Miliary tuberculosis: rapid diagnosis, hematologic abnormalities, and outcome in 109 treated adults
Article Abstract:
Miliary tuberculosis (MTB) is an acute, generalized form of the tuberculosis characterized by the deposition of small seed-size nodules on internal organs. These nodules may not be visible on X-rays, and consequently, diagnosis may be difficult. Tuberculosis has been increasing in frequency in the US largely due to AIDS, but has been very common in South Africa where AIDS is still uncommon. The symptoms, laboratory signs, and medical course of MTB in 109 South African patients is described. The patients ranged in age from 13 to 80 years; 53 were female. Predisposing conditions such as pregnancy, alcoholism, diabetes, and iron overload, were present in 46 patients. Abnormalities in blood cell levels that have been previously associated with MTB were present in these patients. Low levels of lymphocytes were found in 87 percent of patients, low platelet levels in 23 percent, and low levels of other white blood cells were detected in 15 percent of patients. Patients who died of MTB had significantly lower levels of lymphocytes and platelets, and mortality was especially high in those who had pancytopenia (very low levels of all blood cells) or disseminated intravascular coagulation (widespread clotting in blood vessels). Low sodium concentrations were found in 78 percent of patients, and elevated levels of an enzyme, alkaline phosphatase, were present in 83 percent of patients. Diagnosis was aided by fiberoptic bronchoscopy (optic investigation of the airway), bone marrow examination, or liver biopsy. Patients had symptoms for an average of four weeks, although some symptoms had been present for a year. This long delay in seeking medical care is probably a reason why 26 patients died an average of six days after starting treatment. When patients were given a combination of rifampicin plus two other drugs, most patients responded quickly. The 83 survivors were followed for an average of 51 weeks. The study indicates that age over 60 years, low levels of lymphocytes or platelets, low blood level of albumin (a protein), elevated level of transaminase (an enzyme), and treatment delay were associated with increased mortality. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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Infections in frail and vulnerable elderly patients
Article Abstract:
Frail and vulnerable elderly patients often have disabilities such as a lack of mobility, the inability to retain urine, feces or semen, and decreased mental awareness. These patients are at increased risk of developing bacterial infections, the major cause of hospitalization among the elderly. The most common infectious diseases among disabled elderly patients include infections of the lung, urinary tract, and skin, and gastroenteritis, the inflammation of the stomach and intestinal tract; the most common symptom is fever. Factors contributing to the development of bacterial infections include decreased physiologic function; weakened natural defense mechanisms; increased incidence of adverse mechanical factors including pressure ulcers, use of catheters or tube-like structures to drain fluids from the bladder, use of feeding tubes, and soft tissue injuries; and other diseases such as fluid accumulation within the lungs or soft tissues. When considering treatment of the frail and vulnerable elderly patient, the ethical implications of prolonging therapy by means of unusual and unnecessary medical interventions must be considered. Studies have shown that treatment does not always improve the quality of life for these patients. The decrease in kidney function with aging influences the effectiveness, toxicity, and cost of therapy. Because the new antibiotic aztreonam has no adverse effects on the kidney, it may be more useful than aminoglycoside antibiotics for treating gram-negative bacterial infections in the elderly. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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Extragenital Mycoplasma hominis infections in adults
Article Abstract:
Infections with the bacterium Mycoplasma hominis frequently occur in the female urogenital system and may cause postpartum fever in some women. However, the bacteria has also been isolated from infections occurring at other body sites. M. hominis bacteria were isolated from 15 patients with definite infections and from two patients with probable infections; the results are described. Thirteen patients had prior surgery near the infection site and 14 out of 17 patients developed fever and increased white blood cell levels. Four of the patients had competent immune systems, while the remaining patients were immunosuppressed due to treatment for transplants, cancer, or hepatitis. The source of infection could not be definitively established in any patient, but 12 patients previously underwent catheter placement or kidney transplantation. Fourteen patients had received intravenous antibiotic treatment before developing the infection. Serious complications developed in 11 patients, but only one was thought to have died directly as a result of M. hominis infection. Two case reports are described. Anti-mycoplasma antibiotics effectively removed the organism in 13 of 15 patients treated. The study suggests that M. hominis infections outside of the genital area are uncommon, but not rare and may be underdiagnosed. Improved methods for identification of M. hominis infections are needed. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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