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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To study the changes in the epidemiology of extrapulmonary tuberculosis in Tennessee, we compared the 454 cases of extrapulmonary tuberculosis reported between 1977 and 1981 with 356 cases encountered between 1982 and 1986. The data were analyzed by age, sex, race and site of the disease which were compared with the national statistics during the periods. We observed that 11.3 percent of the total TB cases were extrapulmonary. Unlike national statistics, the proportion of extrapulmonary tuberculosis had remained unchanged between the two study periods. Except for a significant decline (p less than 0.001) in genitourinary tuberculosis, the incidence of other extrapulmonary TB had remained the same. The higher incidences of lymphatic, miliary, and meningeal TB were noted in nonwhites, particularly in the younger population, during both study periods. While the national trend showed a steady increase in the percentage of extrapulmonary TB cases, there was no change in Tennessee. The reason for a continued decline of GU TB remains unclear. Although AIDS may have contributed toward the increase nationally, fewer cases of AIDS in the state have not influenced the proportion of extrapulmonary TB. Awareness of such regional differences in the epidemiology of TB, and the impact of HIV infection, will be very useful to physicians and other health care providers involved in the diagnosis, treatment, and prevention of tuberculosis.
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PMID:Epidemiology of extrapulmonary tuberculosis. A comparative analysis with pre-AIDS era. 201 68

The incidence of tuberculosis (TB) is expected to increase substantially during the next 10 years as well as its extrapulmonary manifestations, often in association with the HIV panepidemic. TB meningitis displays some clinical and radiological characteristics but the "gold standard" for diagnosis remains the identification of Mycobacterium tuberculosis in the CSF by direct staining of culture. Direct staining, however, is rarely successful and culturing of M. Tuberculosis can take 4 to 8 weeks. Other techniques may be helpful, such as the detection of an intrathecal synthesis of antimycobacterial antibodies, or the detection in the CSF of the mycobacterial genome by the polymerase chain reaction (PCR). DNA amplification, and especially the "nested" amplification protocol, may represent a major step forward and find its place as a sensitive, specific and rapid test in the routine diagnostic laboratory.
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PMID:The diagnosis of tuberculous meningitis. 761 32

In order to assess the incidence of tuberculous disease in our health area, we reviewed the clinical records of patients from the three hospitals of the area under study during the years 1989, 1990 and 1991, who had positive bacilloscopy, positive Lowenstein's culture in any specimen and/or compatible anatomopathologic report. After excluding 26 patients because they belonged to other health areas, 885 patients remained in the study, out of which 251 (64% men and 36% women) were from the year 1989, 270 (64% men and 36% women) from the year 1990 and 364 (62% men and 38% women) from the year 1991. The mean age was 38.4 (SD 20.5). Fifty-one percent of the patients were between 20 and 35 years old. The rate of new cases was 65.87 per 100.000 population in 1989, 71.05 in 1990 and 95.53 in 1991. Seventy-four cases were HIV-positive (8%). Tuberculous meningitis was present in 12 patients. The highest mortality was 1.79 per 100.000 population in 1990. We conclude that tuberculosis presents a medium-high incidence in our health area.
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PMID:[An epidemiological study of tuberculosis in the health area of Santiago de Compostela during the years 1989, 1990 and 1991]. 821 98

Tuberculosis in the United States has become primarily an inner-city disease. We examined the epidemiology of culture-confirmed tuberculous meningitis among patients cared for at an urban public hospital in Atlanta. During an 11.5-year period (January 1984-June 1995) cerebrospinal fluid cultures for Mycobacterium tuberculosis were positive in 34 patients, accounting for 1.5% of all culture-confirmed tuberculosis cases. All patients were born in the United States, 31 (91%) were black, 16 (47%) of 34 were human immunodeficiency virus (HIV) seropositive, 9 (26.5%) were HIV seronegative, and 9 (26.5%) had an unknown HIV serostatus. No significant differences were seen in clinical presentation, cerebrospinal fluid, or other laboratory data between HIV seropositive and HIV seronegative/ unknown groups, except for a lower serum white blood cell count among HIV seropositive patients. Mortality was striking; 14 (41.2%) died because of tuberculous meningitis despite appropriate therapy initiated a mean of 3 days after admission. Six survivors had permanent neurologic sequelae. Univariate analysis of outcome was not statistically associated with any measured demographic, laboratory value, stage at presentation, treatment regimen, or HIV serostatus. Multivariate analysis of outcome using 13 independent variables also demonstrated no significant association between these variables and outcome, although a trend was seen for increased mortality for white people (P = 0.09) and increasing age (P = 0.09). Tuberculous meningitis among inner-city residents remains a devastating disease associated with high morbidity and mortality that has changed little during the past 4 decades. HIV infection does not change markedly the clinical presentation or the response to therapy.
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PMID:Tuberculous meningitis at a large inner-city medical center. 918 45

Childhood tuberculosis (TB) is on the increase, both in developing countries and in the UK. Children cannot usually be diagnosed as having TB by sputum microscopy and culture alone, so millions of children are destined to die of undiagnosed TB in poor countries. Drug resistance is likely to affect a greater proportion of TB cases in children, because they have been recently infected by adults. Whilst BCG vaccination can protect against miliary TB and TB meningitis, it will not interrupt the chain of transmission. HIV co-infected mothers are capable of passing congenital TB to their children.
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PMID:Childhood tuberculosis--problems ahead. 1074 85

Tuberculosis (TB) continues to be a serious health problem in most of the districts in the 5th Sanitary Region of Buenos Aires Province (RSV) which is located in North Buenos Aires City suburbs. The aim of this study was to analyse and compare the evolution of the TB epidemiological situation in ten districts, in a thirteen year period (1984-96) and to analyse possible reasons for differences. The average annual variation (VAP) of morbidity rate was calculated in order to estimate the trends of TB in these communities along time. Reporting to the National and Provincial TB Control Programmes of TB cases is mandatory for physicians and these data were used as a source of information for the number of cases and rates. A statistical analysis was performed. Our results showed that the VAP value for the whole RSV was lower than -5.0%. On this basis several districts were identified as having a TB critical situation. The proportion of smear positive cases among TB patients reported decreased during this period, suggesting that smear microscopy was being poorly used as a diagnostic tool for TB. Furthermore, the cure rates of the patients attained--in average--only 60.0% and several warning indicators (IA)--like TB meningitis cases and mortality due to TB in people younger than thirty years old, as well as TB--HIV/AIDS association--have been observed to grow in several districts. Previous world global experience and those obtained in other provinces in our own country, suggest that the unique possible strategy for modifying this situation, is to set up the directly observed treatment (DOTS), according to World Health Organization/International Union Against Tuberculosis and Lung Diseases (WHO IVATLD) recommendations, in order to achieve the control of TB.
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PMID:[Tuberculosis in the V Sanitary Zone of Buenos Aires Province. Analysis of its trends between 1984 and 1996]. 1075 96

We report the case of a 25-year-old HIV-negative man with disseminated multidrug-resistant tuberculosis (MDRTB), who-on a retreatment regimen-experienced total resolution of TB miliary disease, but progressive TB meningitis. Therefore, intrathecal treatment with amikacin and levofloxacin was instituted, with successful clinical and microbiological results.
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PMID:Novel treatment of meningitis caused by multidrug-resistant Mycobacterium tuberculosis with intrathecal levofloxacin and amikacin: case report. 1118 Nov 30

Since only people with active tuberculosis (TB) can spread TB, the major ways to prevent the spread of TB to adults and to children are identifying people with infectious TB (i.e., case finding) and providing effective supervised treatment. Passive case finding involves diagnosing infectious smear-positive people with symptoms of TB attending health facilities. The public needs to know the symptoms of TB and the availability of effective treatment, and health workers must have good diagnostic and communication skills. If a mother has TB, the child may be at higher risk of TB. Active case finding involves going into the community to find and treat people who may have TB. It is less cost-effective than passive case finding, however. Anti-TB drugs cure about 95% of TB cases when prescribed and taken correctly. These drugs are given in two phases: an initial intensive phase and a continuation phase. Patience and persistence from parents and careful follow-up and support by health workers are needed to ensure that a young child takes drugs every day and completes a course of treatment. Directly observed therapy helps. The BCG vaccine is not effective against TB, but it can protect young children against the most severe and life-threatening forms of TB (e.g., TB meningitis). The BCG vaccine should be administered as early in life as possible, at least before the age of 12 months. It provides essentially no benefit if given after age 2. In the case where the mother is sputum smear positive, the infant should immediately receive preventive therapy and the BCG vaccination should be postponed until the preventive therapy ends. In developing countries, preventive therapy tends to be limited to young infants whose mothers have active TB and children younger than 5 who are asymptomatic but live in the same household as a person with infectious TB. The BCG vaccination can be safely given to HIV-asymptomatic infants but should not be given to HIV-positive infants with severe immunodeficiency. Health workers should not ignore the needs of children in their quest to identify and treat adult cases of active TB.
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PMID:Principles of tuberculosis control. 1229 63

This is a review of the epidemiology of tuberculosis in children covering the classical aspects of sources, prevalence, annual risk, risk of active disease, frequency of childhood tuberculosis (TB) in the population, and mortality, ending with descriptions of the course of active TB. post-primary pulmonary disease, disease of other systems, and the impact of control measures and poverty. The source of TB is always expectorating adults with active TB-positive sputum. The prevalence of TB in children in developing countries is estimated at 10-20%. Each untreated source infects about 10-13 new persons per year, yet, if treated, that person would only infect 2-3 people per year. The risk of a TB infection evolving into an active infection is about 10% and is highest in the first 2 years after primary infection. The frequency of childhood TB in the population ranges from 2.5% in Japan, to 18.5% in Tanzania with its younger population. The morbidity rate varies with ethnic and socioeconomic group; for example, from 1.3% in White to 17.2% of American Indian children up to age 4 in the U.S. In children, TB rarely follows the typical course seen in adults; post-primary pulmonary disease. Children under 2 often develop hematogenous complications of TB, i.e., extrapulmonary disease. When children get pulmonary disease, they rarely have cavitation, so they do not expel infective sputum. Thus, only 3-13% of children are smear-positive, while 29% may have positive cultures. In children, primary infection may appear as visible mediastinal lymphadenopathy. The highest mortality rates are in children under age 5, mostly from TB meningitis. Case-finding, followed by chemotherapy, has the greatest impact on control of the disease. BCG vaccination of infants prevents active primary disease in the young, but neither BCG nor chemoprophylaxis of children has any effect on controlling the spread of TB in the population. It is likely that HIV disease and the growth of poverty will increase the incidence of TB in developing countries.
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PMID:Epidemiology of tuberculosis in children. 1234 44

Multidrug-resistant (MDR) pulmonary tuberculosis (TB) is well described in the literature. Reports of MDR TB meningitis (MDR-TBM), however, are limited to case reports and a single case series. During the period of 1999-2002, 350 patients with TBM were identified by cerebrospinal fluid culture for TB. Thirty patients (8.6%) had TB that was resistant to at least isoniazid and rifampicin. All 30 patients were included in this study. We reviewed hospital charts of the patients with MDR-TBM and describe our experience. Seventeen patients with MDR-TBM died, and, of those who were known to be alive, many experienced significant morbidity. Eighteen patients were HIV positive. Twenty-two patients had been treated for TB in the past, 3 patients had received no previous treatment for TB, and the history of TB treatment was unknown for 5 patients. The study highlights the prevalence of MDR-TBM and identifies new challenges in the management of affected patients.
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PMID:Multidrug-resistant tuberculous meningitis in KwaZulu-Natal, South Africa. 1499 30


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