Diagnosis of extrapulmonary tuberculosis is often problematic because of the relative paucity of bacilli. Histopathologic analysis of involved tissues typically shows giant cell granulomas with caseating necrosis and few, if any demonstrable AFB. Analysis of mesothelial effusions (i.e., pleural, peritoneal, or pericardial) characteristically reveals a lymphocyte-rich exudate with low concentrations of glucose; however, the initial inflammatory response in these spaces may be predominantly polymorphonuclear leukocytes. An elevated level of adenosine deaminase in pleural or peritoneal fluid is highly sensitive and specific for tuberculosis. Cerebrospinal fluid (CSF) findings in meningitis begin with a modest leukocytosis that shift from polymorphonuclear to lymphocyte dominance; leukocyte counts typically range from 50 to 300 cells/mL. The CSF protein concentration is generally moderately elevated. Glucose levels are progressively depressed in relation to the degree of leukocytosis.
Thursday, December 18, 2008
Extrapulmonary Tuberculosis
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