RESUMO
Objetivo: Presentar el caso de un paciente pediátrico con cuadro inicial de tuberculosis (TB) ganglionar con abandono de tratamiento en 2 ocasiones que evolucionó a la forma miliar y meningitis tuberculosa multidrogorresistente. Reporte del caso: Varón de 4 años con diagnóstico inicial de tuberculosis ganglionar, que abandonó el esquema sensible de tratamiento en dos ocasiones. Tres meses después, se evidenció compromiso bilateral sugestivo de TB miliar y durante la hospitalización desarrolló tuberculosis meníngea e hidrocefalia. Por el antecedente de abandono de tratamiento, se solicitó un estudio de sensibilidad en aspirado gástrico, identificándose como multidrogorresistente; pasando al esquema EZLfxKmEtoCs y manejo de complicaciones, consiguiendo mejoría. Conclusiones: El abandono de tratamiento es una de las principales causas de resistencia a fármacos antituberculosos y de complicaciones. Es necesario reforzar la detección temprana y tratamiento efectivo de esta infección en niños, poniéndose énfasis el seguimiento de casos para evitar abandonos de tratamiento y las complicaciones consecuentes.
Objetive:To describe a pediatric case with initial diagnosis of lymph node tuberculosis (TB) that became multidrug resistant miliar and meningeal tuberculosis (TB-MDR) due to treatment dropout twice. Case report: a 4-year-old boy with initial diagnosis of lymphnode tuberculosis who had two episodes of dropout from the sensitive scheme treatment. Three months later, there was evidence of bilateral involvement suggestive of miliary TB. During hospitalization, he developed meningeal tuberculosis and hydrocephalus. Due to the history of treatment dropout, a sensitivity of gastric aspirate study was requested, identifying it as multidrug-resistant TB. He started the EZLfxKmEtoCs treatment scheme and complications management, achieving improvement. Conclusions: Treatment dropout is one of the main causes of drug resistance in tuberculosis and its complications. It is necessary to reinforce the early detection and effective treatment of this infection in children, focusing on the follow-up of cases to avoid treatment dropout and the consequent complications.
RESUMO
OBJECTIVE: To establish the relationship among age, sex, body mass index, consumption of alcoholic beverages and cigarettes with the inadequate response to the vaccine against Hepatitis B in patients with HIV infection who were treated in the Clinical Unit of Infectious and Tropical Diseases of the Regional Hospital of Trujillo - Peru, from 2014 to 2015. MATERIALS AND METHODS: The study was observational, retrospective, cross-sectional, type cases and controls. RESULTS: In the vaccinated patients, it was found that the age ≥ 50 years old; with OR = 3.4 and CD4 < 200, with OR = 35.0, are the risk factors to get the inadequate response to the vaccine against Hepatitis B. CONCLUSIONS: There is a relationship between the re-count of cells CD4 < 00 and the age over 50 years old with an Inadequate response to the vaccination against hepatitis B in HIV-infected patients in the Regional Hospital of Trujillo.