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      Tuberculose auriculaire concomitante à une localisation pulmonaire chez un patient immunodéprimé par le VIH, à Bamako, Mali Translated title: Ear tuberculosis concomitant with pulmonary localization in an HIV-immunosuppressed patient, in Bamako, Mali

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          Résumé

          Introduction/Justification

          La tuberculose demeure un problème de santé publique majeur. Elle constitue une pathologie opportuniste, très fréquente chez les immunodéprimés par le VIH, classant le sida en stade clinique IV de l'OMS en cas de localisations extra pulmonaires. La tuberculose auriculaire reste une forme clinique rare et sous-diagnostiquée. Nous rapportons un cas de tuberculose auriculaire concomitante à une localisation pulmonaire chez un immunodéprimé par le VIH de 32 ans, hospitalisé à Bamako (Mali) afin de discuter des difficultés diagnostiques et thérapeutiques posées par cette localisation rare.

          Description du cas

          Le patient présentait une toux productive chronique, une otalgie et une otorrhée purulente chronique droite. La recherche de bacilles acido-alcoolo-résistants était positive à l'examen direct dans le liquide de tubage gastrique et l’écouvillonnage du pus auriculaire.

          Un traitement antituberculeux institué pendant 6 mois, associé aux adjuvants, a conduit à la guérison complète du patient.

          Discussion/conclusion

          La localisation auriculaire, bien que rare, doit être activement recherchée. Un traitement étiologique doit être institué pour éviter les complications et les séquelles.

          Translated abstract

          Introduction/Rationale

          Tuberculosis remains a major public health issue. It is an opportunistic pathology, very common in HIV-immunocompromised persons, classifying it at the WHO stage 4. Ear tuberculosis remains a rare and under-diagnosed clinical form. We report here a case of ear tuberculosis concomitant with pulmonary localization in an HIV-immunosuppressed person on triple antiretroviral therapy aged 32 years hospitalized in Bamako (Mali) to discuss the diagnostic and therapeutic difficulties posed by this rare localization.

          Description of the case

          The patient had a chronic productive cough, otalgia and right chronic purulent otorrhea. The search for acid-resistant bacilli was positive for direct examination in gastric casing fluid and swabbing of the ear pus, confirming the diagnosis of tuberculosis. Anti-tuberculosis treatment instituted for 6 months associated with adjuvants resulted in complete healing of the patient.

          Discussion/conclusion

          Although rare, ear localization must be actively sought. Etiological treatment must be instituted upon confirmation of the diagnosis to avoid complications and sequelae.

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          Most cited references13

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          Tuberculosis in ear, nose, and throat practice: its presentation and diagnosis.

          The aim of this study was to increase awareness of the different presentations of head and neck tuberculosis (TB) and to discuss its diagnostic difficulties. A retrospective analysis of patients who presented to us, at a secondary referral hospital, primarily with TB of head and neck was done from January 1999 to July 2003. A total of 117 patients presented with primary head and neck TB during the study period. Most of these (95%) had cervical lymphadenopathy, 2 patients had laryngeal TB, and there was 1 patient each of TB of cervical spine, oropharynx, ear, and retropharyngeal abscess. Forty-one were males, and 76 were females. Thirty percent of cases had associated lung or other organ TB. Nine percent gave history of previous or subsequent TB. 1) Diagnosing TB requires a high index of suspicion. 2) Tuberculosis of the cervical lymph nodes is the commonest presentation followed by laryngeal TB. 3) Fine needle aspiration cytology (FNAC) is a reliable and easy way to diagnose TB. However, newer diagnostic tests will increase the yield of positive cases and should be used whenever required. 4) In the larynx, the vocal cords were the commonest site affected and laryngeal TB need not be associated with lung TB or positive sputum always. 5) Patients who have TB of head and neck must be investigated to exclude pulmonary or systemic TB. 6) In cases of previous or subsequent TB infection, culture and drug sensitivity is indicated to reduce the problem of multiple drug resistance.
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            • Record: found
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            • Article: not found

            Tuberculous otitis media: a significant diagnostic challenge.

            This study was undertaken to revise the diagnostic characteristics of tuberculous otitis media (TOM), a disorder that is often diagnosed late, leading to delay in specific treatment.
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              • Record: found
              • Abstract: not found
              • Article: not found

              Tuberculous otitis media: a case presentation and review of the literature

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                Author and article information

                Contributors
                Journal
                Med Trop Sante Int
                Med Trop Sante Int
                MTSI
                Médecine Tropicale et Santé Internationale
                MTSI
                2778-2034
                2778-2034
                31 December 2023
                17 November 2023
                : 3
                : 4
                : mtsi.v3i4.2023.415
                Affiliations
                [1 ]Service de Maladies infectieuses et tropicales du Centre hospitalier universitaire du Point G, Bamako, Mali
                [2 ]Faculté de Médecine et d'odontostomatologie de l'Université des Sciences, des techniques et des technologies, Bamako, Mali
                [3 ]Centre de recherche et de formation sur la Tuberculose et le VIH (CEREFO), Bamako, Mali
                Author notes
                Article
                10.48327/mtsi.v3i4.2023.415
                10879891
                38390009
                8fce3bc5-ee97-4b80-820b-9fc3837b6c43
                Copyright © 2023 SFMTSI

                Cet article en libre accès est distribué selon les termes de la licence Creative Commons CC BY 4.0 ( https://creativecommons.org/licenses/by/4.0/).

                History
                : 27 August 2023
                : 31 October 2023
                Page count
                Figures: 3, References: 14, Pages: 5
                Categories
                Cas Clinique
                Clinical Case

                vih,tuberculose multifocale,tuberculose auriculaire,hôpital,bamako,mali,afrique subsaharienne,hiv,ear tuberculosis,multifocal tuberculosis,hospital,sub-saharan africa

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