La Tuberculosis Urogenital en Cochabamba, Bolivia: incidencia, seguimiento microbiológico y del tratamiento antituberculoso / Urogenital Tuberculosis in Cochabamba-Bolivia: incidence, microbiological follow-up and monitoring of anti-TB treatment

Objetivo: describir la incidencia de tuberculosis urogenital (TBUG) en los dos centros de referencia diagnóstica del sistema de salud público del departamento de Cochabamba. Métodos: estudio transversal retrospectivo desde enero de 2013 a marzo de 2020; población de estudio: pacientes con sospecha de TBUG con solicitud de cultivo para BK. Recolección de datos: base de datos de los laboratorios y revisión de los expedientes clínicos. Resultados: se identificó a 2266 pacientes con sospecha clínica de TBUG a los que se les realizó cultivos de orina para TB; de los cuales 133 (5,87%) pacientes resultaron con cultivo positivo: 87 de sexo masculino (65,4%) y 46 de sexo femenino (34,6%); De estos, 115 pacientes no cuentan con un seguimiento completo clínico ni microbiológico, de los cuales el 83,3% tenía TB renal, 11,1% genital y 5,6% vesical; el 77,8 % presentaron síntomas del tracto urinario inferior, 33,3 % tenía algún tipo de comorbilidad y 1 requirió cirugía urológica. El tratamiento antituberculoso fue el estándar en el 100%, 1 presentó reacción adversa, pero ninguna resistencia ni defunciones asociadas al tratamiento. Discusión: la incidencia del 5,87% no es despreciable, debido a que se requiere un alto índice de sospecha y contar con el cultivo para el diagnóstico, seguimiento y finalización de la terapia y de este modo disminuir el daño irreversible que afectan la funcionalidad.

Objective: to determine the incidence of urogenital tuberculosis (UGTB) in the 2 diagnostic reference centers of Cochabamba. Methods: retrospective cross-sectional study from January 2013 to March 2020; Study population: patients with suspected UGTB with culture request for BK. Data collection: Laboratory database and review of clinical records. Results: 2266 patients with clinical suspicion of UGTB who had urine cultures for TB were identified; of which 133 (5.87%) patients were culture positive: 87 male (65.4%) and 46 female (34.6%); Of these, 115 patients do not have complete follow-up and only 18 patients were evaluated, of which 83.3% had renal TB, 11.1% genital and 5.6% bladder; 77.8% had lower urinary tract symptoms, 33.3% had some type of comorbidity and 1 required urological surgery. Antituberculosis treatment was standard in 100%, 1 presented adverse reaction, but no resistance or deaths associated with the treatment. Discussion: the incidence of 5.87% is not negligible, due to the fact that a high index of suspicion is required and to have the culture for diagnosis, follow-up and termination of therapy and thus reduce irreversible damage affecting functionality.

Disseminated Tuberculosis of Central Nervous System : Spinal Intramedullary and Intracranial Tuberculomas

As a cause of spinal cord compression, intramedullary spinal tuberculoma with central nervous system (CNS) involvement is rare. Aurthors report a 66-year-old female presented with multiple CNS tuberculomas including spinal intramedullary tuberculoma manifesting paraparesis and urinary dysfunction. We review the clinical menifestation and experiences of previous reported literature.

Isolated tubercular splenic abscess: Can we defer splenectomy? Our single experience with anti-tuberculous therapy alone.

Isolated splenic tuberculosis is an exceedingly rare clinical condition. Microbiological confirmation of diagnosis in such cases is quite difficult. We encountered the case of a 35-year-old female, who presented with persistent low-grade fever and weight loss. The CT scan of the abdomen revealed multiple hypodense splenic lesions. No primary focus of infection was detected in any other organs. Fine needle aspiration of splenic lesion revealed acid-fast bacilli on Ziehl-Neelsen stain. With anti-tuberculous therapy, the lesions regressed significantly in size. We stress that splenic tuberculosis should be considered as a diagnostic possibility even in immunocompetent individuals and choose combination antituberculous therapy as the first line treatment with consideration of splenectomy depending on response.

Study of Antituberculous Medications in Anthracofibrosis / 결핵

PURPOSE: An anthracofibrosis(AF), dark multiple anthracotic pigmentations combined with narrowing and obstruction of bronchi, was reported to be strongly related with past and active pulmonary tuberculosis. This study was performed to determine whether anti-tuberculous regiemens would be helpful in patients with anthracofibrosis who failed to demonstrate the evidences of pulmonary tuberculosis. METHODS: Twenty-two patients with multiple anthracotic pigmentations in bronchia mucosa with luminal narrowing were enrolled in this study. The bacteriological and histological findings for Mycobacterium tuberculosis was reviwed in each patients. They are composed of 8 males and 14 females ranging from 55 to 85 years old in age. RESULTS: The most common symptoms were coughing(73%, 16/22), followed by sputum(41%, 9/22), dyspnea on exertion (32%, 7/22), and hemoptysis(27%, 6/22). The evidence of pulmonary tuberculosis, defined by positive AFB smear or culture of Mycobacterium tuberculosis from sputum or bronchial washing fluid or histological findings of granuloma with caseous necrosis, were found in eleven patients(50%) and the others has showed no evidences. Among 11 patients without pulmonary tuberculosis, only one patient showed the evidences of pulmonary tuberculosis after 16 months, and the 8 patients still showed no evidence of pulmonary tuberculosis during follow-up periods of ranging from 8 months to 60 months. CONCLUSION: Beause the authracofibrosis is closely related to tuberculosis, it needs to find out extensively the evidences of tuberculosis in patient with authracofibrosis. Chemotherapy for tuberculosis should be administrated only with confirmation of tuberculosis on bacteriologic study.