[The characteristics of patients who have died from tuberculosis]. / Características de los pacientes fallecidos por tuberculosis.

OBJECTIVE: To analyze the characteristics of the patients died from tuberculosis (TB) in our hospital. METHOD: We retrospectively reviewed the records of the 46 patients died in-hospital from TB between january, 1992 and june, 1997. MEAN AGE: 55 +/- 19 years (19-85). 35 (76%) males and 11 (24%) females. DIAGNOSIS: pulmonary (63%), disseminated (26%) and extrapulmonary (11%) TB. 87% of the patients had previous comorbidity (35% were seropositive for HIV). The only differences between HIV-infected and non-HIV-infected cases were a greater proportion of normal chest roentgenograms and of toxicity from therapy in seropositive patients. The disease was diagnosed at death in 17% of cases. Chemoprophylaxis had not been used in 5 patients, although they fulfilled criteria for receiving it. Poor compliance with treatment was noted in 6 (13%) patients. CONCLUSIONS: We have found a high prevalence of comorbidity in these patients, which might account for the mortality. Delays in diagnosis, misuse of chemoprophylaxis and poor compliance with therapy might also be implicated in some cases.

[Varicella pneumonia in the previously healthy adult]. / Neumonía varicelosa en el adulto previamente sano.

Varicella (chickenpox) is a contagious, self-limited, usually benign disease common in childhood but uncommon in adulthood. Pneumonia is the most frequent complication of the disease in adults. We retrospectively review 7 cases of varicella pneumonia in previously healthy adults diagnosed in our hospital between 1992 and 1996. All of them were treated with intravenous acyclovir with good therapeutic response save for a patient who developed respiratory insufficiency and died 8 days after his admission. Smoking was the only risk factor detected. Clinical features of our patients are described and the need of an early diagnosis and treatment of varicella pneumonia is emphasized.

Características de los pacientes fallecidos por tuberculosis / Characteristics of patients died from tuberculosis

Objetivo: conocer las características de los pacientes que fallecen por tuberculosis (TB) en nuestro centro. Método: Revisamos retrospectivamente las historias clínicas de los 46 casos de muerte intrahospitalaria debida a TB entre enero de 1992 y junio de 1997. Edad media: 55 ñ 19 años (19-85). 35 (76 %) varones y 11 (24 %) mujeres. Resultados: Tipo de TB: pulmonar (63 %), diseminada (26 %) y extrapulmonar (11 %). El 87 % de los casos presentaban comorbilidad preexistente (el 35 porciento, coinfección por VIH). Las únicas diferencias entre pacientes VIH (+) y (-) fueron un mayor porcentaje de radiografía de tórax normal y de toxicidad medicamentosa en los enfermos seropositivos. En el 17 % de los casos, el diagnóstico se realizó tras el fallecimiento. En 5 pacientes no se había empleado quimioprofilaxis antituberculosa pese a estar indicada, y en 6 (13 %) detectamos un mal cumplimiento terapéutico. Conclusiones: en este tipo de pacientes hay una elevada prevalencia de comorbilidad como posible causa de la mala evolución. La existencia de retrasos en el diagnóstico, un empleo inadecuado de la quimioprofilaxis y un mal cumplimiento terapéutico podrían relacionarse con la mala evolución en algunos casos (AU)

Neumonía varicelosa en el adulto previamente sano / Varicella penumonia in the previously healthy adult

La varicela es una enfermedad contagiosa autolimitada y generalmente benigna propia de la infancia, y poco común en el adulto. La neumonía es la complicación mas frecuente de la enfermedad en el adulto. Revisamos retrospectivamente 7 casos de neumonía varicelosa en adultos previamente sanos diagnosticados en nuestro hospital entre 1992 y 1996. Todos ellos fueron tratados con Aciclovir endovenoso, presentando buena evolución salvo un paciente que desarrolló insuficiencia respiratoria y falleció 8 días tras su ingreso. El tabaco fue el único factor de riesgo detectado. Presentamos las particularidades clínicas de nuestros pacientes y destacamos la necesidad de un diagnóstico y tratamiento precoz de la neumonía por varicela (AU)

[Spontaneous pneumothorax associated with human immunodeficiency virus (HIV) infection]. / Neumotórax espontáneo asociado a la infección por el virus de la inmunodeficiencia humana (VIH).

Spontaneous pneumothorax is a relatively frequent complication of human immunodeficiency virus (HIV) infection. Seven hundred sixty-five HIV-infected inpatients were treated at Marques de Valdecilla University Hospital between 1990 and 1996. Spontaneous pneumothorax developed in 9 patients. Pneumocystis carinii pneumonia was diagnosed in 6 patients (66%), either before or simultaneous to the appearance of pneumothorax. Pneumothorax was related to active or old tuberculosis infection in 3 patients (33%). Prophylactic therapy with nebulized pentamidine was used in 55% of the patients. Successful initial control of pneumothorax was achieved with simple drains in 58% of the episodes, although the recurrence rate was 71%. Pleurodesis with talcum with a chest tube was used successfully in 3 patients, in 2 because of sings of persistent air leakage uncorrected by simple drainage. Pleurodesis initially failed but later controlled pneumothorax the second time it was used. The mortality rate in this series was 66%, with a mean survival time of 55.6 days. We conclude that spontaneous pneumothorax is associated with poor prognosis in HIV infected patients. Prior or concurrent P. carinni pneumonia or tuberculosis were the etiologic factors identified in our patients. A simple pleural drain was associated with a high rate of recurrence, such that pleurodesis seems warranted in all patients.