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Girl, 14 years old, with low grade fever, weight loss and cough.
A girl, 14 years old, came to our clinic presenting cough, low grade fever, night sweating, decreased appetite, weight loss and paleness. Her symptoms started about a month ago. A pulmonologist had diagnosed asthma and administered brochodilatory medication, inhaled corticosteroids and clarithromycin for 3 weeks.

At her admission her temperature was 39 oC, she had minor respiratory distress and tachypnea. Auscultation: rales and decreased air entry in both lungs.

  • Hb 11,8 gr/l, Ht 35%, WBC 11000 (NEU 59%, LYM 32%), ESR 45 mm(1st hour), other biochemical tests within normal values
  • Chest x-ray: upper right and left lobe infiltration. Differential diagnosis between tuberculosis and pulmonary hemosiderosis.
  • Tuberculin SR: 23 mm. (BCG 8 years ago)


Better resolution


Three morning gastric aspiration samples were taken on consecutive days. Direct microscopy with Z.N. stain revealed M.tuberculosis in all three samples, while the child was under treatment with INH-RIF-PZM-EMB since heer admission, as well as isolated from other hospitalized children.

Second x-ray, three days after the first, showing improvement, especially on the left.


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Third x-ray 11 days after the first, showing further improvement. Radiograph improvement was followed by clinical improvement, temperature returning to normal, gain of appetite and weight.


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Chest x-ray 2 months after admission showing further improvement.


Better resolution


The first three cultures developed M.tuberculosis susceptible to all first-line antituberculous drugs. The next two cultures 15 and 30 days after admission were negative. It hasn't been possible yet to trace the source patient who infected the child, neither in her family, nor in her family friends.

The little girl infected four of the 24 pupils attending the same class, three friends from another class of the same school, two of her brothers (one developed tuberculosis) and five cousins (two of them, aged 10 and 15 months, also developed tuberculosis). That totals to 14 children infected, three of them developing disease. Children that came in contact with the index patient are still being checked for infection or disease.

A 4 yr old boy with tb, flank pain, weakness of the legs and fever
L.I. male, 4 years old
Infected with M.tuberculosis in 1998, when he was 2 yr old, by his grandfather, along with 12 more children.
L. is the only one with poor compliance in taking his medication and before treatment completion he stops coming to follow-up visits.
Two years later (2000) he presents with flank pain, weakness of the legs and low fever.
Chest x-ray shows fibrous lesions in the hilar areas and the left upper lobe.


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The child presents pain on pressure of T12-L1-L2 and kyphosis.
Bone scanning shows increased concentration of the contrast material in T12 and L1.
MRI shows destruction of the body of T12 and L1 and spinal cord compression.


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Better resolution


Surgical decompression of the spinal cord is performed and the biopsy shows lesions compatible with tuberculosis. Acid-fast bacteria are detected in the biopsy material. M.tuberculosis was isolated in the culture, sensitive to all primary antituberculous drugs, a pattern compatible with his grandfather's isolate.
The child had to wear a harness to support the spondylodesis T8-L3 and was put on I+R+P+STM for 2 months. After this period he was discharged and was put on DOT with I+R for another 16 months.
Today he doesn't have any neurologic deficits. A minor inflexibility in the lumbar region can be observed.

Images from Greece...