Morbi-mortalidad en pacientes con infección por Mycobacterium tuberculosis comprobada, y co-infección VIH-Tuberculosis en Hospital Roosevelt en Guatemala / Morbi-mortality in patients with proved Mycobacterium tuberculosis infections, co-infected and no co-infected with HIV, at Roosevelt Hospital in Guatemala

RESUMEN

Tuberculosis (TB) es la enfermedad oportunista más importante relacionada con VIH, provocando manifestaciones clínicas graves y con frecuencia diseminadas, y afección extrapulmonar. En Guatemala es la principal causa de muerte en pacientes con Sida. OBJETIVO: Determinar la morbi-mortalidad en pacientes hospitalizados con Tuberculosis en Hospital Roosevelt. MÉTODOS: Se incluyeron pacientes con diagnóstico comprobado por tests microbiológicos positivos para Mycobacterium tuberculosis, mayores de 12 años de edad, ingresados en los servicios de Medicina interna durante el año 2013. Se consideraron positivos los pacientes con frotes de ZN, prueba de PCR-RT (GeneXpert de Cepheid). Se colectaron los datos clínicos y epidemiológicos de los pacientes con un instrumento estandarizado de manera prospectiva, generándose una base de datos en Excel 2010 y realizando el análisis estadístico con SPSS21...(AU)

ABSTRACT

Introduction: Tuberculosis (TB) is the main opportunistic infection related to HIV, causing complex and serious disease, frequently, extra-pulmonary in HIV patients. In Guatemala it represents the main cause of death in AIDS patients and with an increased incidence in patients with other co-morbidities. OBJECTIVE: To determine the morbi-mortalily in admitted patients in internal medicine wards with tuberculosis at Roosevelt Hospital in Guatemala City. METHODOLOGY: Patients with proved infection by clinical and/or culture/PCR-RT positive to Mycobacterium tuberculosis were included, older than 12 years old, admitted to the internal medicine guards, which presented positive culture and/or ZN smears and/or PCR-RT (GeneXpert, Cepheid) positive tests in 2013. Clinical and epidemiological data were collected in a prospective manner, with a standardized instrument, generating an Excel 2010 data base that was analyzed by SPSS21. RESULTS: 200 patients were included, 61% males with man woman ratio of 1.51. 48% presented HIV coinfection. 54% of the patients aged 25 to 44 years old. 43% residents outside Guatemala City. The extra pulmonary TB was present in 65%. The highest mortality was observed in TB-HIV co-infected patients 30.2% versus 10. % in lung cases (p=0.001). 2.1% died in the first 24 hours after admission, 13.5% between 1-7 days; 14.6% after 7 days of hospital stay, (p=0.002). Regarding the CD4 count, the higher mortality index was shown in the cases <100cel/mL 28.12%, versus 2.08% in > 100 (p=0.0001). CONCLUSSIONS In a reference center like Roosevelt Hospital, the coinfection HIV-TB represents 48% of the TB cases. Mortality was higher in extrapulmonary TB and HIV patients with <100 CD4 counts