Treatment Of Miliary Tuberculosis Research Articles

A 73‐year‐old man with loss of consciousness during treatment for miliary tuberculosis

Key messageMiliary tuberculosis is often associated with cerebral tuberculoma, which can manifest during treatment. We present images of a patient with cerebral tuberculoma detected due to emerging neurological symptoms during treatment of miliary tuberculosis.

Neurotuberculose em vigência de tuberculose miliar em lactente: relato de caso

INTRODUCTION: Tuberculosis is a serious infectious disease and a great problem for public health, in all the world. Its incidence has grown, according World Health Organization (WHO). OBJECTIVE: The authors describe a success case of neurotuberculosis, demonstrating the importance of early diagnosis and treatment. CASE REPORT: Male infant, 3 months of life. During the course of a treatment for miliary tuberculosis, the liver enzymes have risen, being necessary to suspend rifampicin, isoniazid, and pyrazinamide. The medicines were gradually reintroduced, but neurological symptoms have been observed, deviation of labial commissure and strabismus. Immediate hospitalization, neurological evaluation, computed tomography (CT), investigation for immunodeficiency and prescription of pyridoxine and dexamethasone. The contrast tomography revealed focal hypodense images and a ring enhancement, compatible with neurotuberculosis. The drugs against tuberculosis were reintroduced and the motor physiotherapy led to the clinical improvement. The discharge ocurred after 10 days. CONCLUSION: Neurotuberculosis requires a long treatment. Early diagnosis and multidisciplinary treatment were important for the favorable evolution of this patient. Cases like that are unusual, contributing to greater knowledge about this disease.

P6‐39: A case of consecutive pneumocystis pneumonitis and varicella pneumonia during the treatment of miliary tuberculosis

P6‐39: A case of consecutive pneumocystis pneumonitis and varicella pneumonia during the treatment of miliary tuberculosis

Disseminated Mycobacterium tuberculosis following renal transplant: A case report

Abstract Miliary tuberculosis (TB) presents a major challenge following a renal transplant in humans. In the current report, we described a patient with disseminated TB following renal transplantation. The article presents the case of a 38-year-old man who presented an 8-month history of fever, chills, sweating, low-back pain and significant weight loss. Chest radiography and computed tomography (CT) scan showed miliary nodules distributed in the two lungs. The transbronchial lung biopsy revealed a granulomatous reaction with caseous necrosis. Magnetic resonance imaging (MRI) of the brain found multiple tuberculomas. Also, MRI of the lumbosacral was indicative of a psoas abscess. Therefore, miliary pulmonary, cerebral and spinal TB was confirmed. The patient was started on an anti-TB regimen and paravertebral aspiration was also done. The patient’s condition improved considerably. In conclusion, this case report can remind us of the importance of maintaining a high clinical suspicion and performing a thorough workup to establish a timely diagnosis and treatment of miliary TB.

Role of endoscopy in recalcitrant intraventricular tuberculoma—innovative novel treatment adjunct

Introduction. Intraventricular tuberculomas are rare entities. To the best of our knowledge, only 14 cases have been reported in English literature. Medical management of cerebral tuberculomas is well accepted. Intraventricular tuberculomas may be recalcitrant for unclear reasons. An effective management protocol for this entity is unclear. To the best of our knowledge, the definitive indication, timing, and possible role of surgery in these lesions have not been discussed in literature. Materials and methods. A 27-year-old nursing professional who was undergoing treatment for miliary tuberculosis at another center presented to us in 2008 with right hemiparesis, deteriorating vision, and progressive decline in consciousness. In addition to antituberculous therapy (ATT), she underwent multiple CSF diversion procedures for the obstructive hydrocephalus secondary to a recalcitrant third ventricular tuberculoma. Finally, she underwent endoscopic decompression of the lesion with a very good clinical response at 1-year follow-up. Discussion. We discuss a patient with recalcitrant intraventricular tuberculoma managed using neuroendoscopy along with the standard antituberculous therapy. We also discuss in detail the technique we utilized for endoscopic management of this lesion. Conclusion. Being a rare entity, a consensus for management of these lesions is not possible, but we have demonstrated that neuroendoscopic management of these rare entities is an option giving the advantage of definitive diagnosis when required, hastening the resolution, and clearing the CSF pathway.

Pulmonary Embolism following Cessation of Infliximab for Treatment of Miliary Tuberculosis.

We report a case of a 41-year-old male who presented with tachycardia and swelling of his left arm six weeks after he started antituberculosis treatment and stopped his rheumatoid arthritis infliximab treatment. He was diagnosed with pulmonary embolism by chest CT and initially treated with warfarin, which interacted with his antituberculosis treatment. This presentation of deep vein thrombosis and pulmonary embolism as part of immune reconstitution inflammatory syndrome has not been previously reported for infliximab treated patients.

HIV associated nephropathy in a child with stable HIV infection

Introduction HIV infection in children is seen much more commonly seen in the UK. HIV associated nephropathy (HIVAN), is commonly considered as a late manifestation in adults having longstanding HIV infection with high viral-load and low T-helper cell (CD4) counts. The authors report a case of HIVAN in a teenager who was already on highly active antiretroviral therapy (HAART) with well suppressed disease activity. Case A Zimbabwe-born 9-year-old boy was diagnosed with miliary tuberculosis and vertically transmitted HIV infection. He was started on anti tuberculosis medications and HAART. Within few months of HAART therapy his viral-load became undetectable and CD4 count got normalised. He successfully completed the treatment of miliary tuberculosis, but 4 years later, he developed nephrotic range proteinuria (7.5 gm/day). He was not hypertensive or oedematous. His urine showed no sediments, serum albumin was low, cholesterol was elevated, with normal creatinine and complement levels, and negative autoimmune screen. Ultrasound revealed echogenic normal sized kidneys. CD4 counts were still normal and viral-load remained undetectable. Drug related causes of nephropathy were ruled out by reviewing the list of medication that he was previously on. Kidney biopsy showed non-collapsing focal segmental glomerular sclerosis suggestive of HIVAN. Treatment Along with regular HAART, he received 8 weeks of prednisolone and was put on enalapril (angiotensin-converting enzyme inhibitor), which markedly improved the proteinuria. His renal function subsequently has remained stable. Conclusion This is a very interesting and unique case not reported in literature till now. Contrary to common belief it has made us postulate that HIVAN can occur at any stage in HIV infection, even in those with HAART induced stable state with undetectable viral-load and normal CD4 count. It has been suggested that renal epithelial cells act as reservoir for HIV-1 and intracellular expression of viral RNA could persist despite HAART. Improved survival following introduction of HAART has resulted in more patients being at-risk of developing kidney diseases. Suggestion As HIVAN can remain asymptomatic in early stages, children with HIV infection should be regularly screened for kidney disease even if they are clinically asymptomatic and on adequate HAART regimen.

Cryptic miliary tuberculosis with a clinical prodrome resembling pancreatitis

Summary The diagnosis of miliary tuberculosis (TB) may be a challenging task for the physician. Pancreatitis is an extremely rare presentation of miliary TB. A healthy 31-year-old American male was admitted because of severe nausea, anorexia, malaise and night sweat for 4 days. He was febrile and his physical examination was unremarkable. The chest X-ray (CXR) was normal and the computed tomographic (CT) evaluation of the abdomen was consistent with pancreatitis. On the 12th day in the hospital, he complained of dyspnea and his chest CT showed bilateral ground-glass opacities. Subsequent bronchoscopy was not diagnostic. Open lung biopsy (OLBx) revealed multiple necrotizing granulomas. The patient responded to antituberculous therapy and was discharged home 3 weeks later. Miliary TB is a curable disease, which can take many forms. A high index of clinical suspicion and diagnostic persistence are required for diagnosis. Early diagnosis and treatment of miliary TB nurtures better outcomes.

CEREBRAL TUBERCULOMAS DEVELOPING DURING TREATMENT OF TUBERCULOUS MENINGITIS

Cerebral tuberculomas developed in two adult Asian immigrants during treatment for miliary tuberculosis and tuberculous meningitis. Both were infected by strains of Mycobacterium tuberculosis sensitive in vitro to all antituberculous drugs, and no evidence of immunodeficiency was detected. Focal neurological signs appeared and the lesions led to the death of one patient despite maximum treatment. The importance of systemic corticosteroids in controlling the raised intracranial pressure is discussed.

Results of specific treatment of miliary tuberculosis in children; a follow-up study of 63 patients treated with antimicrobial agents.

BEFORE antimicrobial therapy miliary tuberculosis was usually a fatal complication of primary tuberculosis. Cases of spontaneous recovery have been reported in children. Wallgren1 described 5 recov...

Isoniazid in the treatment of miliary tuberculosis in children.

<h3>Background</h3> Medication errors commonly occur at transition points in patient care, particularly on admission to hospital. Medicines reconciliation is the process of identifying the most accurate list of a patient’s current medicines and it should be done before the first 24 hour after admission. The participation of pharmacists in obtaining an accurate medication history for hospitalised patients is a key point in improving the process of reconciliation. <h3>Purpose</h3> Evaluate the benefits of the introduction of a pharmacist into the Emergency Department (ED) to improve the reconciliation process. <h3>Material and methods</h3> A prospective intervention study (2016–2017). The medication was reconciled at two different times and places: in admission to the geriatric ward (2016) and the admission to the ED (2017). Patients older than 65 years and six or more drugs admitted to the ward were included. A target was set that ideally 100% of patients admitted would have their medications reconciled within 24 hour of admission. To calculate the percentage of patients reconciled within 24 hour, the total number of patients who met the inclusion criteria for conciliation were collected. We did not collect data on Saturdays or Sundays. For the inferential statistics, the Chi-square test was used. <h3>Results</h3> A total of 394 patients was reconciled, 106 patients in the ward for the first time and 288 patients in the ED for a second time. The percentage of patients with their medicines reconciled by a pharmacist within 24 hour of admission increased from 38% in the ward to 83% in the ED, and was significant (p&lt;0.001). The lack of weekend cover resulted in not meeting the target of 100% of patients having medication reconciliation complete within 24 hour of admission. For those patients in the ED who had been admitted medically but awaited a bed on a ward for a number of hours, the opportunity for their medicines to be reconciled within 24 hour was greatly reduced in the absence of an ED pharmacist. <h3>Conclusion</h3> The presence of an ED pharmacist improves the number of patients who have their medicines reconciled within 24 hour of admission. Since this initial project, we must continue working to expand the role of the clinical pharmacist further and to provide an extended pharmacy service to both hospital staff and patients. <h3>References and/or acknowledgements</h3> No conflict of interest.

Isoniazid (isonicotinic acid hydrazide) in the treatment of miliary and meningeal tuberculosis.

Isoniazid (isonicotinic acid hydrazide) in the treatment of miliary and meningeal tuberculosis.

Streptomycin in the treatment of miliary tuberculosis

Summary<ul><li>1.The clinical features of a case of miliary tuberculosis treated successfully with streptomycin have been described. The diagnosis of tuberculosis was confirmed by biopsy of a cervical lymph gland.</li><li>2.A total dosage of 91 Gm. of streptomycin was given; one gram daily in divided amounts for three months.</li><li>3.Marked improvement both clinically and roentgenographically was obtained. No relapse has occurred within two months after cessation of the treatment.</li></ul>