Tuberculosis infantil en Cuba / Children tuberculosis in Cuba

Introducción: La presencia de tuberculosis infantil constituye una señal de alerta de transmisión en la comunidad. Objetivos: Determinar incidencia y características de la tuberculosis infantil en Cuba en su etapa más reciente. Métodos: Estudio descriptivo, transversal y retrospectivo de los 107 casos diagnosticados 0-18 años, periodo 2013-2017, según datos de la Dirección de Registros Médicos y Estadísticas de Salud, la ficha epidemiológica y datos del Centro de Referencia Nacional de tuberculosis infantil. Se estudiaron variables demográficas, epidemiológicas, clínicas y de estudios que contribuyeron al diagnóstico, así como a la evolución final de los casos. Resultados: Predominó el grupo de edad de 15 - 18 años (52,0 - 48,6 por ciento) , sexo masculino (59,0-55,1 por ciento) y los procedentes de La Habana (43,0 - 40,2 por ciento). La tuberculosis en menores de 19 años representó entre 1,8 y 4,4 por ciento del total de casos en el país. La tasa de incidencia por 100 mil habitantes se comportó en menores de 15 años entre 0,4 y 0,8 con tendencia descendente; en el grupo 15-18 años, entre 0,8 y 3,0 con tendencia ascendente. Predominaron las formas pulmonares (87,0 - 82,6 por ciento) con pobre confirmación bacteriológica (49,0 - 45,7 por ciento). Ningún caso tuvo coinfección VIH-TB ni drogorresistencia. Hubo una fallecida (0,9 por ciento). Conclusiones: Cuba tiene muy baja incidencia de tuberculosis infantil, no es un problema de salud, pero sí un indicador de transmisión de la enfermedad en la comunidad. Para su eliminación, hay que fortalecer las acciones del Programa Nacional de Control, particularmente en La Habana y en el grupo de edad de 15 a 18 años(AU)

Introduction: The presence of children tuberculosis constitutes a transmission alert sign in the community. Objectives: To determine the incidence and characteristics of children tuberculosis in Cuba in its earliest stage. Methods: Descriptive, cross-sectional and restrospective study of 107 diagnosed cases in the ages from 0 to 18 years during the period 2013-2017, according to data provided by the National Division of Medical Records and Health Statistics, epidemiological records and data from the Center of National Reference on Children Tuberculosis. There were studied demographic, epidemiological, clinical and study variables which contributed to the diagnosis as well as to the final evolution of the cases. Results: There was a predominance of the age of group of 15 - 18 years (52.0 - 48.6 percent), masculine sex (59.0 - 55.1 percent) and patients from Havana city (43.0 - 40.2 percent). Tuberculosis in patients under 19 years represented between the 1.8 and 4.4 percent of all the cases in the country. The incidence rate per 100 000 inhabitants in patients under 15 years was 0.4 to 0.8 with a decreasing trend; in the group age of 15 to 18 years it was between 0.8 and 3.0 with an increasing trend. Pulmonary conditions predominated (87.0 - 82.6 percent) with poor bacteriological confirmation (49.0 - 45.7 percent). None of the cases had HIV-TB co-infection nor drugs resistance. There was one deceased girl (0,9 percent). Conclusions: Cuba has a very low incidence of children tuberculosis; it does not represent a health problem but it actually is an indicator of transmission of the disease in the community. For its erradication, it is needed to strenght the actions of the Control´s National Program, particularly in Havana city and the age group of 15 to 18 years(AU)

Tuberculosis o colagenosis: un dilema diagnóstico / Tuberculosis or collagenosis: a diagnostic dylemma

Introducción: Colagenosis y tuberculosis comparten síntomas y signos, pero además, el trastorno autoinmune y los tratamientos inmunosupresores que reciben los pacientes con colagenosis, los hacen más vulnerables a esta infección, lo que puede constituir un dilema diagnóstico. Objetivo: Contribuir al conocimiento de la relación entre tuberculosis y colagenosis. Presentación de casos: Se presentan tres adolescentes con tuberculosis, atendidos en el Centro de Referencia Nacional para la Tuberculosis Infantil. Dos enfermos tenían diagnóstico previo de colagenosis (artritis idiopática juvenil y polimiositis) con tratamiento esteroideo en exacerbaciones o continuo desde hacía un año, respectivamente. El tercero presentó un síndrome febril prolongado con pleuresía y pericarditis, con sospecha de lupus eritematoso diseminado. Se diagnosticó tuberculosis por test de mantoux hiperérgico. El tratamiento fue prolongado con esteroides, drogas antituberculosas y pericardiotomía al inicio del proceso, con evolución tórpida y fallo de tratamiento. Todo el tiempo se trató de descartar una enfermedad del colágeno. Se confirmó por cultivo la tuberculosis en los tres pacientes y la evolución final fue satisfactoria. Se exponen las características de cada enfermo y se analiza la relación entre ambas entidades. Conclusiones: Se presentan tres casos que ejemplifican la relación entre tuberculosis y colagenosis(AU)

Introduction: Collagenosis and tuberculosis share similar symptoms and manifestations; and in addition, the autoimmune disorder and inmunosuppressive treatments that patients with collagenosis receive make them more vulnerable to this infection which can constitute a diagnostic dylemma. Objective: To contribute to a better knowledge on the relation among tuberculosis and collagenosis. Cases presentation: Three adolescents suffering collagenosis are presented. They were attended in the National Reference Center for Children Tuberculosis. Two of the patients had previous diagnostic of collagenosis (juvenile idiopatic arthritis and polymyositis) with steroids treatment in exacerbations or continuous since a year ago. The third patient presented a prolonged febrile syndrome with pleurisy and pericarditis, with suspicions of disseminated lupus erythematosus. Tuberculosis was diagnosed by the test of hyperergic Mantoux. The treatment was prolonged with steroids, antiturberculosis drugs and pericardiotomy at the beginning of the process, with bad evolution and failure of the treatment. All the time it was intended to rule out collagen disease. Tuberculosis was confirmed by culturing in the three patients and final evolution was satisfactorily. Characteristics of each patient were exposed and it was analyzed the relation among both diseases. Conclusions: Three cases that exemplify the relation among tuberculosis and collagenosis(AU)

[Behavior of predictive variables of exacerbations of the COPD in the neumological hospital of Cuba.] / Comportamiento de variables predictivas de exacerbaciones de la EPOC en el hospital neumológico de Cuba.

The use of predictive variables of exacerbations of the COPD is not a practice generalized in our environment, for what we cannot characterize the exacerbating patient neither to design strategies for its integral handling. There was carried out a prospective descriptive study to correlate in patient with diagnosis of COPD from the Neumologic Hospital of Cuba, with the objective of determining the association between clinical, functional variables and imagenological and the exacerbations frequency a year. The population was constituted for patients with clinical diagnosis of COPD and the sample for those patients with confirmed diagnosis that they completed the inclusion approaches. The correlation among the variables was carried out by means of the Coefficient of Correlation of Pearson with an interval of Trust of 95% and the test t student with a significance level (p) smaller than 0.05. 81.82% of the very serious patients are exacerbating with emphysema. 75% of the patients with index of the lung artery / aorta have more than two exacerbations a year. 84.61% of the patient exacerbating presented degree four of the dyspnea. The half pressure of the lung artery next to the VEF1 constituted the best exacerbations predictors in the group of studied patients.

Síndrome de Lady Windermere como causa de tos crónica. A propósito de un caso / Lady Windermere Syndrome as a cause of chronic cough. Report of a case

Resumen Las mycobacterias no tuberculosas son poco reconocidas en la actualidad, pero su prevalencia se incrementa al sospechar su presencia en inmunodeprimidos o en enfermedades crónicas como la fibrosis quística. Se presenta el caso de una paciente con diagnóstico de síndrome de Lady Windermere con tos crónica. Se realizó tomografía computarizada donde se observaron bronquiectasias en el segmento lingular del pulmón izquierdo y en los lóbulos medio e inferior del derecho. En la broncoscopia se aisló complejo Mycobacterium avium-intracellulare. El no considerar en el diagnóstico de pacientes con tos crónica y sin factores predisponentes a las mycobacterias atrasa el diagnóstico y se acelera el deterioro clínico del paciente.

Abstract The nontuberculous mycobacteria are rarely recognized today in the world, being increased their prevalence about to departure of their suspicion in chronic illnesses such as inmunocompromised patients and cystic fibrosis. We present a case with diagnosis of syndrome of Lady Windermere about to departure of a square of chronic cough. Computed tomography was performed where bilateral bronchiectasis is observed in the left lingual segment and right upper lobe. In the Bronchoscopy was isolated complex Mycobacterium avium-intracellulare. The lack of suspicion of nontuberculous mycobacteria in patient without risk factors, with a square of chronic cough leads to the delay in the diagnosis and the patient's clinical deterioration.

Síndrome de Lady Windermere como causa de tos crónica. A propósito de un caso / Lady Windemere syndrome as the cause of chronic cough. A propos of one case

Las micobacterias no tuberculosas son poco reconocidas hoy en el mundo, incrementándose su prevalencia a punto de partida de su sospecha en inmunodeprimidos o en enfermedades crónicas, como la fibrosis quística. Se presenta el caso de una paciente con diagnóstico de síndrome de Lady Windermere a punto de partida de un cuadro de tos crónica. Se realizó tomografía computarizada donde se evidenciaron bronquiectasias en el segmento lingular del pulmón izquierdo y en los lóbulos medio e inferior del derecho. Mediante la broncoscopia se aisló el complejo Mycobacterium avium-intracellulare. La falta de sospecha de micobacterias atípicas en pacientes sin factores predisponentes, con un cuadro de tos crónica, conduce al retraso en el diagnóstico y el deterioro clínico del paciente...

Nontuberculous mycobacteria are rarely recognized in the world today; their prevalence is increasing due to suspicion in immunocompromised patients or in those suffering from chronic illnesses such as cystic fibrosis. A case with of Lady Windermere Syndrome diagnosis that originally started with chronic cough is presented. Tomography showed bilateral bronchiectasis in the left lingual segment and in the middle and lower right lobe. Mycobacterium avium-intracellulare complex was isolated using bronchoscopy. The lack of suspicion of nontuberculous mycobacteria in patients without risk factors and chronic cough leads to diagnosis delay and clinical deterioration of the patient...

[Pancoast tumor. A clinical case]. / Tumor de Pancoast etapa clínica IIb. A propósito de un caso.

We described a patient who was diagnosed with a Pancoast tumor in the Neumológico Benéfico Jurídico Hospital. This neoplastic non metastatic disease more frequently affects the brachial plexus. Therefore, a differential diagnosis of the painful shoulder was carried out and the patient was admitted in our center with the probable Pancoast tumor diagnosis. Subsequently, its study continued and the clinical suspicion was confirmed by a computerized tomography and a magnetic resonance, to be also confirmed later on with an anatomopathological study.

Se presenta el caso de un paciente al cual se le diagnosticó un tumor de Pancoast en el Hospital Neumológico Benéfico Jurídico. Esta enfermedad neoplásica no metastásica es la que más comúnmente compromete el plexo braquial de ahí que deba hacerse el diagnóstico diferencial del hombro doloroso, condición clínica esta con la cual es admitido en nuestro centro. Posteriormente se continuó su estudio y la sospecha clínica fue respaldada por tomografía computarizada y resonancia magnética para posteriormente ser confirmada a través del estudio anatomopatológico.

Tumor de Pancoast etapa clínica IIb. A propósito de un caso / [Pancoast tumor. A clinical case].

We described a patient who was diagnosed with a Pancoast tumor in the Neumológico Benéfico Jurídico Hospital. This neoplastic non metastatic disease more frequently affects the brachial plexus. Therefore, a differential diagnosis of the painful shoulder was carried out and the patient was admitted in our center with the probable Pancoast tumor diagnosis. Subsequently, its study continued and the clinical suspicion was confirmed by a computerized tomography and a magnetic resonance, to be also confirmed later on with an anatomopathological study.

Tumor de Pancoast etapa clínica IIb. A propósito de un caso. / [Pancoast tumor. A clinical case].

We described a patient who was diagnosed with a Pancoast tumor in the Neumológico Benéfico Jurídico Hospital. This neoplastic non metastatic disease more frequently affects the brachial plexus. Therefore, a differential diagnosis of the painful shoulder was carried out and the patient was admitted in our center with the probable Pancoast tumor diagnosis. Subsequently, its study continued and the clinical suspicion was confirmed by a computerized tomography and a magnetic resonance, to be also confirmed later on with an anatomopathological study.

Timosarcoma. Presentación de un caso / Thymosarcoma. Case presentation

Introducción: los tumores del timo son poco frecuentes, cerca de 35 por ciento son malignos, afectan por igual a hombres y mujeres, se presentan usualmente en pacientes por encima de los 40 años; cursan, por lo general, de forma asintomática y cuando producen síntomas habitualmente son de compresión local. Objetivo: presentar este caso por la poca frecuencia de esta enfermedad en la literatura consultada y su rara descripción en pacientes jóvenes.Presentación del caso: paciente masculino, mestizo, de 30 años de edad, con antecedentes de salud, no fumador, quien acude al área de salud por comenzar el mes anterior, en la región anterior del tórax, una tos seca frecuente, esputos hemoptoicos, fiebre en dos o tres ocasiones, falta de aire ocasional relacionada con esfuerzos físicos intensos y pérdida de peso; por todo esto, es remitido al Hospital Neumológico Benéfico Jurídico con el diagnóstico de cáncer de pulmón. Al llegar a nuestro Centro, se le realiza una radiografía de tórax frontal y en vista lateral derecha en la que se observa una radiopacidad mediastino-pulmonar derecha, homogénea, de bordes bien delimitados que se situaba en el mediastino anterosuperior y derrame pleural derecho de pequeña cuantía; se decide su ingreso para estudio y tratamiento con el diagnóstico presuntivo de un tumor del mediastino anterosuperior, posiblemente del timo. Se realizó estudio anatomopatológico y se diagnosticó un timosarcoma.Conclusiones: los tumores del timo son enfermedades malignas poco frecuentes y se pueden presentar en pacientes jóvenes(AU)

Introduction: the thymus tumors are not frequent, already 35 percent are malignant and they are usually present in patients older 40 years of age; generally are asymptomatic and when produce symptoms habitually are from local compression. Objective: because of the few frequency of this disease in the consultation literature and its rare description in young patient, is the reason why we proposed to make the presentation of this case. Case presentation: a male patient is presented, half-breed, with 30 years of age, with health antecedents, non-smoking man, that goes to the health area due to the month before he started with clinical of pain in the anterior thoracic region, frequent dry cough, hemopthoic spits, fever in two or three opportunities, occasional shortness of breath related to intense physical efforts and lost of weight; for all this reason he is remitted to the Hospital Neumol¾gico BenÚfico JurÝdico with the diagnosis of lung cancer. When he arrives to our center we made him a frontal chest X ray and on right lateral view observing a right lung mediastinum homogeneous radiopacity, of well limited borders that was located in the anterior upper mediastinum and right pleural effusion of a little quantity, deciding his admission for study and treatment with the presumptive diagnosis of a mediastinum tumor, possibly of the thymus. There was done on anatomopathologycal study and was diagnose a thymosarcoma. Conclusions: thymus tumors are few frequent malignant disease and they can present in non-elderly patients(AU)

Timosarcoma. Presentación de un caso / Thymosarcoma. Case presentation

Introducción: los tumores del timo son poco frecuentes, cerca de 35 % son malignos, afectan por igual a hombres y mujeres, se presentan usualmente en pacientes por encima de los 40 años; cursan, por lo general, de forma asintomática y cuando producen síntomas habitualmente son de compresión local. Objetivo: presentar este caso por la poca frecuencia de esta enfermedad en la literatura consultada y su rara descripción en pacientes jóvenes. Presentación del caso: paciente masculino, mestizo, de 30 años de edad, con antecedentes de salud, no fumador, quien acude al área de salud por comenzar el mes anterior, en la región anterior del tórax, una tos seca frecuente, esputos hemoptoicos, fiebre en dos o tres ocasiones, falta de aire ocasional relacionada con esfuerzos físicos intensos y pérdida de peso; por todo esto, es remitido al Hospital Neumológico Benéfico Jurídico con el diagnóstico de cáncer de pulmón. Al llegar a nuestro Centro, se le realiza una radiografía de tórax frontal y en vista lateral derecha en la que se observa una radiopacidad mediastino-pulmonar derecha, homogénea, de bordes bien delimitados que se situaba en el mediastino anterosuperior y derrame pleural derecho de pequeña cuantía; se decide su ingreso para estudio y tratamiento con el diagnóstico presuntivo de un tumor del mediastino anterosuperior, posiblemente del timo. Se realizó estudio anatomopatológico y se diagnosticó un timosarcoma. Conclusiones: los tumores del timo son enfermedades malignas poco frecuentes y se pueden presentar en pacientes jóvenes.

Introduction: the thymus tumors are not frequent, already 35 percent are malignant and they are usually present in patients older 40 years of age; generally are asymptomatic and when produce symptoms habitually are from local compression. Objective: because of the few frequency of this disease in the consultation literature and its rare description in young patient, is the reason why we proposed to make the presentation of this case. Case presentation: a male patient is presented, half-breed, with 30 years of age, with health antecedents, non-smoking man, that goes to the health area due to the month before he started with clinical of pain in the anterior thoracic region, frequent dry cough, hemopthoic spits, fever in two or three opportunities, occasional shortness of breath related to intense physical efforts and lost of weight; for all this reason he is remitted to the Hospital Neumológico Benéfico Jurídico with the diagnosis of lung cancer. When he arrives to our center we made him a frontal chest X ray and on right lateral view observing a right lung mediastinum homogeneous radiopacity, of well limited borders that was located in the anterior upper mediastinum and right pleural effusion of a little quantity, deciding his admission for study and treatment with the presumptive diagnosis of a mediastinum tumor, possibly of the thymus. There was done on anatomopathologycal study and was diagnose a thymosarcoma. Conclusions: thymus tumors are few frequent malignant disease and they can present in non-elderly patients.

Biopsia por aspiración con aguja fina guiada por ecografía en el diagnóstico de enfermedades del tórax / Fine needle aspiration biopsy guided by ultrasound in the diagnosis of chest diseases

La biopsia por aspiración con aguja fina guiada por ecografía es un método con una alta rentabilidad en el diagnóstico de lesiones pulmonares de localización preferentemente periféricas. Objetivo: Identificar los resultados citológicos obtenidos mediante la Biopsia por aspiración con aguja fina guiada por ecografía. Método: Se realizó un estudio observacional de tipo analítico que incluyó a 306 pacientes, a los cuales se les realizó biopsia por aspiración con aguja fina guiada por ecografía. Resultados: Del total de pacientes estudiados, el 68,63 por ciento fueron hombres y el 31,37 por ciento fueron mujeres, el grupo de edad predominante fue el de 60 y más años. El patrón ecográfico más observado fue la imagen compleja. Se obtuvo un porciento de utilidad de 95,7 por ciento. El diagnóstico más frecuente fue el carcinoma de pulmón no células pequeñas. Conclusiones: La biopsia por aspiración con aguja fina de pulmón guiada por ecografía es una técnica muy útil para el diagnóstico de enfermedades de pulmón de localización periférica y tiene un bajo índice de complicaciones(AU)

The fine needle aspiration biopsy (BAAF), guided by ultrasound is a method with a high return in the diagnosis of pulmonary lesions preferably peripheral location. Objective: Identify the cytological results obtained by fine needle aspiration biopsy (BAAF) ultrasound-guided. Method: An observational study of analytical type involving 306 patients, was carried out, to which a fine needle aspiration biopsy was carried out (BAAF) guided by ultrasound. Results: From the total of studied patients, 68,63 percent were men and 31,37 percent women, 60 years and older were the predominant age. The most observed ultrasound pattern was the complex image. We obtained a usefulness percent of 95.7 percent. Lung carcinoma non-small cell was the most frequent diagnosis. Conclusions: The ultrasound-guided lung BAAF is a very useful technique for lung disease diagnosis of peripheral location and it has a low rate of complications(AU)

Biopsia por aspiración con aguja fina guiada por ecografía en el diagnóstico de enfermedades del tórax / Fine needle aspiration biopsy guided by ultrasound in the diagnosis of chest diseases

La biopsia por aspiración con aguja fina guiada por ecografía es un método con una alta rentabilidad en el diagnóstico de lesiones pulmonares de localización preferentemente periféricas. Objetivo: Identificar los resultados citológicos obtenidos mediante la Biopsia por aspiración con aguja fina guiada por ecografía. Método: Se realizó un estudio observacional de tipo analítico que incluyó a 306 pacientes, a los cuales se les realizó biopsia por aspiración con aguja fina guiada por ecografía. Resultados: Del total de pacientes estudiados, el 68,63 por ciento fueron hombres y el 31,37 por ciento fueron mujeres, el grupo de edad predominante fue el de 60 y más años. El patrón ecográfico más observado fue la imagen compleja. Se obtuvo un porciento de utilidad de 95,7 por ciento. El diagnóstico más frecuente fue el carcinoma de pulmón no células pequeñas. Conclusiones: La biopsia por aspiración con aguja fina de pulmón guiada por ecografía es una técnica muy útil para el diagnóstico de enfermedades de pulmón de localización periférica y tiene un bajo índice de complicaciones.

The fine needle aspiration biopsy (BAAF), guided by ultrasound is a method with a high return in the diagnosis of pulmonary lesions preferably peripheral location. Objective: Identify the cytological results obtained by fine needle aspiration biopsy (BAAF) ultrasound-guided. Method: An observational study of analytical type involving 306 patients, was carried out, to which a fine needle aspiration biopsy was carried out (BAAF) guided by ultrasound. Results: From the total of studied patients, 68,63 percent were men and 31,37 percent women, 60 years and older were the predominant age. The most observed ultrasound pattern was the complex image. We obtained a usefulness percent of 95.7 percent. Lung carcinoma non-small cell was the most frequent diagnosis. Conclusions: The ultrasound-guided lung BAAF is a very useful technique for lung disease diagnosis of peripheral location and it has a low rate of complications.

Neumonía tuberculosa. Presentación de caso / Tuberculous pneumonia. Case presentation

Introducción: la Neumonía Tuberculosa es una forma infrecuente y grave de presentación de la tuberculosis pulmonar, cuyas características clínicas inducen al diagnóstico erróneo de Neumonía bacteriana, especialmente al diagnóstico de Neumonía neumoccócica.Objetivo: actualización de una entidad poco frecuente a través de la presentación de un caso con diagnóstico confirmado. Presentación del caso: presentamos el caso de una paciente de 22 años de procedencia extranjera con el diagnóstico de neumonía tuberculosa, hospitalizada en el Servicio de Tisiología de mujeres del Hospital Neumológico Benéfico Jurídico. La paciente consultó por fiebre mayor de 380c, tos seca y síntomas generales. Al examen físico, se encontró un típico síndrome de condensación pulmonar. La radiografía de tórax reveló una consolidación del espacio aéreo del lóbulo superior derecho con broncograma aéreo. El hematocrito fue de 0.35 por ciento, leucocitos en cifras normales: 8x 109/l , la vsg en 138 mms/h . Mantoux en 18 mm y el primer examen del esputo BAAR directo codificación 8 y cultivo 6.Conclusiones: la paciente recibió tratamiento antituberculoso de primera línea, con magnífica respuesta clínica, radiológica y bacteriológica(AU)

Introduction: the TB pneumonia is an infrequent serious manifestation of the lung TB, whose clinical features lead to the erroneous diagnosis of bacterial pneumonia, particularly to the diagnosis pneumococcal pneumonia. Objective: Our objective was to update an infrequent entity through the presentation of a case with confirmed diagnosis. Presentation of the case: we are presenting the case of a foreign 22-year-old female patient with TB pneumonia diagnosis who was hospitalized under the TB services for women at Hospital Neumológico Benéfico Jurídico in the TB Service. The patient had fever higher than 38°C, dry coughing, and dyspnea and symptoms in general. During the physical exam the typical syndrome of lung condensation was found. The thorax x-ray revealed a consolidation of the air space in the right high lobe with air bronchogram. The hematocrit measurement of 0.35 percent, leucocytes with normal count: 8x10(9,) eritrosedimentation at 138 mms/h. Mantoux at 18 mm and the first sputum exam with direct BAAR with 8 coding and culture at 6. Conclusions: patient received anti TB treatment of first line with a great clinical, radiological and bacteriological response(AU)

Neumonía tuberculosa. Presentación de caso / Tuberculous pneumonia. Case presentation

Introducción: la Neumonía Tuberculosa es una forma infrecuente y grave de presentación de la tuberculosis pulmonar, cuyas características clínicas inducen al diagnóstico erróneo de Neumonía bacteriana, especialmente al diagnóstico de Neumonía neumoccócica. Objetivo: actualización de una entidad poco frecuente a través de la presentación de un caso con diagnóstico confirmado. Presentación del caso: presentamos el caso de una paciente de 22 años de procedencia extranjera con el diagnóstico de neumonía tuberculosa, hospitalizada en el Servicio de Tisiología de mujeres del Hospital Neumológico Benéfico Jurídico. La paciente consultó por fiebre mayor de 38(0)c, tos seca y síntomas generales. Al examen físico, se encontró un típico síndrome de condensación pulmonar. La radiografía de tórax reveló una consolidación del espacio aéreo del lóbulo superior derecho con broncograma aéreo. El hematocrito fue de 0.35%, leucocitos en cifras normales: 8x 109/l , la vsg en 138 mms/h . Mantoux en 18 mm y el primer examen del esputo BAAR directo codificación 8 y cultivo 6. Conclusiones: la paciente recibió tratamiento antituberculoso de primera línea, con magnífica respuesta clínica, radiológica y bacteriológica.

Introduction: the TB pneumonia is an infrequent serious manifestation of the lung TB, whose clinical features lead to the erroneous diagnosis of bacterial pneumonia, particularly to the diagnosis pneumococcal pneumonia. Objective: Our objective was to update an infrequent entity through the presentation of a case with confirmed diagnosis. Presentation of the case: we are presenting the case of a foreign 22-year-old female patient with TB pneumonia diagnosis who was hospitalized under the TB services for women at Hospital Neumológico Benéfico Jurídico in the TB Service. The patient had fever higher than 38°C, dry coughing, and dyspnea and symptoms in general. During the physical exam the typical syndrome of lung condensation was found. The thorax x-ray revealed a consolidation of the air space in the right high lobe with air bronchogram. The hematocrit measurement of 0.35%, leucocytes with normal count: 8x10(9,) eritrosedimentation at 138 mms/h. Mantoux at 18 mm and the first sputum exam with direct BAAR with 8 coding and culture at 6. Conclusions: patient received anti TB treatment of first line with a great clinical, radiological and bacteriological response.

Cubas Strategy for Childhood Tuberculosis Control, 1995-2005

INTRODUCTION Following a tripling of tuberculosis incidence in Cuba between 1991 and 1994 (from 4.7 to 14.7 per 100,000), the National TB Control Program was revamped in 1995 and the National Reference Center for Childhood TB and Provincial Childhood TB Commissions were created as a strategy for addressing this emerging health problem. OBJECTIVES Assess the impact of Cuba’s new strategy for TB control in children aged <15 years during the period 1995–2005. METHODS A descriptive review of health services and systems was conducted in Cuba, examining 157 cases of TB diagnosed in children aged <15 years during the period 1995–2005 and comparing impact and process indicators for selected years (1995, 2000, and 2005). Impact indicators included reduction in: a) incidence; b) serious forms (peritoneal, meningeal, miliary, combined); c) mortality; and d) case outcomes (cure, death, treatment drop-out, treatment failure). Process indicators were proportion of cases with: a) microbiological tests; b) knowledge of infection source; c) diagnoses obtained through adult case contact tracing; d) time to diagnosis <60 days; and e) post-mortem diagnoses. RESULTS During the period 1995–2005, TB rates in children aged <15 years fell by 50 por ciento (from 1.0 to 0.5 per 100,000), more evident in children <10 years. The Havana rate was three times the national rate. Diagnosis was post-mortem in three serious cases (1.9 por ciento); there were four deaths (2.5 por ciento), none after 2000(AU)

[An alternative for improving the diagnosis of smear-negative tuberculosis and other bronchopulmonary disorders in Cuba]. / Una alternativa para mejorar el diagnóstico de la tuberculosis con baciloscopia negativa y otros problemas broncopulmonares en Cuba.

OBJECTIVE: The diagnosis of tuberculosis in patients with negative acid-fast bacillus smears poses a challenge to both clinicians and public health authorities. In an attempt to aid diagnosis in such cases, an expert committee was established in Ciudad de La Habana, Cuba in 1995. The aim of this study was to describe the progress of the committee's work and the corresponding results for the period 1996 through 2003. PATIENTS AND METHODS: For each patient studied by the commission, we analyzed the following data: patient's residence and referring center, tentative diagnosis proposed by the attending physician, history of antibiotic treatment, and final diagnosis made by the commission. RESULTS: Of the 1703 patients studied, 84.8% were from La Habana, 48.4% were 55 years or older, and 63.8% were men. Between 2001 and 2003, 11.3% of patients were already on antituberculosis treatment when their case was studied by the commission. The corresponding percentage for 1996 through 2000 was 16.9% (P=.001). Active tuberculosis was confirmed in 43.1% of a total of 918 patients with full test results during the period 1996 through 2000 and in 52.2% of a total of 619 patients (52.2%) during the period 2001 through 2003 (P< .001). Of 344 patients with suspected pulmonary tuberculosis and negative acid-fast bacillus smears between 2001 and 2003, 128 (37.2%) were diagnosed with active tuberculosis. CONCLUSIONS: These findings indicate that the work of the commission is viable, sustainable, and useful for preventing overdiagnosis and inappropriate treatment, and that it also serves an educational purpose.

An Alternative for Improving the Diagnosis of Smear-Negative Tuberculosis and Other Bronchopulmonary Disorders in Cuba / Una alternativa para mejorar el diagnóstico de la tuberculosis con baciloscopia negativa y Otros Trastornos Bronconeumopatías en Cuba

OBJECTIVE: The diagnosis of tuberculosis in patients with negative acid-fast bacillus smears poses a challenge to both clinicians and public health authorities. In an attempt to aid diagnosis in such cases, an expert committee was established in Ciudad de La Habana, Cuba in 1995. The aim of this study was to describe the progress of the committee's work and the corresponding results for the period 1996 through 2003. PATIENTS AND METHODS: For each patient studied by the commission, we analyzed the following data: patient's residence and referring center, tentative diagnosis proposed by the attending physician, history of antibiotic treatment, and final diagnosis made by the commission. RESULTS: Of the 1703 patients studied, 84.8 percent were from La Habana, 48.4 percent were 55 years or older, and 63.8 percent were men. Between 2001 and 2003, 11.3 percent of patients were already on antituberculosis treatment when their case was studied by the commission. The corresponding percentage for 1996 through 2000 was 16.9percent (P=.001). Active tuberculosis was confirmed in 43.1 percent of a total of 918 patients with full test results during the period 1996 through 2000 and in 52.2 percent of a total of 619 patients (52.2 percent) during the period 2001 through 2003 (P<.001). Of 344 patients with suspected pulmonary tuberculosis and negative acid-fast bacillus smears between 2001 and 2003, 128 (37.2percent) were diagnosed with active tuberculosis. CONCLUSIONS: These findings indicate that the work of the commission is viable, sustainable, and useful for preventing overdiagnosis and inappropriate treatment, and that it also serves an educational purpose(AU)

OBJETIVO: El diagnóstico de la tuberculosis en pacientes con bacilos ácido-rápido frotis plantea un desafío tanto para los médicos y las autoridades de salud pública. En un intento de ayuda de diagnóstico en estos casos, un comité de expertos se creó en Ciudad de La Habana, Cuba en 1995. El objetivo de este estudio fue describir el progreso de la labor del Comité y los resultados correspondientes para el período 1996 a 2003. PACIENTES Y MÉTODOS: Para todos los pacientes estudiados por la comisión, se analizaron los siguientes datos: la residencia del paciente y centro de referencia, el diagnóstico provisional propuesto por el médico tratante, la historia del tratamiento antibiótico, y el diagnóstico final realizado por la comisión. RESULTADOS: De los 1703 pacientes estudiados, 84,8 por ciento eran de La Habana, el 48,4 por ciento tenía 55 años o más, y el 63,8 por ciento eran hombres. Entre 2001 y 2003, el 11,3 por ciento de los pacientes que ya estaban en tratamiento antituberculoso, cuando su caso fue estudiado por la comisión. El porcentaje correspondiente a 1996 y 2000 fue de 16,9 por ciento (P =. 001). Tuberculosis activa se confirmó en el 43,1 por ciento de un total de 918 pacientes con el pleno los resultados de la prueba durante el período 1996 a 2000 y en el 52,2 por ciento de un total de 619 pacientes (52,2 por ciento) durante el período 2001 hasta 2003 (P <.001). De 344 pacientes con sospecha de tuberculosis pulmonar y negativos bacilo ácido-rápido frotis entre 2001 y 2003, 128 (37,2 por ciento) fueron diagnosticados con tuberculosis activa. CONCLUSIONES: Estos resultados indican que la labor de la comisión es viable, sostenible y útil para la prevención de sobrediagnóstico y un tratamiento inadecuado, y que también sirve a un propósito educativo(AU)

Una alternativa para mejorar el diagnóstico de la tuberculosis con baciloscopia negativa y otros problemas broncopulmonares en Cuba / An alternative for improving the diagnosis of smear-negative tuberculosis and other bronchopulmonary disorders in Cuba

OBJETIVO: El diagnóstico de los pacientes con tuberculosispulmonar y muestras negativas para bacilos ácido-alcoholresistentes (BAAR) representa un desafío clínico y de saludpública, por lo que en Ciudad de La Habana se creó en 1995una comisión para esclarecer su diagnóstico. El objetivo deeste estudio ha sido describir los progresos y resultados deltrabajo de esta comisión entre 1996 y 2003.PACIENTES Y MÉTODOS: Se han analizado los datos recogidosde cada paciente presentado en las sesiones de la comisión:procedencia, diagnóstico de sospecha planteado por el médicoque presentó el caso, antecedentes de tratamiento anteriorcon antibióticos y diagnóstico realizado por la comisión.RESULTADOS: Del total de 1.703 pacientes presentados aesta comisión para esclarecer el diagnóstico, un 84,8%procedía de la Ciudad de La Habana, el 48,4% pertenecía algrupo de edad igual o mayor de 55 años y el 63,8% eranvarones. El porcentaje de casos consultados con tratamientoespecífico contra la tuberculosis ya comenzado fue en 2001-2003 del 11,3%, y en el período 1996-2000, del 16,9% (p =0,001). En 1986-2000, de 918 pacientes que completaron susexámenes, tuvo diagnóstico final de tuberculosis activa un43,1%, y en 2001-2003, el 52,2% de 619 (p = 0,000). De untotal de 344 casos estudiados con sospecha de tuberculosispulmonar con BAAR y cultivo negativos en 2001-2003, eldiagnóstico se corroboró en 128 (37,2%).CONCLUSIONES: Los resultados indican que el trabajo dela comisión es viable, sostenible y de utilidad porque evita elsobrediagnóstico y el tratamiento inapropiado, además decumplir una función docente

OBJECTIVE: The diagnosis of tuberculosis in patients withnegative acid-fast bacillus smears poses a challenge to bothclinicians and public health authorities. In an attempt to aiddiagnosis in such cases, an expert committee was establishedin Ciudad de La Habana, Cuba in 1995. The aim of this studywas to describe the progress of the committee’s work and thecorresponding results for the period 1996 through 2003.PATIENTS AND METHODS: For each patient studied by thecommission, we analyzed the following data: patient’sresidence and referring center, tentative diagnosis proposedby the attending physician, history of antibiotic treatment,and final diagnosis made by the commission.RESULTS: Of the 1703 patients studied, 84.8% were from LaHabana, 48.4% were 55 years or older, and 63.8% were men.Between 2001 and 2003, 11.3% of patients were already onantituberculosis treatment when their case was studied by thecommission. The corresponding percentage for 1996 through2000 was 16.9% (P=.001). Active tuberculosis was confirmedin 43.1% of a total of 918 patients with full test results duringthe period 1996 through 2000 and in 52.2% of a total of619 patients (52.2%) during the period 2001 through 2003(P<.001). Of 344 patients with suspected pulmonary tuberculosisand negative acid-fast bacillus smears between 2001 and 2003,128 (37.2%) were diagnosed with active tuberculosis.CONCLUSIONS: These findings indicate that the work of thecommission is viable, sustainable, and useful for preventingoverdiagnosis and inappropriate treatment, and that it also serves an educational purpose

Adjuvant interferon gamma in patients with pulmonary atypical Mycobacteriosis: a randomized, double-blind, placebo-controlled study.

BACKGROUND: High antibiotic resistance is described in atypical Mycobacteriosis, mainly by Mycobacterium avium complex (MAC). METHODS: A randomized, double-blind, placebo-controlled clinical trial was carried out in two hospitals to evaluate the effect of interferon (IFN) gamma as immunoadjuvant to chemotherapy on patients with atypical mycobacteria lung disease. Patients received placebo or 1 x 106 IU recombinant human IFN gamma intramuscularly, daily for one month and then three times per week up to 6 months as adjuvant to daily oral azithromycin, ciprofloxacin, ethambutol and rifampin. Sputum samples collection for direct smear observation and culture as well as clinical and thorax radiography assessments were done during treatment and one year after. Cytokines and oxidative stress determinations were carried out in peripheral blood before and after treatment. RESULTS: Eighteen patients were included in the IFN group and 14 received placebo. Groups were homogeneous at entry; average age was 60 years, 75% men, 84% white; MAC infection prevailed (94%). At the end of treatment, 72% of patients treated with IFN gamma were evaluated as complete responders, but only 36% in the placebo group. The difference was maintained during follow-up. A more rapid complete response was obtained in the IFN group (5 months before), with a significantly earlier improvement in respiratory symptoms and pulmonary lesions reduction. Disease-related deaths were 35.7% of the patients in the placebo group and only 11.1% in the IFN group. Three patients in the IFN group normalized their globular sedimentation rate values. Although differences in bacteriology were not significant during the treatment period, some patients in the placebo group converted again to positive during follow-up. Significant increments in serum TGF-beta and advanced oxidation protein products were observed in the placebo group but not among IFN receiving patients. Treatments were well tolerated. Flu-like symptoms predominated in the IFN gamma group. No severe events were recorded. CONCLUSION: These data suggest that IFN gamma is useful and well tolerated as adjuvant therapy in patients with pulmonary atypical Mycobacteriosis, predominantly MAC. Further wider clinical trials are encouraged. TRIAL REGISTRATION: Current Controlled Trials ISRCTN70900209.

Adjuvant interferon gamma in patients with pulmonary atypical Mycobacteriosis: a randomized, double-blind, placebo-controlled study

Background High antibiotic resistance is described in atypical Mycobacteriosis, mainly by Mycobacterium avium complex (MAC). MethodsA randomized, double-blind, placebo-controlled clinical trial was carried out in two hospitals to evaluate the effect of interferon (IFN) gamma as immunoadjuvant to chemotherapy on patients with atypical mycobacteria lung disease. Patients received placebo or 1 × 106 IU recombinant human IFN gamma intramuscularly, daily for one month and then three times per week up to 6 months as adjuvant to daily oral azithromycin, ciprofloxacin, ethambutol and rifampin. Sputum samples collection for direct smear observation and culture as well as clinical and thorax radiography assessments were done during treatment and one year after. Cytokines and oxidative stress determinations were carried out in peripheral blood before and after treatment. Results Eighteen patients were included in the IFN group and 14 received placebo. Groups were homogeneous at entry; average age was 60 years, 75 percent men, 84 percent white; MAC infection prevailed (94 percent). At the end of treatment, 72 percent of patients treated with IFN gamma were evaluated as complete responders, but only 36 percent in the placebo group. The difference was maintained during follow-up. A more rapid complete response was obtained in the IFN group (5 months before), with a significantly earlier improvement in respiratory symptoms and pulmonary lesions reduction. Disease-related deaths were 35.7 percent of the patients in the placebo group and only 11.1 percent in the IFN group. Three patients in the IFN group normalized their globular sedimentation rate values. Although differences in bacteriology were not significant during the treatment period, some patients in the placebo group converted again to positive during follow-up. Significant increments in serum TGF-beta and advanced oxidation protein products were observed in the placebo group but not among IFN... (AU)