Derrame pleural de larga evolución en varón exfumador. ¿Cuál es tu diagnóstico? / Long course pleural effusion in male ex-smoker. What is your diagnosis

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[Tuberculosis in the area of Lorca: to adapt or resist]. / Tuberculosis en la comarca de Lorca: adaptarse o resistir.

OBJECTIVE: We studied the epidemiological characteristic of tuberculosis in Lorca area, drug resistant and the effect of the immigration population (Ecuador) in this area. PATIENTS AND METHODS: A retrospective study for six years ago (1999, January to 2004, December) was realized. Epidemiological data, initial diagnostic probability, mycobacteria stain and cultive, drug resistance, treatment response, and epidemiological differences between immigrants and spain population were compared. RESULTS: Within 158 cases registered, 41.7 percent were immigrants with less than one year in Spain, the most part Ecuador population. We observed that extrapulmonar tuberculosis was lower initial diagnostic probability than pleural disease as well too haemoptisis, pleural pain and weight loss. It was identified positive micobacterial stain in 35.4 percent of respiratory samples. It was successfully results in 74 percent of cases and 13.9 percent of patients were lost, this result was frequently registered in immigrants, The isoniazide resistant in patients with not previous treatment was 5.3 percent and it was 9.5 percent in immigrants and 10.8 percent in Ecuador population. CONCLUSION: It is necessary improve: the diagnostic of extrapulmonar tuberculosis and avoid loss patient by programs of capture and then the successfully treatments raise. The isoniazide resistant in this area suggest that we must use initial four drug than tree and this manner not raise the drug resistant in the area.

Tuberculosis en la comarca de Lorca: adaptarse o resistir / Tuberculosis in the area of Lorca: to adapt or resist

Objetivo: analizar las características epidemiológicas de los casos de tuberculosis del área de salud de la comarca de Lorca, su resistencia a fármacos y el impacto de la población inmigrante mayoritaria (Ecuador) en la misma. Pacientes y métodos: estudio longitudinal, retrospectivo de 6 años de duración (de enero de 1999 a diciembre 2004). Se recogieron datos epidemiológicos de cada caso, probabilidad diagnóstica inicial, tinciones diagnósticas, aislamientos, resistencia a fármacos, respuesta al tratamiento, así como, las diferencias epidemiológicas existentes entre inmigrantes y autóctonos. Resultados: Se identificaron 158 casos, 41,7% eran inmigrantes con menos de 1 año de estancia en nuestro país, mayoritariamente procedentes de Ecuador. Observamos que la tuberculosis extrapulmonar para el clínico tenía una probabilidad diagnóstica baja, mientras que la pleural era alta, junto a síntomas como hemoptisis, dolor pleurítico y constitucionales. En 35,4% de los casos se idéntifico germen por tinción en muestras respiratorias. Se obtuvo un 74% de resultados satisfactorios por el tratamiento y 13,9% de abandono asociado frecuentemente con la inmigración. La resistencia a isoniazida en no tratados fue del 5,3% en el área, 9,5% en el caso de inmigrantes y 10,8% en los oriúndos de Ecuador. Conclusión: Se debe mejorar en: la detección de los casos extrapulmonares, evitar el abandono con la captación de los enfermos y la curación de enfermedad. Las resistencias a isoniazida en nuestra área sugiere adaptarse a tratamientos de inicio con cuatro fármacos y no a tres para evitar incremento de resistencias en nuestra área de salud

Objective: We studied the epidemiological characteristic of tuberculosis in Lorca area, drug resistant and the effect of the immigration population (Ecuador) in this area. Patients and methods: A retrospective study for six years ago (1999, January to 2004, December) was realized. Epidemiological data, initial diagnostic probability, mycobacteria stain and cultive, drug resistance, treatment response, and epidemiological differences between immigrants and spain population were compared. Results: Within 158 cases registred, 41.7 percent were immigrants with less than one year in Spain, the most part Ecuador population. We observed that extrapulmonar tuberculosis was lower initial diagnostic probability than pleural disease as well too haemoptisis, pleural pain and weight loss. It was identified positive micobacterial stain in 35.4 percent of respiratory samples. It was succesfully results in 74 percent of cases and 13.9 percent of patients were lost, this result was frecuently registred in immigrants, The isoniazide resistant in patients with not previous treatment was 5.3 percent and it was 9.5 percent in immigrants and 10.8 percent in Ecuador population. Conclusion: It is necessary improve: the diagnostic of extrapulmonar tuberculosis and avoid loss patient by programs of capture and then the succesfully treatments raise. The isoniazide resistant in this area suggest that we must use initial four drug than tree and this manner not raise the drug resistant in the area