Percorsi clinici
Appendicite, anzi no yersiniosi, anzi no tubercolosi!
APPENDICITIS, OR RATHER YERSINIOSIS, OR RATHER TUBERCULOSIS!
Alessandro Consolaro, Martina Fornaro, Linda Balanzoni, Michele Corroppolo1
Sara Pecori2, Enrico Valletta3
Scuola di Specializzazione in Pediatria, 1Chirurgia Pediatrica, 2Anatomia Patologica, 3Clinica Pediatrica, Universitΰ di Verona
Gennaio 2009 - pagg. 39 -42
Abstract
We describe the case of a 5-year boy, born from Moroccan parents, who underwent surgery
for acute appendicitis and granulomatous peritonitis. Histopathological and serological
findings were suggestive of Yersinia pseudotuberculosis infection. All investigations
(excluding QuantiFERON-TB test) were negative for a Mycobacterium tuberculosis infection.
Several months later he developed lumbo-aortic and mesenteric nodal enlargement
and pulmonary hilar lymphadenopaty and tuberculin skin test became positive. A four-drug
therapy for tuberculosis disease was eventually decided with good clinical response. Difficulties
in diagnosing tuberculous peritonitis and need for careful surveillance of people
immigrating from countries endemic for tuberculosis are discussed.
Classificazione MeSH
Bibliografia
et al. The role of Yersinia enterocolitica and Yersinia
pseudotuberculosis in granulomatous appendicitis.
Am J Surg Pathol 2001;25:508-15.
2. Starke F, Munoz FM. Tuberculosis (Mycobacterium tuberculosis). In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF. Nelson Textbook of Pediatrics. 18° ed., Elsevier Ed, 2007:1240-54.
3. Sanai FM, Bzeizi KI. Systematic review: tuberculous peritonitis: presenting features, diagnostic strategies and treatment. Aliment Pharmacol Ther 2005;11:685-700.
4. El Abkari M, Benajah DA, Aqodad N, Bennouna S, Oudghiri B, Ibrahimi A. Peritoneal tuberculosis in the Fes University Hospital (Morocco). Report of 123 cases. Gastroenterol Clin Biol 2006;30:377-81.
5. Tazzioli G, FarinettiA, Gelmini R, Longo G, Barbolini G, Saviano M. Tuberculous peritonitis in no risk patients: diagnostic approach. ANZ J Surg 2005;75:247-8.
6. Mazurek GH, Jereb J, Iademarco MF, et al. Guidelines for using the QuantiFERON-TB Gold test for detecting Mycobacterium tuberculosis infection, United States. MMWR 2005; 54:49-55.
7. Bartolozzi G. La prova con il QuantiFERON TB-2G nella diagnosi differenziale fra tubercolosi attiva e malattie da micobatteri non tubercolari. Medico e Bambino pagine elettroniche 2007;10(2) http://www.medicoebambino.com /_tubercolosi_qft_quantiferon_trattamento_d iagnosi_bcg.
8. NICE CG 33. Tuberculosis. Clinical diagnosis and management of tuberculosis, and measures for its prevention and control. Marzo 2006. www.nice.org.uk/CG033.
9. Molicotti P, Bua A, Mela G, et al. Performance of QuantiFERON-TB testing in a tuberculosis outbreak at a primary school. J Pediatr 2008;152:585-6.
10. Taylor REB, Cant AJ, Clark JE. Potential effect of NICE tuberculosis guidelines on paediatric tuberculosis screening. Arch Dis Child 2008;93:200-3.
11. Connell TG, Ritz N, Paxton GA, Buttery JP, Curtis N, Ranganathan SC. A three-way comparison of tuberculin skin testing, QuantiFERON- TB gold and T-SPOT.TB in children. PLoS ONE 2008;3:e2624.
12. Connell TG, Curtis N, Ranganathan SC, Buttery JP. Performance of a whole blood interferon gamma assay for detecting latent infection with Mycobacterium tuberculosis in children. Thorax 2006;61:616-20.
13. Ministero della Salute. Epidemiologia della tubercolosi in Italia (anni 1995-2005). http:// www.ministerosalute.it/imgs/C_17_pubblicazi oni_613_allegato.pdf.
14. Ministero della Salute. La tubercolosi in Italia nel 2006. http://www.ministerosalute.it/ dettaglio/pdPrimoPianoNew.jsp?id=140& sub=1〈=it.
15. Dye C. Global epidemiology of tuberculosis. Lancet 2006;367:938-40.
2. Starke F, Munoz FM. Tuberculosis (Mycobacterium tuberculosis). In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF. Nelson Textbook of Pediatrics. 18° ed., Elsevier Ed, 2007:1240-54.
3. Sanai FM, Bzeizi KI. Systematic review: tuberculous peritonitis: presenting features, diagnostic strategies and treatment. Aliment Pharmacol Ther 2005;11:685-700.
4. El Abkari M, Benajah DA, Aqodad N, Bennouna S, Oudghiri B, Ibrahimi A. Peritoneal tuberculosis in the Fes University Hospital (Morocco). Report of 123 cases. Gastroenterol Clin Biol 2006;30:377-81.
5. Tazzioli G, FarinettiA, Gelmini R, Longo G, Barbolini G, Saviano M. Tuberculous peritonitis in no risk patients: diagnostic approach. ANZ J Surg 2005;75:247-8.
6. Mazurek GH, Jereb J, Iademarco MF, et al. Guidelines for using the QuantiFERON-TB Gold test for detecting Mycobacterium tuberculosis infection, United States. MMWR 2005; 54:49-55.
7. Bartolozzi G. La prova con il QuantiFERON TB-2G nella diagnosi differenziale fra tubercolosi attiva e malattie da micobatteri non tubercolari. Medico e Bambino pagine elettroniche 2007;10(2) http://www.medicoebambino.com /_tubercolosi_qft_quantiferon_trattamento_d iagnosi_bcg.
8. NICE CG 33. Tuberculosis. Clinical diagnosis and management of tuberculosis, and measures for its prevention and control. Marzo 2006. www.nice.org.uk/CG033.
9. Molicotti P, Bua A, Mela G, et al. Performance of QuantiFERON-TB testing in a tuberculosis outbreak at a primary school. J Pediatr 2008;152:585-6.
10. Taylor REB, Cant AJ, Clark JE. Potential effect of NICE tuberculosis guidelines on paediatric tuberculosis screening. Arch Dis Child 2008;93:200-3.
11. Connell TG, Ritz N, Paxton GA, Buttery JP, Curtis N, Ranganathan SC. A three-way comparison of tuberculin skin testing, QuantiFERON- TB gold and T-SPOT.TB in children. PLoS ONE 2008;3:e2624.
12. Connell TG, Curtis N, Ranganathan SC, Buttery JP. Performance of a whole blood interferon gamma assay for detecting latent infection with Mycobacterium tuberculosis in children. Thorax 2006;61:616-20.
13. Ministero della Salute. Epidemiologia della tubercolosi in Italia (anni 1995-2005). http:// www.ministerosalute.it/imgs/C_17_pubblicazi oni_613_allegato.pdf.
14. Ministero della Salute. La tubercolosi in Italia nel 2006. http://www.ministerosalute.it/ dettaglio/pdPrimoPianoNew.jsp?id=140& sub=1〈=it.
15. Dye C. Global epidemiology of tuberculosis. Lancet 2006;367:938-40.
Corrispondenza: enrico.valletta@azosp.vr.it