Aspectos clínicos y epidemiológicos de los pacientes con tuberculosis extrapulmonar en la provincia de Santiago de Cuba / Clinical and epidemiological aspects of patients with extrapulmonary tuberculosis in Santiago de Cuba

Introducción: La tuberculosis es una infección bacteriana contagiosa, causada por el Mycobacterium tuberculosis, que afecta principalmente a los pulmones, pero puede propagarse a otros órganos. Objetivo: Describir las características clínicas y epidemiológicas de los pacientes con tuberculosis extrapulmonar en la provincia de Santiago de Cuba. Métodos: Se realizó un estudio descriptivo y retrospectivo de los 124 pacientes con tuberculosis extrapulmonar pertenecientes a la provincia de Santiago de Cuba, desde enero de 2007 hasta diciembre de 2017, registrados a través de la tarjeta de notificación de enfermedades de declaración obligatoria. La información se procesó de forma computarizada, a través del paquete estadístico SPSS, versión 20.0. Se utilizaron las frecuencias absolutas y relativas. Resultados: En la serie predominaron el sexo masculino (75,8 %) y el grupo etario de 30-44 años (35,5 %); asimismo, la forma clínica de presentación más frecuente resultó ser la pleural y el municipio con más afectados fue Santiago de Cuba, pero el mayor riesgo de enfermar por tuberculosis extrapulmonar lo presentaron los habitantes del municipio de Mella. Por otra parte, el factor de riesgo que más incidió fue el hábito tabáquico. Conclusiones: Las características clínicas y epidemiológicas encontradas no difieren del contexto epidemiológico mundial. Se observó un desplazamiento hacia edades más tempranas y el VIH no se consideró un factor determinante en la aparición de la enfermedad; igualmente, la sospecha clínica y epidemiológica de esta afección continúa siendo un pilar importante para el diagnóstico de las formas extrapulmonares, especialmente en la población de riesgo.

Introduction: Tuberculosis is a contagious bacterial infection, caused by the Mycobacterium tuberculosis that affects mainly the lungs, but it can spread to other organs. Objective: To describe the clinical and epidemiological characteristics of the patients with extrapulmonary tuberculosis in Santiago de Cuba. Methods: A descriptive and retrospective study of 124 patients with extrapulmonary tuberculosis belonging to Santiago de Cuba, was carried out from January, 2007 to December, 2017, registered through the notification card of diseases of obligatory declaration. The information was processed by computer, through the statistical package SPSS, version 20.0. The absolute and relative frequencies were used. Results: In the series the male sex (75.8%) and the 30-44 years age group (35.5%) prevailed; also, the most frequent clinical form of presentation was the pleural form and the municipality with more patients affected was Santiago de Cuba, but the higher risk of becoming sick due to extrapulmonary tuberculosis was in the municipality of Mella. On the other hand, nicotine addiction was the risk factor of more incidence. Conclusions: The clinical and epidemiological characteristics found don not differ from the world epidemiological context. A displacement toward earlier ages was observed and HIV was not considered a determining factor in the emergence of the disease; likewise, the clinical and epidemiological suspicion of this disorder continues being an important pillar for the diagnosis of extrapulmonary forms, especially in the risk population.

Tuberculosis pleural en un hospital del Noreste Argentino / Pleural tuberculosis in a hospital in Northeast Argentina

La tuberculosis (TB) pleural ocupa el primer lugar dentro de las localizaciones extrapulmonares. El objetivo de este trabajo fue estimar la proporción de TB pleural entre los casos de TB y caracterizar la forma de presentación, métodos de diagnóstico y evolución de los pacientes internados en el Servicio de Clínica Médica del hospital Ángela I. de Llano, Corrientes, Argentina, durante el período enero de 2011 a junio de 2014. Se realizó un estudio observacional y descriptivo. Fueron diagnosticados 10 pacientes con TB pleural. La edad media fue 48.5 ± 16.9 (16-63) años. El tiempo de evolución antes de la consulta fue 21.3 ± 11.6 (7-45) días. Todos fueron exudados unilaterales, con recuento celular de 2152 ± 687 (84-7000) células; 8 casos presentaron predominio linfocitario. El valor promedio de adenosina deaminasa (ADA) fue 92.7 ± 27.0 (60-150) UI/l. La baciloscopia del líquido pleural fue positiva en 4 casos; se obtuvo desarrollo de Mycobacterium tuberculosis en 3 casos. En el estudio histológico 3 presentaron granulomas caseificantes. Se registró un óbito. Si bien suele darse en hombres, de mediana edad, con un tiempo de evolución menor al mes, como un derrame pleural unilateral exudativo a predominio de linfocitos, el diagnóstico de certeza presenta sus limitaciones, por ende la clínica, la epidemiología, los estudios por imágenes, la anatomía patológica y los exámenes de laboratorio, como la determinación de los niveles de ADA, constituyen un aporte valioso para el diagnóstico.

Pleural tuberculosis ranks first in extrapulmonary sites. The aim of this study was to estimate the proportion pleural TB among TB cases, and characterize the presentation, diagnostic methods and outcomes of patients hospitalized in the Ángela I. de Llano hospital, Corrientes, Argentina, between January 1, 2011 and June 30, 2014. We performed a descriptive and observational study. Ten patients were diagnosed with TB pleural effusion. The mean age was 48.5 ± 16.9 (16-63) years. The average evolution time before the consultation was 21.3 ± 11.6 (7-45) days. All were unilateral, exudates, with cell count of 2152 ± 687 (84-7000) cells; 8 cases had lymphocyte predominance. The average value of adenosine deaminase determination (ADA) was 92.7 ± 27.0 (60-150) IU/l. The pleural effusion smear was positive in 4 cases; development of Mycobacterium tuberculosis was obtained in 3 cases; histologically, three presented caseating granulomas. One death was recorded. Although pleural TB usually occurs in male patients, middle-aged, as a unilateral exudative pleural effusion with lymphocytic predominance, with less than a month´s evolution, diagnostic certainty has its limitations, thus clinical suspicion, epidemiology, imaging, pathology and laboratory tests, and determination of adenosine deaminase levels, represent a valuable contribution to diagnosis.

Pleural tuberculosis in the state of Roraima, Brazil, between 2005 and 2013: quality of diagnosis / Tuberculose pleural no estado de Roraima no período de 2005-2013: qualidade diagnóstica

Objective: To evaluate the quality of diagnosis and the epidemiological profile of patients with pleural tuberculosis in the state of Roraima, Brazil, in order to provide technical support for the development and implementation of public policies to combat the disease. Methods: This was a cross-sectional study designed to determine the prevalence of pleural forms of tuberculosis in Roraima between 2005 and 2013 and to evaluate the diagnostic criteria used, as well as their determinants. This study was based on secondary data from the Brazilian Case Registry Database, including all reported cases of pleural tuberculosis in the state during the study period. Diagnoses based on bacteriological or histopathological confirmation were defined as high-quality diagnoses. Results: Among the 1,395 cases of tuberculosis reported during the study period, 116 (8.3%) were cases of pleural tuberculosis, accounting for 38.9% of all cases of extrapulmonary tuberculosis in the sample. The incidence rate of pleural tuberculosis did not follow the downward trend observed for the pulmonary form of the disease during the same period. The prevalence of cases with a high-quality diagnosis was 28.5% (95% CI: 20.4-37.6%). In a univariate analysis, none of the demographic or clinical characteristics collected from the database were found to have a significant impact on the outcome (as explanatory variables). Conclusions: The quality of the diagnoses in our study sample was considered unsatisfactory. Limited access to specific diagnostic methods might have contributed to these results.

Objetivo: Avaliar a qualidade dos diagnósticos e o perfil epidemiológico de portadores de tuberculose pleural no estado de Roraima, visando embasar tecnicamente o fomento e a aplicação de políticas públicas para o enfrentamento dessa doença. Métodos: Estudo transversal, desenhado para determinar a prevalência de formas pleurais da tuberculose em Roraima entre 2005 e 2013 e avaliar os critérios diagnósticos utilizados e seus determinantes. Este estudo foi baseado na revisão de dados secundários do Sistema de Informação de Agravos de Notificação, incluindo todos os casos notificados como tuberculose pleural no estado durante o período de estudo. Diagnósticos baseados em confirmação bacteriológica ou histopatológica foram definidos como de qualidade. Resultados: Dos 1.395 casos de tuberculose notificados no período do estudo, 116 (8,3%) foram da apresentação pleural, totalizando 38,9% das formas extrapulmonares na amostra. A taxa de incidência dessa apresentação clínica não acompanhou a tendência decrescente da forma pulmonar da doença no período. A prevalência de diagnósticos de qualidade encontrada foi de 28,5% (IC95%: 20,4-37,6%) e, na análise univariada, nenhuma variável explicativa dentre as características demográficas e clínicas coletadas do banco de dados tiveram um impacto significativo no desfecho (como variáveis explicativas). Conclusões: A qualidade dos diagnósticos na amostra estudada foi considerada insatisfatória. O acesso limitado a métodos diagnósticos específicos pode ter contribuído para esses resultados.

Tuberculose ativa entre profissionais de saúde em Portugal / Active tuberculosis among health care workers in Portugal

OBJETIVO: Determinar a incidência de tuberculose (TB) ativa em uma coorte de profissionais de saúde (PS). MÉTODOS: Estudo descritivo dos casos de TB ativa identificados entre 2005 e 2010 no rastreio de medicina do trabalho efetuado em 6.112 PS. Casos de TB ativa foram definidos como aqueles com identificação de Mycobacterium tuberculosis por microscopia direta ou cultura; aqueles com sintomas ou sinais clínicos de TB e granuloma necrotizante, detectado por histologia; e aqueles com achados radiológicos consistentes com TB ativa. RESULTADOS: Dos 6.112 PS avaliados, houve 62 casos de TB ativa (TB pulmonar, em 43; TB pleural, em 15; TB ganglionar, em 2; TB do pericárdio, em 1; TB cutânea, em 1). Sete PS estavam assintomáticos no momento do diagnóstico. Dos 62 casos de TB ativa, a doença ocorreu nos primeiros 10 anos de exposição ocupacional em 48 e nos primeiros 5 anos em 36. A maioria dos casos verificou-se em médicos e enfermeiros (22 e 21, respectivamente). CONCLUSÕES: O impacto da TB em PS em Portugal é elevado. Os médicos e enfermeiros são os PS com o maior risco de desenvolver TB ativa. Tal como relatado em estudos prévios, parece haver um risco mais elevado de desenvolver essa doença nos primeiros anos de exposição. Em países de elevada incidência, o rastreio de TB nos PS é importante no controle da transmissão dessa doença.

OBJECTIVE: To determine the incidence of active tuberculosis (TB) in a cohort of health care workers (HCWs). METHODS: Descriptive study of active TB cases identified in an occupational health screening of 6,112 HCWs between 2005 and 2010. Cases of active TB were defined as those in which Mycobacterium tuberculosis was identified by direct microscopy or culture; those in which there were symptoms or clinical signs of TB and necrotizing granuloma, as detected by histology; and those in which the radiological findings were consistent with active TB. RESULTS: Among the 6,112 HCWs evaluated, we identified 62 cases of active TB: pulmonary TB (n = 43); pleural TB (n = 15); lymph node TB (n = 2); pericardial TB (n = 1); and cutaneous TB (n = 1). Seven HCWs were asymptomatic at the time of diagnosis. Of the 62 cases of active TB, 48 developed within the first 10 years of occupational exposure in the workplace, 36 of those occurring within the first 5 years. Physicians and nurses accounted for the highest numbers of cases (22 and 21, respectively). CONCLUSIONS: In HCWs employed in Portugal, the TB burden is high. Physicians and nurses are the HCWs who are at the highest risk of developing active TB. We found the risk of developing this disease to be highest in the first years of exposure, as has been reported in previous studies. In high-incidence countries, TB screening of HCWs is important for controlling the transmission of this disease.

Morphological study of pathological lesions seen in pleural biopsies

To determine the frequency and types of different pathological lesions seen in pleural biopsies in our patients. This is a prospective study carried out in the Department of Pathology, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi. A total of 155 pleural biopsies over a period from 01st January 2007 to 30th June 2008 were reviewed. Haemotoxylin and Eosin [H and E] stained slides were examined to determine the various non- neoplastic and neoplastic lesions. Special stains were performed whenever required. Out of 155 cases of pleural biopsies, 110 cases were diagnosed as non-neoplastic lesions and 29 as neoplastic lesions. The remaining 16 cases were found inconclusive. The non-neoplastic lesions included chronic granulomatous inflammation consistent with tuberculosis 47 cases, chronic non-specific inflammation 42 cases and empyema 21 cases. Chronic granulomatous inflammation consistent with tuberculosis was found to be commonest non-neoplastic lesion with male predominance and maximum number of cases was seen in 2nd decade of life. Neoplastic lesions included adenocarcinoma 26 cases followed by undifferentiated small cell carcinoma, squamous cell carcinoma and malignant lymphoma each comprising single case. Adenocarcinoma was found to be commonest neoplastic lesion with slight female predominance and maximum number of cases was seen in 5th decade of life. The commonest non-neoplastic pleural biopsy lesion was found to be tuberculosis and the commonest neoplastic lesion was adenocarcinoma in pleural biopsy

Aspectos epidemiológicos da tuberculose pleural no estado de São Paulo (1998-2005) / Epidemiological aspects of pleural tuberculosis in the state of São Paulo, Brazil (1998-2005)

OBJETIVO: Analisar as características epidemiológicas e tendências quanto à incidência de TB pleural. MÉTODOS: Estudo descritivo, retrospectivo dos casos de TB reportados entre 1998 e 2005 e coletados do banco de dados do Sistema de Notificação de Tuberculose (Epi-TB) da Secretaria de Saúde do Estado de São Paulo. RESULTADOS: Foram notificados 144.347 casos novos de TB durante o período estudado. A forma pulmonar foi predominante (118.575 casos; 82,2 por cento). Das formas extrapulmonares (25.773 casos; 17,8 por cento), a pleural foi a mais referida (12.545 casos; 48,7 por cento). A incidência (por 100.000 habitantes) de todas as formas diminuiu, (49,7 em 1998 e 44,6 em 2005; R² = 0,898; p < 0,001), enquanto a incidência de TB pleural permaneceu estável (4,1 em 1998 e 3,8 em 2005; R² = 0,433; p = 0,076). A maior incidência de TB pleural ocorreu em pacientes do sexo masculino (2:1) entre 30 e 59 anos de idade. Dos 12.545 pacientes com TB pleural, 4.018 (32,0 por cento) apresentaram comorbidades: alcoolismo (9,5 por cento); HIV (8,0 por cento); diabetes (3,3 por cento); e doença mental (1,2 por cento). O diagnóstico referido fundamentou-se em métodos bacteriológicos (14,2 por cento) e histológicos (30,2 por cento), assim como outros não especificados (55,6 por cento). CONCLUSÕES: No estado de São Paulo, a TB pleural foi a forma extrapulmonar predominante, apresentando incidência estável no período entre 1998 e 2005, apesar da tendência de diminuição das formas pulmonares. A histologia e a bacteriologia definiram o diagnóstico em 44,4 por cento dos casos.

OBJECTIVE: To analyze the epidemiological characteristics of and trends regarding the incidence of pleural TB. METHODS: This was a retrospective descriptive study of TB cases reported between 1998 and 2005 and compiled from the Epidemiological Surveillance Tuberculosis System (Epi-TB database). RESULTS: A total of 144,347 new cases of TB were reported during the period studied. Pulmonary TB was the predominant form (118,575 cases; 82.2 percent). Among the extrapulmonary forms (25,773 cases; 17.8 percent), pleural TB was the form most often reported (12,545 cases; 48.7 percent). For all forms, the incidence (per 100,000 population) decreased (from 49.7 in 1998 to 44.6 in 2005; R² = 0.898; p < 0.001), whereas the incidence of pleural TB remained stable (4.1 in 1998 and 3.8 in 2005; R² = 0.433; p = 0.076). The highest incidence of pleural TB was found among males (2:1) aged from 30 to 59 years. Of the 12,545 patients with pleural TB, 4,018 (32.0 percent) presented comorbidities: alcoholism (9.5 percent); HIV (8.0 percent); diabetes (3.3 percent); and mental illness (1.2 percent). The diagnosis was based on bacteriological (14.2 percent) and histological (30.2 percent) methods, as well as on unspecified methods (55.6 percent). CONCLUSIONS: Pleural TB was the predominant extrapulmonary form of TB in the state of São Paulo, with a stable incidence between 1998 and 2005, although there was a trend toward a decrease in the incidence of the pulmonary forms. The diagnosis of pleural TB was confirmed through histology and bacteriology in 44.4 percent of the cases.

Clinical Manifestations and Diagnosis of Extrapulmonary Tuberculosis

Since the diagnosis of extrapulmonary tuberculosis (EPT) is largely depended on the physician's suspicion in respect of the disease, we believed that it would be worthwhile to scrutinize the clinical characteristics of EPT. Thus, here we present retrospectively evaluated clinical manifestations of patients who were diagnosed as EPT cases in a tertiary referral care hospital. Medical records of 312 patients, diagnosed as having EPT at Yongdong Severance hospital from January 1997 to December 1999, were reviewed retrospectively. In total 312 patients, 149 (47.8%) males and 163 (52.2%) females aged from 13 years to 87 years, were included into this study. The most common site of the involvement was pleura (35.6%). The patients complained of localized symptoms (72.4%) more frequently than systemic symptoms (52.2%). The most common symptom was pain at the infected site (48.1%). Leukocytosis, anemia, and elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were found in 12.8%, 50.3%, 79.3% and 63.1% of the patients, respectively. Twenty-four percent of the patients had underlying medical illnesses such as, diabetes mellitus or liver cirrhosis, or were over 60 years old. In 67.3% of patients, tuberculosis was suspected at the initial visit. However, tuberculosis was microbiologically proven in only 23.7% of the patients. The time interval from the symptom onset to the diagnosis varied, with the mean duration of the period 96 days. Pulmonary parenchymal abnormal lesions were found in 133 patients (42.6%) on chest radiographs. EPT has a wide spectrum of clinical manifestations, so it is difficult to diagnose it. Based on our studies, only 11.2% of the patients were confirmed as EPT. So it is important that the physician who first examines the patient should have a high degree of suspicion based on the chest radiography, localized or systemic symptoms and several laboratory parameters reviewed in this study.

Prevalência de tuberculose pleural no ambulatório de pleurologia do Hospital Universitário Antônio Pedro / Prevalence of tuberculosis pleuritis in unit pleural diseases of the Antônio Pedro Hospital

Introdução: Estudo da prevalência de tuberculose pleural no Ambulatório de Pesquisa em Doenças Pleurais do Hospital Universitário Antônio Pedro, Niterói, RJ, entre março de 1994 e dezembro 1998. Métodos: Todos os pacientes encaminhados para procedimentos e exames que esclarecessem o diagnóstico da causa da síndrome do derrame pleural. Resultados: Um total de 218 pacientes foi avaliado. Tuberculose: 122 pacientes (56,0), limite de idade: 8 - 80 anos; transudato: 27 pacientes (12,0), 42 - 81 anos; adenocarcinoma: 23 pacientes (11,0), 18 - 79 anos; linfomas: 5 pacientes (2,0), 26 - 76 anos; carcinoma indiferenciado: 1 paciente (1,0), 18 anos; carcinoma escamoso: 2 pacientes (1,0), 71 anos cada um; empiema pleural não tuberculoso: 12 pacientes (5,0), 21 - 73 anos; parapneumômico: 10 pacientes (4,0), 9 - 44 anos; infarto pulmonar: 8 pacientes (4,0), 33 - 78 anos; lupus eritematoso sistêmico: 4 pacientes (2,0), 17 - 35 anos; quilotórax: 3 pacientes (1,0), 36 - 44 anos e hemotórax: 1 paciente (1,0) de 35 anos. Conclusão: A prevalência de tuberculose pleural foi de 56,0, com intervalo de confiança, a 95de probabilidade, entre 47,1a 64,8.

Diagnóstico da tuberculose pleural pela ADA, isolada ou combinada a outras variáveis, inclusive em HIV-positivos / Diagnosis of pleural tuberculosis by ADA, isolated or combined with other variables, incluing in HIV positive patients

A tuberculose pleural (TBP) é a de maior incidência entre as formas extrapulmonares e, provavelmente, o diagnóstico mais freqüente dos derrames pleurais observados no Brasil, justificando os estudos para se estabelecerem métodos diagnósticos rápidos e acessíveis. Neste trabalho foi dimensionado o volume da atividade da adenosina deaminase (ADA), isolada ou combinada a outras variáveis de fácil acesso, baixo custo e simples obtenção no diagnóstico da TBP, inclusive em infectados pelo HIV. Trata-se de estudo retrospectivo e seqüencial, avaliando os resultados de punção pleural diagnóstico realizada em dois tempos (toracocentese e biópsia pleural). Pleuris não-tuberculoso (PNT) foi diagnosticado quando presentes três parâmetros entre história clínica, radiologia, bioquímica e citologia do líqüido pleural, anatomopatologia e outros. As três variáveis selecionadas para avaliação combinada com a ADA foram: concentração de proteínas (CPT), taxa de linfócitos (TLT) no líquido pleural e idade dos doentes (IDD). Os resultados foram analisados estatisticamente pelos testes do qui-quadrado (X2) e t de Student. Os níveis de corte foram definidos pela maximização da sensibilidade e especificidade por meio da curva ROC, avaliados os valores diagnósticos e a contribuição independente no diagnóstico etiológico da TBP pela regressão logística múltipla das quatro variáveis. Foram estudados 417 pacientes maiores de 14 anos portadores de derrame pleural (excluídos os empiemas) matriculados no Instituto Clemente Ferreira (ICF) em São Paulo no período de 1990 a 1994. Destes pacientes 268 estavam com TBP, dos quais 47 HIV-negativos e 21 positivos e 149 com PNT, sendo 33 HIV-negativos e 8 positivos. Os valores médios das variáveis analisadas apresentaram diferenças estatisticamente significantes entre os pacientes com TBP e PNT. Os níveis de corte estabelecidos pela curva ROC foram de > 30 U/L para a ADA, de > 4,5 g/dL para a CPT, de > 90 por cento para a TLF e < 45 anos para a IDD. A sensibilidade, a especificidade o valor preditivo positivo, o valor preditivo negativo e a acurácia encontrados foram, respectivamente: para a ADA = 94, 95, 97, 89 e 94 por cento; para a CPT = 80, 64, 80, 64 e 74 por cento para a TLF = 73, 67, 80, 58 e 71 por cento e para a IDD = 77, 69, 77, 69 e 75 por cento. No modelo de regressão logística múltipla a ADA > 30 U/L se associou ao diagnóstico etiológico da TBP com uma razão de chance de 184 vezes...

Tuberculosis: formas clínicas y prevalencia / Tuberculosis: clinical forms and prevalence

Con el objeto de determinar la forma de presentación de la Tuberculosis (TBC) en la población internada en el servicio de Clínica Médica del Hospital Rivadavia se revisaron 2086 historias clínicas correspondientes a todos los pacientes (p) internados en las salas X, VII y I desde el 1/1/1994 al 31/12/1996. Se detectaron 105 casos que corresponden al 5,03 por ciento de los internados. La forma clínica de presentación fue pulmonar en el 58 por ciento (61 p) seguida de TBC pleural en el 22 por ciento (23 p) y menos frecuentes las formas ganglionares 11,4 por ciento (12 p), digestiva 3,8 por ciento (4 p), laríngea 2,8 por ciento (3 p) y ósea 1,9 por ciento (2 p). De los 105 casos 51 (49 por ciento) fueron confirmados por bacteriología positiva y 29 (27 por ciento) por anatomía patológica y en los 25 restantes (24 por ciento) se realizó tratamiento empírico. El rango de edad fue de 16 a 83 con un promedio de 34 y una media de 31 años. 22 pacientes presentaron serología positiva para HIV. En estos pacientes el diagnóstico se realizó clínicamente en el 45 por ciento de los casos (10 p), a través de biopsias en el 32 por ciento (7 p) y por bacteriología en el 23 por ciento de los casos (5 p). La forma de presentación más frecuente en pacientes con SIDA fue la extrapulmonar, representando el 56 por ciento de los casos (9 p). La evolución fue favorable en todos los grupos. Sin embargo de los pacientes con diagnóstico confirmado fallecieron 3 pacientes por enfermedades asociadas (insuficiencia cardíaca, mieloma múltiple y artritis reumatoidea asociada a lupus eritematoso) y 1 paciente con SIDA probablemente resistente al tratamiento. De los pacientes tratados empíricamente 1 paciente con SIDA desarrolló meningitis y falleció y en 2 pacientes se replanteó el diagnóstico inicial.

Relación entre los niveles de adenosina deaminasa y desarrollo de engrosamiento pleural residual en tuberculosis pleural

Introducción: el engrosamiento pleural residual (EPR) es frecuente en tuberculosis pleural (TBCP) y no es claro si puede pronosticarse con la toracentesis inicial. Objetivo: evaluar la relación entre los índices de inflación y la activación linfocitaria pleural especialmente la adenosina deaminasa (ADA) y el desarrollo de EPR en TBCP. Tipo de estudio: observacional analítico de cohorte prospectiva. Lugar de estudio: programa de tuberculosis en el hospital de referencia. Material y métodos: pacientes con diagnóstico de TBCP a quienes se les realizó toracentesis incluyendo determinación de ADA y fueron tratados y controlados sin recibir glucocorticoides. Se definió EPR con métodos radiológicos. Los datos se recolectaron en forma prospectiva. La relación entre predictores y EPR se evaluó con prueba no paranétrica con una p<0,01 de significativa. Resultados: durante 48 meses, 57 pacientes cumplieron los criterios de inclusión; el diagnóstico se realizó en 84 por ciento con biopsia pleural. Se desarrolló EPR en 33 pacientes (58 por ciento) y no hubo EPR en 24 (42 por ciento). Los valores de LDH, proteínas, porcentaje de linfocitos y concentración de glucosa fueron similares en ambos grupos. La concentración de ADA fue similar (grupo con EPR:97 más menos 48; grupo sin EPR: 106 más menos 45; p=0,48, Mann-Whitney) en los dos grupos y no se encontró un punto de corte con apropiada discriminación para pronosticar EPR. Conclusión: en este grupo de pacientes ningún hallazgo de la toracentesis inicial se relacionó con el desarrollo de EPR. Los resultados son similares a los informados por otros investigadores, pero es la primera vez que se describen para el nivel de ADA pleural

Analysis of status of surgery in thoracic tuberculosis.

A retrospective analysis of the surgical procedure in 1655 patients in twenty years in a university hospital for thoracic tuberculosis revealed that the varieties of procedures were necessary in 2.2% cases only. They can be grouped as tubercular empyema with or without bronchopleural fistula in 1507 (91%), complicated pulmonary tuberculosis in 78 (4.7%), cold abscess in the chest wall with or without lymphadenitis in 54 (3.2%) and osteomyelitis of the ribs and sternum in 16 cases (0.9%). This is statistically significant with a confidence interval of 0.1248 to 0.2348. In tubercular empyema 222 procedures were performed of which 162 were minor procedures, intercostal drainage with irrigation: 89 cases, thoracostoma: 56 cases and continuous chest wall tube 17 cases and 60 were major procedures (decortication in 45 cases, thoracoplasty [modified] in 14 cases and muscle transfer in one case). All the above procedures were preceded by an intercostal drainage. In complicated pulmonary tuberculosis the operative procedures were as follows: lobectomy in 33 cases, pneumonectomy in 35 cases and thoracoplasty in 10 cases. Drainage of cold abscess with or without lymphnode resection was performed in 54 cases and in 16 cases of osteomyelitis of the ribs and sternum resection were necessary. All procedures were performed under the cover of antitubercular therapy and supportive treatment with the aim of resolution of process, obliteration of the empyema space, control of sepsis and improvement of activity performance. The morbidity was extensive and mortality was high in major procedures. Good results could be obtained in over 92% cases, and only 66.2% on major surgery cases.

Tuberculous disease in a pediatric referral centre: 16 years experience.

Children with evidence of tuberculous disease registered at the TB Clinic, Institute of Child Health, Madras during the years 1977 to 1992 were analyzed. Progressive primary complex, is the commonest thoracic form of tuberculosis while tuberculous meningitis is the commonest extra thoracic form. The overall prevalence of various clinical forms of tuberculosis has decreased over the last 16 years. There is an increasing trend in the prevalence of progressive primary complex among the BCG vaccinated group. The prevalence of pleural effusion, bone tuberculosis and abdominal tuberculosis is almost same over the last 16 years and is more in the BCG non vaccinated children. In tuberculous adenitis there is no significant variation between the two groups. The occurrence of tuberculous meningitis is in the ratio of 1:3 among BCG vaccinated and non-BCG vaccinated children. Though the prevalence of miliary tuberculosis is negligible, it is significantly more in BCG non-vaccinated children. There is a tendency for slight decrease in overall mortality due to tuberculosis in the last 10 years but the mortality due to tuberculous meningitis continues to be the same over the past 16 years.

Valor diagnóstico de la adenosín deaminasa en pacientes con pleuritis tuberculosa en la ciudad de Medellín 1991-1993

Se realizó un estudio observacional, descriptivo y prospectivo en 145 pacientes: 88 con diagnóstico de tuberculosis pleural confirmado por medio de cultivo o biopsia y 57 con derrame pleural no tuberculoso. Fue practicado en varias instituciones de salud de la ciudad de medellín durante el período de 1991-1993, con el fin de valorar la utilidad de la adenosín deaminasa en el diagnóstico de tuberculosis pleural. Se obtuvo para dicha prueba una sensibilidad de 92.04 por ciento y una especificidad de 89.47 por ciento, mostrando que la adenosín deaminasa es una importante herramienta diagnóstica de bajo costo en nuestro medio

Contribuiçäo ao estudo da tuberculose pleural / Contribution to the study on pleural tuberculosis

Estudo da tuberculose pleural realizado por meio de revisäo bibliográfica e análise de levantamentos de dados, que se inicia com análise da pleura, e prossegue com estudo dos derrames pleurais, salientando a análise do líquido pleural, além da influência do derrame na funçäo pulmonar. Posteriormente, estuda o derrame pleural tuberculoso (DPT), considerando sua patogenia, seus aspectos clínico-epidemiológicos, com destaque para o estudo comparativo entre os dados da literatura e dos levantamentos, alguns dos seus principais aspectos imunológicos, e à análise do líquido pleural com suas alteraçöes bioquímicas, histológicas e bacteriológicas. Analisa também seu tratamento, associaçäo com a Síndrome de Imunodeficiência Adquirida (SIDA) e métodos diagnósticos mais recentes. Ressalta que a punçäo-biópsia com retirada de líquido e de fragmentos de pleura para exames histológicos e bacteriológicos é que fornece o diagnóstico de certeza. Recomenda que, em lugares com poucos recursos, pode-se considerar o diagnóstico presuntivo baseado na história clínico-epidemiológica, no exame físico e na radiografia do tórax com boa chace de acerto

Infección por VIH en pacientes tuberculosos / Hiv infection in tuberculosis patients

Entre junio 1992 y junio 1993 a 117 tuberculosos varones internados en el Hospital Tornú, en Buenos Aires se les efectuó el test VIH. Tenían entre 19 y 50 años de edad. Fueron VIH reactivos 25 enfermos (21,3 por ciento). De los 25 positivos, 21 eran tuberculosospulmonares, 3 pleuropulmonares y 1 ganglionar. La reacción de la tuberculínica (PPD) fue positiva en 8 y negativa en 17. Habían enfermedades asociadas en 16 casos; Pneumocistis carinii en 4, candidiasis en, lues en 3, hepatitis C en 4, Criptococosis en 1, micosis en 1, asma en 1, anemia en 1, hepatitis crónica en 1. En el conteo inicial de linfocitos TCD4 en sangre se efectuó en 8 casos, 4 tenían menos 200 por mm3. El tratamiento de la tuberculosis dio el siguiente resultado: curados 5, evolución favorable 11, fallecidos 2, evolución desconocida 7. Las reacciones adversas a las drogas fueron similares a las de los tuberculosos no reactivos. En resumen, nos ha llaamado la atención el elevado porcentaje de VIH reactivos en la población de tuberculosos varones atendidos en el Hospital Tornú en 1 año. En l986-87, el mismo estudio efectuado en 100 tuberculosos varones dio un 5 por ciento de VIH reactivos