Tuberkuloza u 200 skladatelja Breitenfeld, Darko; Trkanjec, Zlatko; Pap, Mislav ...
Alcoholism and psychiatry research,
06/2018, Letnik:
54, Številka:
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U ovom članku iznosimo pregled dvjestotinjak skladatelja koji su bili zaraženi i patili od tuberkuloze, uz čestu ovisnost. Podatke smo prikupili iz preko 10 000 biografija i 1000 patografija. Osim ...što im je prouzrokovala mnogo patnje i prerano uzrokovala smrt i prekid njihova stvaralaštva (ponekad u samom vrhuncu), tuberkuloza je bila jedan od najčešćih uzroka smrti u skladatelja uopće.
Tijekom dvije godine (2001.-2003.) u Klinici za plućne bolesti “Jordanovac”, Zagreb, Hrvatska, od tuberkuloze je liječeno 464 bolesnika. Osim najčešće plućne tuberkuloze u 97,7% bolesnika, oboljeli ...su liječeni i od eksudativnog tuberkuloznog pleuritisa (0,9%), laringealne tuberkuloze (0,6%), tuberkuloznog meningitisa (0,2%), perikardijalne tuberkuloze (0,2%) te tuberkuloze koja je zahvatila urogenitalni sustav (0,4%). Od ukupnog broja bolesnika 57,3% ih se izjasnilo kao aktivni pušači (muškarci 80,8%), dok je 20,9% deklarirano kao aktivni konzumenti alkohola. Ukupno je 15,1% bolesnika imalo oba rizična čimbenika u anamnezi, tj. i aktivno pušenje cigareta i konzumaciju alkohola. Od komorbiditeta najčešća je bila šećerna
bolest u 30,4% bolesnika, od srčanih bolesti bolovalo je 11,2% bolesnika, dok je kronična opstruktivna plućna bolest bila prisutna u 8% bolesnika. Karcinom pluća bio je najčešće zastupljen među malignim bolestima. Od ukupnog broja oboljelih od karcinoma pluća (51 bolesnik), Mycobacterium tuberculosis izolirali smo u 33% bolesnika. Recidivi tuberkuloze su zabilježeni u 72 (15,5%) bolesnika. Jedan rizični čimbenik imalo je 30,5% bolesnika: pušača je bilo 20,8%, dok je alkohol konzumiralo 9,7% bolesnika, a 32,5% bolesnika imali su oba rizična čimbenika. Zaključno, pušenje cigareta pokazalo se kao najznačajniji rizični čimbenik za razvoj plućne tuberkuloze, kao i za pojavu recidiva tuberkuloze.
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U laboratoriju za dijagnostiku tuberkuloze Službe za mikrobiologiju Zavoda za javno zdravstvo Šibensko-kninske županije, obavlja se mikobakteriološka dijagnostika za cijelu županiju. Obrađujemo ...bolničke i izvanbolničke uzorke, otprilike 1100 uzoraka godišnje.Najčešći uzorak jest iskašljaj, urin, materijal dobiven bronhoskopijom, pleuralni izljev i ostalo.
Biološki lijekovi se primjenjuju u liječenju brojnih autoimunih reumatskih bolesti. U ovom članku prikazujemo dva slučaja ozbiljnih nuspojava liječenja inhibitorima čimbenika nekroze tumora (tumor ...necrosis factor, TNF) kod bolesnika s juvenilnim idiopatskim artritisom (JIA): bolesnice liječene zbog JIA kompliciranog razvojem uveitisa, kod koje se javila milijarna tuberkuloza tijekom liječenja. Nakon liječenja antituberkuloticima došlo je do potpunog oporavka. Njena osnovna bolest je u remisiji. Drugi bolesnik je liječen zbog juvenilnog spondiloartritisa te je razvio upalni proces središnjega živčanog sustava
s ozbiljnim neurološkim posljedicama. Liječen je visokim dozama kortikosteroida koje su potom postupno snižavane. Neurološki ispadi su se dijelom poboljšali, ali su ipak još uvijek prisutni. Slični slučajevi su opisivani i ranije, ali nema preporuka kako bi trebalo liječiti artritis nakon što nastupe takve nuspojave. Željeli bismo naglasiti potrebu stvaranja smjernica za daljnje liječenje artritisa nakon pojave teških nuspojava prilikom liječenja biološkim lijekom.
Cilj: Cilj istraživanja bio je upoznati znanje stanovništva o tuberkulozi i najčešće zablude o njoj i otkriti ciljne skupine za provedbu potencijalnih edukativnih programa. Ispitanici i metode: ...Upitnik koji se sastoji od 13 pitanja o proširenosti bolesti, simptomima, načinima prijenosa, čimbenicima rizika i izlječivosti tuberkuloze; ispitanici su testirani u Zagrebu. Ispitivanje je provedeno među 328 ispitanika na dvije gradske lokacije: u Studentskom centru (N = 157), kao mjestu na kojem se očekuje da će predominantno prevladavati mlađa studentska populacija, i glavnom zagrebačkom trgu, gdje se očekuje da će biti ljudi različite dobi i zanimanja, tj. uzorak opće urbane populacije (N = 171). Rezultati: Uzorak opće urbane populacije pokazao je bolje znanje o kapljičnom prijenosu bolesti, rizičnim čimbenicima za tuberkulozu kao što su pušenje cigareta i alkohol, te definiranju tuberkuloze kao primarno zarazne i izlječive bolesti. Mnogi od ispitanika (gotovo 20 %) nisu znali što su simptomi tuberkuloze, a kao možda najvažnija zabluda ističe se kako se tuberkuloza događa nekome drugome. Zaključak: Kroz ciljane edukativne programe trebalo bi raditi na uklanjanju zabluda o tuberkulozi i poboljšanju znanja, posebice među studentskom populacijom.
Klinički aspekt izolacije netuberkuloznih mikobakterija iz uzoraka respiratornog sustava (iskašljaj, aspirat bronha, bronhoalveolarni lavat) u bolesnika s plućnom tuberkulozom u Hrvatskoj još uvijek ...nije dovoljno poznat. Cilj rada je utvrđivanje učestalosti i kliničkog značaja koizolacije, te naknadne izolacije netuberkuloznih mikobakterija (NTM) u bolesnika od aktivne tuberkuloze pluća u Sisačko – moslavačkoj županiji, koja zadnja dva desetljeća ima najveću incidenciju tuberkuloze u Hrvatskoj. Retrospektivno su analizirani podaci za 285 bolesnika s pozitivnim kulturama uzoraka iz dišnoga trakta na Mycobacterium tuberculosis, koji su od 2007. do 2016. liječeni bolnički i kontrolirani ambulantno zbog aktivne tuberkuloze pluća na Odjelu za plućne bolesti OB „Dr. Ivo Pedišić“ Sisak – lokacija Petrinja, a kod kojih su porastom na kulturi identificirane i NTM. Za određivanje kliničkog značaja izolata NTM korišteni su revidirani kriteriji Američkog torakalnog društva (ATS) i Američkog društva za infektivne bolesti (IDSA) iz 2007. godine. Ovom prvom kliničkom analizom navedenog fenomena u Hrvatskoj, registrirana su četiri bolesnika koji su imali koizolaciju NTM (1,4%) i dva bolesnika kod kojih su izolati NTM identificirani po završenom liječenju (0,7%). Troje bolesnika imalo je dvostruke (50%), a troje jednostruke izolate NTM. Kod nijednog od njih nisu bili ispunjeni cjeloviti kriteriji ATS/IDSA za plućnu mikobakteriozu i kod svih je nastupila spontana konverzija sputuma na NTM. Zaključuje se da se u svim slučajevima radilo o kolonizaciji dišnog sustava NTM bez razvoja klinički značajne plućne infekcije.
Provider: - Institution: - Data provided by Europeana Collections- Tuberculosis is an infection with human mycobacteria strain of Mycobacterium
tuberculosis, with the occurrence of the characteristic ...immune response of
the organism. The most common form is lung disease. According to estimates
by the World Health Organization (WHO), extrapulmonary tuberculosis (EPTB)
accounts for 20-25% of the tuberculosis. Mainly due to atypical clinical
features (except for tuberculous meningitis), the prolong course of the
illness with progressive deterioration of general condition, present only
with fever and often positive inflammatory syndrome, most of theses patients
are considered in the differential diagnosis of fever of unknown origin
(FUO). A particular problem is a difficult diagnosis of EPTB and the need
for more frequent use of invasive diagnostic. Until the appearance of human
immunodeficiency virus (HIV) incidence of tuberculosis in the world was in
decline, but since the eighties of the twentieth century, tuberculosis
re-imposed as a disease of growing interest. It is estimated that the
world's two billion people infected with an M. tuberculosis, of which about
8 million develop active TB annually, and about 2 million die. The incidence
of tuberculosis and EPTB is increasing everywhere in the world and in the
HIV negative population too. In such circumstances, medical doctors must
have growing awareness of the importance of tuberculosis infection, both
lung and extrapulmonary during the diagnostic procedure in febrile
conditions. Tuberculosis can affect any organ in the body; however, the most
frequent localization is pulmonary. The term EPTB means an isolated
occurrence of tuberculosis anywhere in the body outside the lungs. If
present with extrapulmonary localization and involvement of the lungs such
patients are categorized under the diagnosis of pulmonary tuberculosis.
Varieties of clinical presentations of EPTB are numerous which makes
diagnosis difficult. With rare localization which give the characteristic
signs and symptoms (meningitis), or at least can make towards the diagnosis
(tuberculous lymphadenitis), most of the others, especially the deep
localization is only manifested with fever. Because of these difficulties in
diagnosis, the greater proportion EPTB was detected in tertiary
institutions, instead in primary care. The most common localization of EPTB
is tuberculosis of the lymph nodes, genitourinary tuberculosis, abdominal
tuberculosis, pleural tuberculosis, tuberculous pericarditis,
neurotuberculosis, tuberculosis of bones and joints. Other forms of EPTB
occur less frequently. Definitive diagnoses of tuberculosis include
demonstration of M. tuberculosis presents in specimen microbiologically,
histopathologicly or cytologicaly. As EPTB atypical clinical presentation is
often does not take into account in initial considerations of differential
diagnosis. Diagnostics are often required invasive procedures, but often
diagnosed of EPTB was not set as definitive, but it was necessary to based
it on clinical impression. The goal of treatment of tuberculosis is the
eradication of M. tuberculosis Previous experiences in the diagnosis of
patients with clinical presentation FUO indicate the EPTB as a major
etiologic factor. Diagnosis is often late made, after a lengthy process,
which often do not take into account the EPTB. Research objectives were to
show the number and demographic characteristics and age of patients in whom
the course of testing FUO, EPTB were diagnosed, and to assess their relative
frequency in the total number of patients who were examined for FUO and to
show the distribution of patients in relation to some localization of EPTB,
course of the illness, and predominant clinical presentation. To display the
used diagnostic methods and to estimate their efficiency and usefulness in
correlation with our results and literature data and to present the
significance of some parameters for the diagnosis (ADA level, skin PPD test,
the level of interferon-gamma), and to present results of direct
microbiological test for tuberculosis and their limitations in the diagnosis
of EPTB. To establish the existence of predisposing factors or concomitant
diseases, and their impact on the disease and diagnosis. And to present the
results of treatment of patients with EPTB. In this
retrospective-prospective study we included all patients in whom during
evaluation of FOU the EPT was confirmed as the reason of fever in the Clinic
of Infectious and Tropical Diseases between 2000 and 2010. The study
included 2228 patients with FOU, and in 117 EPTB was detected. It includes
only HIV-negative patients, and those in which neurotubeculosis were proven
during FOU diagnostics, and have not presented the characteristic signs of
tuberculous meningitis. In addition to anamnesis and physical examination,
all diagnostic procedures are required for diagnosis EPTB depending on its
localization was conducted. In addition to standard examinations (X-ray of
the lungs, abdomen echo), and standard biochemical tests, depending on
interest and clinical presentation of illness, IVP, CT of the abdomen,
chest, pelvis, heart echo, CT and NMR backbone were made. We also made the
histological processing of tissue suspected of mycobacterium infection
(liver and LGL biopsy). As standard microbiological analysis sample
cultivation (urine and cerebro spinal fluid) was carried out, and TB PCR
test in the urine, and cerebrospinal fluid of patients with clinical
suspicion. We also monitored gamma interferon and adenosine deaminase
levels. During treatment in all of patients treatment response, side effects
and relapses occurrence were monitored, for the treatment period and 3
months after the condition normalization. In data analysis we used the
methods of descriptive and analytical statistics. In the reporting period
there has been a yearly increase in the number of patients examined for FUO,
and increased the number of proven EPTB. EPTB make about 5% of diagnosed
diseases in FOU. Women were more often suffered from the EPTB (1,785:1). The
most frequently the patients were 41-60 years of age. The difference in the
incidence of disease by residence and origin showed no statistically
significant difference. Women living in rural areas were having EPTB more
often than men, but this difference was not significant. The most common
location was the renal tuberculosis, and tuberculosis of the lymph nodes.
Patohistiologicly the diagnosis were made in liver and lymph nodes, genital
and peritoneal localization. Pericarditis was diagnosed by ultrasound, while
other methods of radiological diagnosis (CT and NMR) and used for
neurotuberculosis and spondylodiscitis and intravenous pyelonephrografy for
renal tuberculosis. Although we regularly used cultivation of all available
materials, the sensitive were generally low. Resistant strains were detected
in only 3 isolates. PCR technique of diagnostic was made from the urine and
CSF. The sensitivity in the urine was low, while in the liquor was better.
Biochemical parameters as surogat markers (adenosine deaminase activity and
concentration of IgG) showed significantly higher values in patients with
EPTB. As important disposition factors the presence of tuberculosis in the
family and history of previous tuberculosis were detected, but a significant
number of patients had no risk factors. In the therapy we used isoniazid,
rimfampicin, pyrazinamide, ethambutol and streptomycin. We used three
treatment regimens for 6, 9 and 12 months. The six-month regimen had the
highest incidence of recurrence. Recurrences were reported in 14.5% of
patients. A side effect of therapy in 18% of treated. These results are
comparable with data from the literature. This study was found a constant
number of patients with EPTB, who are mostly middle-aged and slightly more
women. Number of affected from towns and villages are not that different,
but from country women was more frequent. Renal tuberculosis and lymph node
localization were most frequent, but localization was present in the
virtually all organs and / or organ systems. No typical symptoms and the
disease proving were difficult. There are no absolutely reliable and
specific tests for the detection of EPTB. Microbiological methods in case of
positivity were absolutely indicative, but can be false negative. The
percentage of resistant strains is a proven low. For diagnosis of EPTB we
must combine several methods, tests and procedures, and only from their
correlation we can draw a conclusion on the likelihood of diagnosis. Therapy
must be initiated sometimes on clinical suspicion basis supported by
laboratory findings. Therapeutic protocols used for pulmonary tuberculosis
may not always be used for EPTB. The six-month regimen most frequently gives
recurrence. Side effects of therapy were present in less than a fifth of the
treated. It is necessary to redefine the diagnostic and therapeutic
protocols for EPTB and separate them from the protocol for pulmonary
tuberculosis- Tuberkuloza predstavlja infekciju humanim sojem mikobakterije Mycobacterium
tuberculosis uz pojavu karakterističnog imunološkog odgovora organizma.
Najčešća forma bolesti je plućna. Po procenama Svetske Zdravstvene
Organizacije (SZO) vanplućna tuberkuloza (VPTB) čini oko 20-25% formi
bolesti. Zbog uglavnom atipične kliničke slike (izuzimajući tuberkulozni
meningitis), produženog toka u kome su uz progresivno pogoršanje opšteg
stanja, prisutni još samo povišena temperatura i često pozitivan zapaljenski
sindrom, najveći broj ovih bolesnika se razmatra u toku diferencijalne
dijagnoze nejasnog febrilnog stanja (NFS). Poseban problem predstavlja teža
dijagnostika VPTB i potreba za češćim korišćenjem invazivne dijagnostike. U
periodu do pojave virusa humane imunodeficijencije (HIV) incidenca
tuberkuloze u svetu je bila u opadanju, ali se od osamdesetih godina
dvadesetog veka tuberkuloza ponovo nameće kao bolest o
Tuberkuloza (TBC) zarazna je bolest, stoga je prijeko potrebno zaštititi ne samo bolesnike nego i osoblje koje dolazi u kontakt s njima, u prvom redu medicinske sestre i liječnike. Nakon kontakta s ...bolesnicima oboljelima od TBC-a (u kulturama pozitivne) 43-godišnji imunokompetentni medicinski tehničar, zaposlen u psihijatrijskoj bolnici, obolio je od profesionalnog diseminiranog TBC-a. Prva manifestacija bolesti bio je eksudativni perikarditis s dokazanim Mycobacterium tuberculosis (MT), dva mjeseca nakon perikardiocenteze i evakuacije 1200 mL perikardijalnog izljeva. Histološki nalaz limfnih čvorova na više lokalizacija pokazivao je granulomatoznu upalu s nekrozom. Liječenje antituberkuloticima bilo je praćeno komplikacijama. Došlo je do prolaznog, kratkotrajnog, medikamentozno toksičnog hepatitisa, dugotrajnog febriliteta, nespecifičnog ljevostranog pleuralnog izljeva i mononeuritisa desnog peronealnog živca. Liječenje je trajalo 14 mjeseci. Kao trajna posljedica razvio se fibrotoraks, koji je doveo do restriktivnih smetnji ventilacije i smanjene difuzije alveolarno-kapilarne membrane. Ovaj slučaj upozorava na potrebu poboljšanja zaštite zdravstvenih radnika koji su u kontaktu s oboljelima od tuberkuloze, kao i korisnost tuberkulinskog kožnog testa i QuantiFERON-TB testa, koji mogu rano otkriti latentni TBC.
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