[Tuberculosis treatment in 2007]

Recurrence of multiple localizations of false tuberculous aneurysms after aortic surgery: A case report

INTRODUCTION AND IMPORTANCE

Tuberculous aortic aneurysms require rigorous medical and surgical management due to the various complications that pose a significant life risk, with recurrence being one of the most formidable postoperative complications. This recurrence is linked to significant hemorrhage and infection, subsequently increasing the risk of mortality. Aneurysmal involvement due to tuberculosis is documented and can affect all arteries, but localization in the common iliac artery is rare and serious, necessitating immediate management.

CASE PRESENTATION

We present the case of a 47-year-old man who had previously been treated for urogenital tuberculosis and underwent an aorto-aortic bypass three years ago for a juxtarenal abdominal aneurysm. The patient presented to the emergency room with abdominal pain. An emergency CT angiogram revealed a pseudoaneurysm at the site of the distal anastomosis of the bypass and a new pseudoaneurysm of the left common iliac artery. The patient underwent surgery, which involved the removal of the old aortic graft and a new aorto-bilateral iliac bypass using a Dacron graft. Histological analysis of the arterial samples collected during the operation confirmed the tuberculous origin of the aneurysm, and antituberculous treatment was extended for six months. After six months, the patient was in good general condition, and the bypass was patent.

CLINICAL DISCUSSION

For optimal results, medical treatment should precede surgical intervention. The choice between conventional and endovascular surgery is individualized for each case. However, endovascular treatment does not allow for debridement of the infected periaortic tissues, which is associated with a high risk of progression and recurrence of the infection, potentially leading to a fatal outcome.

CONCLUSION

Effective management requires antituberculous treatment and antibiotic therapy prior to surgical intervention to eliminate the aneurysm, control postoperative outcomes, and minimize complications related to tuberculosis. The work has been reported in line with the SCARE criteria (Sohrabi et al., 2023 [17]).

[The aneurysms of the aorta of tuberculous]

Tuberculosis is a public health problem in Morocco, which is difficult to eradicate despite the recognized efficiency of health policies. Aortic aneurysm is rare and lethal complication of spontaneous evolution. Pathophysiological characteristics and the difficulty of early diagnosis worsen the prognosis.

[Lymph node tuberculosis treatment: from recommendations to practice]

PURPOSE

Lymph node infection is the most frequent localization of extrapulmonary tuberculosis. However, there is still no consensus on the length of antimicrobial treatment.

METHODS

We conducted a retrospective study in the Department of infectious diseases and internal medicine in the Amiens Teaching Hospital, France. All patients diagnosed with lymph node tuberculosis between 1998 and 2007 were included; some patients presented with bi- or multifocal tuberculosis. The aim of the study was a practice analysis.

RESULTS

We studied 48 medical records, 16 were excluded for lack of more than 40% of data or because lymph node tuberculosis was non-active. The mean age of the 32 patients included was 49 years. The mean duration of treatment was 10.9 months (standard deviation 2.6, median 11, range 6-18). There was no statistical age difference between subgroups (lymph node tuberculosis versus multifocal tuberculosis). There was no significant difference between the 6-month treatment group and the 9-month treatment group in term of clinical response. One relapse was diagnosed, eight patients (25%) were lost to follow-up at 1 year after treatment. DISCUSSION AND REVIEW: No reliable published data was found as to the optimal duration of treatment. A high quality clinical trial should be carried out to suggest a consensus.

Factors associated with excessively lengthy treatment of tuberculosis in the eastern Paris region of France in 2004

Background

Few data are available on prescriber adherence to tuberculosis (TB) treatment guidelines. In particular, excessively long treatment carries a risk of avoidable adverse effects and represents a waste of healthcare resources. We examined factors potentially associated with excessively long treatment.

Methods

We reviewed the medical records of patients diagnosed with TB in 2004 in the eastern Paris region. Sociodemographic and clinical factors associated with excessively long treatment were identified by logistic regression analyses. Based on contemporary guidelines, excessively long treatment was defined as more than 6 months of a four-drug regimen for thoracic TB with full sensitive strains, and more than 12 months for patients with extrathoracic TB.

Results

Analyses concerned 478 patients with a median age of 36.0 ± 13.5 years, of whom 48% were living in precarious conditions (i.e. poor living conditions and/or no health insurance), 80% were born abroad, and 17% were HIV-seropositive. TB was restricted to the chest in 279 patients (isolated pulmonary, pleuropulmonary, and isolated pleural TB in 245, 13, and 21 patients, respectively), exclusively extrathoracic in 115 patients, and mixed in the remaining 84 patients. Treatment was prescribed by a chest specialist in 211 cases (44.1%) and 295 patients (61.7%) were managed in a single institution. The treatment duration complied with contemporary guidelines in 316 cases (66.1%) and was excessively long in 162 cases (33.9%). The median duration of excessively long treatment was 313 days (IQR: 272-412). In multivariate analysis, isolated thoracic TB, previous TB, HIV infection, a prescriber other than a chest specialist, and management in more than one healthcare center during treatment were independently associated with excessively lengthy treatment.

Conclusion

One-third of TB patients received excessively long treatment, reflecting inadequate awareness of management guidelines or unwillingness to implement them.

[Tuberculosis in France: new challenges for practitioners]

The need for a national tuberculosis control program was based on disparities of incidence by geographical area or by population group, and differences in tuberculosis control practice. This program was developed within the context of the 2004 public health act that prioritised tuberculosis control with the objective "to stabilise the tuberculosis incidence by reinforcing control strategies in groups and zones at risk". The tuberculosis control programme, launched in July 2007, aims to consolidate the decrease of the tuberculosis incidence and to reduce the inequalities. This implies, in particular, reaching the most exposed populations, to ensure an adequate management of cases with a good treatment observance. This also implies preventing transmission in health care settings, and maintaining the low level of multiresistance and must be done despite the loss of expertise due to a decrease in incidence. The six major objectives of the tuberculosis control program are to ensure an early diagnosis and an adequate treatment for all tuberculosis cases, to improve screening, to optimise the BCG policy, to maintain antituberculosis resistance at a low level, to improve the epidemiological surveillance and the knowledge of the determinants of tuberculosis and to improve the management of tuberculosis control activities.