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==Progress==
==Test==
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+'''''Recommended Treatment of Chronic Hepatitis B'''''
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|HBeAg}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|ALT}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|HBV DNA}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Treatment Regimen}}
|-
| style="padding: 5px 5px; background: #F5F5F5;" |'''+'''
| style="padding: 5px 5px; background: #F5F5F5;" |''≤2 x Upper Limit of Normal''
| style="padding: 5px 5px; background: #F5F5F5;" |''>20,000 IU/mL''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Low efficacy with present treatment
*Observe: treatment should be considered as ALT rises
*Biopsy should be considered in adults >40years, when:
:*Persistence of an elevated ALT: [Normal;<2xUpper Limit of Normal]
:*Family history of hepatocellular carcinoma
*Treatment should be considered when:
:*HBV DNA > 20,000 IU/mL
:*Signs of inflammation (moderate to severe) or fibrosis on biopsy
|-
| style="padding: 5px 5px; background: #F5F5F5;" |'''+'''
| style="padding: 5px 5px; background: #F5F5F5;" |''>2 x Upper Limit of Normal''
| style="padding: 5px 5px; background: #F5F5F5;" |''>20,000 IU/mL''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Observation for 3 to 6 months. Treatment should be started if no spontaneous HBeAg loss
*If compensated, liver biopsy should be considered prior to treatment
*If patient is jaundiced or decompensated, start immediate treatment
*Initial therapy may include:
:*IFNα/pegIFNα
:*Lamivudine
:*Adefovir
:*Entecavir
:*Tenefovir
:*Telbivudine
*Adefovir plays a minor role due to increased resistance rate after 1 year, and weak antiviral activity
*Lamivudine and telbivudine play a minor role due to increased resistance rate
*Treatment goal - seroconversion with production of anti-HBe to HBeAg
*Treatment duration:
:*IFN-α - 16 weeks
:*PegIFN-α - 48 weeks
:*Lamivudine or adefovir or entecavir or telbivudine or tenofovir disoproxil fumarate - >1 year; treatment should be continued >6 months after HBeAg seroconversion
:*Tenofovir disoproxil fumarate or entecavir for: absence of response to IFN-α; or when IFN-α is contraindicated
|-
| style="padding: 5px 5px; background: #F5F5F5;" |'''-'''
| style="padding: 5px 5px; background: #F5F5F5;" |''>2 x Upper Limit of Normal''
| style="padding: 5px 5px; background: #F5F5F5;" |''>20,000 IU/mL''†
| style="padding: 5px 5px; background: #F5F5F5;" |
*Initial therapy may include:
:*IFN-α/PegIFN-α
:*Lamivudine
:*Adefovir
:*Entecavir
:*Tenofovir disoproxil fumarate
:*Telbivudine
*Lamivudine and telbivudine play a minor role due to increased resistance rate
*Adefovir plays a minor role due to increased resistance rate after 1 year, and weak antiviral activity
*Treatment end-point not defined
*Treatment duration:
:*IFN-α/PegIFN-α - 1 year
:*Lamivudine or adefovir or entecavir or telbivudine or tenofovir disoproxil fumarate - > 1 year
:*Tenofovir disoproxil fumarate or entecavir for: absence of response to IFN-α; or when IFN-α is contraindicated
|-
| style="padding: 5px 5px; background: #F5F5F5;" |'''-'''
| style="padding: 5px 5px; background: #F5F5F5;" |''[1; >2] x Upper Limit of Normal''
| style="padding: 5px 5px; background: #F5F5F5;" |''>2,000 IU/mL''
| style="padding: 5px 5px; background: #F5F5F5;" |
*If signs of necroinflammation (moderate to severe) or fibrosis on liver biopsy - consider liver biopsy and treatment
|-
| style="padding: 5px 5px; background: #F5F5F5;" |'''-'''
| style="padding: 5px 5px; background: #F5F5F5;" |''≤ Upper Limit of Normal''
| style="padding: 5px 5px; background: #F5F5F5;" |''≤2,000 IU/mL''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Observation. Treatment should be started when: ALT or HBV DNA rise
|-
| style="padding: 5px 5px; background: #F5F5F5;" |'''+/-'''
| style="padding: 5px 5px; background: #F5F5F5;" |''Cirrhosis''
| style="padding: 5px 5px; background: #F5F5F5;" |''Traceable''
| style="padding: 5px 5px; background: #F5F5F5;" |
|-
| style="padding: 5px 5px; background: #F5F5F5;" |'''+/-'''
| style="padding: 5px 5px; background: #F5F5F5;" |''Cirrhosis''
| style="padding: 5px 5px; background: #F5F5F5;" |''Untraceable''
| style="padding: 5px 5px; background: #F5F5F5;" |
|-
|}
 
 
 
 
 
 
 


==Parenchymal lesions==
*Tuberculoma
:* Single or multiple lesions of > 0.5 cm
:* May occur in primary or secundary TB
:* Main finding on Chest X-ray in 5% cases of secondary TB<ref name="pmid3484866">{{cite journal| author=Woodring JH, Vandiviere HM, Fried AM, Dillon ML, Williams TD, Melvin IG| title=Update: the radiographic features of pulmonary tuberculosis. | journal=AJR Am J Roentgenol | year= 1986 | volume= 146 | issue= 3 | pages= 497-506 | pmid=3484866 | doi=10.2214/ajr.146.3.497 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3484866  }} </ref>
:* Results from the surrounding of M. tuberculosis with inflammatory or connective tissue.<ref name="pmid8456658">{{cite journal| author=Lee KS, Song KS, Lim TH, Kim PN, Kim IY, Lee BH| title=Adult-onset pulmonary tuberculosis: findings on chest radiographs and CT scans. | journal=AJR Am J Roentgenol | year= 1993 | volume= 160 | issue= 4 | pages= 753-8 | pmid=8456658 | doi=10.2214/ajr.160.4.8456658 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8456658  }} </ref><ref name="pmid472765">{{cite journal| author=Palmer PE| title=Pulmonary tuberculosis--usual and unusual radiographic presentations. | journal=Semin Roentgenol | year= 1979 | volume= 14 | issue= 3 | pages= 204-43 | pmid=472765 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=472765  }} </ref><ref name="pmid3484866">{{cite journal| author=Woodring JH, Vandiviere HM, Fried AM, Dillon ML, Williams TD, Melvin IG| title=Update: the radiographic features of pulmonary tuberculosis. | journal=AJR Am J Roentgenol | year= 1986 | volume= 146 | issue= 3 | pages= 497-506 | pmid=3484866 | doi=10.2214/ajr.146.3.497 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3484866  }} </ref>
:* The center of the tuberculoma is often necrotic
:* Satellite lesions (80%)
:* Nodular or diffused calcifications in 20-30% cases<ref name="pmid8456658">{{cite journal| author=Lee KS, Song KS, Lim TH, Kim PN, Kim IY, Lee BH| title=Adult-onset pulmonary tuberculosis: findings on chest radiographs and CT scans. | journal=AJR Am J Roentgenol | year= 1993 | volume= 160 | issue= 4 | pages= 753-8 | pmid=8456658 | doi=10.2214/ajr.160.4.8456658 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8456658  }} </ref>
*Thin-walled cavity
:* Present in active and inactive disease
:* May regress after treatment
:* Air-filled sect may persist<ref>{{cite book | last = Fraser | first = Richard | title = Synopsis of diseases of the chest | publisher = W.B. Saunders | location = Philadelphia | year = 1994 | isbn = 0721636691 }}</ref>
:* May be misidentified as an emphysematous bulla or pneumatocelle.
*Cicatrization:
:* Common in secondary TB
:* Marked fibrosis in ≤40% of secondary TB cases, which may present as:
::*Upper love atelectasis
::*Compensatory hyperinflation of the lower lobe
::*Hilar retraction
::*Mediastinal shift
*Unspecific X-Ray findings:<ref name="pmid11452057">{{cite journal| author=Kim HY, Song KS, Goo JM, Lee JS, Lee KS, Lim TH| title=Thoracic sequelae and complications of tuberculosis. | journal=Radiographics | year= 2001 | volume= 21 | issue= 4 | pages= 839-58; discussion 859-60 | pmid=11452057 | doi=10.1148/radiographics.21.4.g01jl06839 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11452057  }} </ref>
::*Parenchymal bands
::*Fibrotic cavities
::*Fibrotic nodules
::*Traction bronchiectasis
*Lung Destruction:<ref name="pmid11452057">{{cite journal| author=Kim HY, Song KS, Goo JM, Lee JS, Lee KS, Lim TH| title=Thoracic sequelae and complications of tuberculosis. | journal=Radiographics | year= 2001 | volume= 21 | issue= 4 | pages= 839-58; discussion 859-60 | pmid=11452057 | doi=10.1148/radiographics.21.4.g01jl06839 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11452057  }} </ref>
:*Common in end-stage of TB
:*Involvement of the airways and parenchyma
:*May follow primary TB or secondary TB
:*Spreads across the lung with cavitation and fibrosis<ref name="pmid8456658">{{cite journal| author=Lee KS, Song KS, Lim TH, Kim PN, Kim IY, Lee BH| title=Adult-onset pulmonary tuberculosis: findings on chest radiographs and CT scans. | journal=AJR Am J Roentgenol | year= 1993 | volume= 160 | issue= 4 | pages= 753-8 | pmid=8456658 | doi=10.2214/ajr.160.4.8456658 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8456658  }} </ref>
:*Concomitant infection with bacteria or bacteria may occur
:*Complicates assessment of TB activity in the lung with the X-ray.
*[[Aspergilloma]]
:*Mass of hyphae, cell debris and mucus, commonly located in a cavity or bronchus<ref name="pmid8744521">{{cite journal| author=Logan PM, Müller NL| title=CT manifestations of pulmonary aspergillosis. | journal=Crit Rev Diagn Imaging | year= 1996 | volume= 37 | issue= 1 | pages= 1-37 | pmid=8744521 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8744521  }} </ref><ref name="pmid8838945">{{cite journal| author=Miller WT| title=Aspergillosis: a disease with many faces. | journal=Semin Roentgenol | year= 1996 | volume= 31 | issue= 1 | pages= 52-66 | pmid=8838945 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8838945  }} </ref><ref name="pmid8577955">{{cite journal| author=Thompson BH, Stanford W, Galvin JR, Kurihara Y| title=Varied radiologic appearances of pulmonary aspergillosis. | journal=Radiographics | year= 1995 | volume= 15 | issue= 6 | pages= 1273-84 | pmid=8577955 | doi=10.1148/radiographics.15.6.8577955 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8577955  }} </ref>
:*Previous history of chronic cavitary TB in 25-55% of cases presenting with [[aspergilloma]]
:*Frequently courses with [[hemoptysis]] (50-90%)
:*X-ray shows a mobile mass ringed by an air shadow 
:*CT shows a mobile mass, generally interspaced with air shadows
:*May be calcified
*Bronchogenic carcinoma<ref name="pmid11452057">{{cite journal| author=Kim HY, Song KS, Goo JM, Lee JS, Lee KS, Lim TH| title=Thoracic sequelae and complications of tuberculosis. | journal=Radiographics | year= 2001 | volume= 21 | issue= 4 | pages= 839-58; discussion 859-60 | pmid=11452057 | doi=10.1148/radiographics.21.4.g01jl06839 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11452057  }} </ref>


===Antiviral Medications===
:*May be misinterpreted as TB progression
There are three types of treatment groups:
:*Scar formation in TB may lead to carcinoma
#[[Interferon]] (IFN)
:*May cause reactivation of TB<ref name="pmid4975011">{{cite journal| author=Snider GL, Placik B| title=The relationship between pulmonary tuberculosis and bronchogenic carcinoma. A topographic study. | journal=Am Rev Respir Dis | year= 1969 | volume= 99 | issue= 2 | pages= 229-36 | pmid=4975011 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4975011 }} </ref><ref name="pmid1265261">{{cite journal| author=Ting YM, Church WR, Ravikrishnan KP| title=Lung carcinoma superimposed on pulmonary tuberculosis. | journal=Radiology | year= 1976 | volume= 119 | issue= 2 | pages= 307-12 | pmid=1265261 | doi=10.1148/119.2.307 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1265261 }} </ref>
#[[Antivirals|Nucleoside analogs]]
#[[Antivirals|Nucleotide analogs]]
====First Line agents====
=====Entecavir (ETV)=====
*An anti-HBV nucleoside analog
*A 94% clearance rate after 5 years of treatment is observed in HBeAg positive patients.<ref name="www.ncbi.nlm.nih.gov">{{Cite web  | last = | first = | title = Chronic Hepatitis B: Integrating Long-Term Treatment Data and Strategies to Improve Outcomes in Clinical Practice | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3337661/ | publisher = | date =  | accessdate = }}</ref>
*A 90% clearance rate after 48 weeks of treatment is observed in HBeAg negative patients.<ref name="Lai-2006">{{Cite journal | last1 = Lai | first1 = CL. | last2 = Shouval | first2 = D. | last3 = Lok | first3 = AS. | last4 = Chang | first4 = TT. | last5 = Cheinquer | first5 = H. | last6 = Goodman | first6 = Z. | last7 = DeHertogh | first7 = D. | last8 = Wilber | first8 = R. | last9 = Zink | first9 = RC. | title = Entecavir versus lamivudine for patients with HBeAg-negative chronic hepatitis B. | journal = N Engl J Med | volume = 354 | issue = 10 | pages = 1011-20 | month = Mar | year = 2006 | doi = 10.1056/NEJMoa051287 | PMID = 16525138 }}</ref>
*A necroinflammation improvement of 96% and fibrosis improvement of 88% is seen after a treatment for 6 years.<ref name="www.ncbi.nlm.nih.gov">{{Cite web  | last = | first =  | title = First-line treatment of chronic hepatitis B with entecavir or tenofovir in ‘real-life’ settings: from clinical trials to clinical practice | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3489060/ | publisher = | date =  | accessdate = }}</ref>


=====Tenofovir (TDF) =====
==Airway Lesions==
*An anti-HBV nucleotide analog
<!--
*A 68% clearance rate in HBV DNA after 4 years of treatment is observed in HBeAg positive patients.<ref name="jid.oxfordjournals.org">{{Cite web  | last =  | first =  | title = http://jid.oxfordjournals.org/content/204/3/415.full | url = http://jid.oxfordjournals.org/content/204/3/415.full | publisher =  | date =  | accessdate =  }}</ref>
-->
*A 84% clearance rate in HBV DNA after 4 years of treatment is observed in HBeAg negative patients.


=====Interferons=====
==Differential Diagnosis of Infectious Diarrhea==
*Antiviral and antiproliferative glycoprotein.
Acute inflammatory diarrhea may be caused by different pathogens. Bellow is a table describing some of these pathogens in terms of transmission and symptoms:<ref name="pmid14702426">{{cite journal| author=Thielman NM, Guerrant RL| title=Clinical practice. Acute infectious diarrhea. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 1 | pages= 38-47 | pmid=14702426 | doi=10.1056/NEJMcp031534 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14702426  }} </ref><ref name="pmid15537721">{{cite journal| author=Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA| title=Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study. | journal=J Trop Pediatr | year= 2004 | volume= 50 | issue= 6 | pages= 354-6 | pmid=15537721 | doi=10.1093/tropej/50.6.354 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15537721  }} </ref>
*No antiviral resistance have been noted
*Best results noted with genotype A or B who are HBeAg positive.


====Second line agents====
  {| style="border: 0px; font-size: 90%; margin: 3px;" align=center
=====Telbivudine (LDT)=====
! style="background: #4479BA; padding: 5px 5px;" rowspan=2 | {{fontcolor|#FFFFFF|Pathogen}}
*[[Antivirals|Nucleoside analog]]
! style="background: #4479BA; padding: 5px 5px;" rowspan=2  | {{fontcolor|#FFFFFF|Transmission}}
*Worse resistance than first line agents and not indicated if resistance to other nucleoside analogs are noted.
! style="background: #4479BA; padding: 5px 5px;" colspan=4 | {{fontcolor|#FFFFFF|Clinical Manifestations}}
 
=====Adefovir (ADV)=====
*[[Antivirals|Nucleotide analog]]
*Worse resistance than first line agents
*Used in cases of nucleotide analog resistance.
 
=====Lamivudine=====
*[[Antivirals|Nucleoside analog]]
*Has a high rate of resistance and hence not used currently.
 
==Pathogenesis==
 
===Treatment===
When listeric meningitis occurs, the overall [[death|mortality]] may reach 70%; from septicemia 50%, from perinatal/neonatal infections greater than 80%. In infections during pregnancy, the mother usually survives. Reports of successful treatment with parenteral [[penicillin]] or [[ampicillin]] exist. [[Trimethoprim-sulfamethoxazole]] has been shown effective in patients allergic to penicillin.
 
Bacteriophage treatments have been developed by several companies. EBI Food Safety and Intralytix both have products suitable for treatment of the bacteria. The [[FDA]] of the United States  approved a cocktail of six [[bacteriophage]]s from Intralytix, and a one type phage product from EBI Food Safety designed to kill the bacteria ''L. monocytogenes''. Uses would potentially include spraying it on fruits and ready-to-eat meat such as sliced ham and turkey.
 
==Table==
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Disease}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Findings}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" | ''''''
| style="padding: 5px 5px; background: #F5F5F5;" |
|-
| style="padding: 5px 5px; background: #DCDCDC;" | ''''''
| style="padding: 5px 5px; background: #F5F5F5;" |  
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |''''''
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Fever}}
| style="padding: 5px 5px; background: #F5F5F5;" |
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Nausea/Vomiting}}
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Abdominal Pain}}
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Bloody Stool}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | ''''''
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''[[Salmonella]]''
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" | Foodborne transmission, community-acquired
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | +
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | ''''''
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''[[Shigella]]''
| style="padding: 5px 5px; background: #F5F5F5;" |  
| style="padding: 5px 5px; background: #F5F5F5;" | Community-acquired, person-to-person
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | +
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | ''''''
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''[[Campylobacter]]''
| style="padding: 5px 5px; background: #F5F5F5;" |  
| style="padding: 5px 5px; background: #F5F5F5;" | Community-acquired, ingestion of undercooked poultry
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | +
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | ''''''
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | [[Escherichia coli|''E. coli'' (EHEC or EIEC)]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" | Foodborne transmission, ingestion of undercooked hamburger meat
! style="padding: 5px 5px; background: #F5F5F5;" | ±
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | ++
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | ''''''
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''[[Clostridium difficile]]''
| style="padding: 5px 5px; background: #F5F5F5;" |  
| style="padding: 5px 5px; background: #F5F5F5;" | Nosocomial spread, antibiotic use
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ±
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | +
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | ''''''
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''[[Yersinia]]''
| style="padding: 5px 5px; background: #F5F5F5;" |  
| style="padding: 5px 5px; background: #F5F5F5;" | Community-aquired, foodborne transmission
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | +
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | ''''''
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''[[Entamoeba histolytica]]''
| style="padding: 5px 5px; background: #F5F5F5;" |  
| style="padding: 5px 5px; background: #F5F5F5;" | Travel to or emigration from tropical regions
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ±
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ±
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | ''''''
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''[[Aeromonas]]''
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" | Ingestion of contaminated water
|-
! style="padding: 5px 5px; background: #F5F5F5;" | ++
| style="padding: 5px 5px; background: #DCDCDC;" | ''''''
! style="padding: 5px 5px; background: #F5F5F5;" | +
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''[[Plesiomonas]]''
| style="padding: 5px 5px; background: #F5F5F5;" | Ingestion of contaminated water or undercooked shellfish, travel to tropical regions
! style="padding: 5px 5px; background: #F5F5F5;" | ±
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==References==
{{reflist|2}}

Latest revision as of 18:19, 16 September 2014

Test

Parenchymal lesions

  • Tuberculoma
  • Single or multiple lesions of > 0.5 cm
  • May occur in primary or secundary TB
  • Main finding on Chest X-ray in 5% cases of secondary TB[1]
  • Results from the surrounding of M. tuberculosis with inflammatory or connective tissue.[2][3][1]
  • The center of the tuberculoma is often necrotic
  • Satellite lesions (80%)
  • Nodular or diffused calcifications in 20-30% cases[2]
  • Thin-walled cavity
  • Present in active and inactive disease
  • May regress after treatment
  • Air-filled sect may persist[4]
  • May be misidentified as an emphysematous bulla or pneumatocelle.
  • Cicatrization:
  • Common in secondary TB
  • Marked fibrosis in ≤40% of secondary TB cases, which may present as:
  • Upper love atelectasis
  • Compensatory hyperinflation of the lower lobe
  • Hilar retraction
  • Mediastinal shift
  • Unspecific X-Ray findings:[5]
  • Parenchymal bands
  • Fibrotic cavities
  • Fibrotic nodules
  • Traction bronchiectasis
  • Lung Destruction:[5]
  • Common in end-stage of TB
  • Involvement of the airways and parenchyma
  • May follow primary TB or secondary TB
  • Spreads across the lung with cavitation and fibrosis[2]
  • Concomitant infection with bacteria or bacteria may occur
  • Complicates assessment of TB activity in the lung with the X-ray.
  • Mass of hyphae, cell debris and mucus, commonly located in a cavity or bronchus[6][7][8]
  • Previous history of chronic cavitary TB in 25-55% of cases presenting with aspergilloma
  • Frequently courses with hemoptysis (50-90%)
  • X-ray shows a mobile mass ringed by an air shadow
  • CT shows a mobile mass, generally interspaced with air shadows
  • May be calcified
  • Bronchogenic carcinoma[5]
  • May be misinterpreted as TB progression
  • Scar formation in TB may lead to carcinoma
  • May cause reactivation of TB[9][10]

Airway Lesions

Differential Diagnosis of Infectious Diarrhea

Acute inflammatory diarrhea may be caused by different pathogens. Bellow is a table describing some of these pathogens in terms of transmission and symptoms:[11][12]

Pathogen Transmission Clinical Manifestations
Fever Nausea/Vomiting Abdominal Pain Bloody Stool
Salmonella Foodborne transmission, community-acquired ++ + ++ +
Shigella Community-acquired, person-to-person ++ ++ ++ +
Campylobacter Community-acquired, ingestion of undercooked poultry ++ + ++ +
E. coli (EHEC or EIEC) Foodborne transmission, ingestion of undercooked hamburger meat ± + ++ ++
Clostridium difficile Nosocomial spread, antibiotic use + ± + +
Yersinia Community-aquired, foodborne transmission ++ + ++ +
Entamoeba histolytica Travel to or emigration from tropical regions + ± + ±
Aeromonas Ingestion of contaminated water ++ + ++ +
Plesiomonas Ingestion of contaminated water or undercooked shellfish, travel to tropical regions ± ++ + +

References

  1. ↑ 1.0 1.1 Woodring JH, Vandiviere HM, Fried AM, Dillon ML, Williams TD, Melvin IG (1986). "Update: the radiographic features of pulmonary tuberculosis". AJR Am J Roentgenol. 146 (3): 497–506. doi:10.2214/ajr.146.3.497. PMID 3484866.
  2. ↑ 2.0 2.1 2.2 Lee KS, Song KS, Lim TH, Kim PN, Kim IY, Lee BH (1993). "Adult-onset pulmonary tuberculosis: findings on chest radiographs and CT scans". AJR Am J Roentgenol. 160 (4): 753–8. doi:10.2214/ajr.160.4.8456658. PMID 8456658.
  3. ↑ Palmer PE (1979). "Pulmonary tuberculosis--usual and unusual radiographic presentations". Semin Roentgenol. 14 (3): 204–43. PMID 472765.
  4. ↑ Fraser, Richard (1994). Synopsis of diseases of the chest. Philadelphia: W.B. Saunders. ISBN 0721636691.
  5. ↑ 5.0 5.1 5.2 Kim HY, Song KS, Goo JM, Lee JS, Lee KS, Lim TH (2001). "Thoracic sequelae and complications of tuberculosis". Radiographics. 21 (4): 839–58, discussion 859-60. doi:10.1148/radiographics.21.4.g01jl06839. PMID 11452057.
  6. ↑ Logan PM, Müller NL (1996). "CT manifestations of pulmonary aspergillosis". Crit Rev Diagn Imaging. 37 (1): 1–37. PMID 8744521.
  7. ↑ Miller WT (1996). "Aspergillosis: a disease with many faces". Semin Roentgenol. 31 (1): 52–66. PMID 8838945.
  8. ↑ Thompson BH, Stanford W, Galvin JR, Kurihara Y (1995). "Varied radiologic appearances of pulmonary aspergillosis". Radiographics. 15 (6): 1273–84. doi:10.1148/radiographics.15.6.8577955. PMID 8577955.
  9. ↑ Snider GL, Placik B (1969). "The relationship between pulmonary tuberculosis and bronchogenic carcinoma. A topographic study". Am Rev Respir Dis. 99 (2): 229–36. PMID 4975011.
  10. ↑ Ting YM, Church WR, Ravikrishnan KP (1976). "Lung carcinoma superimposed on pulmonary tuberculosis". Radiology. 119 (2): 307–12. doi:10.1148/119.2.307. PMID 1265261.
  11. ↑ Thielman NM, Guerrant RL (2004). "Clinical practice. Acute infectious diarrhea". N Engl J Med. 350 (1): 38–47. doi:10.1056/NEJMcp031534. PMID 14702426.
  12. ↑ Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA (2004). "Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study". J Trop Pediatr. 50 (6): 354–6. doi:10.1093/tropej/50.6.354. PMID 15537721.
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