Vertebral tuberculosis as a paradoxical reaction to the treatment of pulmonary and meningeal tuberculosis in an immunocompetent patient: A case report.

INTRODUCTION: Paradoxical reaction in tuberculosis (TB) is defined as the reappearance of general symptoms, aggravation of pre-existing diseases, or appearance of new lesions despite adequate anti-TB therapy. It may result from the hyperactivity of the immune response, resulting in an intense inflammation. There are few cases of vertebral TB reported as paradoxical reaction, mainly among immunocompetents patients. PATIENT CONCERNS: We describe a male immunocompetent patient with confirmed pulmonary and meningeal TB. He was readmitted after 60 days of adequate treatment, with vertebral TB and paravertebral abscess, despite clinical improvement of the other locations. We defined as an uncommon case of a paradoxical reaction, confirmed by nuclear magnetic resonance and molecular rapid test for TB. DIAGNOSIS: Mycobacterium tuberculosis (MTB) was detected in cerebrospinal fluid by molecular rapid test (Gene Xpert MTB/ rifampicina method). Sputum research and culture were positive for the same agent. Lumbosacral spine nuclear magnetic resonance revealed bone destruction from T8 to T11, and a paravertebral collection was found. Gene Xpert MTB/rifampicina and culture were positive for M tuberculosis in the drained material of the paravertebral abscess. INTERVENTIONS: The paravertebral abscess was drainage by tomography-guided. Treatment with 4 anti-TB drugs was extended for 60 days and 2 anti-TB drugs was maintained for 10 months. There was a complete clinical improvement. OUTCOME: After draining the paravertebral abscess, the patient progressively improved and was discharged for outpatient follow-up. He was on antituberculous drugs for 1 year; subsequently, complete resolution of the infection was reported. CONCLUSION: Paradoxical reaction may be a difficult diagnosis in immunocompetent patient. Vertebral TB as a paradoxical reaction is an uncommon presentation. Therapeutic failure or resistance to treatment should be ruled out to confirm the diagnosis of paradoxical reaction.

[Sexual violence against adolescents in Campo Grande, Mato Grosso do Sul, Brazil]. / Violência sexual contra adolescentes em Campo Grande, Mato Grosso do Sul.

OBJECTIVE: To analyze the situation of sexual violence against adolescents. METHODS: Cross-sectional study with spatial analysis, covering 172 reporting forms, from January 2009 to January 2013, in Campo Grande, Mato Grosso do Sul. Data were grouped by neighborhood for spatial analysis. The statistical analysis was descriptive. RESULTS: Adolescents in situations of violence were mostly girls (94.8%) and white (37.8%). Domestic violence prevailed (51.7%) and with one perpetrator (66.9%). Pregnancy (8.7%) was one of the consequences. The cases were evenly distributed in the city without a preferential spatial pattern and regardless of social background. CONCLUSIONS: Despite the underreporting of sexual violence cases, the frequency and the individual and collective consequences of this are serious enough to make it a public health issue.

Violência sexual contra adolescentes em Campo Grande, Mato Grosso do Sul / Violencia sexual contra adolescentes en Campo Grande, Mato Grosso do Sul, Brasil / Sexual violence against adolescents in Campo Grande, Mato Grosso do Sul, Brazil

RESUMO Objetivo Analisar a situação da violência sexual contra adolescentes. Métodos Estudo transversal com análise espacial, abrangendo 172 fichas de notificação, de janeiro de 2009 a janeiro de 2013, em Campo Grande, Mato Grosso do Sul. Para a análise espacial, os dados foram agrupados por bairro. A análise estatística dos dados foi descritiva. Resultados Os adolescentes em situação de violência foram majoritariamente meninas (94,8%) e de cor branca (37,8%). Predominou a violência intrafamiliar (51,7%) e com um perpetrador (66,9%). A gravidez (8,7%) foi uma das consequências. Os casos tiveram distribuição homogênea no município, sem padrão espacial preferencial e sem distinção de estrato social. Conclusões Apesar da subnotificação de casos de violência sexual, a frequência e as consequências individuais e coletivas desta são suficientemente graves para torná-la uma questão de saúde pública.

RESUMEN Objetivo Analizar la situación de la violencia sexual contra adolescentes. Métodos Estudio transversal mediante análisis espacial abarcando 172 fichas de notificación de enero de 2009 a enero de 2013, en la ciudad de Campo Grande, Mato Grosso do Sul, Brasil. Para el análisis espacial se reunieron los datos por barrios, con un análisis estadístico descriptivo. Resultados Los adolescentes en situación de violencia eran en su mayor parte muchachas (un 94,8%) y blancas (un 37,8%). Predominó la violencia intrafamiliar (un 51,7%) y con un perpetrador (un 66,9%). El embarazo (un 8,7%) fue una de las consecuencias. Los casos tuvieron distribución homogénea en el municipio, sin un patrón espacial de preferencia o distinciones por estrato social. Conclusión Pese a la subnotificación de episodios de violencia sexual, la frecuencia y las consecuencias individuales y colectivas son lo suficientemente graves como para transformarla en una cuestión de salud pública.

ABSTRACT Objective To analyze the situation of sexual violence against adolescents. Methods Cross-sectional study with spatial analysis, covering 172 reporting forms, from January 2009 to January 2013, in Campo Grande, Mato Grosso do Sul. Data were grouped by neighborhood for spatial analysis. The statistical analysis was descriptive. Results Adolescents in situations of violence were mostly girls (94.8%) and white (37.8%). Domestic violence prevailed (51.7%) and with one perpetrator (66.9%). Pregnancy (8.7%) was one of the consequences. The cases were evenly distributed in the city without a preferential spatial pattern and regardless of social background. Conclusions Despite the underreporting of sexual violence cases, the frequency and the individual and collective consequences of this are serious enough to make it a public health issue.