unproductive). Cultures were positive for Mycobacterium tuberculosis in the 18 smear-positive patients and a further 12 that had been smear-negative. 94 cases of smear-positive pulmonary tuberculosis were notified during the study period. 18 (19%) were as a result of sputum induction. CONCLUSION: Sputum induction is a useful technique for improving the case detection rate of smear-positive tuberculosis in Malawi.     

Infectiousness of laryngeal tuberculosis

Two patients with laryngeal tuberculosis in the absence of extensive pulmonary tuberculosis are presented. In both, tuberculin testing of household members failed to show infectiousness of their disease. This contradicts the commonly held view that laryngeal tuberculosis is invariably highly infectious. The extent and activity of pulmonary disease probably determines the infectiousness of patients with laryngeal tuberculosis rather than the laryngeal lesion per se.     

Problems in the treatment of patients with pulmonary tuberculosis

The paper presents the current approaches to chemotherapy in patients with pulmonary tuberculosis and shows the main reasons that do not allow one to achieve high outcomes of treatment. These involve the drug resistance of Mycobacterium tuberculosis, the morphological features of a specific process in the lung, the higher incidence of acutely progressive types of pulmonary tuberculosis in particular; tuberculosis-contaminant diseases (diabetes mellitus, gastrointestinal, hepatic, renal diseases, and non-specific respiratory diseases, etc.). Recommendations how to eliminate the reasons for ineffective treatment of pulmonary tuberculosis are given.     

Demonstration of acid-fast bacilli in buffy coat and bone marrow smear--a diagnostic tool in pulmonary tuberculosis

Buffy coat smears prepared from peripheral blood and bone marrow aspirate obtained from proved 60 untreated cases of pulmonary tuberculosis were stained with Ziehl-Neelsen method and thoroughly screened for presence of tubercle bacilli. Acid-fast bacilli were detected in 55% cases in buffy coat, 48.3% cases in bone marrow, 38.3% cases both in buffy coat and bone marrow and 65% cases either in buffy coat or in bone marrow or in both. Considering the fact that demonstration of acid-fast bacilli may not be possible in more than 25-50% of the suspected cases of tuberculosis, these techniques are recommended for evaluation of their utility in establishing diagnosis of tuberculosis, particularly in reference to sputum negative cases of pulmonary tuberculosis and tuberculosis of inaccessible extrapulmonary sites.     

PCR-based rapid detection of Mycobacterium tuberculosis in blood from immunocompetent patients with pulmonary tuberculosis

A PCR test based on insertion sequence IS1081 was developed to detect Mycobacterium tuberculosis complex organisms in the peripheral blood. The method was applied to blood samples from immunocompetent individuals with localized pulmonary tuberculosis. Seven of 16 (43.75%) blood samples were found to be positive for the circulating DNA copies of M. tuberculosis complex.     

Differential diagnosis of pulmonary tuberculosis

Differential diagnosis of pulmonary tuberculosis is discussed. Chest X-ray findings of pulmonary tuberculosis may be greatly varied, because tuberculosis may cause three different lesions: an exudative lesion, a proliferative lesion, and a fibrotic lesion, and because it may invade all the structure. Thus, the differential diagnosis of pulmonary tuberculosis includes very many diseases. The most important differential diagnosis of nodule is tuberculoma and lung cancer. The clue of the diagnosis is the feature of the nodule and surrounding structure, such as pleural indentation, or knotching. There is, however, the limitation of the diagnosis by imaging: some tuberculoma may show the identical feature with the pulmonary adenocarcinoma. It is important to gather the pathological or bacteriological evidences by means of suitable procedures.     

Biopsy for diagnosis of tuberculosis

Recent advances of molecular techniques make diagnosis of pulmonary tuberculosis rapid and easier comparing to conventional techniques. However, diagnosis for tuberculosis, especially tuberculous pleuritis, tuberculous lymphadenitis and non-pulmonary tuberculosis, is not easy. Transbroncheal lung biopsy (TBLB) is a helpful examination for not only pulmonary tuberculosis but also malignant diseases. The pleural biopsy using Cope needle was commonly used as a method for diagnosis of tuberculous pleuritis, and the sensitivity of pleural biopsy is about 50% or more. Furthermore, the pleural biopsy using thoracoscopy was reported to show a higher sensitivity for the diagnosis of tuberculous pleuritis. A lymph node biopsy is also a useful method for diagnosis of tuberculous lymphadenitis. Thus, a biopsy method is the reliable tool for diagnosis of not only pulmonary tuberculosis, but also other organ tuberculosis.     

Resurgence of a forgotten pathology: pylephlebitis caused by tuberculous adenopathies

The incidence of abdominal tuberculosis represents less than 1% of all forms of tuberculosis. We report the case of a portal vein thrombosis associated with tuberculous adenopathy of the hepatic hilum discovered in a young woman free of symptoms, without any risk factors, who had recovered from a cavity pulmonary tuberculosis after a classical anti-tuberculous treatment. This case suggests that abdominal tuberculosis often remains undiagnosed. Reemergence of tuberculosis is likely because of the increase in the incidence of the acquired immunodeficiency syndrome.     

Diagnosis and treatment of pulmonary tuberculosis complicated with chronic liver disease

Immunocompromised or malnutritional hosts are high risk group of pulmonary tuberculosis. Chronic liver disease especially decompensated cirrhosis of the liver is one of the risk group for this infection. When ascites or pleural effusion developed in patient with hepatic cirrhosis, complication of pulmonary tuberculosis must be considered. In such condition, drug metabolism was impaired so that anti-tuberculous drugs should be used carefully, but in almost cases except decompensated cirrhotic patients are tolerable for standard anti-tuberculous combination therapy and they could be cured. Hepatitis C virus infection is common in patients with old pulmonary tuberculosis because many of them were infected Hepatitis C virus at the time of blood transfusion for pulmonary resection or thoracoplasty. In such condition recurrence of pulmonary tuberculosis is rare but probability of recurrence must be considered when they developed decompensated cirrhosis.     

Male genitourinary tuberculosis. Report of 12 cases and review of the literature

The incidence of genitourinary tuberculosis is constant in western countries, despite dramatically falling prevalence of pulmonary tuberculosis. The kidney is especially involved in urinary tuberculosis, and genital tuberculosis mostly affects the epididymis in males and the fallopian tubes in females. Twelve cases of male genitourinary tuberculosis are presented and the literature is briefly reviewed.     

Reactivation of tuberculosis: a problem of aging

Six examples demonstrate the reactivation of pulmonary tuberculosis in elderly patients. In 3 cases the tuberculosis became reactivated 25, 47 and 51 years respectively after the initial diagnosis. In aged patients with pulmonary symptoms and abnormal x-ray findings, the presence of reactivated tuberculosis should always be considered. Sometimes steroid or x-ray therapy for other disease may be the reactivating factor.     

Tuberculosis screening: usefulness of new KREATECH IgA ELISA test

A total of 71 sera from 15 proved cases of pulmonary tuberculosis, 2 cases with doubtful radiological report and 54 suspected cases, contacts, donors etc. were subjected to Elisa IgG, IgM and IgA tests for tuberculosis, with a view to comparing the merits of IgA test with those of IgG and IgM. Kreatech IgA test which is claimed to indicate presence of active tuberculosis was positive in 13 of the proved cases and negative in both the doubtful cases. These preliminary results indicate that KREATECH IgA is a promising new ELISA test which can be a useful laboratory aid in the diagnosis of active tuberculosis, both pulmonary and extrapulmonary, for screening of suspected cases, and for monitoring cases undergoing therapy.     

Clinical efficacy of the amplified Mycobacterium tuberculosis direct test for the diagnosis of pulmonary tuberculosis

The amplified Mycobacterium tuberculosis direct test (MTD) is a rapid diagnostic test based on a nucleic acid amplification technique, which can be used directly on processed clinical specimens. We evaluated the clinical utility of the MTD for diagnosing pulmonary tuberculosis by comparing the sensitivity and specificity of the test with acid-fast smear, mycobacterial culture, and clinical evaluation. The study included 844 respiratory tract specimens from 421 patients, which were submitted to the microbiology laboratory of our urban teaching hospital over a 6-mo period. Compared with culture, MTD had a sensitivity of 93.6% and specificity of 97.8%. MTD was more sensitive in detecting pulmonary tuberculosis in patients with previously undiagnosed disease (74.7%) than in those with established disease receiving chemotherapy (29.2%), and in smear-positive (95.5%) than in smear-negative (70.0%) disease. There were two false positive MTD results in patients with nontuberculous mycobacteria, for a specificity in this population of 97.3%. We conclude that MTD, when used in conjunction with routine smear and culture, is a useful rapid diagnostic test for suspected pulmonary tuberculosis.     

Pulmonary tuberculosis associated with invasive pseudallescheriasis

A 54-year-old woman with pulmonary tuberculosis developed pneumonia caused by Scedosporium apiospermum, the asexual stage of the fungus Pseudallescheria boydii. Mycobacterium tuberculosis and P boydii were cultured in BAL fluid. The patient cleaned swimming pools in a spa health resort and was highly exposed to fungal conidia. She was successfully treated with antituberculosis drugs, miconazole nitrate and ketoconazole, leading to remission of her pulmonary infection. Invasive pulmonary pseudallescheriasis associated with tuberculosis is an unusual finding, especially in an immunocompetent individual.