Tuncer Ozkisa

High resolution computed tomography findings in smear-negative pulmonary tuberculosis patients according to their culture status.

OBJECTIVE The aim of this study was to assess the clinical features and high resolution computed tomography (HRCT) findings in smear-negative pulmonary tuberculosis (PTB) and to evaluate the correlation between these parameters and the culture results. METHODS We retrospectively studied 78 active smear-negative PTB patients. They were divided into two groups according to their culture results. The HRCT findings and clinical features at the beginning of the antituberculosis treatment were reviewed. RESULTS The mean age was 22.48±3.18 years. Micronodules (87%), large nodules (63%) and centrilobular nodules (62%) were the most common HRCT findings. HRCT findings were observed in the right upper (72%), left upper (56%), right lower (32%), and left lower lobes (29%). Cough (37%) and chest pain (32%) were the most frequent symptoms at presentation. CONCLUSIONS There were no significant differences in the HRCT findings and clinical features between the two groups. Thus, in cases of smear-negative and culture-negative PTB, the patient with compatible clinical and radiological features should be considered for tuberculosis treatment.

The impact of sedation type on diagnostic yield of EBUS‐TBNA: Looking from another point of view

Dear Editor, We read with great interest and commendation the article by € Oztaş et al., a retrospective study investigating impact of sedation type, either propofol–midazolam or midazolam alone, used while performing endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) on diagnostic yield and complications. The authors concluded that EBUS-TBNA can be performed under conscious sedation with midazolam since the procedures performed under moderate sedation with midazolam and deeper sedation with midazolam–propofol had similar diagnostic yields and complication rates. Actually, data about diagnostic yield of EBUS-TBNA according to sedation type used during the procedure, are little and controversial. Yarmus et al. reported that EBUSTBNA performed under general anesthesia (GA) yielded more diagnostic efficacy. On the other hand, however, more recently, Casal et al. concluded in their article, which is consistent in part with the study of € Oztaş et al., that EBUSTBNA performed under either moderate sedation (MS) or GA had similar diagnostic yields. However, we suggest that the results of both studies, might not be necessarily generalized to all EBUS performers, as also indicated by Wahidi and Sterman in their editorial comment. There is another point of view, which we would like to bring attention to, is the differences in diagnostic efficacy of EBUS-TBNA in different disease groups. In a systematic review Varela-Lema et al. reported that the sensitivity of EBUS-TBNA for pathological confirmation of mediastinal lymphadenopathies in suspected or established diagnosis of lung cancer ranged 85%-100%. On the other hand, it has been noted that EBUS-TBNA has yielded 79% diagnostic efficacy in sarcoidosis, which is the most frequent benign mediastinal disease for which the procedure is performed. Lower diagnostic yield of EBUS-TBNA in sarcoidosis might be explained by need of more tissue sampling for pathological diagnosis of granulomatous inflammation. Based on our experience (unpublished data yet), EBUSTBNA performed under GA had more diagnostic yield than that of under MS, particularly in patients with sarcoidosis and other benign diseases (Table 1). Furthermore the MS group experienced more complications. To the best of our knowledge, no study has demonstrated the impact of sedation type on efficacy of EBUS-TBNA according to final diagnoses. We suggest that GA should not be disregarded yet as it has a positive impact on diagnostic yield of EBUSTBNA particularly in benign diseases, improves patient comfort and makes easy to perform the procedure for fellows, which facilitates their training. However, there is still lack of randomized multicenter studies and we need more to conclude definitely which provides the optimal sedation with the best diagnostic performance.

The tuberculosis case fatality rate and the treatment results of the young adult male patients of the last 9 years (2002-2010)

Tuberculosis (TB) remains as the second leading infectious disease causing death following human immunodeficiency virus (HIV) worldwide (1). In 2010, 8.8 million (range, 8.5-9.2 million) new TB cases have been defined. According to the 2011 Global Tuberculosis Control Report of the World Health Organization (WHO), the incidence and prevalence of TB were 128/100,000 and 178/100,000, respectively, and the mortality associated with TB was 20/100,000 worldwide (1). In 2010, TB-related death was determined in 1.1 million (range, 0.9-1.2 million) HIV-negative patients and in 0.35 million (range, 0.32-0.39 million) HIV-positive patients worldwide (1). The incidence of TB has been decreasing since 2002 and the number of definite TB cases has been decreasing since 2006. Within the frame of global TB control strategy of WHO, namely “The Stop TB Strategy”, one of the aims is to reduce the prevalence and mortality rates of TB in 1990 by 50% until 2015 (2). This goal was achieved in America and was nearly achieved in the Western Pacific Region.

Miliyer Tüberküloz Olgusunda Rhizobium Radiobacter Bakteriyemisi

Rhizobium species are commonly found in soil, aerobic, motile, free of spores, catalase, oxidase, urease-positive and gram-negative bacillus. Until the 1980s, Rhizobium radiobacter was not accepted as a cause of an infection in humans despite being isolated from clinical samples. For the first time in 1980 it was isolated from a patient with prosthetic valve endocarditis as a cause of an infection. These bacterias are usually cause infection in immunosuppressed patients and/or in patients whom foreign bodies like catheter-dentures are used. Infection may be seen as bacteremia, peritoneal dialysis associated peritonitis, cellulitis, urinary tract infection and endophthalmitis or pneumonia rarely. We present a miliary tuberculosis case who has Rhizobium radiobacter bacteremia. In the current literature, Rhizobium radiobacter bacteremia with tuberculosis has not been reported before. Especially in miliary tuberculosis patients who have persistent fever despite the treatment, Rhizobium radiobacter bacteremia also should be keep in mind.