ABSTRACT
Tuberculosis (TB) can spread to any tissue or organ of the body by way of hematogenous or lymphatic dissemination or contiguity. However, pulmonary TB is the most common presentation and the only form of the disease of epidemiologic importance. Consequently, the literature on the various forms of extrapulmonary TB (EPTB) is scant, and most of the published authors are specialists in specific extrapulmonary forms. As a result, in most of the major areas of study of EPTB, recommendations similar to those for pulmonary TB or others based on little or no evidence have been accepted. This lack of evidence is of particular concern in the case of treatment guidelines. The present article reviews important work that has given rise to current treatment guidelines. While most of these guidelines reveal the lack of evidence available on this subject, it can, nevertheless, be concluded that a 6-month treatment regimen similar to that used in patients with pulmonary TB may be sufficient to treat all forms of EPTB, including meningeal disease. The role of steroids and surgery in the treatment of TB affecting different sites is also discussed. Other topics dealt with are the considerations that should be taken into account and the treatment modifications necessary in patients infected with the human immunodeficiency virus.
Subject(s)
Tuberculosis/therapy , Humans , Tuberculosis/complications , Tuberculosis/diagnosisABSTRACT
La tuberculosis (TB) puede afectar, por diseminación hematógena, linfática o contigüidad, a cualquier órgano o tejido del organismo. Sin embargo, la forma de presentación pulmonar es la más frecuente y la única epidemiológicamente importante. Esto ha motivado que las publicaciones sobre las diversas localizaciones de la TB extrapulmonar (TBE) hayan sido escasas, y casi siempre realizadas por especialistas de las diferentes presentaciones. Por tal motivo, en la mayoría de los grandes campos de estudio de la TBE se han aceptado recomendaciones similares a las efectuadas para la TB pulmonar, o se han seguido otras con escasa o nula evidencia; aspecto especialmente relevante en lo concerniente al tratamiento. En el presente artículo se revisan importantes publicaciones que han dado lugar a las actuales recomendaciones sobre el tratamiento, detrás de la mayoría de las cuales resalta la falta de evidencia existente. En cualquier caso, se concluye que un régimen de 6 meses, similar al de la TB pulmonar, puede ser suficiente para tratar todas las formas de TBE, incluida la meníngea. Se discute, igualmente, el papel que los esteroides y la cirugía pueden tener en las diversas localizaciones de la TB, así como las modificaciones y/o consideraciones que deben tenerse en cuenta en los pacientes infectados por el virus de la inmunodeficiencia humana
Tuberculosis (TB) can spread to any tissue or organ of the body by way of hematogenous or lymphatic dissemination or contiguity. However, pulmonary TB is the most common presentation and the only form of the disease of epidemiologic importance. Consequently, the literature on the various forms of extrapulmonary TB (EPTB) is scant, and most of the published authors are specialists in specific extrapulmonary forms. As a result, in most of the major areas of study of EPTB, recommendations similar to those for pulmonary TB or others based on little or no evidence have been accepted. This lack of evidence is of particular concern in the case of treatment guidelines. The present article reviews important work that has given rise to current treatment guidelines. While most of these guidelines reveal the lack of evidence available on this subject, it can, nevertheless, be concluded that a 6-month treatment regimen similar to that used in patients with pulmonary TB may be sufficient to treat all forms of EPTB, including meningeal disease. The role of steroids and surgery in the treatment of TB affecting different sites is also discussed. Other topics dealt with are the considerations that should be taken into account and the treatment modifications necessary in patients infected with the human immunodeficiency virus
Subject(s)
Humans , Tuberculosis/therapy , HIV Infections/complications , AIDS-Related Opportunistic Infections/therapy , Steroids/therapeutic use , Antitubercular Agents/therapeutic useABSTRACT
BACKGROUND: No large studies have demonstrated the effectiveness of a 6-month regimen for all forms of extra-pulmonary tuberculosis (EPTB). METHODS: Retrospective, observational analysis to evaluate the effectiveness of a 6-month treatment regimen (2HRZE/4H3R3) for all patients diagnosed with EPTB in Caracas, Venezuela, from 1 January 1998 to 31 December 2000, using direct observation. RESULTS: Of 679 patients enrolled, 101 (14.9%) had AIDS. In 83.2% the diagnosis was based on microbiological, histological or genetic amplification information. Of 612 (90.1%) patients who took more than 90% of the doses, treatment had to be altered in six (1%) due to drug side effects. Of the remaining 606 patients who took more than 90% of the doses, 603 (99.5%) were cured and three failed. In the follow-up conducted 2 years after the end of treatment, only 6 relapsed (1%). Cures without relapse were achieved in 24 cases of central nervous system involvement, 27 cases of osteoarticular involvement and in the 42 who had miliary and/or disseminated TB. CONCLUSION: A 6-month treatment regimen for all forms of EPTB, with treatment three times a week during the continuation phase, was highly effective.
