Diagnostico bacteriologico de tuberculosis extrapulmonar en un hospital general. / [Bacteriologic diagnosis of extrapulmonary tuberculosis in a general hospital]

In a study performed in a general hospital within a period of 19 months, a total of 233 specimens of extrapulmonary origin and 543 lung secretions were tested for mycobacteria. The biopsy and punction fluid specimens were cultured without previous decontaminating treatment in Lowenstein Jensen, Stonebrink, Middlebrook 7H9, 7H10, 7H11 media and inoculated into guinea pigs (Table 1). Urine and lung secretion specimens were decontaminated and cultured in Lowenstein Jensen and Stonebrink media. No inoculation into guinea pigs was performed with these samples. The percentages of positivity by culture were: 11.2

for all extrapulmonary specimens (15

excluding 66 urine samples) and 22.5

for the lung secretions. Positive results were obtained in direct smear examinations in 82

of all positive-culture lung secretions and in 8

of the extrapulmonary specimens. Inoculation into guinea pigs gave less positive results than cultures. On the basis of the present study, it is recommended to culture every extrapulmonary specimens for mycobacteria. These samples should be processed immediately after collection and, if possible, without previous decontamination to assure the best test sensitivity. Eight percent of the strains obtained from extrapulmonary specimens were typed as M. bovis.

Ulceras colónicas en pacientes HIV (+). / [Colonic ulcer in HIV (+) patients]

A characteristic rectocolonic endoscopic finding is the presence of ulcers, which may correspond to different diagnosis. Between January, 1989 and May, 1993, we performed 28 colonoscopies and 12 rectoscopies in patients with HIV (+). In all cases, histologic, parasitologic, bacteriologic, virologic, and micrologic studies were practised on tissue biopsies. Eighteen of them presented rectocolonic ulcers (we are not including anal and terminal ileum ulcers). The studies involved 16 males and 2 females, with an average age of 31, 21 years old (20-47), 14 of which were male homosexuals, 2 intravenous drug abusers, 1 hemophilic and an heterosexual female. Symptoms were as follows: 15 with hematochezia, 7 with proctorrhagia, 6 with enterorrhagia and 2 with both manifestations. All the rest, presented chronic diarrhea, loss of weight, anal secretion, asthenia, fever, constipation and anemia in isolated cases. Diagnosis were 6 rectocolonic cytomegalovirus (all occurred during the current year). Other related opportunistic pathogens included an intestinal TBC, a rectal Herpes and a Burkitts lymphoma. Related etiological agents were not found in 9 patients, in spite of systematic quest. Opportunistics found in three of the cases revealed AIDS in those patients. COMMENTS: 1-The indexes of male homosexuals are strikingly higher than the rest of our HIV endoscopy statistics. 2-We observed prevailing idiopathic lesions. 3-The relationship between [quot ]CU like[quot ] pictures, already described, and the immunocomponents of the idiopathic CU is unknown. 4-All our CMV cases are recent. 5-Hematochezia was the most frequent symptom. 6- Herpetic ulcers correspond to HSV type 1. 7-Diffuse ulcers may correspond to lymphoma.