ppt concia "localizzazioni extrapolmonari nella coinfezione"
TRANSCRIPT
LOCALIZZAZIONI EXTRAPOLMONARI NELLA COINFEZIONE
Prof. Ercole Concia VERONA
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Tubercolosi extrapolmonare
1. TBC del sistema nervoso centrale: meningite tubercolare, tubercoloma 2. Pleurite tubercolare 3. Pericardite 4. Spondilodiscite tubercolare (morbo di PoM) 5. Tubercolosi osteoarPcolare 6. Tubercolosi genitourinaria 7. Tubercolosi gastrointesPnale 8. Linfoadenite tubercolare ( scrofola) 9. MediasPnite 10. Tubercolosi cutanea 11. Laringite 12. OPte, rePnite, uveite, panoValmite, congiunPvite fliMenulare 13. Tubercolosi miliare
COMMON SITES OF EXTRAPULMONARY TUBERCULOSIS
SITE Percentage of extrapulmonary cases Pleura 20-‐25 LymphaPcs 20-‐40 Genitourinary 5-‐18 Bone/joint 10 Central nervous system 5-‐7 Abdominal 4 Disseminated 7-‐11
FaMori predisponenP le forme di TBC extrapolmonare
• Razza (neri, indiani…….) • Età (bambini) • Sesso (femminile) • HIV/AIDS • MicobaMeri (ceppo Beijing/w) • ……………………………………………..
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Cho Naing 2013
AIDS HIV RISK EXTRAPULMONARY TBC VERSUS PULMONARY
Sites of TB among the HIV-‐infected and control paPents
HIV INFECTED % PULMONARY 61 DISSEMINATED 38 GENITOURINARY 37 LYMPHNODES 22 PLEURAL 16 SNC 14 INTRA-‐ABDOMINAl 14 MUSKULOSKELETAL AND
CUTANEOUS 8 MISCELLANEOUS 6
CONTROL % 31 8 25 18 27 15 5 15 2 15
R.W Shaffer Medicine 1991
16 E.V. Kourbatova et al. Eur. J. Epid. 2006
Correlation Between Extent of HIV-Induced Immuno-Suppression and Clinical Manifestation of Tuberculosis
Duration of HIV infection
Med
ian
CD
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mm
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De Cock KM, et al. J Am Med Assoc 1992;268:1581-7
Pulmonary tuberculosis
Lymphatic, serous tuberculosis
Tuberculous meningitis
Disseminated tuberculosis
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polmonari BK + polmonari BK - extrapolm.
Ritardo diagnostico nella TB
italiani immigrati
Italiani
Extracom.
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SENS SPEC
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SENS SPEC
TUBERCOLOSI LINFONODALE
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Tuberculosis -‐ LymphadeniLs
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HISTORY of Tuberculosis
Tuberculosis Is an Ancient Disease
Spinal Tuberculosis in EgypLan
Mummies History dates to 1550 – 1080 BC
IdenLfied by PCR
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TUBERCOLOSI CUTANEA
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TUBERCOLOSI UROGENITALE
(organi colpiP: reni,ureteri, vescica,prostata, epididimo, tesPcoli,
salpingi)
Genitourinary Tuberculosis
• Direct infecPon or amyloidosis • Granulomas in glomeruli heal or caseate • Dysuria and hematuria • IVP helpful • Upper and lower GU tract
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40 Renal biopsy specimen of a patient with renal tuberculosis showing acid-fast bacilli (Ziehl-Neelsen staining). H&E, 400 +.
TUBERCOSI ADDOMINALE
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TUBERCOLOSI DEL SNC
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Tuberculous meningitis in Denmark: a review of 50 cases (BMC Inf. Dis. 2011)
BMC Inf. Dis. 2011
BMC Inf. Dis. 2011
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CT showing ventricular dilataPon
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TUBERCOLOSI OSSEA
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Pott’s disease • This enPty was first described by Percivall PoM. He noted this as a painful kyphoPc deformity of the spine associated with paraplegia.
• Tuberculosis of the spine is one of the oldest diseases afflicPng humans. Evidences of spinal tuberculosis have been found in EgypPan mummies daPng back to 3400 BC
MUMMY OF A TB SPINE AND CT SHOWING LESION T10/T11
WOMEN WITH POTT’S DISEASE IN MOMIL CULTURE
Regional DistribuPon 1 Cervical 12%
2 cervicodorsal 5%
3 Dorsal 42%
4 Dorsolumbar 12%
5 Lumbar 26%
6 Lumbosacral 3%
SYNTHES PLATE WITH SAPCER
TUBERCOLOSI: ALTRE LOCALIZZAZIONI
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TB con ascesso tubo-ovarico
TB endometriale
TB mammaria
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Phlyctenular conjuncPviPs
TERAPIA
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I Z R RIZE
% < 70 anni
> 70 anni
EPATITE RASH INTOLLERANZA
GASTRICA
TUBERCOLOSI 2005: EFFETTI COLLATERALI
Istituto Malattie Infettive Università di Verona
SINDROME DA IMMUNORICOSTITUZIONE
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AIDS 2013
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MORTALITA’
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E.V. Kourbatova et al. Eur. J. Epid. 2006
91 E.V. Kourbatova et al. Eur. J. Epid. 2006
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E.V. Kourbatova et al. Eur. J. Epid. 2006
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