Usefulness of Endobronchial Ultrasound in Patients with Human Immunodeficiency Virus Infection and Mediastinal Lymphadenopathy.

BACKGROUND: There are few published studies about the usefulness of endobronchial ultrasound (EBUS) in patients infected with human immunodeficiency virus (HIV). The clinical spectrum of likely diseases in this population is varied and differs from patients not infected with HIV. OBJECTIVE: The aim of this study was to measure the usefulness of EBUS-guided transbronchial needle aspiration (EBUS-TBNA) in HIV-infected patients with mediastinal lymphadenopathy. MATERIALS AND METHODS: We conducted an observational, cross-sectional, retrospective, descriptive study on patients with HIV infection and mediastinal lymphadenopathy who underwent EBUS-TBNA between September 2014 and April 2016. The patients' final diagnosis, regardless of the sample from which it was obtained, was considered the positive gold standard, and the absence of diagnosis was the negative. The study measured diagnostic accuracy of bronchoalveolar lavage (BAL), transbronchial biopsy (TBB), and EBUS-TBNA. RESULTS: A total of 43 procedures were performed; 79.1% (34/43) of the patients were male, and the median age was 35 years (range, 22-66). The overall diagnostic yield including all types of samples was 90.7% (39/43); the yield of BAL was 50% (21), that of TBB 61.9% (26), and that of EBUS-TBNA was 60.5% (26). The combined yield of BAL with TBB was 69.8% (30); the yield of BAL with EBUS-TBNA was 86% (37) and that of TBB with EBUS-TBNA was 88.4% (38). The highest diagnostic accuracy was 97.7% for the combination of TBB and EBUS-TBNA. CONCLUSIONS: The most common infectious diagnoses were tuberculosis, with a higher diagnostic accuracy using EBUS-TBNA than BAL. With malignancies, both EBUS-TBNA and TBB were useful. EBUS-TBNA is a minimally invasive diagnostic tool that should be considered in these patients.

Características de la Tuberculosis en niños menores de 15 años durante las gestiones 2009 -2010 en el Hospital del niño/a "Manuel Ascencio Villarroel" / Tuberculosis characteristics in children under 15 years efforts during 2009-2010 at "Manuel Ascencio Villarroel" child's hospital

La infección por Micobacterium tuberculosis constituye un problema frecuente en nuestra sociedad representando una de las enfermedades infecto-contagiosas de alta prevalencia en niños menores de 15 años. Se realizó un estudio de las características sociales como la procedencia de los casos y características personales como género, y edad de la enfermedad tomando en cuenta: tipo de presentación, complicaciones primarias o tardías, vías de transmisión y el tipo de diagnóstico en menores de 15 años de edad que fueron diagnosticados con tuberculosis (TB) durante las gestiones 2009 - 2010 en el Hospital del niño/a "Manuel Ascencio Villarroel", Cercado - Cochabamba. El estudio fue descriptivo de corte transversal. Se estableció el universo de 1444 casos registrados para atención en el servicio de consulta externa en menores de 15 años. El diagnóstico realizado para la detección de TB fue 100% mediante baciloscopía directa. Entre los resultados representativos, observamos que 54% de los casos corresponden al sexo femenino y los meses Marzo y Noviembre del 2009 y Noviembre de 2010 presentan un mayor número de casos, siendo la procedencia de los menores; zonas periurbanas (46%), zona rural con 38% y la zona central con 7%. Observando las características sociales y de presentación de la enfermedad podemos concluir que la condición social-económica son factores que agravan la prevalencia de esta enfermedad. La incidencia real de los casos que cursan con tuberculosis en menores de 15 años es una situación muy delicada, ya que la mayoría de los casos pueden ser diagnosticados como falsos positivos.

Infection with M.Tuberculosis is a common problem in our society it represents one of the infectious diseases of high prevalence in children under 15 years. A study of the social and the relevance of the cases, personal characteristics such as gender, age and disease, type of presentation, primary or delayed complications, modes of transmission and type of diagnosis in children under 15 years who were diagnosed with TB during 2009-2010 in the Hospital efforts of the child "Manuel Ascencio Villarroel," Cochabamba. The study was cross sectional. It established the universe of 1444 cases registered for care in the outpatient service under 15 years. Among the representative results, we note that 54% of cases are female and the months of March and November 2009 and November 2010 have a higher number of cases. As the origin of minors, peri-urban areas (46%), rural area with 38% and the central area with 7%. The diagnostic method for detection of tuberculosis was 100% by direct smear. Noting the social and presentation of the disease we can conclude that the social-economic statuses are factors that increase the prevalence of this disease.The actual incidence of tuberculosis cases that developed in children under 15 years is a very delicate situation, as most cases can be diagnosed as false positives.