Factors associated with tuberculosis disease in children from a hospital in Western Mexico / Factores asociados con enfermedad tuberculosa en niños de un hospital del occidente de México

Abstract Background: This study aimed to describe the clinical and demographic characteristics of children with confirmed tuberculosis disease and identify associated factors. Methods: We conducted a retrospective and observational study at the Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Inpatient and outpatient children under 18 years of age who were reported to the National Epidemiological Surveillance System (SINAVE, for its Spanish acronym) for suspected tuberculosis and who had molecular or microbiological tests for mycobacteria were included in the study. Multivariate analysis with logistic regression was used to analyze associated factors. Results: One hundred and nine patients under 18 years of age with suspected tuberculosis were included in the study. About 50.5% (55/109) were male, and the median age was 11 years. Tuberculosis was confirmed in 55% (n = 60): 15% (9/60) had a pulmonary infection, and the rest (51/60) had an extrapulmonary infection. The diagnostic tests used were histopathological study (n = 26), expectoration or gastric aspirate stains (n = 17), polymerase chain reaction (n = 12), and cultures (n = 5). Positive purified protein derivative (PPD) or interferon-gamma release assay (IGRA) tests were found in 33.9%. Malnutrition (odds ratio [OR] 15.9, 95% confidence interval [CI]: 2.3-109), and consumption of unpasteurized products (OR 7.45, 95% CI: 1.02-54.3) were associated with tuberculosis disease in children. Conclusions: Malnutrition and consumption of unpasteurized dairy products are associated with tuberculosis.

Resumen Introducción: El objetivo de este estudio fue describir las características clínicas y demográficas de niños con enfermedad tuberculosa confirmada e identificar los factores asociados. Métodos: Se realizó un estudio observacional retrolectivo en el Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Se incluyeron menores de 18 años hospitalizados y ambulatorios que se notificaron al Sistema Nacional de Vigilancia Epidemiológica (SINAVE) por sospecha de tuberculosis y que contaron con pruebas moleculares o microbiológicas para micobacterias. El estudio de los factores asociados se realizó mediante análisis multivariado con regresión logística. Resultados: Se incluyeron en el estudio 109 menores de 18 años con sospecha de tuberculosis. El 50.5% (55/109) fueron de sexo masculino y la mediana de edad fue de 11 años. Se confirmó enfermedad tuberculosa en el 55% (n = 60) de los casos: el 15% (9/60) presentaron infección pulmonar y el resto extrapulmonar. Las pruebas diagnósticas utilizadas fueron el estudio histopatológico (n = 26), tinciones de expectoración o aspirado gástrico (n = 17), reacción en cadena de la polimerasa (n = 12) y cultivos (n= 5). 33.9% de los pacientes presentaron prueba de derivado proteico purificado (PPD) o ensayo de liberación de interferón gamma (IGRA) positiva. Se observó que la desnutrición (razón de momios (RM) 15.9, intervalo de confianza (IC) 95% 2.3 - 109) y el consumo de productos no pasteurizados (RM 7.45, IC 95% 1.02 - 54.3) se asociaron con enfermedad tuberculosa en niños. Conclusiones: La desnutrición y el consumo de lácteos no pasteurizados se asocian con la enfermedad tuberculosa.

Absceso del psoas secundario a tuberculosis vertebral / Psoas abscess secondary to vertebral tuberculosis

Introducción: Presentamos el caso de un paciente masculino de 29 años con absceso del psoas bilateral secundario a tuberculosis vertebral. El absceso del psoas no suele ser frecuente en pacientes con tuberculosis extrapulmonar y principalmente con la enfermedad de Pott, pero cuando aparece suele ser subdiagnosticado debido a la inespecificidad de sus manifestaciones clínicas. Objetivos: Abordaje clínico-quirúrgico del absceso del psoas secundario a la tuberculosis vertebral, o Mal de Pott. Materiales y métodos: Búsqueda bibliográfica efectuada en pubmed. Relato de caso clínico: registro clínico y fotográfico, evolución, presentación de: resultados laboratoriales y de métodos auxiliares y tratamiento. Resultados: Síntomas presentados por un paciente de 29 años: dolor abdominal, dolor en miembro inferior, lumbalgia, expectoración sanguinolenta, dificultad en la deambulación, y cuadro respiratorio previo y síntomas constitucionales como pérdida de peso, anorexia, astenia. Con base en la anamnesis, examen físico y hallazgos en exámenes específicos, se pudo lograr el diagnóstico de absceso del psoas secundario a la tuberculosis vertebral. El tratamiento farmacológico seguido fue el propuesto por la OMS para la Tuberculosis más punción del absceso para drenaje y cultivo del mismo, con catéter multipropósito. El paciente tuvo una evolución favorable y posterior a la intervención neuroquirúrgica fue dado de alta. Conclusión: El paciente evolucionó de forma favorable, y las medidas aplicadas en el desarrollo de su enfermedad, fueron oportunas.

Introduction: We present de case of a 29 year old male patient with bilateral psoas abscess secondary to vertebral tuberculosis. Psoas abscess is not usually frequent in patient with extra-pulmonary tuberculosis and specially Pott's disease, but when it appears it is usually under diagnosed due to non-specificic clinical manifestations. Objectives: Clinical-surgical approach to psoas abscess secondary to vertebral tuberculosis, or Pott's disease. Materials and methods: Bibliographic search carried out in pubmed. Case report: clinical and photographic record, evolution and presentations of laboratory results, diagnostic auxiliary methods and treatment. Results: Symptoms presented by a 29 years old patient: abdominal pain, lower limb pain, low back pai, bloody expectoration, difficulty walking and previous respiratory and constitutional symptoms sucha as weight loss, anorexia, asthenia. Based on the clinicalhistory, physical examination and findins in specific tests, the diagnosis of psoas abscess secondary to vertebral tuberculosis could be achieved. The pharmacological treatment followed was the one proposed by WHO for tuberculosis, plus the drainage and culture of the abscess, with a multipurpose catheter. The patient had a favorable evolution and after the neurosurgical intervetntion he was discharged. Conclusion: The patient evolved favorably, and the measures applied in the development of his disease were appropriate.

Miliary Tuberculosis with Addisons Disease - in old case of pulmonary tuberculosis, and tuberculosis of seminal vesicles - A rare case report

Addison's disease is a rare endocrinal disorder that was first described by Thomas Addison in 1855. Addison抯 disease occurs as a result of a lack of production of adrenocortical hormones, which is a rare but fatal disease if left untreated. The two most common causes of Addison's disease are autoimmune adrenalitis and tuberculosis which refer to hypoadrenalism caused by total or near total destruction or dysfunction of both adrenal cortices. Usual manifestations involve chronic fatigue, muscle weakness, loss of appetite, nausea, vomiting, diarrhoea, hypotension, and hyper pigmentation of the skin. A substantial proportion of patients presenting with extra-pulmonary tuberculosis (TB) have urogenital TB (UG-TB), which is easily under diagnosed because of non-specific symptoms, which are chronic and have cryptic protean clinical manifestations. Most of the clinician are not aware of the possibility of UG � TB. Calcification of seminal vesicle found in this case is a rare condition, which is commonly associated with diabetes, hyperparathyroidism, and genitourinary tuberculosis. We here in report a rare case of adrenal insufficiency due to miliary tuberculosis involving adrenal gland, old pulmonary tuberculosis and genitourinary tuberculosis (seminal vesicles calcification) in a 31 year old male person. He presented with multiple episodes of vomiting, and giddiness which wasalso accompanied with atypical hyperpigmentation. His symptoms resolved after starting anti tuberculous therapy.

Surgical Case of Tuberculous Abdominal Aortic Aneurysm and Thoracic Aortic Aneurysm with Miliary Tuberculosis / 日本心臓血管外科学会雑誌

A 48-year-old woman was scheduled to undergo wrist surgery at the orthopedic surgery clinic. She was adventitiously diagnosed with miliary tuberculosis and saccular-type aneurysms in the suprarenal abdominal aorta and descending thoracic aorta during preoperative examination. Consequently, she received antituberculosis medications. However, the abdominal aortic aneurysm had enlarged rapidly 2 months later. Accordingly, we used an artificial graft patch bonded with rifampicin for the abdominal aortic aneurysm and resected the aneurysm and reconstructed the aorta through partial extracorporeal circulation by clamping the descending thoracic aorta and infrarenal abdominal aorta. Finally, we performed a thoracic endovascular aortic repair of the thoracic aortic aneurysm. Culture of the samples from the wall of the abdominal aortic aneurysm indicated Mycobacterium tuberculosis; therefore, the patient was diagnosed with a tuberculous aneurysm of the aorta. Her postoperative course was good, and she was discharged on day 36. At postoperative month 7, the patient is still on antituberculosis medications and has not experienced a recurrence.

Massive gastrointestinal bleeding as a clinical manifestation of miliary tuberculosis

Tuberculosis is still a public health problem today and can have acute and chronic manifestations challenging clinics for various medical specialties. Because it's a disease of multisystem potential, it is often overlooked when outside the respiratory clinical context. As a result, a clinical case report was carried out at the Hospital de Clínicas de Porto Alegre, in 2020, of a patient with voluminous gastrointestinal bleeding as severe acute clinical manifestation of Miliary and Intestinal Tuberculosis. Due to the potential severity of undiagnosed and untreated tuberculosis, high suspicion is suggested at all levels of health systems (whether public or private) with a view to early diagnosis, treatment and prevention of complications resulting from the disease.

Rifampicin-induced thrombocytopenia in a patient of disseminated tuberculosis

Thrombocytopenia may be associated with a variety of conditions and risks depending on its severity, ranging from mild epistaxis to life-threatening bleeding. Many drugs or herbal remedies can cause thrombocytopenia by either inhibiting platelet production and/or enhancing their destruction from the peripheral blood-mediated through an immunological mechanism implicating drug-dependent antibodies. Drugs are a common cause of acute immune-mediated thrombocytopenia in adults, the drug etiology is often initially unrecognized. Most cases of drug-induced thrombocytopenia are caused by drug-dependent antibodies that are specific for the drug structure and bind tightly to platelets by their Fab regions but only in the presence of the drug. Thrombocytopenia is an uncommon but life-threatening complication of certain antitubercular drugs. The discovery of isolated thrombocytopenia in a patient taking several medications presents a challenging clinical problem. We report a case of a young immunocompetent female who presented with disseminated tuberculosis and was found to have rifampicin-induced thrombocytopenia

A Case of Tubercular Infrarenal Abdominal Aortic Aneurysm / 日本心臓血管外科学会雑誌

The patient was an 81-year-old male. During treatment of a refractory subcutaneous abscess, he was diagnosed with an infection of an infrarenal aortic aneurysm caused by unknown bacteria. Antibiotic administration was initiated, but the infection persisted and there was no improvement of the aortic infection focus or aneurysm morphology. In order to control the infection and avoid rupture of the aortic aneurysm, excision of the infectious abdominal aortic aneurysm, omental plombage, and debridement of the surrounding infected tissue were performed. According to histopathological examination of the extracted sample, findings were consistent with an infection of the aortic aneurysm. Although administration of antibiotics continued, the infection continued to worsen during the postoperative course and an enlarged subcutaneous abscess and miliary tuberculosis were indicated by computed tomography. Therefore, an acid-fast bacteria culture test of the subcutaneous abscess, sputum, and urine and Tuberculous (Tb)-real time polymerase chain reaction (PCR) tests were carried out. According to Tb-PCR test of the subcutaneous abscess, mycobacterium tuberculosis was detected. In the re-evaluation of the extracted sample, granulomatous inflammation with spindle-shaped cell fenestration around the necrotic tissue and the appearance of epithelial cells and multinucleated giant cells were observed. Findings were consistent with a tubercular infection of the aortic aneurysm. Anti-tuberculosis treatment was initiated, and significant improvement of the inflammation and subcutaneous pus in the right chest were observed. On Day 39 after surgery, the patient was discharged from the hospital and walked home with no help. We experienced a successful case of tubercular infection of an infrarenal aortic aneurysm requiring surgery. Infection was controlled and rupture of the aortic aneurysm was avoided with surgical treatment and antituberculosis therapy. (Surgical treatment by excision of infectious abdominal aortic aneurysm, omental plombage, and debridement of the surrounding infected tissue, and antituberculosis therapy were carried out.)

Tuberculous meningitis and miliary tuberculosis in Iran: A review

In recent years, the number of cases of extrapulmonary tuberculosis in Iran has increased. The goal of this study was to determine the epidemiological status, clinical symptoms, diagnostic methods, and treatment strategies of extrapulmonary tuberculosis in Iran, with a focus on tuberculosis meningitis and miliary tuberculosis. Between January 1, 2000 and June 1, 2021, 1 651 cases of tuberculosis meningitis and miliary tuberculosis were discovered in Iran. The prevalence of tuberculosis meningitis was higher in Sistan and Baluchestan, South Khorasan, and Mazandaran compared with other provinces. The most prevalent symptoms of tuberculous meningitis were fever, anorexia, headache, neck stiffness, loss of consciousness, and vomiting. The most commonly used procedures for diagnosing tuberculous meningitis were polymerase chain reaction and cerebrospinal fluid culture. The most prevalent clinical symptoms of miliary tuberculosis were fever, lethargy, weariness, and anorexia. In 70% of chest radiographs, a miliary pattern was visible. Bone marrow biopsy was used to diagnose miliary tuberculosis in 80% of patients, while bronchoalveolar lavage was used in 20% of cases. The conventional 6-month treatment approach for tuberculous meningitis and miliary tuberculosis was used for all of the participants in the investigations. Given the high prevalence of extrapulmonary tuberculosis patients in Iran and the devastating consequences of the disease, the researchers recommend that further study be done to prevent extrapulmonary tuberculosis in the general population.

Tuberculosis miliar, un hallazgo clínico-radiológico: a propósito de un caso / Miliary tuberculosis, a clinical-radiological finding: about a case

La tuberculosis es una enfermedad granulomatosa, con espectro clínico variable. El objetivo es presentar un caso con tuberculosis miliar, una de las formas clínicas menos frecuente de la enfermedad y la utilización del método clínico proporcionó el diagnóstico certero. Se presenta un paciente masculino de 54 años, no fumador, alcohólico atendido en el Hospital Clínico Quirúrgico Hermanos Ameijeiras por referir historia de tos poco productiva, cefalea, fiebre, pérdida de apetito y de peso de dos meses de evolución. En la radiografía y tomografía de tórax se evidencia un patrón miliar y la baciloscopía directa confirma la presencia del Mycobacterium tuberculosis. La TB miliar es muy poco frecuente, pero se puede sospechar ante un patrón radiológico miliar y confirmar mediante análisis microbiológico.

Tuberculosis is a granulomatous disease with a variable clinical spectrum. The objective is to present a case with miliar tuberculosis, one of the least frequent clinical forms of the disease, and the use of the clinical method provided an accurate diagnosis. We present a 54-year-old male, non-smoker, alcoholic who attended in the Ameijeiras Brothers Surgical Clinical Hospital for referring to a history of unproductive cough, headache, fever, loss of appetite, and weight two months of evolution. Chest X-ray and CT showed a miliar pattern and direct bacilloscopy confirmed the presence of Mycobacterium tuberculosis. Miliar TB is very rare but can be suspected by a miliar radiological pattern and confirmed by microbiological analysis.

Tuberculosis miliar / Miliary tuberculosis

Introducción: La tuberculosis es considerada como la enfermedad infecciosa más importante del mundo, a pesar de los esfuerzos que se han invertido para su control. Es producida por el complejo mycobacterium tuberculosis. El órgano más afectado es el pulmón, aunque puede tener repercusión extrapulmonar. Objetivo: Presentar el caso de un paciente diagnosticado de tuberculosis miliar a través del esputo posbroncoscopia. Caso clínico: Se expone el caso de un paciente diagnosticado de una tuberculosis miliar al cual se le realizó broncoscopia diagnóstica y lavado bronquial para bacilo ácido alcohol resistente (BAAR), el cual fue negativo. El diagnóstico se obtuvo por esputo BAAR posbroncoscopia. Conclusiones: El esputo posbroncoscopia es una opción con adecuada rentabilidad en el diagnóstico de esta enfermedad infecciosa(AU)

Introduction: Tuberculosis is considered the most important infectious disease in the world, despite the efforts that have been invested to control it. It is produced by the mycobacterium tuberculosis complex. The most affected organs are the lungs, although it can have extrapulmonary repercussions. Objective: To report the case of a patient diagnosed with miliary tuberculosis through post-bronchoscopy sputum. Clinical case report: The case of a patient diagnosed with miliary tuberculosis is reported. This patient underwent diagnostic bronchoscopy and bronchial lavage for acid-alcohol-resistant bacillus (ABB), which was negative. The diagnosis was obtained by postbronchoscopy ARB sputum. Conclusions: Post-bronchoscopy sputum is an option, with adequate profitability in the diagnosis of this infectious disease(AU)

Levels of vitamin D in tuberculosis and comparison of vitamin D level in severe variant of tuberculosis like tubercular meningitis, miliary tuberculosis, disseminated tuberculosis with non severe variant of tuberculosis like pulmonary tuberculosis, tubercular lymphadenitis etc in paediatric age group

Background: Tuberculosis is deadliest disease killing nearly 2 million people every year. Before the etiologic cause of TB was determined by Koch, cod liver oil and sunlight, both sources of vitamin D, were used in treatment of tuberculosis. After discovery of antibiotics, anti-infectious value of vitamin D was ignored until increasing cost of antibiotics and rise in resistance led to the need to search for alternative and antibiotic-independent therapeutic strategies. This study shed light on vitamin D, which is very safe and inexpensive by adding vitamin D to antibiotic treatment, immune system can be boosted to help body to clear TB, rather than relying on antibiotics.Methods: A prospective, observational, comparative study in which 62 TB patients were taken and vitamin D level were estimated.Results: The results of study show that out of total 62 patients, 31 (50.00%) had deficient(<20ng/ml) vitaminD,23(37.10%) had insufficient(20-30ng/ml) vitamin D, 8(12.90%) had sufficient (>30ng/ml) vitamin D level. Out of 62 patients, 10(62.13%) had severe variety of TB and 52(83.87%) had' nonsevere TB. Among the 52 patients, 24(46.2%) had deficient vitamin D, 20(38.5%) had insufficient vitamin D and 8(15.4%) had sufficient vitamin D. Among the 10 patients with severe TB, 7(70.00%) had deficient vitamin D, 3(30.00%) had insufficient vitamin D and none had sufficient vitamin D level.Conclusions: Majority of children with tuberculosis demonstrated low serum levels of vitamin D (deficient and insufficient levels) suggest that vitamin D deficiency is' risk factor of tuberculosis and very low levels of vitamin D were noted in severe variant of TB then non severe suggest that in severe form of tuberculosis vitamin D levels were less compared to nonsevere variant.

Disseminated Tuberculosis Presenting as Gastric Outlet Obstruction

@#A 12-year-old female had a three-year history of fever, non-bilious vomiting and abdominal pain. Upper gastrointestinal series showed a filling defect at the duodenum. Esophagogastroduodenoscopy exhibited circumferential mass extending from the duodenal bulb to the 2nd part of the duodenum which on histology disclosed chronic granulomatous inflammation. Chest X-ray suggested miliary tuberculosis; endotracheal tube aspirate was PCR positive for Mycobacterium tuberculosis. Patient was diagnosed as disseminated tuberculosis of the duodenum and lungs. Quadruple anti-tuberculosis medication was started but patient succumbed to nosocomial sepsis.

Autopsy findings of miliary tuberculosis in a renal transplant recipient

Miliary tuberculosis is a lethal form of disseminated tuberculosis (TB), deriving its name from the millet-seed-sized granulomas in multiple organs. As TB still remains a leading cause of morbidity and mortality in India, its disseminated forms need to be diagnosed early to ensure more aggressive treatment at the earliest possible time. However, a considerable number of cases are missed ante-mortem. We discuss the case of a 32-year-old immunocompromised, non-HIV patient with an ante-mortem diagnosis of pulmonary TB. However, multiple organ involvement by was demonstrated on autopsy. This case highlights the role of autopsy as a research and learning tool, and prudential clinico-pathologic correlation, which will improve clinical outcomes in the future.

Tuberculosis congénita, tras un enemigo oculto / Congenital tuberculosis, following a hidden enemy

La tuberculosis congénita es una enfermedad de baja ocurrencia, pero con alta morbimortalidad debido a que suele presentar signos inespecíficos, catalogándose a menudo solo como una sepsis neonatal. El diagnóstico correcto suele hacerse por los antecedentes maternos de síntomas graves en la gestación o de formas paucibacilares que se hacen reconocibles en el puerperio, incluyendo la ocurrencia de endometritis y síntomas pulmonares; también se identifica por las pruebas microbiológicas (baciloscopia, cultivos, pruebas genéticas). Radiográficamente el patrón más común es el miliar. En los laboratorios de sangre suele haber biomarcadores inflamatorios elevados, trombocitopenia y pruebas hepáticas anormales. El tratamiento farmacológico suele ser exitoso. Se presenta un caso de una recién nacida, hija de una madre paucibacilar, que fue tratada inicialmente como sepsis neonatal y mejoró luego de la terapia antituberculosa.

Congenital tuberculosis is a disease of low occurrence, but with high morbidity and mortality due to the nonspecific signs usually present but that are often classified only as a neonatal sepsis. A correct diagnosis is made by maternal history of severe symptoms during pregnancy or paucibacillary forms that become recognizable in the postpartum period, including the occurrence of endometritis and pulmonary symptoms. It is also identified by microbiological tests (baciloscopy, cultures, genetic assays). Radiographically, the most common pattern is of miliary lesions. In blood tests, elevated inflammatory biomarkers, thrombocytopenia and abnormal liver tests are found. Drug treatment is usually successful. We present a case of a female baby born from a paucibacillary mother, it was handled first as neonatal sepsis, and her improvement after antituberculous therapy.

Tuberculosis miliar con afectación pulmonar y articular

Se presenta un paciente de sexo masculino que consulta por dolor e impotencia funcional de cadera izquierda. Con los estudios radiográficos se decide una artrodesis coxofemoral y en el acto quirúrgico aparece una secreción con grumos blanquecinos donde se detectan bacterias positivas al Ziehl-Neelsen. La radiografía de tórax muestra un infiltrado miliar difuso en lóbulos superiores y senos costofrénicos libres. Recibe tratamiento antibacilar. El GeneXpert detecta Mycobacterium tuberculosis sin resistencia a rifampicina y en el líquido articular se aisla Mycobacterium tuberculosis utilizando el Método Automatizado Bactec MGIT TM320. El diagnóstico de tuberculosis extrapulmonar por técnicas moleculares y métodos automatizados acelera el desarrollo de micobacterias y permite confirmar la sospecha diagnóstica para una rápida y eficaz intervención terapéutica del paciente.

A male patient comes and consulted for pain and functional impotence of the left hip. With radiographic studies, a hip arthrodesis is decided during surgery and a discharge appears whitish lumps presenting a report Ziehl Neelsen Positive (+). The x- ray shows a diffuse miliary infiltrates in the upper lobes and free costophrenic breasts. He received Antibaciliar treatment. The GeneXpert detects Mycobacterium tuberculosis and rifampin resistance without in joint fluid is isolated Mycobacterium tuberculosis using the automated BACTEC MGIT TM320. The diagnosis of extrapulmonary tuberculosis by molecular techniques and automated methods accelerates the development of mycobacteria and confirm what has been suspected .The diagnosis allows a quick and effective therapeutic intervention.

A Case of Metastatic Tuberculosis Abscess Associated with Miliary Tuberculosis / 대한피부과학회지

No abstract available.

Airway compromise during central venous cannulation in an undiagnosed tubercular retropharyngeal abscess: A case report.

Central venous cannulation is often associated with complications during insertion even by expert’s hand and with the aid of ultrasound. We encountered a patient for central line insertion through the right internal jugular vein having a retropharyngeal abscess of tubercular origin. We accidentally punctured the abscess cavity leading to increased respiratory distress and subsequent need of intubation to the patient. This kind of complication during central line insertion has never been reported before. We intend to report such a case to alert everyone about the grave complications it can lead to and the methods to minimize them in the times ahead.

Tuberculosis miliar en una privada de libertad: presentación de un caso y revisión del tema / Miliary tuberculosis in a private of freedom: a case report and review of the literature

La tuberculosis es una de las enfermedades más antiguas conocidas por el hombre y una de las principales causas de muerte alrededor del mundo. Se estima que aproximadamente un tercio de la población mundial ha sido infectada por esta bacteria del complejo Mycobacterium tuberculosis, cuyo órgano diana es el pulmón, sin embargo se describe que hasta en un tercio de los casos puede haber compromiso de otros órganos. Una de las formas especiales de presentación de esta patología es la llamada tuberculosis miliar, que puede ser tanto pulmonar como extrapulmonar. En este artículo se expone el caso de una privada de libertad cuya autopsia se realizó en la sección de Patología Forense del Departamento de Medicina Legal de Costa Rica.

The tuberculosis is one of the oldest diseases known by mankind and one of the main causes of death around the world. It is estimated that approximately one third of the world population has been infected by this bacteria of the Mycobacterium tuberculosis complex, whose organ target is the lung, however it is described that even in one third of the cases can be affectation of other organs. One of the special forms of presentation of this pathology is the so-called miliary tuberculosis, which can be pulmonary or extrapulmonary. In this article we describe the case of a woman prisoner whose autopsy was performed in the Forensic Pathology Section of the Legal Medicine Department of Costa Rica.

Hepatitis granulomatosa en paciente con tuberculosis miliar: presentación de un caso / Granulomatous hepatitis in a patient with Miliary Tuberculosis: presentation of a case

La hepatitis granulomatosa como elemento inicial de una enfermedad tuberculosa es muy poco frecuente. El rendimiento de las pruebas para el diagnóstico de tuberculosis hepática resulta baja, siendo las principales causas de granulomatosis hepática las infecciones (tuberculosis, brucelosis, hongos, parásitos, etc). En la tuberculosis miliar, durante la diseminación hemática, que ocurre en el desarrollo de la primoinfección, el hígado es capaz de recibir y albergar una carga considerable de bacilos por sus características anatomofuncionales que se agrupan en forma de granuloma, que es un patrón de reacción inflamatoria crónica en el que predomina un tipo especial de célula denominada macrófago. Esto es causa frecuente de síndrome febril prolongado de causa sistémica, puede debutar con manifestaciones clínicas poco precisas. Se presentó un caso del sexo masculino que ingresa en el servicio de Medicina del Hospital Militar Docente Dr Mario Muñoz Monroy, de Matanzas, que ingresa por cuadro de fiebre de origen desconocido, que resultó ser por esta causa.

Granulomatous hepatitis as initial element of a tubercular disease is few frequent; the efficacy of the tests for diagnosing hepatic tuberculosis is low, being infections (tuberculosis, brucellosis, fungi, parasites, etc). The main cause of hepatic granulomatosis. during the hematic dissemination in the miliary tuberculosis, occurring in the development of primo-infection, liver is able of receiving and dwelling a considerable charge of bacilli due to its anatomic functional characteristics; they group in the form of granulomas, a pattern of chronic inflammatory reaction, in which there is a predomination of an special kind of cells called macrophages; it frequently causes a prolonged febrile syndrome and may start with little precise clinical manifestations. We present the case of a male patient entering the Medicine Service of the Military Hospital Dr Mario Muñoz Monroy of Matanzas, with a picture of unknown origin fever, resulting being originated by this cause.

Muerte por tuberculosis milliar / Death from miliary tuberculosis

Se describe el caso clínico de un anciano, en estado senil y desnutrido, quien presentaba síndrome febril prolongado, por lo que fue ingresado en el Hospital Clinicoquirúrgico Docente "Dr. Ambrosio Grillo Portuondo" de Santiago de Cuba, pero al efectuar los exámenes complementarios no se obtuvo un diagnóstico definitivo. Posteriormente tuvo descompensación cardiovascular y fue trasladado a la Unidad de Terapia Intensiva, donde se le realizó urgentemente una radiografía de tórax, la cual mostró lesiones características de tuberculosis milliar. En consecuencia, se interconsultó con especialistas de neumología y se decidió iniciar el tratamiento con drogas antituberculosas; sin embargo, el paciente falleció un día después de comenzada la terapia. La necropsia mostró una granulomatosis crónica inespecífica, cuyo resultado solo se confirmó 2 meses más tarde, cuando el cultivo de las secreciones bronquiales fue positivo (codificación 7) de Mycobacterium tuberculosis.

A case report of an elderly man in senile and malnourished state was described, who had prolonged febrile syndrome and was admitted to «Dr "Ambrosio Grillo Portuondo" Clinical and Surgical Teaching Hospital of Santiago de Cuba, but a definitive diagnosis could not be obtained with complementary tests. Later he had cardiovascular decompensation and was transferred to the Intensive Care Unit, where he underwent an emergent chest radiograph, which showed characteristic lesions of miliary tuberculosis. Consequently, pulmonary specialists were consulted and it was decided to start treatment with antitubercular drugs; however, the patient died a day after the beginning of therapy. The autopsy showed a nonspecific chronic granulomatosis, which results were only confirmed 2 months later, when the culture of bronchial secretions was positive (coding 7) for Mycobacterium tuberculosis.