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Query: UMLS:C0012739 (disseminated intravascular coagulation)
 8,673 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Though the incidence, prevalence, and mortality of tuberculosis have decreased so quickly in last thirty years in Japan, we still have many persons suffering from so called tuberculosis sequelae who complain pulmonary symptoms, particularly respiratory failure. As I have been studying this problems for last many years as a part of tuberculosis treatment, I would like to summarize the present status of the problem. 1) Acute respiratory failure is observed in DIC followed by miliary tuberculosis and in far advanced cases. 2) Chronic respiratory failure is common in pulmonary tuberculosis sequelae. Sexual ratio, male to female is three to two and average age is 60.5. It is quite reasonable that advanced restrictive failure, %VC less than 40%, occurs in 70% of all cases, but obstructive disturbance, FEV1.0% less than 55%, was also observed in 40% of cases. It is still not so clear why tuberculosis sequelae shows obstructive ventilatory failure, but the response to obstruction with the administration of beta-stimulant is observed. Advanced hypoxemia, PaO2 less than 50 Torr, is observed in 30% and hypercapnea is observed in 70% of total cases. Clinical right heart disturbance is observed in 80% of cases. 3) Based on to calculation from the number of interval organ failure and questionnaire to hospitals, the number of persons suffering from respiratory failure is estimated at 20 per 100,000, and it is presumed that the prevalence of respiratory failure will begin to decrease in two to five years later. 4) Pulmonary hypertension, mPA 28.8 mmHg, and higher PVR, 402, are observed in 90 catheterized cases. alpha-NA Peptide in serum and ACT, RVET by echocardiogram are well related to the value of mPA. 5) Average accumulated survival rate is 50% after three years, and it related closely with PaO2. 6) Long term oxygen therapy is the most reasonable and practical treatment for not only to increase the life span but also to improve QOL of the patient. Exercise training is also effective. Almitrine (clinical trial base in Japan), Doxopram and other drugs are effective to recover hypoxemia and to improve pulmonary hypertension. Home mechanical ventilation just started in Japan, and two cases for tuberculosis sequelae are reported. In persons suffering from respiratory failure, special consideration should be made on the treatment of complications, for example abdominal surgery. 7) Social measures, for example, residence with sheltered workshop and vocational training center are quite important to care the respiratory failure due to tuberculosis sequelae. Profile and follow up study of the residence and the training center are reported.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Development and treatment of respiratory failure due to tuberculosis]. 265 73

Although, miliary tuberculosis is an unusual cause of severe acute respiratory failure, we describe nine patients with miliary tuberculosis who developed adult respiratory distress syndrome. This complication occurred in seven patients despite treatment with antituberculous drugs. In two patients who developed the syndrome, miliary tuberculosis was diagnosed only at postmortem. The presence of pulmonary hypertension in all cases and disseminated intravascular coagulation in seven cases suggests a possible pathophysiologic relationship with severe pulmonary vascular damage. The high mortality rate (88.8%) was associated with nonpulmonary organ system failure. Miliary tuberculosis should be considered in patients with adult respiratory distress syndrome of unknown etiology, and simple diagnostic procedures such as sputum, bronchial brushing, and gastric examination should be followed by invasive diagnostic procedures to confirm this etiology. Since untreated miliary tuberculosis is usually fatal, early recognition of this disease is of great importance, and specific therapy may play a lifesaving role.
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PMID:Miliary tuberculosis and adult respiratory distress syndrome. 358 48

Three patients with respiratory failure resulting from miliary tuberculosis had a characteristic clinical presentation that included a long history of a prominent cough, dyspnea, weight loss, tachycardia, tachypnea, pulmonary adventitious sounds, and hepatomegaly. Hematologic investigation showed a normal white cell count with marked left shift in the morphology of white cells in all three patients, and evidence of disseminated intravascular coagulation in one patient. In only one patient was the initial sputum positive for acid-fast bacilli; in the others, invasive diagnostic procedures including lumbar puncture, bone marrow trephine, and open-lung biopsy were necessary for diagnosis. Miliary tuberculosis should be suspected in patients with adult respiratory distress syndrome of unknown etiology. Simple diagnostic procedures such as sputum, bronchial brushings, and urine examination should be followed by bone marrow trephine, liver biopsy, transbronchial lung biopsy, and lumbar puncture if physical signs of meningitis are present.
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PMID:Adult respiratory distress syndrome associated with miliary tuberculosis. 396 42

Four cases of acute respiratory distress syndrome due to miliary tuberculosis are reported. All four patients had tuberculin anergy; three developed disseminated intravascular coagulation. All were treated early with anti-tuberculous drugs. Three patients were intubated and ventilated with positive end expiratory pressure, but they died shortly afterwards. The fourth patient was treated with continuous positive airway pressure and corticosteroids and survived. In view of such reports, the possibility of tuberculosis should be considered systematically in all adult patients with unexplained acute respiratory distress syndrome. The extremely rapid course of the disease and the inconsistent results of standard examinations for tuberculosis justify an "aggressive" diagnostic approach. Extra-pulmonary biopsies, notably of the bone marrow, are very helpful.
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PMID:[A rare cause of acute respiratory distress syndrome in adults: acute disseminated pulmonary tuberculosis. Four cases (author's transl)]. 702 79

Unusual clinical courses and symptoms in miliary tuberculosis cause difficulties in early diagnosis. In a patient with fever of unknown origin, leuko- and thrombocytopenia and hypoplastic bone marrow, tuberculous infection was not diagnosed because drug-induced damage to bone marrow was assumed. A second patient with squamous cell carcinoma of the tongue, miliary tuberculosis and leuko- and thrombocytopenia died in spite of intensive antituberculous therapy. A further patient with miliary tuberculosis developed respiratory distress syndrome and disseminated intravascular coagulation. In fever of unknown origin, unexplained blood disorders, hyponatremia and respiratory distress syndrome without evident cause, "cryptic" miliary tuberculosis should be considered in established the differential diagnosis.
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PMID:[Leukopenia and consumption coagulopathy in miliary tuberculosis]. 742 64

A patient with miliary tuberculosis developed the adult respiratory distress syndrome. The diagnosis of tuberculosis was not made especially because of several negative bacteriological examinations and of initial radiological aspects. Patient died of respiratory failure complicated with disseminated intravascular coagulation. This straightens the hypothesis of a physiopathological relationship between the two syndromes. The necessity of anti-tuberculous therapy should be evocated in every situation of adult respiratory distress syndrome of unknown origin.
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PMID:[Adult respiratory distress syndrome and military tuberculosis (author's transl)]. 742 25

We report the case of a 55-year-old man with chronic renal failure, and a history of prolonged fever and jaundice. Radiological studies revealed a multiloculated irregular liver abscess. Mycobacterium tuberculosis was isolated from the abscess on smear and culture of aspirated pus. Haematological studies revealed the presence of disseminated intravascular coagulation. A detailed search failed to identify any reason for this other than the tuberculous infection. The treatment of tuberculous liver abscess and pathogenesis of disseminated intravascular coagulation in tuberculosis are discussed.
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PMID:Liver abscess and disseminated intravascular coagulation in tuberculosis. 756 59

We reported a survival case of a 78-year-old female with disseminated tuberculosis complicated with severe respiratory failure, pancytopenia, DIC, drug induced fever and pneumothorax. Atypical symptoms and presence of chronic illness make the early diagnosis of disseminated tuberculosis in the elderly difficult. In this report, we emphasized that both a high awareness of possible clinical diagnoses and the performance of some clinical procedures including bronchoalveolar lavage were useful. Disseminated tuberculosis in the elderly with multiple complications which is rare condition, was discussed.
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PMID:[A surviving case of disseminated tuberculosis complicated with severe respiratory failure, pancytopenia, DIC, drug induced fever and pneumothorax in an elderly patient]. 761 83

An immigrant from India presented with a three months history of fever, weight loss, cough and hepatomegaly which were rapidly diagnosed as miliary tuberculosis when gastric lavage revealed acid-fast bacilli. One day after antituberculous therapy was commenced, the patient developed adult respiratory distress syndrome and disseminated intravascular coagulation which were successfully treated by corticosteroids, fresh frozen plasma and mechanical ventilation. Ten other survivors of miliary tuberculosis and adult respiratory distress syndrome were reviewed and the association of adult respiratory distress syndrome with the antimicrobial therapy is discussed.
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PMID:Survival in miliary tuberculosis complicated by respiratory distress. 793 45

A 26-year-old male who had been diagnosed as pulmonary tuberculosis three years ago with an antituberculous chemotherapy of only two months, complained of tiredness, exertional dyspnea and fever since a month ago. Bloody sputum, bloody stool and hematuria have developed three days before admission. Petechiae over the body trunk and lower extremities were observed on admission. Peripheral blood examination revealed lymphocytopenia (672/microliters), low hemoglobin content (6.2 g/dl), thrombocytopenia (3,000/microliters), elevated FDP (36.2 micrograms/ml) and D-dimer (25.0 micrograms/ml) values. Chest radiograph showed a massive pleural effusion in the right hemithorax, bilateral pulmonary infiltrates and a cavity on CT scan. Together with positive acid-fast bacilli in sputum, diagnoses of relapsed pulmonary tuberculosis, tuberculous pleurisy associated with DIC (disseminated intravascular coagulation) were made. Left hydronephrosis which was presumed to be a consequence of infundibulum stenosis due to renal tuberculosis, was detected by abdominal ultrasonography. Treatment with antituberculous drugs and protease inhibitors were started with thoracic tube drainage. DIC condition was improved by the 20th hospital day and sputum culture turned to be negative after the 4th week, however, fever up to 38 degrees C continued until the end of the 7th week and a D-dimer which is a representative marker for secondary fibrinolysis, continuously showed a high level up to the 10th week of hospitalization. The patient was uneventful during the three months follow up period after discharge. DIC is a well known complication of sepsis including miliary tuberculosis, whereas it is rarely associated with cavitary tuberculosis and no case of prolonged elevation of D-dimer have been reported.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of pulmonary, pleural, and renal tuberculosis associated with DIC and a prolonged increase in D-dimer]. 804 Oct 60


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