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Objective: The purpose of this study was to determine the clinical, radiographic, and ultrasonographic aspects of mediastinal nodal tuberculosis and ascertain its clinical course in the era of HIV infection., Patients and Methods: We reviewed retrospectively 39 patients referred to the Ouédraogo Yalgado National Hospital Center and the National Anticancer Institute between February 1996 and December 1999 for mediastinal nodal tuberculosis. Endoscopic proof of tuberculosis was obtained in 30 cases (81.8%). HIV serology was positive in 26 of the 30 patients tested (86.6%)., Results: Nodal mediastinal tuberculosis accounted for 1.7% of the cases of tuberculosis recorded over the same period at the Anticancer Institute. Mean age of the patients was 32.8 years and the sex ratio was 1.05 in favor of men. Clinically, a past medical history was found in 18 cases (46%) including a herpes zoster in 6 (15.4%), cough in 38 (97.5%). Weight loss (95%), fever (100%) and peripheral node enlargement (20%) were found frequently, probably related to HIV infection more than tuberculosis. Radiographically, standard x-rays evidenced associated lesions in 22 cases, with 59% having predominant parenchymatous lesions. Other localizations of tuberculosis were very frequent (42.5%)., Discussion: Bronchial fibroscopy is most contributive to diagnosis of mediastinal nodal tuberculosis with an 81.8% yield in our series. HIV infection had a determining effect on the disease course since among the 16 patients who died, 14 were HIV-positive (52%).

One hundred years after Yersin discovered Yersinia pestis during the plague epidemic in Hong Kong in 1894, human plague still has not been eliminated. The epidemic in 1994 in India, a country where no cases had been observed since 1996, raised great concern. Plague is an epizootic bacterial infection caused by a Gram negative coccobacillus, Y. pestis, transmitted by the bite of infected fleas. Bubonic plague is the most common form. Other clinical presentations include asymptomatic plague, abortive plague, pharyngeal plague, septicemic plague, meningeal plague, and primary or secondary pneumonic plague which is observed in 5 to 20% of cases. Plague is a highly communicable disease between humans despite antibiotic therapy which has reduced mortality by 80%. The prognosis depends on early diagnosis. Streptomycin and cyclines are the gold standard treatment.

The authors have conducted a retrospective study of 200 cases of tuberculous spondylitis, and wish to draw attention to the clinical and, chiefly, radiological aspects of the disease. Intrathoracic Pott's abscesses are principally observed in developing countries but they are not exceptional in France, and their varied semeiology deserves to be described.

One hundred and fifty-nine cases of confirmed mediastinal tuberculous adenopathy were analysed retrospectively. This series, which is the first reported in French-speaking Africa, shows that the disease is not uncommon there, and not restricted to black Africans living in Europe. The clinical symptoms are not specific. Radiography is more interesting, and the extreme scarcity of bacillys-containing expectoration encourages endoscopy. The finding of a fistula at fibroscopy confirms the diagnosis. This easy examination is particularly useful since M. tuberculosis can be grown in cultures from ground bronchial fistula biopsies in 86% of the cases. Associated tuberculous lesions in other sites are very frequent (45%), as is extension of the disease from lymph nodes to lung tissue (79%). This clinical form of tuberculosis can be treated with modern short course chemotherapy which is remarkably effective.

In an 18-year old male patient a large cavity of the right upper lobe was occupied first by a tuberculous sequestration, then 2 years later, by a fungus ball. This case shows that the so-called "sleigh-bell" image is not pathognomic of aspergilloma and that this disease is far from being exceptional in Africa.

The authors report 3 cases of intrabronchial fistulisation of paravertebral abscesses due to tuberculous spondylitis of the thoracic spine. This complication is relatively rare (these 3 cases were in a series of 178 cases of Pott's disease) and is easy to diagnose due to its characteristic radio-clinical features. As mentioned in old publications, this type of fistulisation does not seem to have serious consequences. There are no particular aspects of treatment.