Past Pulmonary Tuberculosis Research Articles

ПОСТТУБЕРКУЛЕЗНАЯ ОБСТРУКТИВНАЯ БОЛЕЗНЬ ЛЕГКИХ (обзор зарубежной литературы)

Abstract. Introduction. Post-tuberculous obstructive pulmonary disease has been considered as a chronic disease for the last decade. Despite successful clinical cure of tuberculosis, up to 50% of patients have post-tuberculous obstructive pulmonary disease, defined as the “signs of chronic respiratory distress, with or without symptoms, at least partially attributable to prior pulmonary tuberculosis”. Aim. To consider the epidemiological and pathophysiological relationships between chronic airway obstruction in COPD and tuberculosis and to highlight the diagnostic and therapeutic approaches to managing patients with post-tuberculous obstructive pulmonary disease. Materials and Methods. We searched available information databases up to June 2023 using key terms, i.e. COPD, tuberculosis associated with COPD, post-tuberculous obstructive pulmonary disease. Results and Discussion. Post-tuberculous obstructive pulmonary disease is one of the many TB complications that significantly affects the economic, social, and psychological well- being of individuals, families, and communities. Post-tuberculous obstructive pulmonary disease includes a group of heterogeneous conditions affecting the large and small airways, such as bronchiectasis or obstructive airways; lung parenchyma, pleura, and/or pulmonary vasculature, and may present with symptoms partly associated with past pulmonary tuberculosis. Post-tuberculous obstructive pulmonary disease results from a complex interaction between human immune reactivity, pathogens, and environmental factors that affects long-term respiratory health. Major risk factors for post-tuberculous obstructive pulmonary disease include smoking, low socioeconomic status, vitamin D deficiency, and diabetes mellitus. People with post-tuberculous obstructive pulmonary disease have a reduced life expectancy and an increased risk of TB recurrence. Conclusions. Currently, due to the lack of controlled clinical trials, there are no generally accepted recommendations for the diagnosis and treatment of post-tuberculous obstructive pulmonary disease. The management of patients with post-tuberculous obstructive pulmonary disease mainly includes adjuvant therapy used in other chronic obstructive pulmonary diseases and in pulmonary rehabilitation. Early diagnosis and timely treatment are essential to limit lung damage.

Prevalance of obstructive airway disaese in patients who were treated for pulmonary tuberculosis in past

Background: Tuberculosis remains the world’s deadliest communicable disease. The chronic lung disease as result of tuberculosis is much explored with the available literature. This study assessed the scope of current guidelines and evidence on Post -Tubercular sequalae and pulmonary impairment to inform policy and research action. Material and methods: A cross sectional study was undertaken in patients treated for pulmonary tuberculosis. Pulmonary Function Test (FVC, FEV1, FEV1/FVC and small airway parameters) were performed with a spirometer model (RMS HELIOS 3185) and extent of radiological extent assessed by doing chest X Ray - PA View. The details regarding the demographic factors, duration of disease and duration of treatment were obtained in structured proforma. Results: Most of cases in this study belonged to 41 – 60 years of age group and majority were females. About 51.5% of the cases received treatment with ATT and 64.1% of the cases were diagnosed with disease for less than 5 years.

High prevalence of latent tuberculosis using the QuantiFERON-TB Gold Plus test in Takayasu arteritis.

This study aims to investigate latent tuberculosis using the QuantiFERON-TB Gold Plus method in patients with Takayasu arteritis (TA). This case-control study included 22 patients with TA (3 males, 19 females; median age: 36.5 years; IQR, 32 to 50 years), 22 healthy individuals (3 males, 19 females; median age: 38.5 years; IQR, 32.5 to 50 years), and 66 patients with diffuse connective tissue diseases (DCTDs) (4 males, 62 females; median age: 41 years; IQR, 29.8 to 54 years). Two control groups were formed: (i) age- and sex-matched healthy individuals and (ii) patients with other DCTDs. Epidemiological data were collected, and the QFT-Plus test was performed. The QFT-plus positivity was compared among the groups. A higher prevalence of QFT-Plus positive cases was observed in the TA group (8/22) than in the healthy control group (1/22) (p=0.020) or in the group with other DCTDs (3/66) (p=0.001). There was a statistically significant difference in the past pulmonary tuberculosis prevalence between the TA and DCTD groups (p=0.013). The prevalence of latent tuberculosis in TA patients (36.4%) was higher than that in both control groups and higher than the prevalence of latent tuberculosis among the general Brazilian population. Although a positive association was found, it is not possible to establish a direct cause-effect relationship. Given the increasing use of anti-cytokine therapies in TA, it is necessary to thoroughly screen patients with TA before initiating immunosuppressive therapy to avoid tuberculosis reactivation.

A PROSPECTIVE STUDY ON CLINICAL PROFILE AND OUTCOME OF PATIENTS WITH TUBERCULOUS MENINGITIS AT A TERTIARY CARE CENTRE IN MAHARASHTRA

BACKGROUND: Tuberculous meningitis (TBM) is one of the most fatal forms of tuberculosis, early diagnosis and treatment of which can reduce morbidity and mortality. This study was undertaken to achieve data regarding clinical prole and outcome of patients from western India as epidemiological data is lacking from this region. METHODS: This prospective observational study was conducted on 136 patients admitted in medical ward and critical care unit of a tertiary care hospital in Maharashtra over 18 months. Clinical, biochemical, radiological and microbiological evaluation was done. Data was analyzed using SPSS 22 version software and p value of <0.05 as signicant. RESULTS: The mean age of cases was 35.2 ± 14.69 years, majority from age group of 18 - 40 years. Out of 136 cases, 62 (45.6%) were males and 74 (54.4%) females. Commonest clinical features were fever and headache, followed by altered sensorium and seizure. Symptoms were mostly of acute onset (<14 days). 42 cases (30.9%) were associated with present or past pulmonary tuberculosis and 34 (25%) with retroviral disease. 7 cases (5.2%) had hemiparesis and 3 (2.2%) had ophthalmoplegia. Mean ESR was 56.59 + 22.87. CSF showed lymphocytosis (mean 88.4 + 18.09 %), low glucose percentage (mean 39.57 + 0.2 %) and high protein (mean 146.02 + 106.62 mg/dl). 117 cases (86%) showed positive neuroimaging. Outcome was poor in stage III disease. CONCLUSION: Tuberculous meningitis usually presents as acute onset illness with fever, headache or altered sensorium. CSF Gene Xpert has low sensitivity as compared to neuroimaging. Advanced disease was associated with poor outcome.

Health-related quality of life after pulmonary tuberculosis in South Korea: analysis from the Korea National Health and Nutrition Examination Survey between 2010 and 2018

BackgroundAlthough several studies have reported an association between tuberculosis and health-related quality of life, the change in health-related quality of life after pulmonary tuberculosis has been rarely studied. The purpose of this study was to investigate the effect of past history of pulmonary tuberculosis on health-related quality of life using a nationwide, cross-sectional, observational study in Korea.MethodsAmong 72,751 people selected using a stratified multi-stage sampling method, 7260 Korean participants were included using propensity score matching. Past history of pulmonary tuberculosis was defined as a previous diagnosis of pulmonary tuberculosis excluding patients with active pulmonary tuberculosis. The primary outcome, health-related quality of life, was assessed by EQ-5D disutility.ResultsBefore matching, the mean EQ-5D of individuals with pulmonary tuberculosis history was lower (0.066 vs. 0.056, p: 0.009). However, the difference was nullified after matching (0.066 vs. 0.062, p = 0.354). In multivariable Poisson regression analysis, EQ-5D disutility score was not associated with past pulmonary tuberculosis history. In subgroup analysis, past pulmonary tuberculosis history increased odds of low health-related quality of life in young (odds ratio [OR] 1.57, 95% confidence interval [CI] 1.17–2.11, p = 0.003), unmarried (OR 1.98, 95% CI 1.05–3.73, p = 0.036), or separated patients (OR 1.30, 95% CI 1.02–1.66, p = 0.032). Age and marital status were modulating factors on the effect of past pulmonary tuberculosis history on health-related quality of life.ConclusionsThere was no difference in health-related quality of life between individuals with and without past pulmonary tuberculosis history. Young and unmarried groups had increased odds for low health-related quality of life after pulmonary tuberculosis due to modulating effects of age and marital status.

Cardiopulmonary dysfunction in perinatally HIV-infected South African adolescents on antiretroviral therapy: baseline findings from the Cape Town Adolescent Antiretroviral Cohort.

IntroductionAntiretroviral therapy (ART) has reduced morbidity and mortality in sub‐Saharan Africa, but the burden of coexistent cardiopulmonary disease in perinatally HIV‐positive adolescents on antiretroviral therapy (ART) has not been well described. The aim of this study was to investigate the prevalence and associations of cardiopulmonary dysfunction in adolescents with perinatally acquired HIV on ART.MethodsFor this cross‐sectional analysis, 515 perinatally HIV‐positive adolescents ages 9 to 14 years on ART for at least six months, and a comparator group of 110 age‐matched HIV‐uninfected adolescents were tested between August 2013 and April 2015 using echocardiography, six‐minute walk test (6MWT) and spirometry. Those with either abnormal spirometry or abnormal 6MWT and any right or left systolic or diastolic dysfunction or abnormal mean pulmonary arterial pressure were considered as having impaired cardiopulmonary function. Logistic regression was used to investigate determinants of impaired cardiopulmonary function.ResultsOverall, 474 adolescents with perinatally acquired HIV (mean [SD] age, 12 [1.6] years; median [IQR] ART duration, 7 [4.6 to 9.3] years; median [IQR] CD4 count, 712 [571 to 959] cell/mm3) and 109 HIV‐uninfected adolescents mean (SD) age 11.8 (1.8) years, had successful cardiac and lung function testing. Impaired cardiopulmonary function was detected in 13% of adolescents with perinatally acquired HIV and 8% of HIV‐uninfected adolescents, p = 0.136. Among adolescents with perinatally acquired HIV, those with low tricuspid annular plane systolic excursion (TAPSE) had significantly lower mean FEV1, 1.5 L versus 1.6 L, p = 0.011. Height (OR 0.7, 95%CI 0.5 to 0.9), body mass index (OR 0.7, 95%CI 0.5 to 0.9) and past pulmonary tuberculosis (OR 2.3, 95%CI 1.2 to 4.4) were significantly associated with a low cardiopulmonary function.ConclusionsDespite being on ART, cardiopulmonary dysfunction occurs in an appreciable proportion of perinatally HIV‐infected adolescents but no significant difference to uninfected controls. This finding requires further exploration. Factors associated with dysfunction may be amenable to public health interventions to reduce cardiopulmonary disease in this population.

Association of Lung Function with Serum 25-Hydroxyvitamin D Level according to the Presence of Past Pulmonary Tuberculosis in Korean Adults.

BackgroundVitamin D deficiency is associated with an increased risk of pulmonary tuberculosis (PTB) infection and the treatment outcome. The aim of this study was to examine the relationship between the serum 25-hydroxyvitamin D (25[OH]D) level and lung function in Korean adults according to whether or not there is a history of PTB.MethodsThe data for subjects aged 19 years or older from the Korea National Health and Nutrition Examination Survey 2008–2012 who underwent spirometry, chest radiography, and serum 25(OH)D level measurement were analyzed.ResultsEvidence of past PTB infection was found in 1,482 (9.6%) of 15,516 subjects. The serum 25(OH)D level was lower in the group with past PTB than in the non-PTB group (P=0.013). Respiratory dysfunction was more common in the past PTB group than in the non-PTB group (restrictive pattern, 14.0% vs. 9.6%; obstructive pattern, 29.6% vs. 8.2%; both P<0.001). After adjusting for age, sex, height, and season, the mean difference in forced expiratory volume in 1 second (FEV1) between the highest and lowest quartiles of 25(OH)D was 100.2 mL (standard error=49.3 mL, P for trend=0.049) in the past PTB group and 34.7 mL (standard error=13.6 mL, P=0.009) in the non-PTB group.ConclusionFEV1 tended to increase as the vitamin D quartile increased in both study groups. This relationship was more pronounced in subjects with a history of PTB. A higher serum 25(OH)D level might be beneficial in preserving lung function after PTB infection.

P1.04-020 Management of Lung Cancer in Patients with past Pulmonary Tuberculosis and Their Possible Causative Link

Lung cancer and tuberculosis cause significant morbidity and mortality worldwide. In the past, it was well known that lung cancer is a specific epidemiological successor of pulmonary tuberculosis (PTB) and that it often develops in scars caused by PTB. In recent years, the relevance of the two diseases has drawn attention in terms of the close epidemiological connection and chronic inflammation-associated carcinogenesis. Although studies have found a relationship between PTB and lung cancer, results for the long-term risk and the role of confounding factors remain inconclusive. Therefore, it is important to delineate the relationship between PTB and lung cancer. Clinical files of all patients diagnosed with lung malignancy between 2011 and 2016 were investigated retrospectively in terms of patient characteristics, definite histopathological diagnosis and stage of tumor, operation methods, and associated complications. Mean age was 56.4 years. Past PTB was detected in 3% of operated carcinoma patients and in 6% of all patients diagnosed with lung malignancy. Central lung cancer was diagnosed in 80% of cases and peripheral in 20%. Epidermoid cancer was diagnosed in 51% of cases, adenocarcinoma in 24% and adenoepidermoid carcinoma in 25%. All cases of operable lung cancers were in stage I and II, while inoperable lung cancers were in stage IIIB and IV. Lobectomy was performed in 100% of the operated cases. None of the patients received anti-TB treatment preoperatively or postoperatively because by the time they were diagnosed with lung cancer, their sputum culture for M.Tuberculosis had converted negative. No postoperative mortality or reactivation of TB was seen. PTB is an important risk factor for lung cancer, possibly related to chronic inflammation and shared risk factors. Our study adds to the evidence that implicates chronic inflammation and pulmonary scarring in the etiology of lung cancer. However, further studies are needed to clarify whether there is a direct causative link between PTB and lung cancer. Surgery is the method of choice in treatment of lung cancer in subjects with past PTB history.

Tuberculosis, Airway Obstruction and Mortality in a Finnish Population

ABSTRACTThere is little long-term follow-up data concerning the association between past pulmonary tuberculosis (TB), airway obstruction and mortality. We aimed to analyse a national health examination survey data from 6701 adult Finns undergoing spirometry between 1978 and 1980 (follow-up through 2013). We identified TB either through a disease history or by a TB-indicative scar on a chest x-ray. We specified obstruction using the lower limit of normal (LLN) and classified severity using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages 1–4. After adjusting for smoking and other confounders, past TB associated with obstruction. Compared to non-TB patients, the adjusted odds ratio (OR; 95% CI) of obstruction reached 2.21 (1.52–3.21) among patients with a scar recorded by one radiologist, 2.48 (1.63–3.78) when recorded by both radiologists and 4.59 (2.86–7.37) among patients with a disease history. Among those with neither past TB nor obstruction, with past TB only, with an obstruction only and with both, we found hazard ratios (HRs; 95% CIs) for subsequent mortality of 1.00 (reference), 1.11 (1.03–1.20), 1.62 (1.31–2.00) and 1.77 (1.45–2.16), adjusted for age, gender, smoking, body mass index (BMI), physical activity, education and general health. In conclusion, past TB strongly determines obstruction, although on its own quite weakly predicts premature death. TB and obstruction combined predict an additive mortality pattern.

Prevalence of pulmonary tuberculosis in young adult patients with Type 1 diabetes mellitus in India

Background: There is limited information on prevalence of pulmonary tuberculosis (PTB) in patients with type-1- diabetes. We assessed the prevalence of PTB in patients with type-1-diabetes attending the outpatient-clinic in a tertiary-care hospital. Methods: 151 patients with type-1-diabetes were screened for PTB by clinical examination and chest-radiography. Sputum Acid-Fast Bacilli Test (AFB) and Mycobacterium tuberculosis (M.tb) culture were performed in patients with clinical and radiological features suggestive of a possibility of PTB and also in those with history of PTB in the past. Their average glycated haemoglobin (HbA1c) during preceding 2 years was assessed. Sputum culture positive patients were managed by a pulmonologist. Results: 5/151 patients had respiratory symptoms and radiographic findings suggestive of PTB. 20/151 patients were asymptomatic but had history of PTB. Four of the five symptomatic patients and 12 with past PTB were positive for sputum M.tb by culture, giving a prevalence of 10.6 % sputum culture positive in type-1-diabetes. Average HbA1c was comparable in patients with and without positive sputum culture. ESR and Mantoux test were not discriminatory in these groups. Four clinically symptomatic M.tb culture positive and four asymptomatic patients with sputum culture positive for M.tb on two occasions (6 weeks apart) were put on antitubercular treatment (ATT). Patients who were culture positive for M.tb only on one occasion were kept on a close follow up. Conclusions: Patients with type-1-diabetes mellitus in India have high prevalence of PTB. They need to be actively screened for PTB by sputum M.tb culture in order to initiate early treatment and to prevent transmission in the community.

Prevalence of pulmonary tuberculosis in young adult patients with Type 1 diabetes mellitus in India.

BackgroundThere is limited information on prevalence of pulmonary tuberculosis (PTB) in patients with type-1-diabetes. We assessed the prevalence of PTB in patients with type-1-diabetes attending the outpatient-clinic in a tertiary-care hospital.Methods151 patients with type-1-diabetes were screened for PTB by clinical examination and chest-radiography. Sputum Acid-Fast Bacilli Test (AFB) and Mycobacterium tuberculosis (M.tb) culture were performed in patients with clinical and radiological features suggestive of a possibility of PTB and also in those with history of PTB in the past. Their average glycated haemoglobin (HbA1c) during preceding 2 years was assessed. Sputum culture positive patients were managed by a pulmonologist.Results5/151 patients had respiratory symptoms and radiographic findings suggestive of PTB. 20/151 patients were asymptomatic but had history of PTB. Four of the five symptomatic patients and 12 with past PTB were positive for sputum M.tb by culture, giving a prevalence of 10.6 % sputum culture positive in type-1-diabetes. Average HbA1c was comparable in patients with and without positive sputum culture. ESR and Mantoux test were not discriminatory in these groups. Four clinically symptomatic M.tb culture positive and four asymptomatic patients with sputum culture positive for M.tb on two occasions (6 weeks apart) were put on antitubercular treatment (ATT). Patients who were culture positive for M.tb only on one occasion were kept on a close follow up.ConclusionsPatients with type-1-diabetes mellitus in India have high prevalence of PTB. They need to be actively screened for PTB by sputum M.tb culture in order to initiate early treatment and to prevent transmission in the community.

Pulmonary impairment after tuberculosis in a South African population.

BackgroundIn South Africa, pulmonary tuberculosis (PTB) remains a problem of epidemic proportions. Despite evidence demonstrating persistent lung impairment after PTB cure, few population-based South African studies have investigated this finding. Pulmonary rehabilitation post-cure is not routinely received.ObjectivesTo determine the effects of PTB on lung function in adults with current or past PTB. To determine any association between PTB and chronic obstructive pulmonary disease (COPD).MethodsThis study was observational and cross-sectional in design. Participants (n = 55) were included if they were HIV positive on treatment, had current PTB and were on treatment, and/or had previous PTB and completed treatment or if they were healthy adult subjects with no history of PTB. A sample of convenience was used with participants coming from a similar socio-economic background and undergoing spirometry testing. Multiple regression analyses were conducted on each lung function variable.ResultsCompared to normal percentage-predicted values, forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC) and FEV1:FVC were significantly reduced in those with current PTB by 23.39%, 15.99% and 6.4%, respectively. Both FEV1 and FVC were significantly reduced in those with past PTB by 11.76% and 10.79%, respectively. There was no association between PTB and COPD – those with previous PTB having a reduced FEV1:FVC (4.88% less than the norm), which was just short of significance (p = 0.059).ConclusionsLung function is reduced both during and after treatment for PTB and these deficits may persist. This has implications regarding the need for pulmonary rehabilitation even after medical cure.

English

Psuedallescheria boydii is a common soil fungus that is increasingly reported as a human pathogen. Lung is the most common extra cutaneous site of infections .Invasive pulmonary disease is seen usually in an immunocompromised host. We are reporting an unusual first case of invasive pulmonary pseudoallescheria sis in an immunocompetent patient from Central India.Microscopy of bronchoalveolar lavage of a treated and cured patient of past pulmonary tuberculosis revealed hyphae (approx 3-5 µ) which were septate & dichotomously branched resembling aspergillus species.The organism was cultured & identified as P.boydii. . Previously recognized causative agent of disease in an immunocompromised host is now causing disease in immunocompetent host.

Granuloma of Epididymis in a Patient Treated with Intravesical BCG Therapy—Complication of BCG Therapy or Tuberculosis?

We present a case of a 72-year-old man treated for superficial bladder carcinoma from the year 2007. The patient underwent a surgical intervention for transitional cell carcinoma of the bladder, followed by intravesical BCG immunotherapy. Two years later, the right testis and epididymis were found to be enlarged. A resection was carried out. Histological examination revealed granulomatous infiltration with eosinophillic necrosis in cauda epididymis. No bacteriologic tests of the resected material were performed. Due to a suspected BCG infection or TB, the patient was transferred to the Institute of Tuberculosis and Lung Diseases in Warsaw, for pulmonary evaluation. Chest X-ray, chest CT scan and bronchoscopy were performed but apart from scars in the bronchi suggesting a history of TB, they did not contribute to the diagnosis. Tuberculin skin test was 21 mm. Diagnosis was determined by spoligotyping which found genetic material of Mycobacterium tuberculosis in specimens preserved in a paraffin block. Tuberculosis of the right epididymis and past pulmonary tuberculosis were diagnosed. The patient was treated with rifampin, isoniazid and pyrazynamid.

Clinical presentation and predictors of outcome in patients with severe acute exacerbation of chronic obstructive pulmonary disease requiring admission to intensive care unit.

BackgroundSevere acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) is a common reason for emergency room (ER) visit about which little has been documented from India.MethodsProspective study of the clinical presentation and predictors of outcome in 116 patients presenting with severe AE-COPD requiring admission to the medical intensive care unit between January 2000 and December 2004.ResultsTheir mean age was 62.1 ± 9.8 years. There were 102 males. Mean duration of COPD was 7.2 ± 5.8 years. All males were smokers (22.3 ± 11.2 pack years); 35.2% smoked cigarettes and 64.8% smoked bidis. All women were exposed to domestic fuel. Associated co-morbid illnesses were present in 81 patients (69.8%); 53(45.7%) had one co-morbid illness and the remaining 28 (54.3%) had two or more co-morbid illnesses. Evidence of past pulmonary tuberculosis (PTB) was present in 28.4% patients; 5 patients who also had type II diabetes mellitus had active PTB. Arterial blood gas analysis revealed respiratory failure in 40 (33.8%) patients (type I 17.5% and type II 82.5%). Invasive mechanical ventilation was required in 18 patients. Sixteen (13.7%) patients died. Stepwise multivariate logistic regression analysis revealed need for invasive ventilation (OR 45.809, 95%CI 607.46 to 3.009;p < 0.001); presence of co-morbid illness (OR 0.126, 95%CI 0.428 to 0.037;p < 0.01) and hypercapnia (OR 0.114, 95%CI 1.324 to 0.010;p < 0.05) were predictors of death.ConclusionCo-morbid conditions and metabolic abnormalities render the diagnosis of AE-COPD difficult and also contribute to mortality. High prevalence of past PTB and active PTB in patients with AE-COPD suggests an intriguing relationship between smoking, PTB and COPD which merits further study.

Severe Adult Chickenpox Infection Requiring Intensive Care

Introduction: Chickenpox (varicella) in adults can be severe with increased mortality. This study investigated the clinical presentation and outcome of 12 adult chickenpox patients requiring intensive care. Materials and Methods: A retrospective, observational study was performed in an adult medical intensive care unit of a university-affiliated hospital involving consecutive patients with varicella admitted over 4 years (1997-2000). Results: The 12 patients had a mean ± SD age of 40 ± 20 (range, 15 to 86) years. Two patients were above 65 years old (aged 73 and 86 years). All but 1 were male. None had previous varicella vaccination. Six patients had direct exposure to persons with chickenpox infection. Four patients had underlying pulmonary pathology: past pulmonary tuberculosis (2), emphysema (1) and recurrent right pleural effusion from autoimmune serositis (1). The mean APACHE II score was 14.2 (range, 6 to 26). Ten patients had varicella pneumonia (of whom 2 had acute respiratory distress syndrome and 5 had acute lung injury), 1 had chickenpox encephalitis and 1 patient presented concomitantly with diabetic ketoacidosis. The median duration of stay in the intensive care unit (ICU) was 11 days (range, less than 1 day to 76 days). Nine patients (75%) required mechanical ventilation (median duration, 14 days; range, less than 1 day to 79 days). All patients were treated with acyclovir. There were 3 deaths (25%); 2 were above 65 years old and 1 was 37 years old with acute myeloid leukaemia on chemotherapy. Conclusion: Patients with varicella infection requiring intensive care carry significant mortality. In our series, old age appears to be associated with increased mortality (P = 0.045).

Antibodies toMycobacterium paratuberculosis in patients with Crohn's disease

IgG antibodies against Mycobacterium paratuberculosis protoplasmic antigen were looked for by an enzyme immunosorbent assay in patients with Crohn's disease, Ulcerative colitis, active pulmonary tuberculosis, past pulmonary tuberculosis, and in healthy controls. Serum reactivity for these antibodies was not correlated to PPD skin test positivity without history of mycobacterial disease. A cutoff based on the mean absorbance value of a pool of healthy blood donors was chosen. Positive values were found in 12/24 (50%) patients with active pulmonary tuberculosis and 2/10 (20%) skin-test-positive subjects with past pulmonary tuberculosis as expected, because antigenic sharing is common among different mycobacteria. The control group of blood donors showed borderline positivities in 3/149 cases (2.01%). Positive values were found in 4/108 (3.70%) patients with Crohn's disease and 2/40 (5%) with ulcerative colitis. We conclude that our data do not support a causal relationship between the M. paratuberculosis and Crohn's disease, but occasional patients with inflammatory bowel diseases show unexpected positivities for these mycobacterial antibodies.