60 Tubercle and Lung Disease: Supplement

In 135 tuberculosis patients and in 5.5 healthy the fre- quency of antigenic determinants (AD) in immunobloting was detected on AG-H37 Rw. In the healthy AD were detected in the interval from 14 to 100 kD. More freguent (to 20%) were AD of 52, 34, 27, 16 kD, the other were met more rare. In tuberculosis patients it was a more wide AD-spectrum and AD freguency was higher. The most seturated AD-spectrum was detected in patients with infiltrative tuberculosis. Among AD, detected in tuber- culosis of lungs patients the most distinguished was AD 45 kD. In patients with focal tuberculosis it was met in 36,4 % of the cases, in patients with infiltrative tuberculosis - 45,3 % , in patients with disseminated tuberculosis - 70 % , in patients with fibro-cavernous tuberculosis - 57,1% , in patients with primary tuberculosis complex - 80,0%, in patients with tuberculoma - 40,0% of the cases. Among healthy AD 45 kD was not met. The next AD 31 kD among the patients with focal tuberculosis was met in 45,5 % , among the patients with infiltrative tuberculosis - 284 % , among the patients with disseminated tuberculosis 40,O %, among the patients with primary tuberculosis complex - 70,O % and in healthy in 10,4% of the cases. AD 15 kD was met in infiltrative tuberculosis - in primary tuberculosis complex - 60,O %, in tuberculoma - 50,O % of the cases, and in healthy in 3,6% of the cases. It may be considered, that AD 15, 31,45 kD are more characterized for the patients with the tuberculosis of Lungs.

217 ENDOCBRONCHIAL TUBERCULOSIS: AN ANALYSIS OF 24 CASES

Dereli, S., Akko& A., Aydilek, R., Tufan, M., Ozsoz, A., Halilcolar, H., Akpmar, O., Erel, F., Keyf, A. I., Acar, A., &an, E. S., MogolkoG, N.; Multi Centric Study: Dokuz Eyliil Univ. Med. Fat. Chest Disease Department, inciraltt, izmirf Turkey

24 cases with endobronchial tuberculosis were reviewed. 9 of the patients were male and 15 were female. The mean age was 32 * 16. Tuberculosis was considered to be the first diagnosis in only 3 case while primary bronchial carcinoma was considered in 10 cases, asthma in 5 cases, pneumonia in 4 cases and metastatic tumor/lymphoma in 2 cases. The most common symptoms were cough and weight loss. The ratio of the presence of acid fast bacilli in sputum of the patients was only 25 % while it was 54 % in bronchial lavage. Mucosal ulcerations, oedema, fragility, hyperemia, cubble stone appearance and stenosis were detected in 20 cases and mass lesions obstructing the lobar bronchus were observed in 4 cases via bronchoscopy. Bronchoscopy was found to be the main diagnostic method.

218 EVALUATION OF 1026 PATIENTS WITH PULMONARY TUBERCULOSIS

Cobanh, B., Acrcan, T., Ayas, G., Caktr, M., Zeydan, E., Tagkm, A.; Ankara University Medical Faculty, Chest Diseases and Tuberculosis Department Cebeci, 06100 Ankara, Turkey

On the recent ten years 1,026 patients (807 males 219 females, mean age; 35.1 +- 13.9) who had been hos- pitalized, were reviewed. The most of the patients (61.5 %) were young, between the age of 20 to 40. Patients with a previous history of Tb were 15.6%. Cough (80%), sputum (47 %), night sweat (44 %), fever (33 %), loss of weight (28%) were the most presenting symptoms. Acid fast bacilli (AFB) in sputum were positive in 92% of the patients. On discharge, AFB were still positive in 26 % On chest x-ray 63 % had cavitary lesion(s) Diabetes mellitus was found in 8.2 % of the patients. Four patients,

one of whom had also kaposi sarcoma, were suspected of AIDS, however were HIV negative. Milier Tb was seen in 1.2 %. Pleural (2.7 %), laryngeal (1 %), lymph node (l%), osseous (0.4%), peritoneal (0.2%), meningeal (0.2 %), pericardial (0.1%) and ileal (0.1%) Tb coexisted in some patients. Patients usually received four drug therapy. Side effects of the therapy were increased trans- aminases (3.7 %), autotoxicity (1.5 %), skin rash (0.9 %), increased uric acid (0.8 %), psychologic disturbance (0.7 %), neuropaty (0.4 %), flu like syndrome (0.2 %), fever (O.,l%) and hyperglysemia (0.1 %). Thirteen patients died during the theraphy. Five had respiratory failure, two malignancy, one chronic renal failure, one heart failure. Four of them (0.4%) died of Tb. In conclusion; Tb is still a health problem in our country especially in young population.

219 TUBERCULOUS MEDIASTINAL LYMPH- ADENITIS: TWO UNUSUAL CLINICAL PRESENTATIONS

Gris, P., Wilmet, B.. Benchillal, A., Wattiez, A., De Jonghe, M., Gillard, C.; Service de Pneumologie Hopital Civil de Jumet, 6040 &met, Belgium

We record here two cases of active intrathoracic tuber- culosis with atypical clinical manifestations.

In the first case, a 51-year-old Caucasian man was referred with a 3-month history of dry cough, nighttime chills, sweats and weight loss. Physical examination was normal. CT scan of the chest disclosed an isolated subcarinal lymph node enlargement. However, chest plain film revealed neither widening of the tracheal bifurcation angle nor parenchymal involvement. Bronchoscopy was normal and tuberculin skin test was negative. Mediastinoscopy was performed and histological examination showed typi- cal lesions of tuberculosis on nodal biopsy specimen. Staining of this material was positive for acid-fast bacilli identified as Mycobacterium Tuberculosis.

The second case was that of a48-year-old man, alcoholic who presented with a painless presternal mass slowly expanding, reaching the size of an orange. It was a soft, fixed and non pulsatile cystic mass on palpation. CT scan studies showed an extension of the mass through the anterior chest wall via a sternal osteomyelitic fracture, and a parenchymal infiltrate. The diagnosis was made only by histological examination of surgical biopsy of the mass revealing features of chronic necrotizing lymphadenitis with M. Tuberculosis isolated on culture, without any sign of actinomycosis.

Both cases totally recovered after classic treatment (isoniazid-rifampin-pyrazinamide).

In conclusion, we describe two extremelly uncommon presentation of tuberculosis: isolated intrathoracic lymph- adenitis in one case, and mediastinal lymphadenitis pre- senting as a chest wall mass with sternal osteomyelitis in the second one. We must always be aware of the protean manifestations of adult pulmonary tuberculosis.

220 CHARACTERISTICS OF THE RWANDA NATIONAL TB/LEPROSY PROGRAMME (PNILT)

Twagirayezu, D. and Van Deun, A.; PNILT, BP 2315, Kigali, Rwanda

The Rwanda National TB/Leprosy Program, operative since 1990, disposes of specialized personnel at national