Case Of Miliary Tuberculosis Research Articles

Severe Infections in Childhood Leukemia

Severe infections during the course of childhood ALL were surveyed as a whole in 100 consecutive patients, followed up for 2-8.5 years from the ALL diagnosis. The most important findings were a total absence of disseminated candidiasis, a relative infrequency of gram-negative septicemia (8 episodes), and a predominance of gram-positive cocci (29 episodes) in the 48 verified septicemias. S. aureus was responsible for 50% of culture-positive septicemias. The gram-positive predominance depended probably on local factors, and reservation in using broad-spectrum antibiotics might have played a part. There were 9 cases of disseminated Varicella-zoster, cured successfully with antiviral agents. Pneumocystis carinii pneumonitis numbered 8 episodes, concentrated to the early remission period. One case of miliary tuberculosis was found. Risk factors regarding age of patient and phase or intensity of cytotoxic therapy are evaluated.

Homograft aortic valve replacement: seven years' experience with antibiotic-treated valves.

One hundred and sixty-five patients had their aortic valve replaced with antibiotic-sterilised homograft. In all cases, a two-layered freehand technique of valve implantation was used. Tailoring (narrowing) of the annulus was required in 29 cases, and an aortic root gusset was used to enlarge the non-coronary sinus in 68 cases. There was an early mortality of 1.8% and late mortality of 2.4%. The actuarial survival rate was 95% at a maximum follow-up of seven years. The incidence of valvar regurgitation (early diastolic murmur) was 11.5% up to six months after operation and an additional 7.2% subsequent to this. Overall, it was trivial in 10.3%, mild in 7.8%, and moderate in 0.6%. Most valve regurgitation was non-progressive and actuarial analysis showed 74% regurgitation-free valves at the end of seven years. The age of the donor and the valve storage time showed some relationship to valve deterioration. Special attention has been paid to the control of hypertension to prevent accelerated graft degeneration. The results suggest that this has been successful. Anticoagulant therapy was not used and thromboembolism has not been seen in patients undergoing isolated aortic valve replacement. There was one case of miliary tuberculosis after homograft valve replacement but no pyogenic or fungal endocarditis occurred. No haemolysis, calcification, or valvar stenosis were observed. This series, followed for a maximum of seven years, shows excellent sustained valve performance and a very low incidence of important postoperative regurgitation, with 91.8% of the survivors symptom-free.

Klinisch nicht erkannte Tuberkulosen im Obduktionsgut

Among 18,724 unselected postmortems performed between 1955 and 1975 811 (4.33%) cases of post-primary tuberculosis were found among which 370 (45.6%) were active and 441 (54.4%) inactive. Occurrence of death involved tuberculosis in 32% of all cases discovered at autopsy. The age group over 50 years was mainly affected and males were clearly more frequently involved, particularly in pulmonary tuberculosis. 333 cases of tuberculosis (41.1%) had been recognised clinically and had mainly consisted of chronic pulmonary forms. In the older age group the proportion of cases diagnosed prior to death decreased steadily. Tuberculosis was associated with other diseases in most patients, particularly with cardiovascular disease and malignant tumours. During the investigation period the number of patients with active tuberculosis decreased. The number of cases of miliary tuberculosis among the active forms remained approximately the same.

Miliary Tuberculosis

Twenty-six cases of miliary tuberculosis were studied in retrospect. The mean age of the patients was 62 years. Eighteen patients suffered from another underlying chronic disease. Nine had been treated with corticosteroids or cytotoxic agents. A limited manifestation of tuberculosis had been previously verified or suspected in ten cases. Fever was present in 85% of the patients, frequently combined with fatigue or abdominal pain. Serum alkaline phosphatase was elevated in 81% of the cases. Minor haematological abnormalities (anaemia, etc.) were found in 16 cases and pancytopenia, stimulated lymphocytes or chronic myeloid leucaemia in six. Miliary mottling was found in the chest radiographs of 13 patients. Other findings were pleural effusion, mediastinal node enlargement, opacities suggesting pneumonia or old, possibly tuberculous lesions. Antituberculosis therapy was initiated in 12 patients, two of whom died within a few days. There was a high frequency of liver or system involvements. It is concluded that laparoscopy or liver needle biopsy are valuable diagnostic procedures in patients with fever and elevated alkaline phosphatases of unknown aetiology. A therapeutic test with antituberculous drugs should be undertaken in suspected cases.

Miliary tuberculosis following homograft valve replacement.

Postoperative septicaemia with infective endocarditis is a recognized complication of open-heart surgery, in particular homograft or prosthetic replacement of cardiac valves. Several infective organisms, both bacterial and fungal, have been incriminated but infection due to tubercle bacilli has not, to our knowledge, been reported. The clinicopathological features of this condition are discussed. During a five-year period, over 800 homograft replacements in the aortic and/or mitral positions have been performed at Harefield Hospital. Seven cases of miliary tuberculosis following homograft valve replacement are descrbied here. In three, there was a past history suggestive of tuberculosis infections but necropsy failed to reveal any caseous or other tuberculous lesion apart from recent miliary tuberculosis. Vegetations on the homograft valves contained microcolonies of acid-fast bacilli in most cases. Tubercle bacilli of the human type were recovered by culture or guinea-pig inoculation in six of the seven cases, and in three the diagnosis was established during life; two of these survived on antituberculosis chemotherapy. The onset of symptoms varied from a few weeks to 12 months after operation. The main presenting symptom was intermittent pyrexia. In two patients the diagnosis was made on radiological and clinical grounds and in both, tubercle bacilli were grown from drill biopsy specimens of lung tissue. The source of infection was presumed to be the homograft valves contaminated in the postmorten room. The antibiotic mixture used in the sterilization of the homografts was not effective against tubercle bacilli.

Lysozyme activity in hematologic and non-hematologic disorders with special reference to reactive monocytosis associated with chronic infections and inflammatory reactions.

The clinical significance of serum and urinary lysozyme estimation was evaluated in patients with hematologic and non-hematologic disorders. Markedly increased serum lysozyme ranging from 17.0 to 150.0 μ/ml with the mean of 48.1 μ/ml and profuse lysozymuria with the mean daily excretion of 938 mg were observed in monocytic leukemia. Slight to moderate increases of serum lysozyme were found in chronic myelocytic leukemia with the mean of 16.7 μ/ml and polycythemia vera with the mean of 15.1 μ/ml, and in the former disease lysozymuria was less marked, except for one excreting 110 mg per day, than that in monocytic leukemia. In cases of acute and chronic lymphocytic leukemias, lysozyme levels lower than normal serum levels were detected. With regard to lysozyme activity in reactive monocytosis, a case of miliary tuberculosis with pulmonary and hepatosplenic involvement was presented in which moderately elevated serum lysozyme and a large amount of lysozyme in urine to such an extent as suggestive of monocytic leukemia were found by serial estimations. Two other patients with miliary tuberculosis, who were undergoing chemotherapy, showed increased serum lysozyme activities. An additional case with possible diagnosis of cholecystitis exhibited peripheral monocytosis and greatly increased serum and urinary lysozyme concentrations. Such cases suggest that proliferation of monocytic cells, not only in leukemia but also in the rare conditions including prominent reactive monocytosis (3-5×1011 monocytes in the body), can cause marked increase of lysozyme when the amounts of lysozyme exceed the capacity to dispose the enzyme by catabolic mechanism. Pulmonary tuberculosis with varied degrees of disease activity did not cause an increase of lysozyme, while in patients with sarcoidosis elevated serum lysozyme activities were observed, indicating that total mass of monocytic cells were increased in the latter conditions. On the other hand, proliferation of lymphoid cells and reticuloendothelial cells resulted in no increase of lysozyme. Non-hematologic disorders such as hepatic, cardiac disorders and neoplasm except for renal disease caused no increase of lysozyme.

Steroid-Responsive Hypercalcemia in Disseminated Bone Tuberculosis

There are many established causes of hypercalcemia. These include hyperparathyroidism, malignancies with or without bony metastases, sarcoidosis, bone atrophy, thyroid dysfunction, Addison disease, vitamin D intoxication, and the milk-alkali syndrome. 1 Hypercalcemia with disseminated bone tuberculosis is extremely rare. However, a case of miliary tuberculosis in which symptomatic hypercalcemia developed was reversed by corticosteroid therapy. Patient Summary A 28-year-old officer began serving a tour of duty in the Republic of Vietnam in September 1969. In March 1970, the patient noted the onset of fever, chills, nausea, and vomiting. A chest roentgenogram was normal, and peripheral blood smears revealed falciparum malaria. Despite several courses of antimalarial therapy and clearing of the parasitemia, fever persisted; and in late May, he was transferred to Walter Reed General Hospital. On admission, the patient complained of weakness, anorexia, and had a 9.04-kg weight loss. He was a thin, chronically ill appearing, white man in no

PANCYTOPENIA WITH LEUKEMIA-LIKE PICTURE. EFFECTS OF HISTOPLASMOSIS.

FROM THE DAWN of medical history, syphilis and tuberculosis have been the great mimickers of disease. Osler claimed that he who knows syphilis and tuberculosis knows medicine. Generalized fungus diseases could be added to this list. This report concerns a patient with an extensive and generalized histoplasmosis and manifestations of pancytopenia and leukemia. Since 1938, four fatal cases of histoplasmosis and three cases of miliary tuberculosis with recovery have presented an identical, obscure clinical course. Report of a Case A 55-year-old woman was studied because of periodic epistaxis and melena. She lost one-halt cup of blood from her nose 12 hours before consultation and an equal quantity from her anus. For some time she bruised easily after minor trauma. Recently after having prophylactic treatment for her teeth, she experienced bleeding from the gums. She had lost 18 lb (8.2 kg) during the previous five-month period; drugs had not been administered.

Streptomycin in tuberculous meningitis and miliary tuberculosis: A five-year survey

Summary (1) The results of the streptomycin treatment of 63 cases of tuberculous meningitis and 15 of miliary tuberculosis over five years are presented. (2) The need for early diagnosis of tuberculous meningitis is discussed. The significance of C.S.F. changes, especially sugar, is considered. (3) The response to treatment is classified and discussed. Every case of miliary tuberculosis should have a lumbar puncture on diagnosis and at intervals thereafter, to exclude possible association with latent meningitis.

Comparative studies on the bone-marrow, blood and gastric juice culture of tubercle bacilli in children.

SummaryBone‐marrow (bm), blood (b) and gastric juice (gj) cultures have been taken from 51 cases of primary complex (bm. 11, b. 3, gj. 5 pos.), 9 cases of t.b. of serous membranes (bm. 3, b. 0, gj. 0 pos.), 9 cases of miliary tuberculosis (bm. 4, b. 0, gj. 2 pos.) and 16 cases of t.b. meningitis (bm. 8, b. 2, gj. 2 pos.). The practical and theoretical importance of these findings is discussed.

A case of miliary tuberculosis during pregnancy treated by streptomycin: Rogers, William N., Wilson, Eileen, and Goodier, Thomas E. W.: J. Obst. & Gynaec. Brit. Emp. 57: 795, 1951

A case of miliary tuberculosis during pregnancy treated by streptomycin: Rogers, William N., Wilson, Eileen, and Goodier, Thomas E. W.: J. Obst. & Gynaec. Brit. Emp. 57: 795, 1951

Significance of the presence of Koch's bacillus in the cerebrospinal fluid

SummaryReport of :1° A case of « serous tuberculous meningitis » in adult, with positive culture for tubercle bacillus and spontaneous recovery;2° 2 cases of miliary tuberculosis with, at once, positive culture of the spinal fluid, without any clinical symptoms of meningeal involvement and without any modification of the spinal fluid.

Tuberculous pericarditis as a forerunner of generalized miliary tuberculosis

A case of miliary tuberculosis, in which the first obvious symptoms were those of tuberculous pericarditis, has been described and the effects of streptomycin outlined. The fact that treatment resulted in a remission and brought about a complete disappearance of radiological and clinical signs gives some hope that the cases of tuberculous pericarditis in the course of a miliary dissemination are those which would benefit most by the use of streptomycin. To give the patient the best chance of remission, early diagnosis would seem to be essential. A short survey of current and early literature has been given in an attempt to stress the fact that tuberculous pericarditis, although not common, is not very rare, and that it should be more suspected than it has been hitherto.

Seven cases of miliary tuberculosis in puerpery collected over three years

Seven cases of miliary tuberculosis in puerpery collected over three years

SUBACUTE MILIARY TUBERCULOSIS

While the literature on acute miliary tuberculosis in children in the United States is extensive, the reports on the subacute and chronic forms are rather meager. Greengard reported fifty-four cases of miliary tuberculosis in children from the Cook County Hospital in 1925, all of them fatal, only 9 per cent of the children surviving from three to four months. The pathologic explanation for the almost invariable fatality of miliary tuberculosis is as follows: At successive times, there occur discharges of tubercle bacilli into the blood stream from some primary focus, usually a lymph node. This is borne out by the resultant crops of tubercles, the tubercles of each crop being of approximately the same size. Successively repeated discharges of tubercle bacilli into the blood stream are almost invariably the rule, which accounts for the generalized infection that rapidly overwhelms the organism. It is conceivable that if the primary focus is

RÉSUMÉ OF WORK ON TUBERCULOSIS IN CHILDREN FOR 1916

C. von Weller 1 reports two cases of miliary tuberculosis of the placenta, with clinical latent tuberculosis of the mother. He calls attention to the fact that the reported cases of placental tuberculosis may be arranged in three groups. Cases in which the mother was known to be tuberculous and in which, as a result of this knowledge, the placenta was given intensive study and found to exhibit the characteristic lesions of tuberculosis, either with or without a demonstration of the bacilli. Cases in which the mother was known to be tuberculous, and in which the presence of tubercle bacilli in the placenta or fetal blood was demonstrated by staining methods or by animal inoculation without the recognition of tuberculosis of the placenta. Cases in which the maternal tuberculosis was clinically unrecognizable and in which characteristic histopathologic lesions of tuberculosis were found in the routine examination of