Secondary Pulmonary Tuberculosis Research Articles

Perfusing chemotherapy by percutaneous lung puncture "holing" for pulmonary tuberculoma-a ten-year single center experience.

Pulmonary tuberculoma is a special form of secondary pulmonary tuberculosis, with a poor response to drug treatment. We used the method of drug administration via percutaneous lung puncture "holing" to treat pulmonary tuberculoma and observe its short- and long-term efficacy, summing up our 10-year clinical experience. A total of 54 patients with pulmonary tuberculoma were included in this study. They themselves were taken as the control group. Three to six months of conventional anti-tuberculosis treatment was conducted firstly. Then those patients with no changes of sizes in tuberculoma were recommended to receive drug administration via percutaneous lung puncture. Isoniazid (INH, 0.1 g) and amikacin (AMK, 0.2 g) were injected into tuberculoma (once or twice per week, 10 times as a course of treatment). After two months of drug treatment by lung puncture, the sputum smear test showed the negative conversion rate of tubercle bacillus was 87% (13/15), and the positive conversion rate was 8% (3/39). The tuberculosis bacillus culture indicated that the negative conversion rate was 100% (7/7). The reexamination after one year showed the negative conversion rate of tubercle bacillus in the sputum smear test was 80% (4/5). About 58% (31/54) of tuberculoma disappeared or significantly reduced, in which, 40% (21/54) of tuberculoma disappeared. The tuberculoma diameter reduced from 3.6 cm × 2.8 cm to 1.7 cm × 1.1 cm on average. Side-effects included postoperative pneumothorax 9% (5/54), hemoptysis 7% (4/54) and fever 11% (6/54). A total of 34 patients were followed up for five years, and the disappearance rate of tuberculoma was up to 47% (16/34), with no recurrence. The drug administration via percutaneous lung puncture-"holing" in pulmonary tuberculoma takes a significant effect obviously, good short- and long-term effects and less side effects.

Hyponatremia Due to Pulmonary Tuberculosis: Review of 200 Cases

BackgroundPulmonary Tuberculosis (PTB) is one of the common diseases with high prevalence of mortality and morbidity in developing countries. Various complications have been reported along with PTB. The subclinical electrolyte imbalances are customary in cases with PTB.ObjectivesThe aim of this study was the evaluation of patients with PTB and hyponatremia.Patients and MethodsWe evaluated patients with diagnosis of secondary PTB who have been admitted to Baqiyatallah hospital, Tehran, Iran from 2005 till 2010. The diagnosis of PTB was based on the appearance of acid fast bacilli in sputum smears or sputum cultures, without any evidence of miliary TB. Demographic and laboratory characteristics relative to electrolytes were recorded according inclusion and exclusion criteria.ResultsThe mean age was 59.22 ± 20.57 years and 91 (45.5%) patients were male. The mean serum sodium concentration was 134.54 ± 4.95 mmol/L and more than half of subjects (51%) have shown hyponatremia. The mean age difference between hyponatremic and eunatremic groups was statistically significant (61.95 versus 56.02 years) (P = 0.047). No significant relationship was found between hyponatremia and gender, anti-TB medications and co-morbidity conditions.ConclusionsIn this study, an older age was suggested as an important predisposing factor for hyponatremia in patients with PTB which had been observed as less of a determinant. We recommend further evaluations for hyponatremia in patients presenting with PTB, particularly for those who are older.

A preliminary study on the relationship between HLA-Cw polymorphism and susceptibility to pulmonary tuberculosis

To analyze the relationship between HLA-Cw polymorphism and susceptibility to pulmonary tuberculosis (PTB), and therefore to explore the susceptible or resistant genes of PTB. A hundred and twelve patients who were confirmed to have secondary PTB in Shandong Chest Hospital from May 2010 to May 2011 were selected as the PTB group, including 62 males and 50 females aged 19 - 69 years (mean 41.7). According to the acid-fast staining results, PTB patients were divided into a smear-negative group (SN group, 77 cases) and a smear-positive group (SP group, 35 cases). A hundred and ten subjects who underwent physical examination in Shandong Chest Hospital at the same period were selected as the control group, including 59 males and 51 females aged 21 - 67 years (mean 38.3). After genomic DNA was extracted, genotyping of HLA-Cw was conducted by sequence specific primer polymerase chain reaction (PCR-SSP) method. Then Hardy-Weinberg (H-W) equilibrium was tested, and gene frequencies(%) were estimated = 1-(1-phenotype frequencies)(1/2). Gene frequencies were compared between the PTB group and the control group, and between the SN group and SP group by χ(2) test. According to Bonferroni's principle, α was divided by the number of alleles (n = 8), and P < 0.006 25 was regarded as statistically significant. The frequency of HLA-Cw08 was significantly higher in PTB patients (43.6%, 75/112) compared with the controls (27.4%, 52/110), χ(2) = 8.790, P < 0.006 25. Among PTB patients, HLA-Cw04 had a significantly higher frequency in the SP group (20.7%, 13/35) than in the SN group (4.7%, 7/77), while HLA-Cw08 had a significantly lower frequency in the SP group (22.5%, 14/35) than in the SN group (54.4%, 61/77), χ(2) = 12.909, 16.732, both P < 0.006 25. HLA-Cw polymorphism is related to susceptibility to PTB. HLA-Cw08 may be one of the susceptible genes for PTB, and HLA-Cw04 and 08 may be related to MTB infectious status and clinical outcomes.

High level isoniazid resistance correlates with multiple mutation in the katG encoding catalase proxidase of pulmonary tuberculosis isolates from the frontier localities of Iran

The aim of this study was to investigate the significance of multiple-mutations in the katG gene, predominant nucleotide changes and its correlation with high level of resistance to isoniazid in Mycobacterium tuberculosis isolates that were randomly collected from sputa of 42 patients with primary and secondary active pulmonary tuberculosis from different geographic regions of Iran. Drug susceptibility testing was determined using the CDC standard conventional proportional method. DNA extraction, katG gene amplification, and DNA sequencing analysis were performed. Thirty four (80%) isolates were found to have multiple-mutations (composed of 2-5 mutations) in the katG gene. Increased number of predominant mutations and nucleotide changes were demonstrated in codons 315 (AGC-->ACC), 316 (GGC-->AGC), 309 (GGT-->GTT) with a higher frequency among patients bearing secondary tuberculosis infection with elevated levels of resistance to isoniazid (MIC ≥ 5-10 µg/mL). Furthermore, it was demonstrated that the combination of mutations with their predominant nucleotide changes were also observed in codons 315, 316, and 309 indicating higher frequencies of mutations among patients with secondary infection respectively. In this study, 62% (n= 21) of multi-mutated isolates found to have combination of mutations with predominant nucleotide changes in codons 315 (AGC-->ACC), 316 (GGC-->GTT), 309 (GGT-->GGT), and also demonstrated to be more frequent in isolates of patients with secondary infections, bearing higher level of resistance to isoniazid (≥ 5-10 µg/mL).

Clinical classification of 288 cases of bronchial tuberculosis based on an expert consensus

To study the clinical application and significance of the recently published expert consensus on endobronchial tuberculosis (EBTB). A retrospective analysis of 288 cases of EBTB hospitalized in Tianjin Haihe Hospital from May 2005 to April 2010 was carried out. The classification and typing of the disease were based on a consensus report recently published by Chinese Journal of Tuberculosis and Respiratory Diseases. Chi-square test was performed to analyze the differences between groups. Of the 288 cases of EBTB, 47.9% (138/288) was classified as Type I (Inflammatory infiltrative), 33.3% (96/288) as Type II (ulcerous necrotic), 5.2% (15/288) as Type III (granulomatous hyperplastic), 7.3% (21/288) as Type IV (scar stricture) and 0.4% (1/288) as Type V (Bronchomalacia), respectively. There were 17 cases (5.9%) classified as a mixed type with a combination of Type IV or Type V disease with 1 or more of the other types. 37.5% (108/288) of the patients were young females, while young and middle-aged patients with type I and type II diseases accounted for 74.7% (215/288) of the cases, much more than old aged patients (6.6%, 19/288). 97.2% (n=280) of the cases suffered from secondary pulmonary tuberculosis. In 107 cases, the disease was located in the left, 162 cases in the right, while in 109 cases the right upper lobe bronchus was involved, and right main bronchus in 36 cases, 3 cases and 58 cases in left upper lobe with and without lingular segment, 10 cases in lingular segment only. Chest CT showed that local mucosal thickening of the trachea or bronchus was evident in 40.3% (116/288); toothed or spike protuberance in 30.9% (89/288), bronchial obstruction in 11.1% (32/288), and bronchial stenosis in 87.9% (253/288). The negative rate of sputum in the first month after interventional therapy was 60.2% (56/93), significantly higher than that in non-interventional therapy group (23.1%, 18/78). The new consensus report on EBTB was clinically useful for classification and typing of the disease, and for the selection of treatment modalities.

Capnography-Guided Nasotracheal Intubation of a Patient with a Difficult Airway and Unwanted Respiratory Depression

Capnography-Guided Nasotracheal Intubation of a Patient with a Difficult Airway and Unwanted Respiratory Depression

Unusual Presentation of a Patient with Primary Pulmonary Tuberculosis and Sickle Cell Anemia

Unusual Presentation of a Patient with Primary Pulmonary Tuberculosis and Sickle Cell Anemia