[Tuberculosis in the elderly in a general hospital in the Region of Madrid, 1994-2003]. / Tuberculosis en ancianos en un hospital general de la Comunidad de Madrid, 1994-2003.

INTRODUCTION: Tuberculosis in the elderly is a health problem that is on the increase nowadays in industrialised countries. The aim of this study is to describe epidemiological, clinical and microbiological characteristics of tuberculosis in elderly patients in a general hospital in the Region of Madrid from 1994 to 2003. METHODS: Only microbiologically and/or histopathologically confirmed tuberculosis were studied. Epidemiological, clinical and microbiological variables were analyzed. Microbiological and histopathological laboratory results and medical records were collected. RESULTS: The proportion of cases occurring among the elderly rose from 12.4% between 1994 and 1998 to 17.8% between 1999 and 2003 (p <0.05). A total of 160 tuberculosis cases were studied: 92.5% were microbiologically (culture) confirmed and 7.5% histopathologically confirmed. The average time to culture positivity was 18.8 days (SD: 6.5). 88.7% isolates were susceptible to streptomycin, isoniazid, rifampin, ethambutol, and pyrazinamide. The main locations of tuberculosis were pulmonary (59.4%), ganglionary (11.9%) and genitourinary (10.0%). A positive smear in the sputum was discovered for 52.6% of pulmonary tuberculosis. The most prevalent risk factors were immunosuppression (14.8%) and diabetes mellitus (12.3%). Neither of them were VIH, intravenous drug users or immigrants. 50.7% cases were hospitalized. CONCLUSIONS: Tuberculosis in the elderly is on the increase in our region nowadays. The epidemiological pattern of tuberculosis in the elderly differs from that observed in younger patients. Therefore specific control and prevention strategies are needed in order to reduce tuberculosis incidence in aged populations.

[Recent transmission of tuberculosis in Madrid (Spain): usefulness of molecular techniques]. / Transmisión reciente de la tuberculosis en Madrid: utilidad de las técnicas moleculares.

BACKGROUND: Recent studies suggest that many tuberculosis cases in urban areas result from recent transmission. The aim of this study was to determine patterns of tuberculosis transmission in Madrid. PATIENTS AND METHODS: A prospective population-based molecular epidemiological study of patients diagnosed of tuberculosis was conducted in three urban districts of Madrid (455.050 inhabitants) during 1997-1998. Clinical, demographic and epidemiological data were reviewed. Patients were included in clusters when their isolates contained: a) six or more IS6110 bands in an identical pattern, or b) five or fewer IS6110 bands that matched identically and had an identical spoligotyping pattern. RESULTS: Of 207 positive-culture patients, 148 (71,5%) were DNA fingerprinted. A total of 18 clusters which included 62 patients (41,9%) were identified. Clusters contained between 2 and 12 cases. Risk factors for clustering included: age < 35 years (OR = 4,1, 95% CI: 1,9-8,9), injection drug use (OR = 4,7, 95% CI: 1,6-14,8), HIV infection (OR = 2,7, 95% CI: 1,1-6,8), and a history of imprisonment (OR = 2,9, 95% CI: 1,2-7,2). The epidemiological investigation identified connections among 27% of clustered patients. CONCLUSIONS: A high proportion of cases of tuberculosis in urban Madrid result from recent transmission. Molecular epidemiology studies give valuable information for urban tuberculosis control.

[Mycobacterium avium-intracellulare disseminated infection in patients with AIDS]. / Infección diseminada por Mycobacterium avium-intracellulare en pacientes con SIDA.

BACKGROUND: Disseminated infection by Mycobacterium avium-intracellulare is almost exclusively produced in individuals with HIV infection. The incidence of this infection in Spain is unknown. METHODS: The clinical and microbiologic registries of 30 patients with AIDS and disseminated infection by Mycobacterium avium are reviewed. METHODS: Twenty-three percent of the patients with AIDS had, at some time in their evolution, disseminated infection by M. avium. The clinical picture included prolonged fever, digestive symptoms, weight loss and appearance of lymph node enlargement. This infection appeared in patients with severe alteration of cellular immunity (mean CD4 lymphocytes: 0.19 x 10(9)/l). Although medium term prognosis was bad the causes of death of the patients were other opportunistic diseases related with the immunodeficiency. CONCLUSIONS: Infection by Mycobacterium avium is frequent among the population of individuals with HIV infection. With the appearance of prolonged fever in a patient with HIV infection and CD4 lymphocyte count lower than 0.2 x 10(9)/1 appropriate microbiologic studies including blood cultures for mycobacteria should be initiated.

[Primary laryngeal tuberculosis caused by Mycobacterium bovis]. / Tuberculosis laríngea primaria por Mycobacterium bovis.

It is suggested that laryngeal tuberculosis is a common complication of pulmonary tuberculosis. The most frequent germ is Mycobacterium tuberculosis. We present a case in which a infrequent bacillus, Mycobacterium bovis, was isolated without lung afectation. Considerations about morphologic and microbiologic findings are discussed.

[Tuberculosis in the autopsy. Clinical and pathological study: an analysis of 92 cases of active tuberculosis found in 2,180 autopsies]. / Tuberculosis en la autopsia. Estudio anatomoclínico: análisis de 92 casos encontrados entre 2.180 autopsias.

BACKGROUND AND OBJECTIVE: Tuberculosis is an infectious disease currently having great importance in the daily clinical practice in Spain. Some cases of active tuberculosis are not identified until after the patient had died and an autopsy has been performed. This study has analyzed the clinical and pathological characteristics of patients diagnosed with active tuberculosis in the autopsy. MATERIAL AND METHOD: We reviewed all the autopsies performed in the University Hospital 12 de Octubre of Madrid between 1974 and 2002. The autopsy reports and clinical records were examined in those cases in which active tuberculosis was found. RESULTS: We found 92 cases of active tuberculosis, 57% corresponding to men. Mean age of this group was 64 years. A total of 20% of the patients died within 48 hours after admission. Predisposing factors were identified in 90% of the cases. Dyspnea (24% of cases) and wasting syndrome (23%) were the main symptoms that motivated patients to request medical attention. Up to 30% of cases had normal chest X-ray. Tuberculosis was suspected in only 46% of patients before death. Principal cause of death was tuberculosis in 61% of patients, 52% of patients had pulmonary tuberculosis, 28% suffered from miliary tuberculosis and 20% from extra-pulmonary tuberculosis. The lungs were the most frequently affected organ. Epithelioid granulomas were found in all patients. CONCLUSIONS: Tuberculosis is an uncommon finding in the autopsy as the cause of death. The presence of unspecific symptomatology, insufficient cost-effectiveness of the diagnostic tests and precocious death, are identified as the most frequent causes of undiagnosed tuberculosis.