Testicular tuberculosis presenting with metastatic intracranial tuberculomas only: a case report

<p>Abstract</p> <p>Introduction</p> <p>Intracranial tuberculomas are a rare complication of tuberculosis occurring through hematogenous spread from an extracranial source, most often of pulmonary origin. Testicular tuberculosis with only intracranial spread is an even rarer finding and to the best of our knowledge, has not been reported in the literature. Clinical suspicion or recognition and prompt diagnosis are important because early treatment can prevent patient deterioration and lead to clinical improvement.</p> <p>Case presentation</p> <p>We present the case of a 51-year-old African man with testicular tuberculosis and multiple intracranial tuberculomas who was initially managed for testicular cancer with intracranial metastasis. He had undergone left radical orchidectomy, but subsequently developed hemiparesis and lost consciousness. Following histopathological confirmation of the postoperative sample as chronic granulomatous infection due to tuberculosis, he sustained significant clinical improvement with antituberculous therapy, recovered fully and was discharged at two weeks post-treatment.</p> <p>Conclusion</p> <p>The clinical presentation of intracranial tuberculomas from an extracranial source is protean, and delayed diagnosis could have devastating consequences. The need to have a high index of suspicion is important, since neuroimaging features may not be pathognomonic.</p

Clinico-epidemiological profile and diagnostic procedures of pediatric tuberculosis in a tertiary care hospital of western Nepal-a case-series analysis

<p>Abstract</p> <p>Background</p> <p>Changing epidemiology and diagnostic difficulties of paediatric tuberculosis (TB) are being increasingly reported. Our aim was to describe clinico-epidemiological profile and diagnostic procedures used for paediatric TB.</p> <p>Methods</p> <p>A retrospective case-series analysis was carried out in a tertiary care teaching hospital of western Nepal. All pediatric TB (age 0-14 years) patients registered in DOTS clinic during the time period from March, 2003 to July, 2008 were included. Medical case files were reviewed for information on demography, clinical findings, investigations and final diagnosis. Analysis was done on SPSS package. Results were expressed as rates and proportions. Chi square test was used to test for statistical significance.</p> <p>Results</p> <p>About 17.2% (162/941) of TB patients were children. Common symptoms were cough, fever and lymph node swelling. The types of TB were <b/>pulmonary TB (46.3%, 75/162), followed by extra-pulmonary TB (41.4%, 67/162). Twelve patients (7.4%) had disseminated TB. Distribution of types of TB according to gender was similar. PTB was common in younger age than EPTB which was statistically significant. EPTB was mainly localized to lymph node (38, 50.7%), and abdomen (9, 12%). Five main investigations namely Mantoux test, BCG test, chest radiograph, erythrocyte sedimentation rate (ESR) and fine needle aspiration cytology (FNAC) or biopsy were carried out to diagnose TB.</p> <p>Conclusions</p> <p>Paediatric TB in both pulmonary and extrapulmonary forms is a common occurrence in our setting. Age incidence according to type of TB was significant. Diagnosis was based on a combination of epidemiological and clinical suspicion supported by results of various investigations.</p

Infecções em dispositivos neurológicos implantáveis em crianças e adolescentes

OBJETIVO: Determinar a freqüência, as causas, o sítio específico e as manifestações clínicas e laboratoriais das infecções em crianças e adolescentes após a implantação de dispositivos neurológicos (DVP) no Hospital Governador João Alves Filho (Aracaju SE). MÉTODO: Estudo prospectivo, observacional, não controlado de 50 pacientes, submetidos a DVP (58 procedimentos), no período de janeiro de 2003 a outubro de 2004. RESULTADOS: Observaram-se taxas de infecção por procedimento de 27,6%, taxas de infecção de índice cirúrgico zero, 1 e 2 de 25,7% e 30,4%, respectivamente (NNIS-CDC). A infecção de sítio cirúrgico foi a principal complicação com 50% das infecções. CONCLUSÃO: Taxa de infecção por procedimento, paciente e índice de risco cirúrgico mostraram-se elevadas. Não houve significância estatística com relação à idade, etiologia da hidrocefalia, ao tipo de procedimento (derivação primária e reinserção), tempo de internação pré-operatória, duração da cirurgia, antibioticoprofilaxia, cateter SNC prévio e índice de risco cirúrgico. _________________________________________________________________________________________ ABSTRACT: OBJECTIVE: To determine frequency, etiology, site and clinical and laboratory findings of ventriculoperitoneal shunt (VPS) infections in children and adolescents with hydrocephalus managed in Hospital Governador João Alves Filho, Aracaju SE, Brazil. METHOD: A non-controlled prospective observational study comprising 50 patients that underwent VPS (58 procedures) from January/2003 to October/2004. RESULTS: Infection rate per procedure was 27.6%; surgical risk index (NNISS-CDC) 0 and 1-2 were 25.7% and 30.4% respectively; surgical site infection was the main complication with 50% of the cases. CONCLUSION: Infection rates per procedure, per patient, and per surgical risk index were high. No statistical differences were found related to the following: age, etiology of hydrocephalus, type of procedure, pre-operative length of stay, duration of procedure, antibiotic prophylaxis, previous central nervous system catheter, and surgical risk index