Coinfección COVID-19 y tuberculosis: experiencia de una terapia intensiva durante el periodo enero 2020-junio 2022 / COVID-19 and tuberculosis co-infection: experience of an intensive care unit during the period of January-june 2022

Antecedentes: Se ha demostrado que la coinfección tu-berculosis y COVID-19 presenta peor evolución clínica. La inmunidad protectora se debilita frente a esta situación, generando fallo en el control de ambas infecciones, reac-tivación de formas latentes de tuberculosis y progresión exacerbada de los casos activos. Asimismo, la terapia con corticoides utilizada dentro del tratamiento de infecciones graves por COVID-19 puede generar inmunosupresión y precipitar la progresión de la tuberculosis.Objetivos: Describir las características clínicas, presenta-ción y evolución de los pacientes críticos con coinfección COVID-19 y tuberculosis. Evaluar la incidencia y letalidad de la asociación COVID-19 y tuberculosis en cuidados in-tensivos. Materiales y métodos: Se realizó un estudio retrospectivo, descriptivo. Se revisaron 12 historias clínicas de pacientes con coinfección COVID-19-tuberculosis sobre 1014 histo-rias clínicas de pacientes ingresados con diagnóstico de COVID-19, durante el periodo comprendido enero 2020 y junio 2022. Se utilizó estadística descriptiva. Resultados y discusión: Sobre un total de 1014 historias clínicas, se encontraron 12 pacientes con coinfección (in-cidencia de 0,011). La letalidad global en cuidados inten-sivos fue del 75%, a los 45 días fue del 83,3%, duplicando la letalidad general de los pacientes COVID-19 no coinfec-tados ingresados durante el mismo periodo (75% versus 37%). Los pacientes que requirieron ingreso a ventilación RESUMENARTÍCULO ORIGINALmecánica tuvieron una letalidad del 100% y aquellos que tenían infección por virus de inmunodeficiencia adquirida presentaron una letalidad de 100%. Resulta importante describir los hallazgos y alertar sobre la evolución desfavorable de aquellos pacientes que pre-sentan esta asociación a fin de optimizar el manejo y espe-cialmente recomendar la búsqueda de coinfección cuando el criterio clínico lo requiera

Background: Coinfection with tuberculosis and COVID-19 has been shown to have a worse clinical course. Protective immunity is weakened in this situation, leading to failure to control both infections, reactivation of latent forms of TB and exacerbated progression of active cases. Furthermore, corticosteroid therapy used in the treatment of severe COVID-19 infections can lead to immunosuppression and precipitate TB progression.Objectives: To describe the clinical characteristics, presentation and evolution of critically ill patients with COVID-19 and tuberculosis co-infection.To evaluate the incidence and lethality of COVID-19 and tuberculosis association in intensive care.Materials and methods: A retrospective, descriptive study was conducted. Twelve medical records of patients aged 18 years or older admitted to intensive care with a diagnosis of COVID-19 during the period January 2020 to July 2022 were reviewed. Descriptive statistics were used.Results and discussion: Out of a total of 1014 medical records, 12 patients were found with co-infection (incidence 0.011). The global intensive care case fatality was 75%, at 45 days it was 83.3%. This was twice the overall case fatality of non-co-infected COVID-19 patients admitted during the same period (75% versus 37%). Patients requiring admission to mechanical ventilation had a 100% case fatality and those with acquired immunodeficiency virus infection had a 100% case fatality.It is important to describe the findings and to alert to the worse evolution of those patients presenting with this association, in order to improve management and recommend searching for co-infection when clinical criteria require it

[Evaluation of the control measures adopted against an epidemic of AIDS-related multidrug-resistant tuberculosis in a Latin-American hospital]. / Evaluación de las medidas de control adoptadas frente a la epidemia de tuberculosis multirresistente asociada al sida en un hospital hispanoamericano.

BACKGROUND: Since 1992 AIDS-related multidrug-resistant tuberculosis (MDRTB) has been detected among patients admitted to the Hospital Muñiz in Buenos Aires (Argentina). The aim of the present study was to evaluate the effectiveness of the control measures adopted against the nosocomial spread of MDRTB/AIDS, which affected 803 patients between 1992 and 2002. METHODS: An action plan was applied that included bacilloscopy screening on admission, isolation rooms for patients with TB/AIDS, an isolation ward for patients with MDRTB/AIDS, a radiometric method for the diagnosis of multidrug-resistance, a reserve supply of second line drugs, and respiratory protection for health care workers. RESULTS: Between 1995 and 2002, a statistically significant decreasing trend in cases of MDRTB/AIDS and admissions for TB/AIDS was observed (33.9% vs 80.5%). Mortality among patients with MDRTB/AIDS also significantly decreased. Bacilloscopy screening allowed the diagnosis of 63.4% of patients admitted with TB/AIDS. Respiratory isolation facilities and effective treatment of patients with MDRTB diagnosed through the radiometric method were progressively implemented. Admission of patients with AIDS showed no significant variations throughout the study period. The CD41 count of patients requiring admission did not vary significantly. CONCLUSION: The nosocomial epidemic curve of MDRTB in patients with AIDS significantly decreased, despite the persistence of susceptible patients with low CD41 levels. The decreasing tendency of MDRTB/AIDS cases could be attributed to the impact of the control measures implemented.

Evaluación de las medidas de control adoptadas frente a la epidemia de tuberculosis multirresistente asociada al sida en un hospital hispanoamericano / Evaluation of the control measures adopted against an epidemic of AIDS-related multidrug-resistant tuberculosis in a latin-american hospital

Desde 1992 se detectaron pacientes con tuberculosis multirresistente (TBMR) asociada al sida internados en el Hospital Muñiz (Buenos Aires). El objetivo del trabajo es evaluar la eficacia de las medidas adoptadas frente a la expansión nosocomial de la TBMR/sida, que afectó a 803 enfermos entre 1992-2002. Métodos. Se aplicó un plan de acción que incluyó: cribado baciloscópico de admisión, habitaciones de aislamiento para TB/sida, sala de aislamiento para TBMR/sida, diagnóstico de multirresistencia mediante método radiométrico; banco de fármacos de segunda línea y protección respiratoria del personal de salud. Resultados. Entre 1995 y 2002, se observó una tendencia estadísticamente significativa en la disminución de casos de TBMR/sida y de los internamientos por TB/sida (33,9% frente a 80,5%, respectivamente), así como una disminución significativa en la mortalidad de los primeros. El cribado baciloscópico permitió diagnosticar el 63,4% de los casos de TB/sida internados. Progresivamente fueron empleados los recursos de aislamiento respiratorio y tratamiento eficaz de los casos de TBMR diagnosticados por método radiométrico. Respecto de la población susceptible, el ingreso de pacientes con sida al hospital no varió significativamente a lo largo del período estudiado, tampoco lo hizo el recuento de linfocitos T CD41 de los pacientes que requirieron internamiento. Conclusión. Se observó una disminución significativa de la curva epidémica nosocomial de TBMR en pacientes con sida, pese a la persistencia de pacientes susceptibles con bajo nivel de linfocitos T CD41. Se considera que esta evolución decreciente de la TBMR/sida puede ser atribuida al impacto de las medidas de control implementadas (AU)

Since 1992 AIDS-related multidrug-resistant tuberculosis (MDRTB) has been detected among patients admitted to the Hospital Muñiz in Buenos Aires (Argentina). The aim of the present study was to evaluate the effectiveness of the control measures adopted against the nosocomial spread of MDRTB/AIDS, which affected 803 patients between 1992 and 2002. Methods. An action plan was applied that included bacilloscopy screening on admission, isolation rooms for patients with TB/AIDS, an isolation ward for patients with MDRTB/AIDS, a radiometric method for the diagnosis of multidrug-resistance, a reserve supply of second line drugs, and respiratory protection for health care workers. Results. Between 1995 and 2002, a statistically significant decreasing trend in cases of MDRTB/AIDS and admissions for TB/AIDS was observed (33.9% vs 80.5%). Mortality among patients with MDRTB/AIDS also significantly decreased. Bacilloscopy screening allowed the diagnosis of 63.4% of patients admitted with TB/AIDS. Respiratory isolation facilities and effective treatment of patients with MDRTB diagnosed through the radiometric method were progressively implemented. Admission of patients with AIDS showed no significant variations throughout the study period. The CD41 count of patients requiring admission did not vary significantly. Conclusion. The nosocomial epidemic curve of MDRTB in patients with AIDS significantly decreased, despite the persistence of susceptible patients with low CD41 levels. The decreasing tendency of MDRTB/AIDS cases could be attributed to the impact of the control measures implemented (AU)

[Respiratory distress due to pulmonary hemorrhage in leptospirosis]. / Dístrés respiratorio debido a hemorragia pulmonar por leptospirosis.

Two patients who lived in Buenos Aires suburbs died from leptospirosis in July 2000 and March 2001. They developed a nonspecific febrile illness followed by hemorrhagic pneumonia and respiratory distress in absence of typical manifestations such as jaundice, nephropathy, thrombocitopenia or hemorrhages in other organs. In the house and surroundings of one patient rodents were captured and three strains of leptospira, serogroup Icterohaemorrhagiae were isolated. Laboratory guinea pigs were inoculated and they were sacrificed as soon as respiratory symptoms appeared. Necropsy showed primary lung injury, which was similar to the histopathological lesions found in one of the patients. Neither jaundice, nor renal damage was found. Pericardiac hemorrhages were considered as a possible cause of cardiopulmonary collapse. This clinical form has not been reported previously in this region, where conditions are indeed suitable for the human illness to appear.

Dístrés respiratorio debido a hemorragia pulmonar por leptospirosis / [Respiratory distress due to pulmonary hemorrhage in leptospirosis]

Two patients who lived in Buenos Aires suburbs died from leptospirosis in July 2000 and March 2001. They developed a nonspecific febrile illness followed by hemorrhagic pneumonia and respiratory distress in absence of typical manifestations such as jaundice, nephropathy, thrombocitopenia or hemorrhages in other organs. In the house and surroundings of one patient rodents were captured and three strains of leptospira, serogroup Icterohaemorrhagiae were isolated. Laboratory guinea pigs were inoculated and they were sacrificed as soon as respiratory symptoms appeared. Necropsy showed primary lung injury, which was similar to the histopathological lesions found in one of the patients. Neither jaundice, nor renal damage was found. Pericardiac hemorrhages were considered as a possible cause of cardiopulmonary collapse. This clinical form has not been reported previously in this region, where conditions are indeed suitable for the human illness to appear.

Dístrés respiratorio debido a hemorragia pulmonar por leptospirosis. / [Respiratory distress due to pulmonary hemorrhage in leptospirosis]

Two patients who lived in Buenos Aires suburbs died from leptospirosis in July 2000 and March 2001. They developed a nonspecific febrile illness followed by hemorrhagic pneumonia and respiratory distress in absence of typical manifestations such as jaundice, nephropathy, thrombocitopenia or hemorrhages in other organs. In the house and surroundings of one patient rodents were captured and three strains of leptospira, serogroup Icterohaemorrhagiae were isolated. Laboratory guinea pigs were inoculated and they were sacrificed as soon as respiratory symptoms appeared. Necropsy showed primary lung injury, which was similar to the histopathological lesions found in one of the patients. Neither jaundice, nor renal damage was found. Pericardiac hemorrhages were considered as a possible cause of cardiopulmonary collapse. This clinical form has not been reported previously in this region, where conditions are indeed suitable for the human illness to appear.