‘Tuberculoma’ of the lung

Pugh, David; Jones, E. R.; Martin, William J.

doi:10.1016/s0041-3879(52)80024-8

Cited by 7 publications

(2 citation statements)

References 5 publications

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“…Tuberculomas are isolated nodular masses caused by the tubercle bacillus; they range in size from 0.5 to 4 cm in diameter, and are smooth and sharply defined (14)(15)(16)(17)(18). Macleod and Smith (15) described the necrotic tissue that forms the core of most of these lesions as having three appearances: "the ghost of tuberculous granulation tissue" -an interlacing fibrous network enclosing poorly defined giant cells; "the ghost of bronchopneumonia" -where the alveolar structure of the lung is conserved; and completely amorphous areas without evidence of fibre structure or lining alveoli.…”

Section: Discussionmentioning

confidence: 99%

“…Reports of the finding of tubercle bacilli in the sputum of patients with tuberculomas have varied in different series; for example, Pugh and associates (17) reported the sputum positive for tubercle bacilli in only three of 28 cases, while Sochocky (18) reported sputum positive for tubercle bacilli on microscopy or on culture in 17 of 30 cases. Because closed tuberculosis lesions usually contain less than 10 4 organisms (20), patients with isolated closed lesions would not be expected to be sputum smear-positive because the latter requires 10 4 or more bacteria/mL of sputum to be present (21).…”

Section: Discussionmentioning

confidence: 99%

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′Pseudo′ Treatment Failure of Pulmonary Tuberculosis in Association with a Tuberculoma

Long

Chomyc

Der

et al. 2000

Canadian Respiratory Journal

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Failure of tuberculosis patients to respond to treatment is usually explained by one or more of five mechanisms: improper drug prescription; patient nonadherence to prescribed therapy; primary or acquired drug resistance; drug malabsorption; and rarely, exogenous reinfection with a drug-resistant isolate. Response to treatment is best measured bacteriologically; two different smear and one culture criteria for failure are widely used. Patients meeting either smear, but not culture, criteria for treatment failure may be said to have 'pseudo' treatment failure. Whether a patient can meet both smear criteria for failure, and not have a mechanism for treatment failure nor meet culture criteria, is unknown. A case of 'pseudo' treatment failure is reported in which both smear criteria for failure were met, but no mechanism for failure was proven to be operative. Key Words: Treatment failure; Tuberculosis; TuberculomaPseudo-échec du traitement de la tuberculose pulmonaire associée à un tuberculome RÉSUMÉ : L'échec du traitement de la tuberculose est en gé-néral causé par l'un des cinq phénomènes suivants : mauvais choix de médicament, non-observance au traitement de la part du patient, résistance primaire ou acquise au médica-ment, mauvaise absorption du médicament et, plus rarement, réinfection exogène par une souche résistante au médica-ment. La réponse au traitement se mesure le mieux par les analyses bactériologiques. On utilise le plus souvent deux frottis différents et une culture. Les patients qui répondent aux critères des frottis et non de la culture pour la définition de l'échec thérapeutique subiraient ce qu'on appelle un pseudo-échec du traitement. On ignore si un patient peut répondre aux critères associés au frottis pour l'échec thérapeutique et ne présenter aucun des phénomènes explicatifs ni répondre au critère associé à la culture. Un cas de pseudo-échec du traitement est décrit ici; il se caractérise par la présence des deux critères associés aux frottis, sans mécanisme explicatif.A ssuming that a curative regimen is available and can be tolerated, instances of tuberculosis (TB) treatment failure are almost always explained by one or more of five mechanisms: improper drug prescription; patient nonadherence to prescribed therapy; primary or acquired drug resistance; drug malabsorption; and rarely, exogenous reinfection with a drugresistant isolate (1-3). Depending upon their availability, sputum smear (World Health Organization [WHO]) or culture (American Thoracic Society [ATS]) criteria may be used to determine the presence of treatment failure. For the WHO, treatment failure is said to exist when a patient remains or again becomes smear-positive five months or more after starting treatment. It also is a patient who was initially smear-negative before starting treatment and becomes smear-positive after the second month of treatment (4). For the ATS, failure exists when the sputum culture fails to convert after five to six months of treatment (5). Culture criteria are the gold standard, but they have l...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%