Comparison of different diagnostic modalities for isolation of Mycobacterium Tuberculosis among suspected tuberculous lymphadenitis patients / Comparação de diferentes modalidades de diagnóstico para isolamento de Mycobacterium tuberculosis entre pacientes com suspeita de linfadenite tuberculosa

Tuberculosis is a communicable disease with high morbidity and mortality rates in developing countries. The study's primary objective is to compare conventional methods such as acid-fast bacillus (AFB) culture and microscopy with rapid diagnostic methods. The secondary objective is to compare histopathological and microbiological findings in suspected patients with tubercular lymphadenitis. A total of 111 samples (August 2018 to September 2019) of lymph nodes were processed for AFB microscopy, AFB cultures, drug-susceptibility testing (DST), histopathology, and Xpert Mycobacterium Tuberculosis (MTB)/resistance to Rifampin (RIF) assays. Out of 111 lymph node samples, 6 (5.4%) were positive for AFB smear microscopy, 84 (75.6%) were positive for AFB culture, 80 (70.7%) were positive on Gene Xpert, and 102 (91.8%) were indicative of tuberculosis for histopathology studies. Mycobacteria growth indicator tube (MGIT) culture positivity was 84 (75.6%) higher than solid Lowenstein-Jensen (LJ) culture 74 (66.6%). Positive cultures underwent phenotypic DST. Two cases were Multidrug-resistant (MDR) on DST, while three cases were Rifampicin resistant on Gene Xpert. The sensitivity of Genexpert was (62%) against the conventional AFB culture method. The poor performance of conventional lymphadenitis diagnostic methods requires early and accurate diagnostic methodology. Xpert MTB/RIF test can help in the treatment of multidrug-resistant TB cases. Nonetheless, rapid and conventional methods should be used for complete isolation of Mycobacterium tuberculosis.

A tuberculose é uma doença transmissível com altas taxas de morbimortalidade nos países em desenvolvimento. O objetivo principal do estudo é comparar métodos convencionais, como cultura de bacilo álcool-ácido resistente (BAAR) e microscopia, com métodos de diagnóstico rápido. O objetivo secundário é comparar os achados histopatológicos e microbiológicos em pacientes com suspeita de linfadenite tubercular. Um total de 111 amostras (agosto de 2018 a setembro de 2019) de gânglios linfáticos foi processado para microscopia de AFB, culturas de AFB, teste de susceptibilidade a drogas (DST), histopatologia e Xpert Mycobacterium tuberculosis (MTB)/ensaios de resistência à rifampicina (RIF). Das 111 amostras de linfonodos, 6 (5,4%) foram positivas para baciloscopia de AFB, 84 (75,6%) foram positivas para cultura de AFB, 80 (70,7%) foram positivas para o GeneXpert e 102 (91,8%) foram indicativas de tuberculose para estudos histopatológicos. A positividade da cultura do tubo indicador de crescimento de micobactérias (MGIT) foi 84 (75,6%), maior que a cultura sólida de Lowenstein-Jensen (LJ), 74 (66,6%). As culturas positivas foram submetidas a DST fenotípico. Dois casos eram multirresistentes (MDR) ao DST, enquanto três casos eram resistentes à rifampicina no GeneXpert. A sensibilidade do GeneXpert foi 62% contra o método convencional de cultura AFB. O fraco desempenho dos métodos convencionais de diagnóstico de linfadenite requer metodologia de diagnóstico precoce e precisa. O teste Xpert MTB/RIF pode ajudar no tratamento de casos de tuberculose multirresistente. No entanto, métodos rápidos e convencionais devem ser usados para o isolamento completo do Mycobacterium tuberculosis.

Comparison of different diagnostic modalities for isolation of Mycobacterium Tuberculosis among suspected tuberculous lymphadenitis patients

Abstract Tuberculosis is a communicable disease with high morbidity and mortality rates in developing countries. The study's primary objective is to compare conventional methods such as acid-fast bacillus (AFB) culture and microscopy with rapid diagnostic methods. The secondary objective is to compare histopathological and microbiological findings in suspected patients with tubercular lymphadenitis. A total of 111 samples (August 2018 to September 2019) of lymph nodes were processed for AFB microscopy, AFB cultures, drug-susceptibility testing (DST), histopathology, and Xpert Mycobacterium Tuberculosis (MTB)/resistance to Rifampin (RIF) assays. Out of 111 lymph node samples, 6 (5.4%) were positive for AFB smear microscopy, 84 (75.6%) were positive for AFB culture, 80 (70.7%) were positive on Gene Xpert, and 102 (91.8%) were indicative of tuberculosis for histopathology studies. Mycobacteria growth indicator tube (MGIT) culture positivity was 84 (75.6%) higher than solid Lowenstein-Jensen (LJ) culture 74 (66.6%). Positive cultures underwent phenotypic DST. Two cases were Multidrug-resistant (MDR) on DST, while three cases were Rifampicin resistant on Gene Xpert. The sensitivity of Genexpert was (62%) against the conventional AFB culture method. The poor performance of conventional lymphadenitis diagnostic methods requires early and accurate diagnostic methodology. Xpert MTB/RIF test can help in the treatment of multidrug-resistant TB cases. Nonetheless, rapid and conventional methods should be used for complete isolation of Mycobacterium tuberculosis.

Resumo A tuberculose é uma doença transmissível com altas taxas de morbimortalidade nos países em desenvolvimento. O objetivo principal do estudo é comparar métodos convencionais, como cultura de bacilo álcool-ácido resistente (BAAR) e microscopia, com métodos de diagnóstico rápido. O objetivo secundário é comparar os achados histopatológicos e microbiológicos em pacientes com suspeita de linfadenite tubercular. Um total de 111 amostras (agosto de 2018 a setembro de 2019) de gânglios linfáticos foi processado para microscopia de AFB, culturas de AFB, teste de susceptibilidade a drogas (DST), histopatologia e Xpert Mycobacterium tuberculosis (MTB)/ensaios de resistência à rifampicina (RIF). Das 111 amostras de linfonodos, 6 (5,4%) foram positivas para baciloscopia de AFB, 84 (75,6%) foram positivas para cultura de AFB, 80 (70,7%) foram positivas para o GeneXpert e 102 (91,8%) foram indicativas de tuberculose para estudos histopatológicos. A positividade da cultura do tubo indicador de crescimento de micobactérias (MGIT) foi 84 (75,6%), maior que a cultura sólida de Lowenstein-Jensen (LJ), 74 (66,6%). As culturas positivas foram submetidas a DST fenotípico. Dois casos eram multirresistentes (MDR) ao DST, enquanto três casos eram resistentes à rifampicina no GeneXpert. A sensibilidade do GeneXpert foi 62% contra o método convencional de cultura AFB. O fraco desempenho dos métodos convencionais de diagnóstico de linfadenite requer metodologia de diagnóstico precoce e precisa. O teste Xpert MTB/RIF pode ajudar no tratamento de casos de tuberculose multirresistente. No entanto, métodos rápidos e convencionais devem ser usados para o isolamento completo do Mycobacterium tuberculosis.

Comparison of different diagnostic modalities for isolation of Mycobacterium Tuberculosis among suspected tuberculous lymphadenitis patients / Comparação de diferentes modalidades de diagnóstico para isolamento de Mycobacterium tuberculosis entre pacientes com suspeita de linfadenite tuberculosa

Abstract Tuberculosis is a communicable disease with high morbidity and mortality rates in developing countries. The study's primary objective is to compare conventional methods such as acid-fast bacillus (AFB) culture and microscopy with rapid diagnostic methods. The secondary objective is to compare histopathological and microbiological findings in suspected patients with tubercular lymphadenitis. A total of 111 samples (August 2018 to September 2019) of lymph nodes were processed for AFB microscopy, AFB cultures, drug-susceptibility testing (DST), histopathology, and Xpert Mycobacterium Tuberculosis (MTB)/resistance to Rifampin (RIF) assays. Out of 111 lymph node samples, 6 (5.4%) were positive for AFB smear microscopy, 84 (75.6%) were positive for AFB culture, 80 (70.7%) were positive on Gene Xpert, and 102 (91.8%) were indicative of tuberculosis for histopathology studies. Mycobacteria growth indicator tube (MGIT) culture positivity was 84 (75.6%) higher than solid Lowenstein-Jensen (LJ) culture 74 (66.6%). Positive cultures underwent phenotypic DST. Two cases were Multidrug-resistant (MDR) on DST, while three cases were Rifampicin resistant on Gene Xpert. The sensitivity of Genexpert was (62%) against the conventional AFB culture method. The poor performance of conventional lymphadenitis diagnostic methods requires early and accurate diagnostic methodology. Xpert MTB/RIF test can help in the treatment of multidrug-resistant TB cases. Nonetheless, rapid and conventional methods should be used for complete isolation of Mycobacterium tuberculosis.

Resumo A tuberculose é uma doença transmissível com altas taxas de morbimortalidade nos países em desenvolvimento. O objetivo principal do estudo é comparar métodos convencionais, como cultura de bacilo álcool-ácido resistente (BAAR) e microscopia, com métodos de diagnóstico rápido. O objetivo secundário é comparar os achados histopatológicos e microbiológicos em pacientes com suspeita de linfadenite tubercular. Um total de 111 amostras (agosto de 2018 a setembro de 2019) de gânglios linfáticos foi processado ​​para microscopia de AFB, culturas de AFB, teste de susceptibilidade a drogas (DST), histopatologia e Xpert Mycobacterium tuberculosis (MTB)/ensaios de resistência à rifampicina (RIF). Das 111 amostras de linfonodos, 6 (5,4%) foram positivas para baciloscopia de AFB, 84 (75,6%) foram positivas para cultura de AFB, 80 (70,7%) foram positivas para o GeneXpert e 102 (91,8%) foram indicativas de tuberculose para estudos histopatológicos. A positividade da cultura do tubo indicador de crescimento de micobactérias (MGIT) foi 84 (75,6%), maior que a cultura sólida de Lowenstein-Jensen (LJ), 74 (66,6%). As culturas positivas foram submetidas a DST fenotípico. Dois casos eram multirresistentes (MDR) ao DST, enquanto três casos eram resistentes à rifampicina no GeneXpert. A sensibilidade do GeneXpert foi 62% contra o método convencional de cultura AFB. O fraco desempenho dos métodos convencionais de diagnóstico de linfadenite requer metodologia de diagnóstico precoce e precisa. O teste Xpert MTB/RIF pode ajudar no tratamento de casos de tuberculose multirresistente. No entanto, métodos rápidos e convencionais devem ser usados ​​para o isolamento completo do Mycobacterium tuberculosis.

Resección de tumor de Buschke-Löwenstein en una mujer embarazada: reporte de un caso y revisión de la bibliografía / Buschke-Löwenstein tumor resection in a pregnant women: A case report and literature review

Resumen INTRODUCCIÓN: El tumor de Buschke-Löwenstein se asocia con el virus del papiloma humano por lo que se considera una infección de transmisión sexual. Se caracteriza por un condiloma gigante, verrugoso, exofítico, con forma de coliflor, de crecimiento lento, pero que durante el embarazo puede crecer rápidamente y formar condilomas solitarios que afectan las estructuras vecinas. CASO CLÍNICO: Paciente de 18 años, primigesta, con 35 semanas de embarazo, sin antecedentes de importancia para el padecimiento actual. Cuatro meses previos inició con verrugas en el perineo, con aumento acelerado de su tamaño en los últimos 30 días, asociado con dolor intenso a la movilización, secreción fétida, eritema e irritación interglútea y formación de un tumor friable con tendencia al sangrado y áreas de necrosis. CONCLUSIONES: El tumor de Buschke-Löwenstein es una alteración poco frecuente causada por el virus del papiloma humano, que puede tener crecimiento acelerado por el estímulo hormonal, propio del estado gestacional. El tratamiento de primera línea es la resección quirúrgica. El seguimiento de las pacientes debe ser estrecho, debido al alto índice de recidiva.

Abstract BACKGROUND: Buschke-Löwenstein tumor is associatted with the human papillomavirus (HPV), which is considered a sexually transmitted infection, characterized by the presence of a giant wart, exophytic condyloma with the shape of a cauliflower, slow growth, but during pregnancy it can grow fast as a solitary condyloma, affecting other structures. This case provides a better understanding of an unusual pathology, which with surgical treatment was obtained aesthetic results and with adequate functionality of external genitalia. CLINICAL CASE 18-year-old female, primiparous with 35 weeks pregnant, with no significant history, 4 previous months begins with the presence of warts in the perineal region with accelerated increase in size in the last 30 days, associated with intense pain on mobilization, fetid discharge, and area oferythema and intergluteal irritation, friable tumor with a tendency to bleed with areas of necrosis. CONCLUSIONS: The Buschke-Löwenstein tumor is a rare pathology caused by HPV, which can present accelerated growth due to the hormonal stimulus of the gestational state, this tumor does not resolve spontaneously, so the surgical approach is considered top of the line. The follow-up of these patients must be close due to the high rate of recurrence.

Evaluación del método de Petroff modificado con solución salina para el diagnóstico de micobacterias en el sistema Bact/Alert 3D / Assessment of Petroff method modified with saline solution for the diagnosis of mycobacteria in Bact/Alert 3D system

Introducción: Existen diferentes métodos de descontaminación de muestras pulmonares para el diagnóstico de micobacterias. El Programa Nacional de Control de Tuberculosis recomienda el método de Petroff modificado con solución salina, pero no existen evidencias documentadas que avalen este método. Objetivo: Evaluar el método de Petroff modificado con solución salina para el diagnóstico de micobacterias en el sistema Bact/Alert 3D. Métodos: Se realizó un estudio observacional analítico de pruebas diagnósticas utilizando 100 muestras pulmonares recibidas en el Laboratorio Nacional de Referencia e Investigaciones de Tuberculosis, Lepra y Micobacterias del Instituto Pedro Kourí, abril 2016 enero 2017. La muestra se dividió en 3 alícuotas y se descontaminaron mediante 3 métodos; luego se inocularon en los medios de cultivo sólido y líquido. Se compararon los resultados del cultivo en cuanto: tiempo de detección de crecimiento, tasa de contaminación, por ciento de positividad, además se calcularon indicadores de desempeño. Resultados: Al comparar el método Petroff modificado con solución salina con el Petroff modificado con solución fosfato en Löwenstein Jensen, el tiempo de detección de crecimiento, por ciento de positividad y la tasa de contaminación se comportaron de forma similar y la sensibilidad (93,75 por ciento), concordancia (96,47 por ciento) e índice de Youden (0,91) fueron elevadas. Al compararlo el Petroff modificado con solución salina con el N-Acetil-L-Cisteína, las variables no mostraron diferencias significativas y los Indicadores de Desempeño se comportaron por encima del 93 por ciento, para el medio sólido y líquido. Conclusiones: Los resultados avalan la continuidad del uso del Petroff modificado con solución salina como método de descontaminación de las muestras pulmonares en la red de laboratorios de Cuba y como alternativa en el pretratamiento de las muestras para el medio líquido (Bact/Alert 3D), además constituye un soporte para el Programa Nacional de Control de Tuberculosis(AU)

Introduction: There are different decontamination methods of pulmonary samples for the diagnosis of mycobacteria. The National Program for the Control of Tuberculosis recommends Petroff method modified with saline solution; but there are not documented evidences that endorse it. Objective: Assess Petroff method modified with saline solution for the diagnosis of mycobacteria in Bact / Alert 3D system. Methods: An observational analytic study of diagnostic tests was conducted; there were used 100 pulmonary samples received in the National Laboratory of References and Researches of Tuberculosis, Leprosy and Mycobacteria of Pedro Kourí Institute, from April 2016 to January 2017. The sample was divided in 3 aliquots and those were decontaminated using 3 methods; then, they were inoculated in the solid and liquid culture means. Cultures´ results were compared according to: growth's detection time, contamination rate, percent of positivity; in addition, performance indicators were calculated. Results: When comparing Petroff method modified with saline solution with Petroff method modified with phosphate solution in Löwenstein Jensen, the growth's detection time, the percent of positivity and the rate of contamination behaved similarly, and sensitivity (93,75percent), concordance (96,47percent) and Youden´s index (0,91) were high. When the Petroff method modified with saline solution was compared with N-Acetil-L- Cisteina, the variables did not show significative differences and the behaviour indicators were over 93percent for the solid and liquid mean. Conclusions: The results endorse the continuity of the use of Petroff method modified with saline solution as a decontamination method of pulmonary samples in the network of Cuban laboratories and as alternative to the pre-treatment of the samples for the liquid mean (Bact/Alert 3D); it also constitutes a support for the National Program for the Control of Tuberculosis(AU)

Tumor de Buschke-Löwenstein en una niña. A propósito de un caso

El tumor de Buschke-Löwenstein es un condiloma acuminado gigante, benigno, cuyas lesiones clínicas son mayores de 10 cm, por lo que el tratamiento de elección debería ser siempre quirúrgico. Se presenta el caso de una niña de un año con condiloma gigante en la vulva, tumor de Buschke-Löwenstein de rápida evolución, a quien se le practicó resección quirúrgica satisfactoria. Se revisó la literatura respecto a su diagnóstico y tratamiento.

Buschke-Löwenstein tumor is a benign giant condyloma acuminatum, whose clinical lesions are larger than 10 cm, so the treatment of choice should always be surgical. We present the case of a one-year-old girl with giant condyloma of the vulva, a rapidly evolving Buschke-Löwenstein tumor, who underwent successful surgical resection. The literature was reviewed regarding its diagnosis and treatment.

Case report: Buschke-Löwenstein tumor in a non-immunosuppressed patient

The present work aims to report a case of Buschke-Löwenstein tumor (BLT), which is a mass of genital warts that usually affects immunosuppressed people. The reported case was diagnosed in a young patient with no known immunosuppression. Several tests were performed to confirm the diagnostic hypothesis, including immunohistochemistry, histological, molecular and imaging analysis. The results obtained were confirmatory in all analyses, except in the molecular one. Because BLT is a rare condition, there is still great literary heterogeneity regarding the ideal treatment, but some options can be considered, such as excision and radiotherapy. (AU)

Tumor de Buschke-Löwenstein: presentación de un caso / Buschke-Lowenstein tumor: presentation of the case

RESUMEN Fundamento: el tumor de Buschke-Löwenstein es un condiloma acuminado gigante mayor de 10 cm más frecuente en hombres, por lo que el tratamiento de elección debe ser siempre quirúrgico. Objetivo: describir un caso de condiloma acuminado gigante. Presentación del caso: paciente masculino blanco de 54 años de edad, que acudió a consulta con formaciones papilomatosis con aspecto de coliflor de consistencia blanda y húmedas, en ambas regiones inguinales; del lado derecho de 13 cm de diámetro y de 19 cm la izquierda y en la raíz del pene y región perianal de 2 cm, asociadas a dolor de ligera intensidad en miembros inferiores y fetidez ocasional. Se le realizaron estudios preoperatorios incluidos serología y VIH no reactivos. Se operó, realizándole exéresis y cierre con colgajo cutáneo abdominal. Evolucionó estable clínicamente, aunque presentó una infección de la herida quirúrgica donde se reportó Escherichia coli, sensible a gentamicina; cumplió con el tratamiento y egresó sin complicaciones posteriores. Conclusiones: el tumor de Buschke-Löwenstein se considera en la actualidad como una forma de carcinoma verrucoso, no presenta atipias celulares, descrito como benigno, pero un tercio de los casos puede malignizar. No obstante, por las frecuentes recidivas, es considerado por algunos autores como un tumor maligno. A pesar de existir varios tratamientos, es el quirúrgico el de mejores resultados.

ABSTRACT Background: the Buschke-Löwenstein tumor is a giant acuminate condyloma larger than 10 cm, more frequent in men, so the treatment of choice must always be surgical. Objective: to describe a case of giant acuminate condylomata. Case report: 54-year-old white male patient, who came with papillomatosis formations with soft and moist consistency of cauliflower, in both inguinal regions; on the right side of 13 centimeters in diameter and 19 centimeters on the left and at the root of the penis and perianal region of 2 centimeters, associated with pain of slight intensity in the lower limbs and occasional fetidity. Preoperative studies including non-reactive serology and HIV were performed. He underwent surgery, performing excision and closure with abdominal skin flap. He evolved clinically stable, although he presented an infection of the surgical wound where Escherichia Coli, gentamicin sensitive, was reported; he complied with treatment and left without further complications. Conclusions: Buschke-Löwenstein tumor is currently considered as a form of verrucous carcinoma, it does not present cellular atypia, described as benign, but one third of the cases can be maligne. Despite frequent recurrences, some authors consider it as a malignant tumor. Despite the existence of several treatments, the surgical treatment is the one with the best results.

Tumor de Buschke-Löwenstein: tratamiento quirúrgico en el embarazo. Reporte de un caso y revisión de la bibliografía / Buschke-Löwenstein tumor: surgical treatment in pregnancy. Case report and literature review

Resumen ANTECEDENTES: El tratamiento del tumor de Buschke-Löwenstein durante el embarazo aún se discute, por lo que se prefiere iniciarlo en el puerperio. OBJETIVO: Reportar un caso de tumor de Buschke-Löwenstein, además de conocer y ampliar su protocolo de tratamiento, pues se considera un reto, debido a la recidiva, alto grado de malignidad y escasa bibliografía relacionada con la enfermedad durante el embarazo. CASO CLÍNICO: Paciente de 17 años, con embarazo previable y diagnóstico de infección de VPH de bajo riesgo, con condiloma genital incipiente, sin tratamiento, inadecuado control prenatal y sin inmunodepresión. Ingresó a la unidad hospitalaria con embarazo pretérmino, por pérdida del bienestar fetal en el tercer trimestre. Mediante ultrasonido se descartó la afectación fetal; sin embargo, se encontró anemia materna y fetidez genital, por lo que se decidió efectuar la resección de la tumoración. El procedimiento transcurrió sin contratiempos. Hasta la fecha no muestra recidiva. El embarazo llegó a término y finalizó por vía abdominal, sin complicaciones. CONCLUSIONES: El tumor de Buschke-Löwenstein es una neoplasia poco común relacionada con inmunodepresión, raramente aparece durante el embarazo y se prefiere iniciar el tratamiento en el puerperio. Se considera un factor de riesgo por la amenaza de parto pretérmino, el efecto proinflamatorio y la afectación materna-fetal, debido al sangrado materno crónico. Es importante considerar el tratamiento durante el embarazo, evaluando el riesgo-beneficio.

Abstract BACKGROUND: The management of the Buschke-Löwenstein tumor in pregnancy is controversial, preferring its treatment in the puerperium. OBJECTIVE: A clinical case report, know and expand the management of the Buschke-Löwenstein tumor, since this is considered a therapeutic challenge due to its important recurrence, high degree of malignancy and its scarce bibliography in which management is carried out during pregnancy. CLINICAL CASE: A 17-years old patient with preventable pregnancy and diagnosis of low risk HPV infection, presents incipient genital condyloma, which does not want any management, antecedent of inadequate prenatal control and without conditions that indicate immunosuppression. Later, she entered with preterm pregnancy due to loss of fetal well-being in the third trimester, fetal involvement was ruled out, however, maternal anemia and genital stinking were found, so it was decided to successfully resect the tumor, without recurrence and ending pregnancy. Ending the pregnancy by abdominal route. CONCLUSIONS: Buschke-Löwenstein tumor is a rare pathology related to immunosuppression, rarely occurs in pregnancy and its resolution is preferred in the puerperium. It can become a risk factor for the threat of preterm delivery due to its proinflammatory effect and generate a compromise of the binomial due to chronic maternal bleeding. It is important not to rule out your treatment during pregnancy by assessing risk benefit.

Falo passivo e sedução originária / Passive phallus and originary seduction

A partir da teoria da sedução generalizada, propomos um resgate históricoepistemológico da noção de "falo passivo", elaborada por Loewenstein e Bonaparte. Criticamos as teorias dos autores para mostrar que a castração e as narrativas de gênero como códigos tradutivos permitem compreender o falo passivo como uma possível resposta às seduções precoces. Concluímos demonstrando que a noção poderia apontar para a diversidade do pulsional, mas tal como apresentada por ambos autores, reproduz a operação de recalcamento na medida em que é conceituada em termos de diferença.

From the generalized seduction theory, we propose an historical and epistemological rescue of the notion passive phallus, elaborated by Loewenstein and Bonaparte. We criticize the theories of both authors in order to show that castration and gender narratives as traductives codes allow to understand the passive phallus as a possible response to the early seductions. We conclude demonstrating that the notion could point to the drive diversity, but as showed by both authors, reproduces the repression operation inasmuch as conceptualized in terms of difference

Tumor de Buschke-Löwenstein. presentación de un caso / Tumor de Buschke-Löwenstein. apresentação de um caso / uschke-Löwenstein tumor. case report

Se presentó un paciente masculino de 68 años, que acudió a consulta de Dermatología por presentar lesiones vegetantes en coliflor en región inguinal izquierda, pubis y perineales, de 10 años de evolución y nunca tratadas. El tumor de Buschke-Löwenstein o condiloma acuminado gigante es una tumoración epitelial benigna, causada por el virus del papiloma humano, trasmisible sexualmente, en raros casos puede malignizar. Se realizó escisión quirúrgica y estudio histopatológico de la lesión inguinal, las restantes lesiones fueron eliminadas con ácido tricloroacético, tratamiento tópico, logrando regresión total de las mismas y se le administró levamisol, inmunomodulador sistémico. La evolución posquirúrgica fue satisfactoria(AU)

A male patient of 68 years was presented who consulted Dermatology to present vegetating and cauliflower lesions in the left inguinal, pubic and perineal region, 10 years of evolution and never treated. Tumor of Buschke-Löwensteinor giant condyloma is a benign epithelial tumor is caused by the human papillomavirus, sexually transmitted and in rare cases can become it in malignant. Surgical excision and histopathological examination of the inguinal lesion was done, the remaining lesions were removed with trichloroacetic acid, topical treatment, achieving complete regression thereof and administered levamisole and systemic immunomodulator. The postoperative course was satisfactory(AU)

Paciente do sexo masculino, 68 anos, apresentou-se aoServiço de Dermatologiadevido a lesões vegetantes nacouve-flor naregião inguinal esquerda, púbis e períneo, comduração de 10 anose nunca tratadas. O tumor de Buschke-Löwenstein ou o condiloma acuminado gigante é um tumor epitelial benigno, causado pelo papilomavírus humano sexualmente transmissível, podendo, em casos raros, malignizar. Excisãocirúrgica e estudo histopatológico da lesão inguinal foram realizados, as lesõ es remanescentesforam eliminadas com ácido tricloroacético, tratamento tópico, obtendoregressão total das mesmas e foi administrado levamisol, imunomodulador sistêmico. A evoluçãopós-operatória foi satisfatória(AU)

Tumor de Buschke-Löwenstein - Condiloma gigante acuminado / Buschke-Löwenstein's Tumor - Giant Condyloma Acuminatum

Presentamos el caso de un hombre de 21 años de edad, infectado por el virus de la inmunodeficiencia humana (VIH) que presenta lesiones verrucosas gigantes compatibles con un tumor de Buschke-Lowenstein (TBL) que afectaban la región perineal, anorrectal y genitales externos. También existía afectación del párpado superior derecho. (AU)

We report the case of a 21-year-old male patient, infected with human immunodeficiency virus (HIV) that presents giant warty lesions compatible with a Buschke-Lowenstein tumor (BLT) that affected the perineal, anorectal and external genital region. He also had a right upper eyelid lesion. (AU)

Tumor de Buschke-Löwenstein: relato de três casos / Buschke-Löwenstein Tumor: report of three cases

O tumor de Buschke-Löwenstein é uma doença rara, de transmissão sexual, associada ao papilomavírus humano, principalmente dos subtipos 6 e 11. Caracteriza-se como uma lesão exofítica, em forma de couve-flor, de progressão lenta, com alto poder de infiltração local. O seu principal fator de risco é a imunossupressão e o tratamento geralmente é cirúrgico, com ou sem terapias adjuvantes. O impacto na vida da paciente é grande, com altas taxas de recorrência após excisão cirúrgica. Relatamos 3 casos de condiloma gigante com achados histopatológicos diversos, com graus de infiltração e papilomatose variados.

The Buschke-Löwenstein Tumor is a rare, sexually transmitted disease, triggered by human papillomavirus, specially the subtypes 6 and 11. It is characterized as a cauliflower-shape exophytic mass, slowly progressive, with high local recurrence rates and high infiltration. The main risk factor is immunosuppression. Surgical treatment is usually preferred, with or without adjuvant therapy. It has a great impact on the patients' life, impairing their life quality. We report three cases of Giant Condyloma with diverse histopathological findings with varying degrees of infiltration and papillomatosis.

Tumor de Buschke-Lowenstein: presentación de un caso y revisión de la literatura / Buschke-Lowenstein tumour: Case presentation and review of the literature

Presentar el caso de una paciente con tumor de Buschke-Lowenstein, y hacer una revisión de la literatura respecto a su diagnóstico y tratamiento.Materiales y métodos: se presenta el caso de una paciente de 19 años de edad, con condiloma gigante de rápida evolución en la vulva, o tumor de Buschke-Lowenstein, a quien se le realiza vulvectomía parcial en un hospital de tercer nivel de referencia, ubicado en Bogotá, Colombia. Se realizó una revisión de la literatura registrada en las bases de datos Medline vía Pubmed, EBSCO, ProQuest y SciELO, del 2000 al 2015; se incluyeron artículos de revisión y reportes de casos. Se consultaron los artículos publicados en inglés y español con los siguientes términos MeSH: "condiloma gigante", "Buschke-Lowenstein".Resultados: se identificaron 26 títulos, de los cuales se incluyeron 20 estudios. De ellos, 18 correspondieron a reportes de caso, uno a una serie de casos y uno a un artículo de revisión. Su origen se encuentra frecuentemente ligado a la infección por VPH serotipos 6 y 11, y posee un bajo riesgo de malignidad. El diagnóstico se basa en la historia clínica y la exploración física, aunque el diagnóstico histopatológico es el patrón de oro. El tratamiento quirúrgico ha sido el más utilizado y se basa en la resección completa de la lesión. No hay información consistente sobre el tiempo libre de enfermedad.Conclusión: el tumor de Buschke-Lowenstein constituye una entidad poco frecuente, cuyo abordaje diagnóstico requiere un alto índice de sospecha clínica. El tratamiento se basa en la resección completa de la lesión y, en algunas ocasiones, esta se acompaña de terapia adyuvante con el ánimo de disminuir las tasas de recurrencia. Se requieren más estudios que aborden el diagnóstico y el tratamiento de esta entidad...

To present the case of a patient with a Buschke-Lowenstein tumour, and to conduct a review of the literature on its diagnosis and treatment.Materials and Methods: Case presentation of a 19 year-old female patient with a rapidly progressing vulvar giant condyloma or Buschke-Lowenstein tumour who underwent partial vulvectomy in a level III referral Hospital in Bogotá, Colombia. A review of the literature was conducted in the Medline databases via PubMed, EBSCO and ProQuest, and in SciELO, of articles published between 2000 and 2015, including review articles and case reports. The search covered articles published in English and Spanish using the MeSH terms giant condyloma and Buschke-Lowenstein.Results: Overall, 26 titles were identified, of which 20 studies were included. Of these, 18 were case reports, 1 was a case series and 1 was a review article. Diagnosis is made on the basis of the clinical history and physical examination, although the histopathological diagnosis is the gold standard. Complete surgical resection of the lesion has been the treatment most widely used. There is no consistent information regarding disease-free time period.Conclusion: The Buschke-Lowenstein tumour is an infrequent condition and the diagnostic approach requires a high degree of clinical suspicion. Treatment is based on complete resection of the lesion and is accompanied on occasions by the administration of adjuvant therapy in order to reduce the rate of recurrence. Further studies are needed on the diagnosis and treatment of this condition...

Tumor de Buschke Lowenstein / Buschke Lowenstein Tumor

El tumor de Buschke Lowenstein o condiloma gigante es una tumoración epitelial benigna, causada por el virus del papiloma humano, trasmisible sexualmente, en muy pocos casos se transforma en maligna. Se presentó un paciente masculino de 51 años, con tabaquismo crónico, etilismo ocasional y relaciones sexuales inestables y desprotegidas. Acudió al Servicio de Urología del Centro Oncológico Provincial de Holguín a causa de lesiones verrugosas inguinales, penoescrotales y perineales, que se trataron años antes, sin embargo, el abandono del tratamiento por parte del paciente favoreció el desarrollo de nuevas lesiones, mostró infección sobreañadida por Proteus mirabilis que respondió con ciprofloxacino. Se realizó escisión quirúrgica de las lesiones inguinoescrotales y perineales, en las lesiones penianas, se combinó con tratamiento tópico. Se administraron también inmunomoduladores. La evolución postoperatoria fue satisfactoria. Las lesiones penianas, tratadas con podofilino y 5-fluorouracilo, experimentaron ulceración y regresión total. Durante el seguimiento, realizado por un año, se observó la aparición de lesiones de pequeño tamaño que se trataron localmente. Actualmente, no existe un tratamiento completamente resolutivo para esta enfermedad.

Buschke Lowenstein tumor or Acuminate Giant Condyloma is a benign epithelial tumor, caused by Human Papillomavirus, sexually transmissible and in rare cases, it becomes to malignant one. A male patient of 51 years old, chronic smoker, occasional alcoholic was presented in this article. Unstable with sexual relations. The patient came to Urology service for inguinal, penoscrotal and perineal verrucous damages, that were treated and reduced (2009), but the patient abandoned the treatment causing the damage development. Add infection by Proteus mirabilis was solved with ciprofloxacino. Surgical reception of inguinoescrotal and perineals damages were performed. For penile damages the topic treatment was combined. Satisfactory postoperative evolution was observed. The penile damages were treated with podofilino and 5-Fluorouracilo, so ulceration and total reduction were observed. Inmunomodulators were also given. For one year the patient presented small lesions. Nowadays there is no a specific and definitive treatment.

Isoniazid and rifampin drug susceptibility testing: application of 2,3,5-triphenyl tetrazolium chloride assay and microscopic-observation drug-susceptibility assay directly on Ziehl-Neelsen smear positive sputum specimens

Abstract The current study was aimed to evaluate the performance of direct 2,3,5-triphenyl tetrazolium chloride assay and direct microscopic observation drug susceptibility assay with indirect Löwenstein-Jensen proportion method directly on Ziehl-Neelsen smear positive sputum specimens. Methods Direct acid fast bacilli smear positive sputum specimens (n = 264) were subjected to isoniazid and rifampicin drug susceptibility testing by direct 2,3,5-triphenyl tetrazolium chloride assay, direct microscopic observation drug susceptibility assay, and the performances were compared with indirect Löwenstein-Jensen proportion method. Results The direct 2,3,5-triphenyl tetrazolium chloride assay demonstrated an overall sensitivity, specificity, positive predictive value, and negative predictive value of 99.2%, 82.4%, 99.2%, and 88.5%, respectively, for the detection of isoniazid and rifampicin resistant Mycobacterium tuberculosis isolates when compared to indirect Löwenstein-Jensen proportion method. Likewise, the overall sensitivity, specificity, positive predictive value and negative predictive value of direct microscopic observation drug susceptibility assay were 98.8%, 82.4%, 99.2%, and 78.2%, respectively. Conclusion The direct 2,3,5-triphenyl tetrazolium chloride assay was found to be an economical alternative method for the rapid and accurate detection of isoniazid and rifampicin resistance from direct acid fast bacilli smear positive sputum specimens.

Giant condyloma acuminatum: report of surgical treatment and evolution of healing / Condiloma acuminado gigante: relato de tratamento cirúrgico e evolução da cicatrização

O condiloma acuminado gigante, variante rara do condiloma acuminado anogenital, apresenta crescimento rápido associado a estados de imunodeficiência.Relatamos os resultados com os cuidados com a ferida operatória. Trata-se de homem de etnia negra, 55 anos, portador do vírus da imunodeficiência humana com condiloma acuminado acometendo desde as regiões inguinais até o sulco interglúteo, que foi ressecado permanecendo a ferida aberta para posterior enxertia. Os cuidados com essa ferida incluíram solução de polihexametileno biguanida/betaína, solução de ácidos graxos essenciais, hidrofibra/prata e película. Evoluiu com infecção secundária sendo a hidrofibra substituída por espuma de poliuretano/prata/ibuprofeno. Houve melhora da infecção e da dor, contração das bordas e presença de tecido de granulação em toda a lesão. Naquelas condições, o enxerto de pele foi realizado no 41º dia. A despeito dos possíveis vieses de confusão, pode-se inferir que esses cuidados prepararam o leito da ferida para receber o enxerto de pele.

Giant condyloma acuminatum, a rare variant of anogenital condyloma, shows rapid growth associated with immunodeficiency. Wound care after resection andoutcomes were reported. NGS, black, 55 years, HIV positive, with giant condyloma acuminatum affecting from the groin to the intergluteal groove, which wasresected, remaining the wound opened for later skin graft. Topical care included polihexametilene biguanide/betaine solution, essencial fatty acids solution,hydrofiber/silver, and poliuretane film. The wound developed secondary infection, so hidrofiber was replaced by polyurethane foam/silver/ibuprofen. Therewas improvement in infection and pain, contraction of the edges and the presence of granulation tissue across the lesion. In those conditions the skin graft was performed after 41 days. Despite possible confusion bias, it can be inferred that the care adopted prepared the wound bed to receive the skin graft.

Reconstrucción perineal inmediata en extensa resección abdominoperineal rectal / Immediate perineal reconstruction after vast rectal abdominoperineal resection

Background: Buschke-Lowenstein tumor is a benign skin lesion secondary to human papilloma virus infection. It usually appears as an exophytic anogenital mass and may progress to a squamous cell carcinoma. It can be treated with chemo, radio or immunotherapy and occasionally it requires radical surgery. Case report: We report a 53 years old male with a perianal lesion lasting 15 years that was treated with chemo-radiotherapy that relapsed with malignant transformation. Since the pathological study showed a squamous cell carcinoma, a rectal abdominoperineal resection was planned. The defect that left the surgical procedure was covered with musculocutaneous flaps from gracilis muscle of the thigh.

Introducción: El tumor de Buschke-Lõwenstein es una lesión cutánea benigna, secundaria a la infección por virus papiloma humano, usualmente se presenta como una gran masa exofítica genitoanal y tiene riesgo de evolucionar a carcinoma espinocelular. Dentro de su tratamiento existen varias alternativas, desde menos agresivas como quimio-radioterapia e inmunoterapia, que suelen tener alta tasa de recidiva, hasta la cirugía radical. Caso clínico: Presentamos el caso de un paciente masculino, con una lesión perianal de 15 años de evolución, inicialmente se sometió a terapias locales conservadoras y quimiorradioterapia y posteriormente recidivó con transformación maligna. Habiéndose confirmado histológicamente la presencia de carcinoma espinocelular, debió abordarse mediante una resección abdominoperineal rectal. Dicha cirugía determinó un gran defecto de cobertura perianal y perineal que fue reparado mediante colgajos músculo-cutáneos de gracilis y fasciocutáneos de muslo. Discusión: Si bien se han descrito algunos métodos de resección local, sólo la cirugía radical permite su eliminación completa disminuyendo el riesgo de recurrencia. Ello genera un defecto perianal de difícil manejo, para el cual existen varias opciones reconstructivas: injertos, colgajos locales y regionales, y, con menor frecuencia, colgajos libres. Se debe considerar que en aquellos defectos de gran tamaño, con gran pérdida de tejido, las opciones de reconstrucción del defecto con volumen y cobertura cutánea adecuada son limitadas. Presentamos nuestra experiencia con algunas de estas técnicas, entre las que destaca el colgajo de músculo gracilis, con los múltiples beneficios que posee.

Nuevas herramientas para el diagnóstico de la tuberculosis / New tools for tuberculosis diagnosis

Introducción: en las últimas décadas se han desarrollado nuevas herramientas para disminuir el tiempo de diagnóstico de las infecciones por Mycobacterium tuberculosis. Objetivo: introducir nuevas herramientas para la identificación de M. tuberculosis y comparar los resultados con el cultivo en Löwenstein Jensen. Métodos: se estudiaron 1 368 muestras recibidas en el Laboratorio Nacional de Referencia de Tuberculosis del Instituto de Medicina Tropical Pedro Kourí, de agosto 2010 - agosto 2014. Las muestras después de procesadas fueron inoculadas en paralelo en Löwenstein Jensen y en BacT ALERT. Los resultados se ana­lizaron y compararon con relación al total de aislamientos, tiempo de detección de crecimiento y tasa de contaminación, se calcularon además los indicadores de desempeño del BacT ALERT. Resultados: por Bact/ ALERT se identificó Mycobacterium tuberculosis en 126 (98,5 por ciento) muestras y 116 (88,5 por ciento) por el Löwenstein Jensen. El tiempo de detección de crecimiento de Mycobacterium tuberculosis por el BacT/ ALERT fue de 16,6 días, dos veces menor que el obtenido por el Löwenstein Jensen (35,5 días). La tasa de contaminación por el Bact/ ALERT y Löwenstein Jensen fue de 11 por ciento y 7,8 por ciento, respectivamente. La sensibilidad, especificidad e índice de Youden fue de 99,1 por ciento, 99,0 por ciento y 0,98, respectivamente; y el índice de validez del 99 por ciento. Conclusiones: el sistema Bact/ ALERT resultó un método útil porque acortó significativamente el tiempo de diagnóstico de la tuberculosis permitiendo comenzar el tratamiento de forma oportuna, sobre todo en pacientes con baciloscopia negativa. El uso combinado del Löwenstein Jensen y medio líquido aseguró la recuperación del total de cepas de M. tuberculosis(AU)

Background: in recent decades, new tools have been developed to decrease the time of diagnosis of infections with Mycobacterium tuberculosis. Objective: to introduce the new tools for identification of M. tuberculosis and compare the results with culture in Löwenstein Jensen. Methods: 1 368 samples received at the National Tuberculosis Reference Laboratory of the IPK from August 2010 to August 2014. After samples processed were inoculated in parallel on Löwenstein Jensen and BacT ALERT. The results obtained are analyzed and compared with respect to the total isolates, time detection of growth and contamination rate, the performance indicators of BacT ALERT also calculated. Results: by Bact / ALERT were identified Mycobacterium tuberculosis in 126 (98.5 percent) samples and 116 (88.5 percent) by Löwenstein Jensen. The time detection of growth of Mycobacterium tuberculosis by BacT / ALERT was 16.6 days, two times lower than that obtained by the Löwenstein Jensen (35.5 days). The contamination rate by Bact / ALERT and Löwenstein Jensen was 11 percent and 7.8 percent, respectively. The sensitivity, specificity and Youden index was 99.1 percent, 99.0 percent and 0.98, respectively; and the validity index was 99 percent. Conclusions: bact / ALERT system proved a useful method because it significantly shortened the time of tuberculosis diagnosis and start allowing treatment in a timely manner, especially in smear-negative patients. The combined use of liquid medium and Löwenstein Jensen assured recovery of all strains of Mycobacterium tuberculosis(AU)