El dilema en los laboratorios de Koch, ¿Cultivar o no Cultivar? / The Dilemma in Koch's Laboratories, To Cultivate or Not to Cultivate?

La nueva norma técnica para el control y la eliminación de la tuberculosis es un gran avance para el diagnóstico de este microorganismo en Chile. Actualmente la principal técnica microbiológica para el diagnóstico de laboratorio es la biología molecular, que reduce el tiempo del resultado a tan solo un par de horas. La normativa actual indica que en el paciente caso presuntivo de tuberculosis (CPT) la técnica exclusiva a realizar es Biología molecular. La literatura indica que la detección a través de amplificación de material genético de la micobacteria tiene un límite de detección de 15,6 UFC/ ml, por tanto, todas las muestras bajo ese límite umbral potencialmente podrían no ser diagnosticadas bajo esta estructura emanada por el ministerio de Salud en Chile. Nuestra recomendación es continuar con el estudio de cultivo en medios líquidos o sólidos para todas las muestras hasta obtener literatura que avale lo contrario

The new technical standard for the control and elimination of tuberculosis in Chile is a great advance for the diagnosis of this microorganism. Currently the main microbiological technique for laboratory diagnosis is PCR, which reduces the time to result to just a couple of hours. The current regulations indicate that in the patient with a presumptive case of tuberculosis (CPT) t he exclusive technique to be performed is PCR. The literature indicates that the detection through amplification of genetic material of the mycobacterium has a detection limit of 15.6 CFU/ml, therefore, all samples under this threshold limit could potentially not be diagnosed under this structure emanated by the Ministry of Health in Chile. Our recommendation is to continue with the study of culture in liquid or solid media for all samples until literature confirms otherwise

Escrofuloderma: tuberculosis cutánea y pulmonar asociada a coinfección COVID-19: reporte de caso / Scrofuloderma, cutaneous and pulmonary tuberculosis associated with COVID-19: report of one case

Cutaneous tuberculosis represents 1-1.5% of extrapulmonary tuberculosis, including a variety of clinical conditions. Scrofuloderma and lupus vulgaris are the most common forms. We report a 49-year-old woman who sought medical attention through tele-dermatology concerning a cervical nodule associated with suppuration and cutaneous involvement. The diagnoses of scrofuloderma and pulmonary tuberculosis were confirmed, and during her evolution she presented a coinfection with SARS-CoV-2. The possible associations between tuberculosis and COVID-19 were reviewed.

Caracterización socio-epidemiológica y evolución de la tuberculosis en la Región Metropolitana de Chile, 2005 a 2018 / Socio-epidemiological caracterization and evolution of tuberculosis in the Metropolitan Region of Chile, 2005 to 2018

Resumen Introducción: El Programa chileno de Control y Eliminación de Tuberculosis (PROCET) ha permitido reducir la mortalidad por esta enfermedad en 78%, entre los años 2004 y 2013. No obstante, luego de décadas de resultados exitosos, a partir del 2000 ocurrió un enlentecimiento en la reducción de incidencia y desde el 2014, un aumento de ésta. Objetivos: Describir la evolución socio-epidemiológica de los casos de tuberculosis (TBC), desde 2005 al 2018, estratificando según país de origen, en Servicios de Salud de la Región Metropolitana (RM). Métodos: Estudio transversal con componente ecológico. Se consideraron las variables: edad, sexo, localización de la TBC, confirmación bacteriológica, co-infección con VIH, privación de libertad, país de procedencia y efectividad de la terapia anti-tuberculosis. Resultados: Se notificaron 7.507 casos, de los cuales 75,1% fue de localización pulmonar y 65,4% bacteriológicamente demostrado. Un 19,0% de los casos pertenecieron a personas no nacidas en Chile, con un aumento de esta proporción en los últimos seis años. Las tasas de incidencia, descendientes en la primera mitad del período, exhibieron un alza a partir del 2012, alejándolas del umbral de eliminación. Se observó en 74,3% éxito en la terapia y 13,4% de muerte en los casos evaluados. Conclusiones: En los últimos años, la incidencia de TBC en la RM aumentó. Los nuevos grupos vulnerables, especialmente los migrantes, requieren con urgencia, que se implementen y refuercen estrategias como la educación, pesquisa activa y acciones de control de TBC.

Abstract Background: The Chilean Program for the Control and Elimination of Tuberculosis (PROCET) has reduced mortality from this disease by 78% between 2004 and 2013. However, after decades of successful results, starting in 2000 there was a slowdown in the reduction of incidence and since 2014, an increase in it. Aim: To describe the socio-epidemiological evolution of tuberculosis (TB) cases treated at health clinics in the Metropolitan Region (MR) of Chile from 2005 to 2018, stratifying by country of origin. Methods: Cross-sectional study with ecological components, including analyses of age, sex, TB localization, bacteriological confirmation of diagnosis, co-infection with HIV, incarceration, country of origin, and effectiveness of tuberculosis treatment. Results: A total of 7,507 TB cases were recorded during the study period; 75.1% of cases were pulmonary tuberculosis, and 65.4% were bacteriologically confirmed. Overall, 19.0% of cases involved persons born outside of Chile, with the proportion of cases in foreign-born persons increasing over the past 6 years. Incidence decreased during the first half of the study period but then began to increase after 2012, moving the country away from the threshold of elimination. A total of 74.3% of cases were treated successfully, and 13.4% expired. Conclusion: In recent years, TB incidence has increased in the MR of Chile, possibly attributable to growing populations of vulnerable groups such as immigrants. This finding suggests an urgent need to implement and reinforce strategies such as education, an active screening model and more efficient contact tracing to prevent the spread of TB.

Evolución de la coinfección por TB/VIH en la Región Metropolitana de Chile, 2005 a 2018 / Evolution of tuberculosis/HIV coinfection in Metropolitan Santiago, Chile from 2005 to 2018

Background: Tuberculosis (TB)/HIV coinfection has a high mortality rate. Aim: To describe socio-epidemiological characteristics of tuberculosis (TB)-HIV coinfection, and aspects associated with its prevalence, from 2005 to 2018. Material and Methods: Analysis of the registry of the tuberculosis control and elimination program of three public health services of metropolitan Santiago. The variables considered were: TB/HIV coinfection, age, sex, location of tuberculosis, bacteriological confirmation, incarceration, commune of residence, country of origin and effectiveness of the tuberculosis therapy. Results: We analyzed 7507 TB cases, of whom 12% corresponded to cases of coinfection. The number of coinfections doubled in the last 6 years. In 2018, 45% of coinfection cases occurred in migrants. Of the total cases evaluated, 53% were successfully treated and 28% died. Conclusions: The remarkable increase in TB/HIV coinfection, urgently demands new prevention and control strategies, aimed at the most vulnerable groups.