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1.
Acta pediatr. esp ; 76(11/12): 142-144, nov.-dic. 2018.
Artigo em Espanhol | IBECS | ID: ibc-177434

RESUMO

Introducción: La presencia de adenopatías intratorácicas es el patrón característico de la tuberculosis pediátrica. Puede interpretarse como una infección o una enfermedad tuberculosa, con las consiguientes diferencias terapéuticas. El objetivo de este estudio fue determinar si los pacientes con adenopatías intratorácicas aisladas presentan diferencias clínicas, diagnósticas y microbiológicas respecto a los pacientes con otras formas de enfermedad tuberculosa. Material y métodos: Se estudiaron todos los pacientes menores de 14 años diagnosticados de enfermedad tuberculosa en Cantabria entre 2005 y 2014. Se clasificaron en dos grupos: pacientes con adenopatías intratorácicas exclusivamente y pacientes que presentaron otras formas de tuberculosis. Se compararon entre ambos grupos los síntomas clínicos, la velocidad de sedimentación globular, el resultado de la prueba de la tuberculina (PT) y el aislamiento microbiológico. Resultados: Se diagnosticaron 81 pacientes con enfermedad tuberculosa. El 38,3% presentó tuberculosis ganglionar intratorácica y el resto otras formas de tuberculosis. La media de edad ± desviación estándar en el momento del diagnóstico fue de 70,46 ± 43,6 meses. Los pacientes con tuberculosis ganglionar resultaron asintomáticos con mayor frecuencia y presentaron diámetros de induración de la PT significativamente mayores. El aislamiento microbiológico se consiguió en un 25,9% del total. No se observaron diferencias significativas en el aislamiento microbiológico entre ambos grupos (el 35,5 frente al 16,13%; p= 0,074). En ningún paciente con adenopatías detectadas mediante tomografía computarizada se aisló Mycobacterium tuberculosis. Discusión: El aislamiento de M. tuberculosis constituye el gold standard para el diagnóstico de enfermedad tuberculosa, estableciendo el diagnóstico diferencial con la infección. En este estudio, los pacientes con tuberculosis ganglionar presentaron un porcentaje de aislamiento microbiológico similar a los pacientes con otras formas de tuberculosis. Según estos resultados, el aislamiento microbiológico de las tuberculosis ganglionares no sería un hallazgo casual, por lo que las formas ganglionares deberían considerarse una enfermedad en lugar de una infección tuberculosa


Introduction: The presence of intrathoracic lymph nodes is the characteristic pattern of pediatric tuberculosis but can be interpreted as infection or tuberculosis disease with different therapeutic approaches. The aim of this study was to determine if patients with isolated intrathoracic lymph nodes had clinical, diagnostic and microbiological features compared with patients diagnosed with other forms of tuberculosis disease. Material and methods: All patients younger than 14 years of age diagnosed with tuberculosis in Cantabria between 2005 and 2014 were included in the study. They were classified into two groups: patients with exclusively intrathoracic adenopathies and those with other forms of tuberculosis. Clinical symptoms, erythrocyte sedimentation rate, tuberculin skin test (TST) results and microbiological isolation between the two groups were compared. Results: A total of 81 patients were diagnosed with tuberculosis, 38.3% had nodal tuberculosis and the rest other forms of tuberculosis. The mean age at diagnosis was 70.46 ± 43.6 months. Patients with nodal tuberculosis were more frequently asymptomatic and had significantly higher TST induration diameters. Microbiological isolation was achieved in 25.9% of the patients and no significant differences in microbiological isolation between the two groups were observed (35.5 vs. 16.13%; p= 0.074). No Mycobacterium tuberculosis was isolated in any patient with lymphadenopathies detected by computed tomography. Discussion: The microbiological isolation is the gold standard of tuberculosis disease. Isolation of M. tuberculosis was not significantly superior in the group of patients with exclusive lymph node tuberculosis suggesting that lymph node tuberculosis should be considered a true tuberculosis disease


Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Linfadenopatia/diagnóstico , Tuberculose dos Linfonodos/diagnóstico , Sedimentação Sanguínea , Teste Tuberculínico , Mycobacterium tuberculosis/isolamento & purificação , Tomografia Computadorizada de Emissão , Mediastinite/diagnóstico por imagem , Mediastinite/patologia , Estudos Retrospectivos
2.
J Healthc Qual Res ; 33(4): 206-212, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-31610976

RESUMO

OBJECTIVE: To assess the results of the implementation of a protocol for the outpatient management of paediatric patients with tuberculosis, and to compare it with the previous approach. MATERIAL AND METHODS: All patients younger than 14 years of age diagnosed with tuberculosis in Cantabria between 2005 and 2014 were included in the study. The pre-implementation period included patients admitted for gastric aspirate collection and to start treatment until 2010 (Pre-group). The post-implementation period was from 2010 onwards, using a protocol established for the outpatient management of these patients, with admission only being for clinical or social reasons, post-implantation period (Post-group). RESULTS: A total of 82 patients were studied: 29 from the Pre-group and 53 from Post-group. The median age was 61 months (IQR 32.5-97.75). All patients in the Pre-group were systematically admitted, compared to 26.4% of the Post-group (P<.001). The mean hospital stay was higher (7.27±7.1 days) in the Pre-group than in Post-group (3.4±11.46 days) (P<.0001). Only in 6.9% of patients from Pre-group were the 3 microbiological samples recommended for diagnosis following the international guidelines were provided, whereas they were provided by 73.58% patients from Post-group (P<.001). Of the cultures performed, 26.6% were positive for Mycobacterium tuberculosis, 37.5% of the Pre-group and 21.6% of the Post-group (P=.121). No significant differences were observed between the groups in other parameters related to treatment such as, therapeutic adherence, treatment not adjusted to the guidelines, treatment withdrawal or relapse.. DISCUSSION: Although guidelines recommend three microbiological samples for culture, no superior microbiological isolation was detected despite the increased number of samples collected. The management in hospital clinics of patients with suspected tuberculosis with stable clinical situation show similar or better clinical and microbiological results to the previous management, with lower hospital admission rate and with the subsequent cost savings.

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