BACKGROUND: Although pulmonary tuberculosis is effectively controlled with 6 months or 9 months short course standard regimens, comparable numbers of treatment failures ensued because of inadequate treatment mainly due to patient's poor compliance. Indequate treatment with standard regimens during initial treatment may cause emergence of drug resistance and prolong the duration of chemotherapy. Also it may make the patient lesser compliant and finally increase the morbidity and the mortality. METHODS: A clinical study was done to evaluate clinical and bacteriological characteristics of 94 patients who were retreated for pulmonary tuberculosis. RESULTS: 1) 62 of the 94 patients were male and 32 patients were female. Mean age is 51 years old in male and 45 years old in female. 2) The extent of the disease on the chest radiograph was minimal in 10(11.1%) patients, moderate in 31(33.3%) patients, and far advanced in 52(55.6%) patients. 3) On sputum bacteriologic examination, 73(77.7%) patients were positive in sputum AFB smear and/or culture for Mycobacterium tuberculosis. 4) Results of drug sensitivity test performed in 42 patients showed that the resistance to one drug is in 9(20.5%) patients, two drugs in 18(40.8%) patients, and more than three drugs in 14(31.8%) patients. 5) Poor patient's compliance was the leading cause of the retreatment of pulmonary tuberculosis (43.6%) 6) Only 24(25.5%) patients of the 94 retreatment patients were successfully treated and 39 (41.6%) patients were dropped out during follow-up. CONCLUSION: We concluded that poor patient's compliance was the most important cause of treatment failure not only in primary treatment patients but also in retreatment patients. Primary treatment of pulmonary tuberculosis should be completed under strict monitoring of the patient because significant number of retreatment patients had multiple drug resistance and poor outcome.
Compliance ; Drug Resistance ; Drug Resistance, Multiple ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Mortality ; Mycobacterium tuberculosis ; Radiography, Thoracic ; Retreatment ; Sputum ; Treatment Failure ; Tuberculosis* ; Tuberculosis, Pulmonary

BACKGROUND: It is not known with certainty whether patients with persistently positive sputum smear results who have also had negative sputum culture results require prolongation of treatment for tuberculosis in order to avoid an increased risk of eventual relapse. The purpose of the present study was to retrospectively describe the treatment characteristics and evaluate the appropriate duration of treatment in these patients. METHODS: Sixty of 69 patients with sputum smear positive and culture negative tests at 5 months after first line anti-tuberculous chemotherapy from 2002 to 2003 were retrospectively analyzed. Exclusion criteria included incomplete treatment or resistance to rifampicin or two additional antibiotics, as determined by a drug susceptibility test (DST). RESULTS: Smear conversion of the study subjects was observed after 8.3+/-2.3 months treatment, and the patients were culture negative after 2.0+/-0.8 months. The relapse rates of the study subjects were 3.8, 10.0, and 25.8% after 1, 2, and 5 years of anti-tuberculosis chemotherapy, respectively. The relapse rates were not significantly affected by a series of risk factors such as age, sex, presence of diabetes, a sputum culture examination after 2 months treatment, previous treatment history, chest radiograph, and duration of the treatment (p>0.05). CONCLUSION: Regimen change is not required for patients with persistent smear positive but culture negative tests in the fifth month for first line antituberculous treatment. However, a further study will be needed to clarify the high relapse rate in this specific group of patients.
Anti-Bacterial Agents ; Drug Therapy* ; Humans ; Radiography, Thoracic ; Recurrence ; Retrospective Studies ; Rifampin ; Risk Factors ; Sputum* ; Tuberculosis ; Tuberculosis, Pulmonary

Intradural extramedullary (IDEM) tuberculoma of the spinal cord is uncommon entity and moreover, few reports have been documented on concurrent IDEM and intracranial tuberculomas. Authors report a case of IDEM spinal tuberculoma having intracranial lesion simultaneously. A 49-year-old woman suffered from paraparesis and urinary incontinence while being given medical treatment for tuberculous meningitis. Magnetic resonance imaging (MRI) revealed an IDEM mass lesion between the T1 and T2 spinal levels, and multiple intracranial tuberculous granulomas. Surgical resection of the IDEM tuberculoma followed by anti-tuberculous medication resulted in good outcome.
Brain/radiography ; Case Report ; Female ; Follow-Up Studies ; Human ; Magnetic Resonance Imaging ; Middle Age ; Mycobacterium tuberculosis/isolation & purification ; Spinal Cord Diseases/radiography* ; Tuberculoma/surgery ; Tuberculoma/radiography ; Tuberculoma/drug therapy ; Tuberculoma/complications* ; Tuberculosis, Meningeal/surgery ; Tuberculosis, Meningeal/radiography ; Tuberculosis, Meningeal/drug therapy ; Tuberculosis, Meningeal/complications*

A 23-month-old girl visited with chronic cough and her chest radiograph showed miliary tuberculosis. There was no neurological abnormality. But CSF findings showed WBC 22/mm3(lymphocyte 20%, neutrophil 80%) and positive result of polymease chain reaction(PCR) for M. tuberculosis. MR imaging showed multiple ring enhanced nodules and ovoid nonenhancing bright signal lesion on the cerebrum, cerebellar parenchyme, and left basal ganglia. Antituberculous chemotherapy was done and follow-up MR imaging was done after six months. One month after treatment, the number and size of nodules had decreased. Six months after treatment, the multiple enhanced nodules and leptomeningeal enhancement were not observed, and high signal intensity of genu portion of left internal capsule and posterior portion of putamen were decreased.
Basal Ganglia ; Brain* ; Cerebrum ; Cough ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Infant ; Internal Capsule ; Magnetic Resonance Imaging* ; Neutrophils ; Putamen ; Radiography, Thoracic ; Tuberculosis* ; Tuberculosis, Meningeal ; Tuberculosis, Miliary*

PURPOSE: To evaluate sequential changes in miliary nodules, as seen on chest radiographs in patients withmiliary tuberculosis. MATERIALS AND METHODS: We retrospectively analyzed sequential changes in miliary nodules,as seen on the chest radiographs of 13 patients with miliary tuberculosis who recovered completely ofterantituberculous medication. Two were children and 11 were adults, and their ages ranged from 2 monts to 73years(mean, 38 years). In cases in which miliary tuberculosis had been diagnosed from initial chest radiographs,follow-up chest radiographs were obtained 5 to 15(mean, 10) months later. After complete resolution of miliarynodules, as seen on chest radiographs, high-resolution CT scanning was performed in three patients. RESULTS: Asseen on follow-up chest radiographs obtained at one week, the number and size of miliary nodules had decreased ineight of nine patients (89%), and on those obtained at one month, these decreases were seen in all 13 patients.The mean duration of complete resolution of miliary nodules was 6.3 months ; in children, this was 3.5(range, 2-5)months, and in adults, 6.8 (range, 3-10) months. In all three patients involed, high-resolution CT scans obtainedafter complete radiographic resolution of miliary nodules showed no recurrence. CONCLUSION: In patients withmiliary tuberculosis, the size and number of nodules had decreased within one month of adequate chemotherapy andon chest radiographs, complete resolution was seen at 6.3 months, on average.
Adult ; Child ; Drug Therapy ; Follow-Up Studies ; Humans ; Radiography, Thoracic ; Recurrence ; Retrospective Studies ; Thorax ; Tomography, X-Ray Computed ; Tuberculosis ; Tuberculosis, Miliary ; Tuberculosis, Pulmonary*

Tuberculous aneurysm of the aorta is exceedingly rare. To date, the standard therapy for mycotic aneurysm of the abdominal aorta has been surgery involving in-situ graft placement or extra-anatomic bypass surgery followed by effective anti-tuberculous medication. Only recently has the use of a stent graft in the treat-ment of tuberculous aortic aneurysm been described in the literature. We report two cases in which a tuberculous aneurysm of the abdominal aorta was success-fully repaired using endovascular stent grafts. One case involved is a 42-year-old woman with a large suprarenal abdominal aortic aneurysm and a right psoas abscess, and the other, a 41-year-old man in whom an abdominal aortic aneurysm ruptured during surgical drainage of a psoas abscess.
Adult ; Aneurysm, Infected/drug therapy/radiography/*surgery ; Antitubercular Agents/therapeutic use ; Aortic Aneurysm, Abdominal/drug therapy/radiography/*surgery ; *Blood Vessel Prosthesis Implantation ; Case Report ; Female ; Human ; Male ; Psoas Abscess/surgery ; *Stents ; Tuberculosis, Cardiovascular/drug therapy/radiography/*surgery

BACKGROUND: During the last decade, the reports of drug-resistant tuberculosis in Korea were not common. Therefore, we investigated the anti-tuberculosis drug resistance rate according to medical history and radiological findings, as well as the relationship between the drug resistance and treatment outcomes to provide guidelines for selection of drug regimen before drug sensitivity test. METHODS: The study population was composed of 745 hospitalized patients who received drug susceptibility test for M. tuberculosis and anti-tuberculosis chemotherapy for the last 5 years. RESULTS: The majority had resistance to at least one drug (91.3%; 3.8+/-2.6 drugs). Drug resistance rate of first line drugs was 25~55%; especially higher in retreatment cases and those with the cavity on chest X-ray. Drug resistance was not correlated with radiographic finding. The success rate for treatment was higher in new cases, patients with less severe disease status and those without cavity on chest X-ray. When new cases had no resistance to all of EHR (84.1%), the negative conversion rate by first line drugs was above 70~90%. For retreatment patients, the negative conversion rate was above 70% only when they were susceptible to all of EHR (31%). The relapse rate was 4~13%. CONCLUSIONS: Probably the prevalence of drug-resistant tuberculosis in Korea will be considerably high. The drug resistance and treatment outcome was affected more by history of previous medical treatment than radiological findings. The previous EHRZ regimen is very effective as the initial treatment in new case, but revised retreatment regimen composed of at least 4 drugs is needed in the previously treated patients.
Drug Resistance ; Drug Therapy ; Humans ; Korea ; Medical History Taking ; Prevalence ; Radiography, Thoracic ; Recurrence ; Retreatment ; Thorax ; Treatment Outcome ; Tuberculosis* ; Tuberculosis, Multidrug-Resistant*

We report a case of a patient who presented with hemophagocytic syndrome (HPS) and adrenal crisis associated with bilateral adrenal gland tuberculosis, and resulted in a poor outcome. A 50-year-old man was transferred to our hospital from a local clinic due to fever, weight loss, and bilateral adrenal masses. Laboratory findings showed leukopenia, mild anemia, and elevated lactate dehydrogenase. Computed tomography (CT) of the abdomen revealed bilateral adrenal masses and hepatosplenomegaly. CT-guided adrenal gland biopsy showed numerous epithelioid cells and infiltration with caseous necrosis consistent with tuberculosis. Bone marrow aspiration and biopsy showed significant hemophagocytosis without evidence of malignancy, hence HPS associated with bilateral adrenal tuberculosis was diagnosed. During anti-tuberculosis treatment the patient showed recurrent hypoglycemia and hypotension. Rapid ACTH stimulation test revealed adrenal insufficiency, and we added corticosteroid treatment. But pancytopenia, especially thrombocytopenia, persisted and repeated bone marrow aspiration showed continued hemophagocytosis. On treatment day 41 multiple organ failure occurred in the patient during anti-tuberculous treatment and steroid replacement.
Adrenal Gland Diseases/*complications/drug therapy/radiography ; Antitubercular Agents/therapeutic use ; Histiocytosis, Non-Langerhans-Cell/*etiology/pathology ; Human ; Isoniazid/therapeutic use ; Male ; Middle Aged ; Tomography, X-Ray Computed ; Tuberculosis, Endocrine/*complications/drug therapy/radiography

We report a rare case of oculomotor nerve palsy and choroidal tuberculous granuloma associated with tuberculous meningoencephalitis. A 15-year-old male visited our hospital for an acute drop of the left eyelid and diplopia. He has been on anti-tuberculous drugs (isoniazid, rifampin) for 1 year for his tuberculous encephalitis. A neurological examination revealed a conscious clear patient with isolated left oculomotor nerve palsy, which manifested as ptosis, and a fundus examination revealed choroidal tuberculoma. Other anti-tuberculous drugs (pyrazinamide, ethambutol) and a steroid (dexamethasone) were added. After 3 months on this medication, ptosis of the left upper eyelid improved and the choroidal tuberculoma decreasedin size, but a right homonymous visual field defect remained. When a patient with tuberculous meningitis presents with abrupt onset oculomotor nerve palsy, rapid re-diagnosis should be undertaken and proper treatment initiated, because the prognosis is critically dependent on the timing of adequate treatment.
Adolescent ; Antitubercular Agents/therapeutic use ; Blepharoptosis/diagnosis/drug therapy/microbiology ; Choroid Diseases/diagnosis/drug therapy/*microbiology ; Dexamethasone/therapeutic use ; Drug Therapy, Combination ; Ethambutol/therapeutic use ; Glucocorticoids/therapeutic use ; Humans ; Magnetic Resonance Imaging ; Male ; Meningoencephalitis/diagnosis/drug therapy/*microbiology ; Mycobacterium tuberculosis/*isolation & purification ; Oculomotor Nerve Diseases/diagnosis/drug therapy/*microbiology ; Perimetry ; Pyrazinamide/therapeutic use ; Radiography, Thoracic ; Tuberculoma/diagnosis/drug therapy/*microbiology ; Tuberculosis, Meningeal/diagnosis/drug therapy/*microbiology ; Tuberculosis, Ocular/diagnosis/drug therapy/microbiology ; Visual Fields

OBJECTIVE: This study was designed to describe the radiological findings of extensively drug-resistant (XDR) pulmonary tuberculosis (TB) and to compare the observed findings with findings of drug-sensitive (DS) and non-XDR multidrug-resistant (MDR) TB in non-AIDS patients. MATERIALS AND METHODS: From September 1994 to December 2007, 53 MDR TB patients (M:F = 32:21; mean age, 38 years) and 15 XDR TB non-AIDS patients (M:F = 8:7; mean age, 36 years) were enrolled in the study. All of the MDR TB patients had received no treatment or less than one month of anti-TB treatment. In addition, all XDR TB patients received either no anti-TB treatment or only first-line anti-TB drugs. In addition, 141 consecutive DS TB patients (M:F = 79:62; mean age, 51 years) were also enrolled in the study for comparison. Chest radiograph, CT and demographic findings were reviewed and were compared among the three patient groups. RESULTS: For patients with XDR TB, the most frequent radiographic abnormalities were nodules (15 of 15 patients, 100%), reticulo-nodular densities (11 of 15, 73%), consolidation (9 of 15, 60%) and cavities (7 of 15, 47%) that were located mainly in the upper and middle lung zones. As seen on radiographs, significant differences were found for the frequency of nodules and ground-glass opacity lesions (all p < 0.001) (more frequent in DS TB patients than in MDR and XDR TB patients). For the use of CT, significant differences (more frequent in MDR and XDR TB patients) were found for the frequency of multiple cavities, nodules and bronchial dilatation (p = 0.001 or p < 0.001). Patients with MDR TB and XDR TB were younger as compared to patients with DS TB (p < 0.001). Imaging findings were not different between patients with MDR TB and XDR TB. CONCLUSION: By observation of multiple cavities, nodules and bronchial dilatation as depicted on CT in young patients with acid-fast bacilli (AFB) positive sputum, the presence of MDR TB or XDR TB rather than DS TB can be suggested. There is no significant difference in imaging findings between patients with XDR TB and MDR TB.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Drug Resistance, Bacterial ; Drug Resistance, Multiple, Bacterial ; Female ; Humans ; Image Processing, Computer-Assisted/methods ; Lung/drug effects/radiography ; Male ; Middle Aged ; Observer Variation ; Retrospective Studies ; Tomography, X-Ray Computed/methods ; Tuberculosis, Multidrug-Resistant/*radiography ; Tuberculosis, Pulmonary/*drug therapy/*radiography ; Young Adult