Respuesta paradojal al tratamiento antituberculoso en una paciente con SIDA / PARODOXICAL RESPONSE TO ANTITUBERCULOSE TREATMENT IN A PATIENT WITH AIDS

La tuberculosis (TB) es una enfermedad infectocontagiosa de gran importancia en la salud pública y representa una de las 10 principales causas de muerte a nivel mundial. Una de las complicaciones del tratamiento antituberculoso es la respuesta paradojal, que se define como un empeoramiento clínico o la aparición de nuevas lesiones en un paciente que comienza un tratamiento antifímico. Esta reacción está mediada por una respuesta de hipersensibilidad a los antígenos de Mycobacterium tuberculosis. Suele aparecer entre 2 y 4 meses luego de iniciado el tratamiento antituberculoso, generalmente precedida por una mejoría inicial del cuadro. Se presenta una mujer con sida y tuberculosis ganglionar con respuesta paradojal a la terapéutica antimicobacteriana y se realiza una revisión bibliográfica del tema.

Tuberculosis (TB) is an infectious disease of great importance in public health and represent one of the 10 leading causes of death worldwide. One of the complication of the antituberculous treatment is the paradoxical reaction, which is defined as a worsening or the appearance of new lesions in a patient receiving antimicobacterial treatment. This paradoxical response is mediated by a hypersensitivity reaction to mycobacterial antigens. It usually appears between 2 and 4 months after initiation of tuberculosis treatment and is preceded by an initial improvement of the clinical condition. Here, we describe a woman with AIDS and lymph node tuberculosis with a paradoxical reaction to antimycobacterial therapy and the subject is reviewed.

Anal mycobacterial infections / Infecções micobacterianas do ânus

Abstract Background Mycobacterial infections are a serious public health problem worldwide. Involvement of the anal canal and perineum is very rare, but constitute an important differential diagnosis with other equally serious pathologies that may affect the region, such as malignant neoplasms and Crohn's disease. Objectives To conduct a literature review on mycobacterial infections of the perianal region considering the most recent information for diagnostic and therapeutic guidance of this disease. Methods Research was performed on the PUBMED and LILACS databases with the expressions Mycobacterium, Anal, Infection and Tuberculosis. We reviewed articles referring to series of treated cases, clinical reports and literature review published since 2005. Results Information was compiled on the epidemiology of mycobacterial infections; the clinical behavior of affected individuals; diagnostic options and their validity in clinical practice; and, finally, therapeutic options. Conclusions Mycobacterial infections of the anus and perineum are rare. The most common clinical presentations are the presence of ulceration and fistulization. The diagnosis involves more than one procedure for identifying the bacilli and should consider the presence of manifestations in more than one organ. The treatment is based on pharmacological intervention. Surgery is recommended for acute complications or chronic sequelae of the disease.

Resumo Introdução Infecções micobacterianas constituem um grave problema de saúde pública a nível mundial. As manifestações anoperineais são raras, mas constituem um importante diagnóstico diferencial com outras patologias igualmente graves que podem acometer a região, como as neoplasias malignas e a doença de Crohn. Objetivos Realizar um levantamento da literatura sobre infecções micobacterianas da região anoperineal, considerando as informações mais atuais para orientação diagnóstica e terapêutica dessa enfermidade. Métodos Foi realizada pesquisa nos bancos de dados PUBMED e LILACS com as expressões Mycobacterium, Anal, Infection e Tuberculosis. Foram revisados artigos referentes a séries de casos tratados, relatos clínicos e revisão da literatura publicada a partir de 2005. Resultados Foram compiladas informações sobre a epidemiologia das infecções micobacterianas; o comportamento clínico dos indivíduos afetados; opções diagnósticas e sua validade na prática clínica; e, por fim, opções terapêuticas. Conclusões Infecções micobacterianas da região anoperineal são raras. As apresentações clínicas mais comuns são a formação de ulceras e a fistulização. O diagnóstico envolve mais de um procedimento para identificação dos bacilos, e deve considerar a presença de manifestações em mais de um órgão. O tratamento é principalmente medicamentoso, sendo a cirurgia recomendada nas complicações agudas ou sequelas crônicas da doença.

Infecciones por micobacterias en otorrinolaringología: revisión de la literatura / Mycobacterial infections in otolaryngology: review

Las micobacterias constituyen un grupo de bacilos aeróbicos no capsulados y no móviles, algunos de los cuales son patógenos causantes de graves enfermedades en los mamíferos incluyendo tuberculosis y lepra. Chile, a pesar de pertenecer al grupo de países de baja prevalencia de tuberculosis en América, presentó un enlentecimiento en la curva de descenso de incidencia. Así mismo, se ha visto un aumento de micobacterias atípicas tanto en muestras pulmonares como extrapulmonares respecto a décadas anteriores. Por otra parte, las infecciones por micobacterias adquieren importancia en otorrinolaringología dado que la tuberculosis de cabeza y cuello representa alrededor del 10% a 35% de los casos de tuberculosis, siendo su localización más frecuente los ganglios linfáticos. La siguiente revisión abarcará los cuadros de infecciones por micobacterias en otorrinolaringología, sus manifestaciones clínicas, diagnóstico y tratamiento.

Mycobacteriums are a group of aerobic non-capsuled and non-mobile bacillus some of which can cause diseases in mammals such as tuberculosis and leprosy. Chile, despite belonging to the group of countries with low prevalence of tuberculosis in America, presented a slowing in the decline in incidence curve. At the same time there has been an increase in atypical mycobacterium in pulmonary and extrapulmonary samples, comparedto past decades. On the other hand infections by mycobacterium become important because the head and neck tuberculosis accounts for about 10%-35% of cases of tuberculosis, the most common site being the lymph nodes. The following review will cover mycobacterial infections in otolaryngology clinical manifestations, diagnosis and treatment.

Disseminated Mycobacterium fortuitum Infection Associated with Venous Access Device.

Mycobacterium fortuitum is an important opportunistic pathogen among the rapidly growing Mycobacteria. Disseminated disease occurs as a consequence of bacteremia linked to vascular catheters, which carry high morbidity and mortality when they occur in immuno-compromised patients. Conventional culture methods often miss these organisms since they may grow more slowly (after 48 h) and are dismissed as skin contaminants because of their morphological resemblance to diphtheroids on grams staining. We report a case of 10 months old child with primitive neuroectodermal tumor who developed disseminated disease with M. fortuitum that was related to an indwelling intravascular device. The isolates were confirmed as M. fortuitum by polymerase chain reaction based DNA sequencing targeting heat shock protein 65 gene. The child was treated with, rifampicin, ethambutol and azithromycin. The patient improved remarkably and became afebrile 2 days after institution of therapy and removal of the catheter. The treatment was given for 3 months.

Mycobacterium marinum infection: a case report

The infection by Mycobacterium marinum in humans is relatively uncommon. When it occurs, it mainly affects the skin, usually with a chronic, indolent and benign evolution. The diagnosis requires a high index of suspicion, and a significant delay may be observed between the first symptoms to the final diagnosis. This present case reports a M. marinum infection in an immunocompetent patient that had a chronic undiagnosed injury on the dominant hand for at least five years. The patient had several medical consultations, without proper suspicion, hampering adequate diagnostic investigation. Histopathology detected tuberculoid granulomas, but showed no acid-fast bacilli. The culture in appropriate medium and the polymerase chain reaction-restriction enzyme analysis (PRA)-hsp65 confirmed the diagnosis. Treatment with clarithromycin (1 g/day) for three months was effective. Although uncommon, this infection is a contact zoonosis. Therefore, it is important for clinicians to be aware of this diagnosis and properly guide preventable measures to professionals that are in risk group.

Mycobacteriosis in patients with breast implants: a case review from the Ivo Pitanguy Institute / Micobacteriose em implantes mamários: revisão da casuística do Instituto Ivo Pitanguy

INTRODUCTION: Reports of infections caused by rapidly growing mycobacteria during plastic surgery have increased in recent years despite improvements in techniques of asepsis/antisepsis and antibiotic prophylaxis. Infections occurring after the insertion of breast implants are a cause of patient morbidity and a significant problem for the surgeon. METHODS: Breast implant surgery cases complicated by mycobacterial infections at the Infirmary ward 38th of the Santa Casa da Misericórdia, Rio de Janeiro were retrospectively reviewed. A description of the current guidelines for the prevention and treatment of mycobacteriosis is included. Laboratory confirmed and clinically suspected cases were included in this study. RESULTS: Of 483 augmentation mammaplasty cases, 3 patients developed mycobacterial infections in the last 3 years. In 2 patients, there was a suspicion of infection that was not confirmed by laboratory data. CONCLUSIONS: Prophylaxis is fundamental for reducing the incidence of mycobacteriosis during plastic surgery procedures. However, the identification, diagnosis, and treatment of mycobacterial diseases are important to minimize the morbidity of this type of infection.

INTRODUÇÃO: Nos últimos anos, foram crescentes os registros de infecções por micobactéria de crescimento rápido em cirurgia plástica, mesmo com a melhoria dos métodos de assepsia/ antissepsia e da antibioticoprofilaxia. A infecção após inclusão de implantes mamários causa grande morbidade às pacientes e transtorno ao cirurgião. MÉTODO: Estudo retrospectivo dos casos de infecção por micobactéria de crescimento rápido da 38ª Enfermaria da Santa Casa da Misericórdia do Rio de Janeiro, após inclusão de implantes mamários, em que são apresentadas propostas de prevenção e tratamento da micobacteriose. Foram incluídos os casos confirmados laboratorialmente e os clinicamente suspeitos. RESULTADOS: Até o presente momento foram confirmados 3 casos de infecção por micobactéria, num total de 483 mamaplastia de aumento no decorrer de 3 anos. Em 2 pacientes, houve suspeita de infecção, porém sem confirmação laboratorial. CONCLUSÕES: A profilaxia é o pilar fundamental para a redução do impacto da micobacteriose em procedimentos de cirurgia plástica. Entretanto, saber identificar, diagnosticar e tratar corretamente a micobacteriose é de suma importância para minimizar a morbidade da paciente.

Comentarios clínicos acerca de las micobacteriosis pulmonares / Pulmonary mycobacterioses: clinical commentaries

Las micobacteriosis pulmonares son afecciones provocadas por micobacterias ambientales, de evolución crónica y clínicamente similares a la tuberculosis. Se analiza una serie de 26 casos asistidos en el Hospital Muñiz de la Ciudad de Buenos Aires, con una edad promedio de 59.2 años, 73.1% de sexo femenino y 80.1% de los casos de nivel socioeconómico mediano a alto. Se hallaron enfermedades predisponentes en el 88.5% de los casos (tuberculosis previa, EPOC, silicosis, reflujo gastroesofágico). Desde el punto de vista radiológico se observaron nódulos, bronquiectasias y cavidades pequeñas en 14 casos y lesiones bilaterales cavitarias extensas en 12. Se destacó la mayor frecuencia de Mycobacterium avium complex como patógeno, la mejor evolución de los pacientes con menor compromiso pulmonar y la de los afectados por M. avium en relación con otras micobacterias. Los fármacos más utilizados en el tratamiento fueron claritromicina y azitromicina, asociados a etambutol. La proporción global de curaciones fue baja (57.7%) pero superior en los casos provocados por M. avium (86.7%).

Infección diseminada por Mycobacterium malmoense en un paciente con SIDA / Mycobacterium malmoense infection in a patient with AIDS

Paciente varón de 56 años de edad con antecedentes de asma bronquial, que se transformó en el primer caso cubano de infección respiratoria con infiltración hepática por Mycobacterium malmoense.

Infección diseminada por BCG en la Región de Los Lagos, Chile: reporte de cinco casos clínicos / Disseminated infection by BCG in Región de Los Lagos, Chile: five cases report

The bacillus Calmette-Guerin (BCG) is the attenuated strain of Mycobacterium bovis used in developing countries for preventing serious forms of tuberculosis. The neonatal BCG vaccine is applied in countries with high prevalence of tuberculosis. Most of the vaccinated individuals develop no adverse reactions; although, some subjects show side effects due to a host altered immunity. These reactions range from a simple adenomegaly in the same side of BCG vaccine inoculation, to a spread infection, often fatal. A regional or systemic spread has been described in patients with secondary or primary immunodeficiencies and partial or total genetic defects of interleukin IL-12/23 and IFN-gamma called as a whole "Mendelian susceptibility to mycobacterial infections" (MSMD). We describe five patients infected with M. bovis BCG-diagnosed between 1995-2008, at the base hospital in the city of Puerto Montt, Region de Los Lagos, Chile. These patients have the clinical course of MSMD.

El bacilo Calmette-Guérin (BCG), es la cepa atenuada de Mycobacterium bovis utilizada en países en vías de desarrollo para la prevención de formas graves de tuberculosis. La vacuna BCG neonatal se administra en países con alta prevalencia de la enfermedad. La mayoría de los vacunados no presenta reacciones adversas, algunos evidencian reacciones secundarias a una inmunidad alterada del huésped. Dichas reacciones varían desde una simple adenomegalia ipsilateral a la inoculación de BCG, hasta una infección diseminada, a menudo mortal. La infección diseminada se ha descrito en pacientes inmuno deficientes secundarios, primarios y en pacientes con defectos genéticos del eje interleuquina 12-23 (IL12/23)-interferón gama (IFN-gamma ) denominados "Síndrome de predisposición mendeliana a infecciones micobacterianas" (PMIM). Describimos cinco pacientes con infección por M. bovis-BCG diagnosticados entre 1995-2008, en el Hospital Base de Puerto Montt, Región de Los Lagos, Chile que cumplen con los criterios del PMIM.

Mycobacteriosis in domestic dogs. Report of two cases in Sao Paulo, Brazil

Na clínica dermatológica veterinária por vezes atendem-se carnívoros domésticos com lesöes ulceradas de evoluçäo prolongada e, geralmente, rebeldes à terapia usual, que podem ser originárias de infecçöes por micobactérias do gênero Mycobacterium. Pela escassez de descriçöes na bibliografia brasileira, pelo inusitado das lesöes e pela resposta à terapia preconizada, descrevem-se dois casos de micobacteriose em caninos atendidos na FMVZ/USP. As cadelas (Pastor Alemäo, Doberman), adultas, apresentavam lesöes ulceradas graves, nas faces posteriores dos pavilhöes auriculares, de aspecto granulomatoso, exsudativas, recobertas por crostas hemorrágicas. Inexistiam linfoadenomegalia satélite e tampouco sintomas nos demais sistemas orgânicos. Complementaram-se os exames físico, hematológico e radiológico por curetagem das lesöes e biópsias de pele que foram entäo submetidas a exames histopatológico, bacteriológico (direto: técnicas de Holst-Mitchinson e Radhakrishna, Ziehl-Neelsen); cultivo (meios de Lowenstein-Jensen e de Stonebrink & Leslie), em diferentes temperaturas; teste de tuberculina (PPD mamífero e aviário). Demonstrou-se, na bacterioscopia e na histopatologia, a presença de bacilos ácido-álcool resistentes que näo cresceram nos meios de cultivo convencionais, mesmo quando submetidos a várias temperaturas distintas, bem como quadro tecidual piogranulomatoso típico. Após a interposiçäo da terapêutica tópica (soluçäo de Burrow, sal sódico de rifamicina) e parenteral (rifampicina) obteve-se flagrante melhora com remissäo do quadro lesional. Discutem-se a etiopatogenia do quadro e as condutas diagnóstica e terapêutica

Acción del agua del Volcán Copahue (Neuquén, Argentina) sobre micobacterias / Action of the Copahue volcano waters on mycobacteries

Se efectúa un estudio de la acción del agua del Volcán Copahue (AVC) sobre 14 cepas de micobacterias. Los tres ensayos utilizados para determinar resistencia o sensibilidad al agua dieron resultados coincidentes. Las Micobacterias no tuberculosas presentaron distintos grados de resistencia, en cambio M.tuberculosis, M. bovis y M.marinum mayor sensibilidad. Se complementa con breves estudios de la acción del AVC sobre el efecto pH, destrucción del "factor cuerda" de los bacilos, y pérdida de su actividad enzimática (catalasa y peroxidasa)