ABSTRACT
UNLABELLED: The decision related to treatment initiation in smear-negative pulmonary TB is controversial. To determine differences between the characteristics of smear-negative, culture-positive pulmonary TB (Group D-) cases, we compared them with those patients who presented positive smear microscopy and cultures (Group D+). In addition, we compared the characteristics found in Group D- cases, in whom the treatment was started before confirmation by culture (sub-group D-TI) with those who were treated only after a positive culture was obtained (subgroup D-TD). We compared 270 patients of Group D+ with 48 of Group D-. The subgroups of Group D- (D-TI and D-TD) were compared with Group D+. Clinical symptoms, history, X-rays, other lung diseases and related extrapulmonary diseases were analysed Significant differences between groups D+ and D- related to age, history, X-rays and other lung diseases were found. There were no significant differences between Group D+ and subgroup D-TI, except for the age. The same and even more accentuated differences between Group D+ and D- were found between Group D+ and subgroup D-TD. CONCLUSIONS: Group D- was divided into to subgroups: D-TI, similar to D+, determined the decision to immediately start the treatment and D-TD, completely different; other possible diagnoses were considered and decision of treatment was delayed until a positive culture was obtained. This conduct proved to be the correct one in these cases where the diagnosis by culture was available.
Subject(s)
Tuberculosis, Pulmonary/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Mycobacterium tuberculosis/isolation & purification , Tuberculosis, Pulmonary/microbiology , Tuberculosis, Pulmonary/therapyABSTRACT
Pulmonary toxicity associated with gold salt treatment of rheumatoid arthritis is unusual. Only 60 cases had been reported before 1986. This disorder consists primarily of pulmonary interstitial involvement, characterized by hypersensitivity pneumonitis which can lead to variable degrees of pulmonary fibrosis. However, this disease has a good prognosis if treated properly with the simple interruption of gold salts or with corticosteroids, with complete cure in the majority of cases. A case with good response to corticosteroid therapy is reported and the differential diagnosis with pulmonary fibrosis associated with rheumatoid arthritis is analyzed.
Subject(s)
Alveolitis, Extrinsic Allergic/chemically induced , Gold/adverse effects , Alveolitis, Extrinsic Allergic/drug therapy , Arthritis, Rheumatoid/drug therapy , Female , Gold/therapeutic use , Humans , Middle Aged , Prednisone/therapeutic use , PrognosisABSTRACT
Pulmonary toxicity associated with gold salt treatment of rheumatoid arthritis is unusual. Only 60 cases had been reported before 1986. This disorder consists primarily of pulmonary interstitial involvement, characterized by hypersensitivity pneumonitis which can lead to variable degrees of pulmonary fibrosis. However, this disease has a good prognosis if treated properly with the simple interruption of gold salts or with corticosteroids, with complete cure in the majority of cases. A case with good response to corticosteroid therapy is reported and the differential diagnosis with pulmonary fibrosis associated with rheumatoid arthritis is analyzed.
ABSTRACT
La toxocidad pulmonar por la sales de oro usadas en el tratamiento de la artritis reumatoidea es exepcional. Sólo 60 casos han sido recopilados en la literatura mundial hasta 1986. La afección consiste fundamentalmente en patología pulmonar intersticial, caracterizada por una neuromonitis por hipersensibilidad que puede llevar a grados variables de fibrosis pulmonar. Sin embargo, esta afección tratada oportunamente tiene buen prognóstico, ya que con la simple suspensión de las sales de oro o la administración conjunta de corticoides, la lesión revierte en la mayoría de los casos en su totalidad. Se presenta un caso con buena respuesta a la terapéutica coricoidea y se analizan las diferencias con la fibrosis pulmonar asociada a la artritis reumatoidea (AU)
Subject(s)
Humans , Middle Aged , Female , Gold/adverse effects , Pneumonia/chemically induced , Arthritis, Rheumatoid/drug therapy , Gold/therapeutic use , Pneumonia/drug therapy , Prednisone/therapeutic use , PrognosisABSTRACT
La toxocidad pulmonar por la sales de oro usadas en el tratamiento de la artritis reumatoidea es exepcional. Sólo 60 casos han sido recopilados en la literatura mundial hasta 1986. La afección consiste fundamentalmente en patología pulmonar intersticial, caracterizada por una neuromonitis por hipersensibilidad que puede llevar a grados variables de fibrosis pulmonar. Sin embargo, esta afección tratada oportunamente tiene buen prognóstico, ya que con la simple suspensión de las sales de oro o la administración conjunta de corticoides, la lesión revierte en la mayoría de los casos en su totalidad. Se presenta un caso con buena respuesta a la terapéutica coricoidea y se analizan las diferencias con la fibrosis pulmonar asociada a la artritis reumatoidea
