Q J Med 2014; 107:861
Correspondence Response: Blood culture for suspected disseminated tuberculosis Sir, Thank you for your valuable and educational questions in ‘Correspondence’. Owing to space restrictions, I was unable to include some important information. For blood cultures, we performed tuberculosis cultures in addition to regular bacterial culture; however, the results were negative. The smears, cultures and polymerase chain reaction used to detect Mycobacterium tuberculosis in the bone marrow fluid (obtained via a bone marrow puncture), urine and cerebrospinal fluid all yielded negative results. A human immunodeficiency virus antigen–antibody test was also performed at the time of hospital admission and after 1 month, and both the results were negative. A colonofiberscopy performed to address right lower abdominal pain during the initial stages
of treatment revealed an inflammatory lesion in the ileocecum. A granulomatous lesion was observed during pathological examination, and M. tuberculosis was observed upon acid-fast staining. M. tuberculosis was also cultured from intestinal fluids. A liver biopsy was not performed. In cases of suspected miliary tuberculosis, it is important to attempt to verify the presence of M. tuberculosis to the extent possible by collecting samples such as the bone marrow, blood, urine, cerebrospinal fluid and intestinal fluid as well as collecting sputum and gastric juice specimens. Tsuneaki Kenzaka Ayako Noda, Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan email: [email protected] doi:10.1093/qjmed/hcu093 Advance Access Publication 23 April 2014
! The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
Correspondence Response: Blood culture for suspected disseminated tuberculosis Sir, Thank you for your valuable and educational questions in ‘Correspondence’. Owing to space restrictions, I was unable to include some important information. For blood cultures, we performed tuberculosis cultures in addition to regular bacterial culture; however, the results were negative. The smears, cultures and polymerase chain reaction used to detect Mycobacterium tuberculosis in the bone marrow fluid (obtained via a bone marrow puncture), urine and cerebrospinal fluid all yielded negative results. A human immunodeficiency virus antigen–antibody test was also performed at the time of hospital admission and after 1 month, and both the results were negative. A colonofiberscopy performed to address right lower abdominal pain during the initial stages
of treatment revealed an inflammatory lesion in the ileocecum. A granulomatous lesion was observed during pathological examination, and M. tuberculosis was observed upon acid-fast staining. M. tuberculosis was also cultured from intestinal fluids. A liver biopsy was not performed. In cases of suspected miliary tuberculosis, it is important to attempt to verify the presence of M. tuberculosis to the extent possible by collecting samples such as the bone marrow, blood, urine, cerebrospinal fluid and intestinal fluid as well as collecting sputum and gastric juice specimens. Tsuneaki Kenzaka Ayako Noda, Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan email: [email protected] doi:10.1093/qjmed/hcu093 Advance Access Publication 23 April 2014
! The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
