[Trends in the incidence of tuberculosis in the area of Seville-South (Spain) during the 1990s]. / Evolución de la incidencia de la tuberculosis en el Area Sur de Sevilla en la década de los noventa.

OBJECTIVE: To describe the incidence of tuberculosis (TB) in the hospital area of Seville-South between 1990 and 1999. METHOD: Study of the incidence of TB in the area's population between 1990 and 1999 by way of periodic survey of informants who were likely to see cases. RESULTS: The annual incidence of TB rose from 1990 (26.64/105) to its peak in 1992 (38.3/105), stabilized between 1992 and 1995, and later fell to 15.7/105 in 1999. Bacillary cases followed a similar pattern, with a peak of 13.76/105 in 1992 and a low of 6.06/105 in 1998. The annual incidence of TB-AIDS rose between 1990 (2.63/105) and 1995 (9.08/105), and then fell to 4.13/105 by 1999. The highest incidences were in the 25-to-34-year-old range in the periods from 1990 to 1993 (50.74/105) and 1994 to 1996 (61.49/105), whereas the incidence decreased among 55-to-64-year-olds (28.55/105) from 1997 to 1999. The age distribution was affected by rates in the TB-AIDS group, which contributed 48%, 50% and 55% in each period, respectively, for individuals in the 25-to-34-year-old range. CONCLUSIONS: The annual incidence of TB was 41,1% lower in 1999 than in 1990, as a result of the marked decrease beginning in the middle of the decade. The impact of TB-AIDS patients on the evolution of annual incidence and on age distribution was considerable throughout the decade.

Evolución de la incidencia de la tuberculosis en el área sur de Sevilla en la década de los noventa / Trends in the incidence of tuberculosis in the area of Seville-south (Spain) during the 1990s

OBJETIVO: Describir la incidencia de la tuberculosis (TB) en el Área Hospitalaria Sur de Sevilla entre 1990 y 1999.MÉTODO: Estudio de incidencia de la TB en la población del área entre 1990 y 1999, mediante la consulta periódica de todas las fuentes susceptibles de aportar casos. RESULTADOS: La tasa de incidencia anual (TIA) de TB ascendió desde 1990 (26,64/105) hasta alcanzar su pico en 1992 (38,3/105), se estabilizó entre 1992 y 1995 y, posteriormente, sufrió un descenso mantenido hasta 1999 (15,7/105). La curva de bacilíferos siguió una evolución similar, con un pico de 13,76/105 en 1992 y un mínimo de 6,06/105 en 1998. La TIA en el grupo TB-sida ascendió desde 1990 (2,63/105) hasta 1995 (9,08/105), descendiendo posteriormente de forma mantenida hasta 1999 (4,13/105). Por edades, las tasas más elevadas se registraron en el grupo de edad de 25-34 años, tanto en el período 1990-1993 (50,74/105) como en 1994-1996 (61,49/105), mientras que en 1997-1999 recayeron en el grupo de 55-64 años (28,55/105). Esta distribución por edades estuvo influida por el grupo de TB-sida, que contribuyó con un 48, un 50 y un 55 por ciento, respectivamente, en cada período a la tasa global del grupo de 25-34 años. CONCLUSIONES: La TIA de TB para el global de casos se redujo en un 41,1 por ciento en 1999 respecto al valor de 1990, produciéndose este acusado descenso a partir de la mitad de la década. Los pacientes con TB-sida tuvieron una influencia importante tanto en la evolución de las TIA a lo largo de la década, como en la morfología de la curva por edades. (AU)

[Outcome of treating initial tuberculosis in the area south of Seville in a 5-year period (1994-1998]. / Resultados del tratamiento de la tuberculosis inicial en el área sur de Sevilla en un período de 5 años (1994-1998).

OBJECTIVE: To analyze the outcome of treating initial tuberculosis (ITB) in the hospital district south of Seville (Spain). MATERIAL AND METHOD: A descriptive study of treatment outcome in cases of ITB in our district between 1 January 1994 and 31 December 1998. Outcome was classified according to World Health Organization guidelines:successful (S) potentially unsuccessful (PU), exitus (EX) and transferred out (T).Four hundred fifty-four patients (mean age 35 years) were enrolled; 22% were HIV+ and 21% were intravenous drug users (IVDU). Treatment was self-administered in all cases, with 98% being given the standard prescription of 6 or 9 drugs. No subsequent case history was found for 15 cases, such that outcome could not be assessed. RESULTS: Of the 439 evaluable cases, outcome was S for 74% (326/439), PU for 16% (70/439), EX for 8% (36/439) and T for 6. Outcome for HIV + patients was poorer than for HIV- patients (S: 35/98 versus 291/341, p < 0.00005;PU: 40/98 versus 30/341, p < 0.00005), and the mortality rate of HIV+ patients was higher than that of HIV- patients (EX:18/98 versus 18/341, p < 0.0008). Among those classified PU,no cases of treatment failure were recorded and up to 78% (31/40)were cases of loss of follow-up or abandonment. The variable most closely related to PU was IVDU status (OR = 10.5, p < 0.00005). CONCLUSION: a) Outcomes for the general population are acceptable. b)A marginal group has been identified as characterized by two variables, HIV+ and IVDU, which are the factors associated with poorer outcome of self-administered treatment, indicating that supervised treatment is advisable in cases where those factors are present.

Resultados del tratamiento de la tuberculosis inicial en el área sur de Sevilla en un período de 5 años (1994-1998) / Outcome of treating initial tuberculosis in the area south of Seville (Spain) over a five-year period (1994-1998)

OBJETIVO: Analizar los resultados del tratamiento de la tuberculosis inicial (TBI) en el Área Hospitalaria Sur de Sevilla. MATERIAL Y MÉTODO: Estudio descriptivo de los resultados obtenidos en los casos de TBI diagnosticados en nuestra área entre el 1 de enero de 1994 y el 31 de diciembre de 1998. Los resultados finales se han clasificado en cuatro categorías atendiendo a las recomendaciones de la Organización Mundial de la Salud (OMS): satisfactorios (RS), potencialmente insatisfactorios (RPI), fallecimientos (EX) y traslados (TD). Se incluyen 454 casos con una edad media de 35 años, de los cuales el 22 por ciento eran VIH positivo y el 21 por ciento eran adictos a drogas por vía parenteral (ADVP). En todos los casos el tratamiento fue autoadministrado, y al 98 por ciento se les prescribió un régimen estándar de 6 o 9 fármacos. En 15 casos no se encontró la historia clínica para evaluar el resultado del tratamiento. RESULTADOS: De los 439 casos evaluables, hubo un 74 por ciento (326/439) de RS, un 16 por ciento (70/439) de RPI, un 8 por ciento (36/439) de EX y 6 TD. Los pacientes VIH positivo presentaron peores RS (35/98 frente a 291/341; p < 0,00005) y RPI (40/98 frente a 30/341; p < 0,00005), así como una mayor mortalidad (18/98 frente a 18/341; p < 0,0008) que los VIH negativos. Entre los RPI, no se detectaron fracasos, y hasta el 78 por ciento (31/40) fueron debidos a pérdida o abandono. La variable que mejor se correlacionó con el RPI fue la ADVP (OR: 10,5; p < 0,00005). CONCLUSIÓN: a) Los resultados obtenidos en población general son aceptables, y b) existe un grupo marginal, caracterizado por el binomio VIH-ADVP, que tienen unos pésimos resultados con el tratamiento autoadministrado, y en los que sería necesario aplicar tratamientos supervisados (AU)

[Muckle-Wells syndrome associated with idiopathic interstitial pneumopathy]. / Síndrome de Muckle-Wells asociado a neumopatía intersticial idiopática.

Muckle-Wells syndrome is characterized by recurrent episodes of urticaria, fever, polyarthralgia, deafness and secondary amyloid (AA type), familial type with autosome dominant features; few cases have been described. A case of a patient with idiopathic interstitial pneumopathy, diagnosed 7 years before the onset of clinical amyloid, is presented. The patient had lymph glands enlargement and nephrotic syndrome and died 18 months later due to renal insufficiency. We have not found this association previously described in any medical literature.

Yield of percutaneous needle lung aspiration in lung abscess.

STUDY OBJECTIVE: To evaluate the accuracy of PLA with a thin needle in the bacteriologic diagnosis of patients with lung abscess and in demonstrating possible coexistence of an underlying lung carcinoma, and the influence of this technique in the treatment and outcome of these patients. DESIGN: Case series. SETTING: Tertiary university referral center. PATIENTS: Consecutive sample of 50 patients with clinical picture suggestive of pulmonary infection and single or multiple cavitation of at least 1 cm in diameter on chest x-ray films, and lack of clinical suspicion of active pulmonary tuberculosis. One patient was excluded from the study after demonstration of tuberculosis by PLA. INTERVENTIONS: Lung aspirates were obtained under fluoroscopic guidance by introduction of a 22-gauge disposable spinal needle within the abscess cavity and were immediately transported to the bacteriology laboratory and pathology department for processing. All patients were initially treated with clindamycin. Tobramycin was added in all those patients with hospital-acquired infection, lack of foulness of sputum, and those who were initially severely ill. Definite treatment was based on the results of bacteriologic cultures. MEASUREMENTS AND MAIN RESULTS: Cultures of LAs were positive in 82 percent (40/49) of patients. In 20 cases the isolates were monobacterial (13 aerobic bacteria and seven anaerobic). In the remaining 20 cases, cultures grew more than one kind of bacteria (four exclusively aerobic, five exclusively anaerobic, and 11 mixed), with an average of 3.25 types of bacteria per case. Anaerobes were found as a single bacteria or associated with other aerobic bacteria in only 58 percent (23/40). The results of LA cultures led to change in the initial antibiotic trial in 23 patients (47 percent). Of ten cases in which bronchogenic carcinoma was demonstrated, cytologic study of LA was done in nine, and eight had positive cytologic yield. Pneumothorax occurred in seven cases (14 percent) as the sole complication. CONCLUSIONS: (1) Percutaneous lung aspiration had a high diagnostic yield and accuracy in our series, with a relatively low incidence of complications. (2) Anaerobic bacteria were less frequently implicated in our cases than previously reported. This finding led to significant changes in the initial empiric antibiotic treatment.