Lesiones fibróticas inactivas versus tuberculosis pulmonar con bacteriología negativa / Inactive Fibrotic Lesions Versus Pulmonary Tuberculosis With Negative Bacteriology

El presente artículo analiza el concepto de lesiones fibróticas inactivas de presumible origen tuberculoso (old healed tuberculosis), su definición por sus características radiológicas y la presencia de prueba de la tuberculina (TST) positiva. Se revisa el fundamento basado en la evidencia de la indicación de tratamiento de infección tuberculosa latente en estos casos, el riesgo de reactivación en la literatura antigua y reciente, así como los problemas que plantea el diagnóstico diferencial con la tuberculosis activa con bacteriología negativa. Se consideran los datos sobre prevalencia de lesiones fibróticas en la literatura reciente. Se analiza el posible papel de las técnicas de Interferon Gamma Release Assay (IGRA) versus TST, así como otras técnicas moleculares de detección antigénica en esputo que pueden ayudar a hacer el diagnóstico. Se analizan las actuales indicaciones de quimioprofilaxis, las diferentes opciones y se proponen algoritmos diagnósticos y terapéuticos basados en la estratificación del riesgo según la edad y otros factores, para manejar las lesiones radiológicas que plantean diagnóstico diferencial entre lesión fibrótica inactiva y tuberculosis pulmonar con bacteriología negativa

This article analyzes the concept of inactive fibrotic lesions of presumed tuberculous origin (old healed tuberculosis), defined by radiological characteristics and a positive tuberculin skin test (TST), and we examine the evidence-based foundation for the indication of treatment of latent tuberculosis infection in these cases. We explore the risk of reactivation in older and recent literature, and the problems raised by the differential diagnosis with active tuberculosis with negative bacteriology. We also analyze data on the prevalence of fibrotic lesions in the recent literature. We examine the possible role of Interferon Gamma Release Assays (IGRAs) versus TST and other molecular antigen detection techniques in sputum that can aid in establishing the diagnosis and we discuss the current indications for chemoprophylaxis and the different options available. We propose diagnostic guidelines and therapeutic algorithms based on risk stratification by age and other factors in the management of radiological lesions that raise a differential diagnosis between fibrotic lesions and active pulmonary tuberculosis with negative bacteriology

[Hot topics respiratory infections]. / Hot topics en infecciones respiratorias.

A critical review of articles on respiratory infections published in the last three months of 2008 to the end of 2009. There are articles on patients with bronchiectasis that study their quality of life, as well as those that analyse the decrease in the number of exacerbations due to the immunomodulatory effect of using low doses of macrolides in these patients. In the diagnosis of tuberculosis, works on the application of interferon-A are especially relevant, whilst on the treatment of this disease, articles that study therapeutic innovations in the management of TB-MDR and TB-XDR or -TDR are also highlighted. As far as publications on pneumonia are concerned, there are those that analyse the progression of community acquired pneumonias (CAP) in patients affected with chronic obstructive pulmonary disease. Furthermore, special importance is given to the initial epidemiological and clinical studies of the influenza A (H1N1) pandemic. Also of interest is the evaluation of prognostic scales as predictors of ventilation support and/or the use of pressor amines, as well as the use of biological markers to complement the predictive value of these prognostic scales. Aetiological and clinical studies of pneumonias associated with the health system continue to be of great interest and their possible differences compared to CAPs. Also of interest in the treatment of the pneumonias, is the analysis of the potential inflammation modulatory ability of different drugs.