ABSTRACT
Introducción: Es probable que el SARS-CoV-2 favorezca el paso de infección a enfer medad tuberculosa. Si bien la información es limitada, existen avances en la comprensión de la interacción COVID-19 y tuberculosis. Nuevas investigaciones arrojaron similitudes inesperadas en la patogenia y evolución de la coinfección. Linfopenia prolongada, hipe rinflamación, lesión del tejido pulmonar y desequilibrio en los subconjuntos de células T CD4+ asociados con COVID-19 podrían propagar la infección por M. tuberculosis y progresión de la enfermedad. Casos clínicos: Presentamos tres pacientes jóvenes, sin comorbilidades, con factores de riesgo para infección tuberculosa latente, diagnosticados de tuberculosis pulmonar posterior cursado COVID-19 leve, de tratamiento sintomático (no corticoideo). Discusión: Estos casos plantean el probable impacto del SARS-CoV-2 en el paso de infección tuberculosa latente a enfermedad, excluida la ya demostrada influencia de los corticoides y formas graves de COVID-19. Existe cada vez más evidencia que refuerza esta idea.
Introduction: SARS-CoV-2 is likely to favor the transition from infection to tuberculosis disease. Although information is limited, there is progress in understanding the inter action between COVID-19 and Tuberculosis. New investigations yielded unexpected similarities in the pathogenesis and evolution of the coinfection. Prolonged lymphopenia, hyperinflammation, lung tissue injury, and imbalance in CD4+ T-cell subsets associated with COVID-19 could propagate M. tuberculosis infection and disease progression. Clinical cases: we present three young patients, without comorbidities, with risk factors for Latent Tuberculous Infection, diagnosed with pulomonary Tuberculosis post mild COVID-19, treated symptomatically (not corticosteroids). Discussion: These cases raise the probable impact of SARS-CoV-2 in the transition from Latent Tuberculous Infection to disease, excluding the already proven influence of corticosteroids and severe forms of COVID-19. There is increasing evidence to sup port this idea.
ABSTRACT
Resumen Si bien aún no hay una definición precisa de inflamación sistémica en EPOC, su reconocimiento se ha basado en estudios que han demostrado un aumento de concentración plasmática de diversos marcadores inflamatorios entre ellos proteína C reactiva (PCR) y, en los últimos años se ha postulado también la microalbuminuria. Los objetivos de este trabajo fueron determinar la microalbuminuria y la PCR como potenciales biomarcadores de inflamación sistémica. Para ello se reclutaron pacientes EPOC estable y tabaquistas no EPOC diagnosticados mediante espirometria, mayores a 40 años sin HTA ni diabetes tipo I ó II, en el periodo comprendido entre octubre de 2017 a marzo de 2019. A ambos grupos se le extrajo una muestra de sangre venosa para determinar PCR ultrasensible y 3 muestras de orina para determinar microalbuminuria, tomando una media de las mismas. Se consideró albuminuria significativa cuando en al menos dos de tres determinaciones hubiese valores entre 30 y 300 mg/g de creatinina urinaria. La PCR ultrasensible se consideró positiva con un valor igual o superior a 5 mg/L. De los 47 pacientes analizados se obtuvo una albuminuria media de 13.91 ± 5.04 en el grupo EPOC en comparación con 2.50 ± 0.36 del grupo control. De la misma forma se compararon las medias de PCR ultrasensible, arrojando un valor de 5.06 ± 2.24 en los pacientes EPOC en relación a 2.46 ± 0.51 de los controles. Ambas variables mostraron diferencias estadísticamente no significativas entre los grupos de estudio (p = 0,058 para albuminuria media y p = 0.330 para PCR ultrasensible).
ABSTRACT
Abstract There isn't yet a clear definition for systemic inflammation in COPD (chronic obstructive pulmonary disease), but its recognition has been based on studies that show an increase in the plasma concentration of various inflammatory markers, such as the c-reactive protein (CRP), and in recent years, also the microalbuminuria has been suggested. The purposes of this work were to determine the microalbuminuria and CRP as potential biomarkers of systemic inflammation. We enrolled patients with stable COPD and non-COPD smokers diagnosed through spirometry; older than 40 years without AHT (arterial hypertension) or diabetes type I or II, between October 2017 and March 2019. In both groups, a venous blood sample was collected to determine high-sensitivity CRP and 3 urine samples were taken to determine microalbuminuria, calculating the mean value. At least two out of three determinations between 30 and 300 mg/g of urine creatinine were considered to be significant albuminuria. The high-sensitivity CRP was considered positive with a value ≥ 5 mg/L. Of the 47 analyzed patients, a mean albuminuria of 13.91 ± 5.04 was obtained in the COPD group, in comparison with 2.50 ± 0.36 in the control group. Also, the high-sensitivity CRP mean values were compared, showing 5.06 ± 2.24 in COPD patients and 2.46 ± 0.51 in the control group. Both variables showed non-statistically significant differences between the study groups (p = 0.058 for mean albuminuria and p = 0.330 for high-sensitivity CRP).
ABSTRACT
Objetivos: Determinar las características epidemiológicas de los pacientes con diagnóstico de Tuberculosis (TB) que asistieron en el período comprendido entre el 01 de mayo de 2010 y 30 de abril de 2013 al Hospital Tránsito Cáceres de Allende (HTCA) de Córdoba Argentina. Materiales y métodos: Estudio descriptivo, observacional y prospectivo, en 106 pacientes mayores de 15 años. Resultados: Se observó mayor frecuencia entre los 15 -35 años (48%), 55% fueron masculinos, 90% fueron argentinos, la mortalidad fue del 4%; el 50% con ocupación estable, comorbilidades: Diabetes mellitus 19% y VIH 1%, tabaquismo 61%, alcohol 23% y drogas ilícitas 22%, IMC
Objectives: To determine the epidemiologic characteristics of patients diagnosed with TB who attended the hospital Transito Caceres de Allende of Cordoba, Argentina in the period from May 1st, 2010 to April 30th, 2013. Materials and methods: Descriptive, observational and prospective study in 106 patients older than 15 years old. Results: There was a higher frequency on the 15 to 35 years old (48%), male 55%, Argentine 90%, case fatality 4%, stable employment 50%, comorbidities: diabetes mellitus 19% , HIV 1%, tobacco smoking 61%, alcohol addiction 23%, consumption of illegal drugs 22%, BMI lower than 21: 63%. Bacteriologic diagnosis: positive direct smear microscopy 73%, positive culture 66% and pathologic histology 20%, treatment adherence: adherence 97%, healed 92 %, self administered treatment 96%, MDR-TB 3%. Forms of presentations: pulmonary TB 72%, extrapulmonary TB 28%. Radiological abnormalities: unilateral infiltrates with cavity 27%, unilateral without cavity 20%. Laboratory tests: Leukocytosis 15%, high erythrocyte sedimentation 82%, Adverse Drug Reactions: hepatoxicity 4%. Conclusions: Male young adult is more likely to become ill. Diabetes, HIV and BMI < 21 must prompt screening studies in symptomatic patients. Smoking habit, unemployment and bad social economics conditions are positive epidemiologic factors. Usual laboratory data is nonspecific but can provide some guiding. Thorax (chest) radiography, microscopy and culture are accessible diagnostic resources. MDR-TB is not yet a relevant problem in our hospital. Treatment related hepatotoxicity did not require interruption of therapy. Self administered treatment strategy with high adherence, low dropout and high healing rate indicate a big success of the program.