J. Ben Amar

Traitement de la tuberculose

The aim of this article is to give practicing physicians a practical approach to the treatment of latent and active tuberculosis. Most patients follow TB standard treatment recommended by WHO that depend on category of patient. It is a combination of four essential tuberculosis drugs of the first group: isoniazid, rifampicin, pyrazinamid and ethambutol; in some cases streptomycin can replace ethambutol. This initial phase of intensive treatment is followed by a consolidation phase. Drugs should be administered in the morning on an empty stomach one hour before meals. Treatment of latent tuberculosis (TB) infection is an important component of TB control programs. Preventive treatment can reduce the risk of developing active TB.

Article originalMaladie veineuse thromboembolique au cours de la tuberculoseVenous thromboembolism in patients with acute tuberculosis

BACKGROUND Studies have demonstrated a link between tuberculosis and hypercoagulable state, with reported rates of 0,6%-10% venous thromboembolism (VTE) in all adults with tuberculosis. The present study aimed to evaluate the current incidence and characteristics of VTE in a large sample of patients with acute tuberculosis. METHODS We report a retrospective study about 26 patients who have confirmed tuberculosis complicated with VTE disease. RESULTS Sixteen men and ten women were brought together. The mean age was 42.58 years. The thromboembolic complication revealed tuberculosis among 5 patients, appearing during hospitalization of 21 patients among which 16 of them receiving antituberculosis drug. We have listed 10 cases of immediate pulmonary thromboembolism and 16 cases of deep vein thrombosis complicated with pulmonary embolism in 6 cases. Oral anticoagulation drug were associated with heparin after a mean of 4.57 days. Duration average of achievement of an effective dose was of 21.05 days and we prescribe low molecular weight heparin for 6 months on 2 cases. There was favorable evolution among 14 patients, 4 of them have lost sight and the evolution was fatal by cataclysmic haemoptysis in one case, a patient died hepatocellular insufficiency and 6 died by pulmonary embolism. CONCLUSION Immunological and hematological abnormalities are incriminated in the genesis of VTE disease during tuberculosis by creating hypercoagulate state. The accumulation of morbidity of these two affections as well as the difficulty of therapeutic care made by medical interaction ifampicin-anticoagulants aggravate the prognostic.

Maladie veineuse thromboembolique au cours de la tuberculose

BACKGROUND Studies have demonstrated a link between tuberculosis and hypercoagulable state, with reported rates of 0,6%-10% venous thromboembolism (VTE) in all adults with tuberculosis. The present study aimed to evaluate the current incidence and characteristics of VTE in a large sample of patients with acute tuberculosis. METHODS We report a retrospective study about 26 patients who have confirmed tuberculosis complicated with VTE disease. RESULTS Sixteen men and ten women were brought together. The mean age was 42.58 years. The thromboembolic complication revealed tuberculosis among 5 patients, appearing during hospitalization of 21 patients among which 16 of them receiving antituberculosis drug. We have listed 10 cases of immediate pulmonary thromboembolism and 16 cases of deep vein thrombosis complicated with pulmonary embolism in 6 cases. Oral anticoagulation drug were associated with heparin after a mean of 4.57 days. Duration average of achievement of an effective dose was of 21.05 days and we prescribe low molecular weight heparin for 6 months on 2 cases. There was favorable evolution among 14 patients, 4 of them have lost sight and the evolution was fatal by cataclysmic haemoptysis in one case, a patient died hepatocellular insufficiency and 6 died by pulmonary embolism. CONCLUSION Immunological and hematological abnormalities are incriminated in the genesis of VTE disease during tuberculosis by creating hypercoagulate state. The accumulation of morbidity of these two affections as well as the difficulty of therapeutic care made by medical interaction ifampicin-anticoagulants aggravate the prognostic.

Pseudotumeur inflammatoire pulmonaire invasive

Inflammatory pseudotumor of the lung is an uncommon nonneoplastic tumor of unknown origin. It can mimic lung carcinoma. We report a 65-year-old man who presented with productive cough, weight loss, and a heterogeneous right apical lung condensation. This clinical and radiographic presentation suggested a malignant lung tumor. Surgery was performed and the histological examination of the surgical specimen concluded to an inflammatory pseudotumor. A pneumonectomy was performed because of the tumor extension towards the lower lobe and the mediastinum. No recurrence was observed after a 2-year follow-up. Surgery is essential to confirm the diagnosis of inflammatory pseudotumor. Complete resection is the only guarantee to prevent recurrence.

Hémoptysie révélatrice d’une amylose trachéobronchique

The authors report the case of a 68-year-old man complaining of haemoptysis and breathlessness. Bronchoscopy revealed a budding formation in tracheal bifurcation. Multiple biopsies were performed and concluded as to AL type amyloidosis. Tracheobronchial amyloidosis is an uncommon localised form of amyloidosis that can simulate lung cancer.

Infections pulmonaires mycosiques chez des patients non neutropéniques

UNLABELLED Lung mycosis is rare. Diagnosis and treatment must be done the earliest possible. METHODS It is about a retrospective study on clinical records including patients hospitalized for lung infection. RESULTS From 2008 to 2011, 16 patients (13 men and three women, average age 42 years) developed a pulmonary infection. Twelve of our patients had respiratory or extrarespiratory histories. None of our patients had a neutropenia. The diagnoses were lung aspergilloma in four cases, invasive lung aspergillosis in three cases, allergic bronchopulmonary aspergillosis in three cases, mucormycosis in three cases, trichosporonosis in a case, actinomycosis in one case and penicilliosis in one case. An antifungal treatment consisting in amphotericin B or itraconazole was given to four patients and six patients, respectively. Surgery was chosen for six patients. The evolution was good for 12 patients, one presented renal failure, and three patients died.

Article original/Original articleInfections pulmonaires mycosiques chez des patients non neutropéniquesLung mycosis in non neuropenic patients

UNLABELLED Lung mycosis is rare. Diagnosis and treatment must be done the earliest possible. METHODS It is about a retrospective study on clinical records including patients hospitalized for lung infection. RESULTS From 2008 to 2011, 16 patients (13 men and three women, average age 42 years) developed a pulmonary infection. Twelve of our patients had respiratory or extrarespiratory histories. None of our patients had a neutropenia. The diagnoses were lung aspergilloma in four cases, invasive lung aspergillosis in three cases, allergic bronchopulmonary aspergillosis in three cases, mucormycosis in three cases, trichosporonosis in a case, actinomycosis in one case and penicilliosis in one case. An antifungal treatment consisting in amphotericin B or itraconazole was given to four patients and six patients, respectively. Surgery was chosen for six patients. The evolution was good for 12 patients, one presented renal failure, and three patients died.

Insuffisance respiratoire aiguë au cours de la maladie de Von Reckling Hausen

Au cours de la neurofibromatose type I ou maladie de Von ecklinghausen, l’appareil respiratoire peut être touché à ifférents niveaux avec une fréquence de 5 à 20 % en foncion des séries [1]. La manifestation la plus fréquente reste e développement de neurofibromes aux dépens des nerfs ntercostaux ou des nerfs intra pulmonaires. La cage thoraique peut être le siège d’anomalies dont les plus fréquentes ont des atteintes costales et rachidiennes, représentées par es cyphoscolioses, le scalloping vertébral, le spondylolishésis, et les défauts d’ossification. La cyphoscoliose et le calloping vertébral sont les plus fréquents (40 % des cas) [2] t prédominent au niveau cervical et thoracique [3]. Elles ntrainent des conséquences ventillatoires à type de trouble estrictif avec retentissement gazométrique pouvant préciiter l’évolution vers l’insuffisance respiratoire aiguë et le écès à l’occasion d’atteinte infectieuse pulmonaire. D’autres atteintes peuvent se voir notamment de la paroi rachéobronchique qui peut être rarement le siège de neuofibromes (moins de 30 cas rapportés dans la littérature) ont le développement se fait de façon pédiculé ou intraural. Cette atteinte peut être totalement asymptomatique omme elle peut mimer un asthme et se traduire par une yspnée [4] et c’est l’endoscopie qui va redresser le diagostic. Au niveau médiastinal, l’atteinte est représentée par des umeurs prédominant dans le médiastin postérieur qui sont réquemment des neurofibromes plexiformes, développés m h t c

Des infections pulmonaires récidivantes

Un homme âgé de 19 ans, non tabagique, avait comme antéédents des bronchopneumopathies récidivantes. Il signalait une ronchorrhée purulente depuis trois ans qui contenait parfois es débris alimentaires. L’examen physique notait un retard stauropondéral, une déformation thoracique avec à l’auscultation ulmonaire des râles ronflants diffus aux deux champs pulmoaires. La radiographie du thorax retrouvait des images alvéolaires t kystiques prédominantes au niveau du lobe supérieur droit vocatrices de dilatations de bronches. Biologiquement, la CRP tait à 179 mg/l avec une hyperleucocytose à 17 000 par millimètre ube. La fibroscopie bronchique montrait des sécrétions purulentes bondantes provenant de l’arbre bronchique droit. Le test de la ueur était normal. Le scanner thoracique retrouvait des bronchecasies prédominantes au niveau du lobe supérieur droit. Un transit sogastroduodénal à la baryte était fait (Fig. 1).