Pancoast tumor mimicking lung tuberculosis, a case report.

It is well-recognized that tuberculosis (TB) can mimic several clinical diseases, particularly cancer. On several occasions, lung TB can be misdiagnosed as cancer, particularly in developed countries with a rare case of TB and high incidence of lung cancer, and vice versa- in which Indonesia, with a high incidence of TB, lung cancer may be mistakenly identified as TB, delaying the initiation of definitive therapy and causing unnecessary diagnostic and treatment procedures. We reported a 59-year-old male who complained of right upper chest pain, accompanied by chronic cough and weight loss, with a history of 6-month treatment with a TB regimen without resolution of his symptoms. Core biopsy CT guiding pathology anatomy revealed atypical adenocarcinoma. All patients seeking medical attention must be treated carefully, avoiding diagnostic procedures that can result in a delay in definitive therapy.

GeneXpert como método de diagnóstico de la tuberculosis en Santiago de Cuba / GeneXpert as diagnostic method of tuberculosis in Santiago de Cuba

Introducción: La tuberculosis es un problema de salud en el mundo, por lo que se necesitan métodos como el GeneXpert para realizar un diagnóstico rápido y seguro. Objetivo: Determinar la precisión del GeneXpert como método para el diagnóstico de la tuberculosis en Santiago de Cuba en relación con los estudios tradicionales. Métodos: Se efectuó un estudio descriptivo y transversal desde diciembre de 2018 hasta igual mes de 2019 de 31 pacientes a quienes se les realizaron los 3 métodos para el diagnóstico de la tuberculosis. Se utilizaron variables, tales como edad, sexo, muestras estudiadas, positividad de los métodos utilizados, así como concordancia entre el GeneXpert y el cultivo mediante el índice de Kappa. Resultados: En la serie predominaron los pacientes mayores de 50 años (48,4 %), el sexo masculino (66,7 %) y el esputo como muestra más representativa (80,6 %); asimismo, el cultivo resultó positivo en 32,3 % y el GeneXpert en 22,6 %. En tanto, se diagnosticó tuberculosis en 11 pacientes y el índice de Kappa fue de 0,58. Conclusiones: La determinación de GeneXpert en el diagnóstico de la tuberculosis es precisa, dada su sensibilidad y especificidad altas en relación con los estudios tradicionales de esputo y cultivo, lo cual se confirmó por la elevada concordancia del índice de Kappa.

Introduction: Tuberculosis is a health problem worldwide, reason why methods as the GeneXpert are needed to carry out a quick and safe diagnosis. Objective: To determine the accuracy of GeneXpert as a method for the diagnosis of tuberculosis in Santiago de Cuba in connection with the traditional studies. Methods: A descriptive and cross-sectional study was carried out from December, 2018 to the same month in 2019 of 31 patients to whom the 3 methods for the diagnosis of tuberculosis were carried out. Some variables were used, such as age, sex, studied samples, positivity of the used methods, as well as consistency between the GeneXpert and the culture by means of the Kappa index. Results: In the series there was a prevalence of the patients over 50 years (48.4 %), male sex (66.7 %) and sputum as more representative sample (80.6 %); also, the culture was positive in 32.3 % and GeneXpert in 22.6 %. As long as, tuberculosis was diagnosed in 11 patients and the Kappa index was 0.58. Conclusions: The determination of GeneXpert in the diagnosis of tuberculosis is necessary, given its high sensibility and specificity in connection with the traditional studies of sputum and culture, which was confirmed due to the high consistency of the Kappa index.

Application of routine laboratory data in combination with machine learning in the differential diagnosis of lung tuberculosis / 中华检验医学杂志

Objective:To investigate the application value of establishing the differential diagnosis model of pulmonary tuberculosis using routine laboratory data.Methods:The retrospective study was conducted. The routine laboratory data of newly diagnosed patients with pulmonary tuberculosis and other pulmonary diseases in Beijng Jishuitan Hospital and Beijing Hepingli Hospital from May 2015 to November 2021were collected. According to the random numbers showed in the computer, all the 11516 patients were divided into training dataset and test dataset with a ratio of 9∶1. Four machine learning algorithms, Support Vector Machine, Random Forest, K-Nearest Neighbor and Logistic Regression, were used to build models and select features. The diagnostic accuracy of each model was verified by using the 10-fold cross-validation method and the performance of each model was evaluated by using the receptor operator of characteristic (ROC) curve.Results:Random Forest was selected as the optimal machine learning algorithm to build the best feature model in the study. According to importance scale of factors, the differential diagnosis model of pulmonary tuberculosis consisting of 37 non-specific test indexes. In the validation set and test set the accuracy and area under curve (AUC) of the models were 0.747 and 0.736, the sensitivity, specificity and accuracy were 68.03% and 68.75%, 70.91% and 67.90%, 70.30% and 68.12%, respectively.Conclusion:A key tool in the differential diagnosis model of pulmonary tuberculosis was established by routine laboratory data in combination with machine learning. The results of this study need to be further verified by more data from medical institutions.

Metástasis coroidea como manifestación inicial de adenocarcinoma de pulmón en paciente joven: informe de caso / Choroidal metastasis as an initial manifestation of lung adenocarcinoma in a young patient: case report

Introducción: se presenta el caso de un paciente de 36 años, a quien se le realizó el diagnostico de tuberculoma coroideo, otorgando tratamiento sin mejoría de los síntomas. Posteriormente fallece dilucidándose el diagnóstico de adenocarcinoma de pulmón con metástasis a coroides. Objetivo: informar el diagnóstico de metástasis coroidea como manifestación inicial, de adenocarcinoma de pulmón, en un paciente joven. Diseño de estudio: reporte de caso. Resumen del caso: masculino de 36 años de edad, antecedente de tuberculosis en la infancia, tabaquismo positivo no significativo. Presenta baja visual de ojo derecho, siendo diagnosticado con tuberculoma coroideo, asociado a sudoración nocturna, lumbalgia, tos y QuantiFERON-TB positivo. Se inicia tratamiento antituberculosis. Posterior, presenta deterioro respiratorio y neurológico requiriendo intubación orotraqueal, ulteriormente fallece. La autopsia elucida el diagnóstico de adenocarcinoma de pulmón con metástasis a coroides, hígado y riñón. Conclusión: las metástasis coroideas conllevan un mal pronóstico visual y sistémico, se requiere un alto índice de sospecha en pacientes menores de 50 años sin factores de riesgo. Se convierten en un reto diagnóstico, sobre todo en países donde predominan las enfermedades infecciosas. El papel del oftalmólogo es realizar el diagnóstico oportuno y correcto, evitando así retrasar el tratamiento.

Background: the case of a 36 year-old patient is presented, who was diagnosed with choroidal tuberculoma, giving treatment without improvement. Then, the diagnosis of pulmonary adenocarcinoma and choroidal metastases was elucidated. Objective: to report the diagnosis of metastasis as the initial manifestation of lung adenocarcinoma in a young patient. Study design: case report. Case summary: male, 36 years old, history of tuberculosis in childhood, positive smoking, but not significant. He presented visual loss of the right eye, being diagnosed with a choroidal tuberculoma, associated with night sweats, cough and positive QuantiFERON-TB test, treatment for tuberculosis was initiated. Later he had respiratory and neurological deterioration requiring orotracheal intubation, but unfortunately he died. Autopsy reveals lung adenocarcinoma with choroidal, liver and kidney metastases. Conclusion: choroidal metastases lead to poor visual and systemic prognosis, a high suspicion is required in patients under 50 years of age without risk factors. They become a diagnostic challenge, especially in countries where infectious diseases are predominat. The ophthalmologist's role is to make the diagnosis timely and correctly, thus avoiding delaying treatment.

Factores determinantes relacionados con la incidencia de la tuberculosis en un municipio de Santiago de cuba / Determining factors related to the incidence of the tuberculosis in a municipality of Santiago de Cuba

Introducción: La tuberculosis es una enfermedad infectocontagiosa que afecta a un gran número de personas a escala mundial. Objetivo: Describir las características de dicha enfermedad en el municipio de Mella, atendiendo a algunos determinantes sociodemográficos, socioculturales, de la conducta social, biológicos, ambientales y de los servicios de salud e identificar en la comunidad los factores de riesgo presentes. Métodos: Se realizó un estudio con diseños combinados, de tipo ecológico y de corte transversal. El universo quedó constituido por los 7 casos notificados con tuberculosis pulmonar en el municipio de Mella, provincia de Santiago de Cuba, desde el 2016 hasta el 2018. Resultados: Entre los grupos de riesgo más afectados figuraron: adultos mayores, alcohólicos, diabéticos y desnutridos; con mayor incidencia en el sexo masculino. Entre otros hallazgos se detectaron las posibles asociaciones entre la incidencia de la tuberculosis y los factores de riesgo. Conclusiones: Las tasas de incidencias se asociaron de forma directa con la densidad poblacional, el hacinamiento, la poca ventilación y la insuficiente iluminación.

Introduction: Tuberculosis is an infectocontagious disease that affects a great number of people worldwide. Objective: To describe the characteristics of this disease in the municipality of Mella, according to some social-demographic, social -cultural, social-behavioural, biological, environmental determinants as well as of health services and to identify the risk factors present in the community. Methods: An ecological, cross sectional study with combined designs was carried out. The universe was constituted by the 7 cases notified with lung tuberculosis in the municipality of Mella, Santiago de Cuba, from 2016 to 2018. Results: Among the most affected risk groups we can mention: elderly, alcoholic, diabetics and undernourished adults; with more incidence in male sex. Among other findings, the possible associations between the incidence of tuberculosis and the risk factors were detected. Conclusions: The rates of incidences were associated in a direct way to the populational density, overcrowding, little ventilation and scarce illumination.

Programa de intervención comunitaria dirigido a pacientes con riesgo de tuberculosis pulmonar / Project of community intervention directed to patients with risk of Lung Tuberculosis

Introducción: En la actualidad la tuberculosis pulmonar continúa siendo uno de los procesos infecciosos más observados en el mundo. Objetivo: Diseñar un programa de intervención comunitaria dirigido a pacientes con riesgo de tuberculosis pulmonar. Métodos: Se realizó un estudio de tipo descriptivo transversal en el consultorio 9 del Policlínico Docente Mario Antonio Pérez Mollinedo durante el periodo de noviembre de 2015 a marzo de 2017. Se seleccionó una muestra de 56 pacientes de una población de 125 dispensarizados con riesgo de tuberculosis. La estrategia de selección se basó en el muestreo no probabilístico intencional por criterios. Se aplicaron diferentes métodos y técnicas, como el análisis documental y cuestionarios. Para el procesamiento de la información se empleó la estadística descriptiva. Resultados: Los factores de riesgo a los que se encontraban expuestos los pacientes eran: el hábito de fumar (57,1 por ciento); el consumo de bebidas alcohólicas (46,4 por ciento); residir en condiciones de hacinamiento (44,6 por ciento); viviendas con malas condiciones (33,9 por ciento); estar expuestos a más de 2 factores de riesgo (58,9 por ciento); padecer de diabetes mellitus (14,2 por ciento), asma bronquial y enfermedad pulmonar obstructiva crónica (21,4 por ciento); y bajo nivel de conocimiento sobre la tuberculosis pulmonar (83,9 por ciento). Conclusiones: El programa de intervención comunitaria dirigido a pacientes con riesgo de tuberculosis pulmonar, según la evaluación de los especialistas, es pertinente y factible. En la actualidad se encuentra en fase de aplicación en el área de salud donde se realizó la investigación(AU)

Introduction: Nowadays, lung tuberculosis is still one of the most important infectious processes in the world. Objective: To design a project of community intervention directed to patients with risk of lung tuberculosis. Methods: It was carried out a descriptive cross-sectional's type study in the Family Doctor's Office #9 belonging to Mario Antonio Pérez Mollinedo Teaching Policlinic from November, 2015 to March, 2017. It was selected a sample of 56 patients from a population of 125 patients classified as with risk of Tuberculosis. The selection's strategy was based in an intentional non-probabilistic sampling by criteria. Different methods and techniques were applied as documentary analysis and questionnaires. Descriptive statistic and the analysis of qualitative data were used for processing information. Results: The risk factors that these patients were exposed were: smoking habit (57.1 percent); consumption of alcoholic beverages (46.4 percent); to live in overcrowding conditions (44.6 percent); housings with bad conditions (33.9 percent); to be exposed to more than 2 risk factors (58.9 percent); suffering Diabetes Mellitus (14.2 percent); bronchial asthma and COPD (21.4 percent); and low level of knowledge on lung tuberculosis (83.9%). Conclusions: The project of community intervention directed to patients with risk of Lung Tuberculosis, according to the specialists' assessment, it is pertinent and feasible. At the moment is in the application phase in the health area where it was carried out the investigation as part of a thesis of specialty(AU)

Factores de riesgo de la tuberculosis pulmonar en pacientes timorenses / Risk factors of lung tuberculosis in patients from East Timor

Se realizó un estudio observacional y analítico, de casos y controles, pareados por sexo y edad, de 126 pacientes ingresados en la sala de aislamiento del Hospital Nacional Guido Valadares, en Dili, Timor Oriental, durante el año 2015, con vistas a determinar los factores de riesgo asociados a la tuberculosis pulmonar en ellos. El grupo de casos, de 42 integrantes, incluyó a los recién diagnosticados con tuberculosis y a los que presentaron recaída, fallo terapéutico, resistencia a múltiples fármacos, así como padecimiento previo de la afección con secuelas (bronquiectasias concomitantes con infección, hemoptisis); en tanto, el grupo de controles lo conformaron 84 pacientes con entidades respiratorias no tuberculosas. De las variables analizadas, la presencia de alcoholismo, la desnutrición, el contacto íntimo con pacientes cuya baciloscopia dio positiva y el ser recluso o ex-recluso, fueron los factores de riesgo de mayor asociación causal y estadística en el contagio de la enfermedad y constituyeron los resultados más relevantes de esta investigación

An observational, analytic and cases-controls study of 126 patients paired by sex and age, admitted to the isolation room of Guido Valadares National Hospital, in Dili, East Timor, was carried out during 2015, aimed at determining the risk factors associated with lung tuberculosis in them. The cases group with 42 members, included those recently diagnosed with tuberculosis and those that presented relapse, therapeutic failure, resistance to multiple drugs, as well as previous suffering of the disorder with sequelae (concomitant bronchiectasis with infection, hemoptysis); as long as, the control group was conformed by 84 patients with non tuberculous breathing entities. Of the analyzed variables, the presence of alcoholism, malnutrition, intimate contact with patients whose baciloscopia was positive and being prisoner or former-prisoner, were the risk factors of more causal and statistical association in the infection of the disease and constituted the most outstanding results in this investigation

Chest ultrasound findings in pulmonary tuberculosis.

In resource-limited countries, the diagnosis of pulmonary tuberculosis (TB) is based on clinical findings, chest radiography and the demonstration of acid-fast bacilli in sputum. Few data are available on the use of ultrasound (US) to diagnose pulmonary TB. Chest US was performed in patients with lung TB from a rural African setting, to look for signs of the disease and to clarify the role US may have in the diagnosis of pulmonary TB. Sixty adult patients diagnosed with lung TB underwent chest US. All patients had abnormal findings. The most frequent was a subpleural nodule (SUN), which was mostly multiple and also found in radiologically normal areas. Other findings were lung consolidations, cavitations, miliary patterns made of miniature SUNs, and pleural and pericardial effusions. Chest US is a complementary tool in evaluating patients with suspected lung TB in resource-limited settings where the disease has high prevalence.

Tuberculosis: tendencia, pronóstico y factores de riesgo afines en la provincia de Santiago de Cuba (2004-2014) / Tuberculosis: tendency, prognosis and common risk factors in Santiago de Cuba (2004-2014)

Se realizó un estudio descriptivo, transversal y retrospectivo, con vistas a describir la evolución histórica de la incidencia de la tuberculosis en la provincia de Santiago de Cuba, desde 2004 hasta 2014. El universo quedó constituido por 100,0 % de los casos nuevos notificados por tarjeta de enfermedades de declaración obligatoria. Se mostró una tendencia descendente de esta afección, la cual se mantuvo en zona de éxito; la media histórica predominó en pacientes de 25-44 años, aunque en el 2014 descendió en este grupo. Se evidenciaron cambios importantes en la frecuencia de factores de riesgo, pues disminuyó ostensiblemente el grupo de institución cerrada, ancianos y alcoholismo; solo hubo un incremento del tabaquismo. Para los próximos 2 años se pronosticó un riesgo de enfermar de menos de 2 casos por cada 100 000 habitantes.

A descriptive, cross-sectional and retrospective study, aimed at describing the historical course of the tuberculosis incidence in Santiago de Cuba, was carried out from 2004 to 2014. The universe was constituted by 100.0% of the new cases notified by compulsory declaration diseases records. A descending tendency of this disorder was shown, which stayed in the success area; the historical mean in patients aged 25 to 44 prevailed, although in 2014 it decreased in this group. Important changes were evidenced in the frequency of risk factors, because the closed institution, elderly and alcoholism groups diminished ostensibly; there was only an increase of nicotine addiction. For the next 2 years there was a risk prediction of getting sick of less than 2 cases for every 100 000 inhabitants.

Fibrosis pulmonar idiopática en un ecuatoriano adulto de la provincia de Riobamba / Idiopathic lung fibrosis in an adult Ecuadorian from Riobamba province

Se presenta el caso clínico de un paciente de 52 años, expuesto a las cenizas del volcán Tungurahua en erupción, quien acudió a la Consulta de Medicina Familiar Comunitaria del Cantón Guano, provincia ecuatoriana de Riobamba, por presentar cuadro de tos productiva en horario matutino, mucoide de coloración blanco amarillenta, toma del estado general, fiebre vespertina, pérdida de apetito y peso. Según los resultados radiográficos y tomográficos presentó signos sugestivos de tuberculosis pulmonar; los esputos BAAR directos y los cultivos negativos. Los hallazgos anatomopatológicos permitieron confirmar el diagnóstico de fibrosis pulmonar idiopática.

The case report of a 52 years patient is presented, exposed to the ashes of Tungurahua volcano in eruption, who went to the Community Family Medicine Department of the Canton Guano, Ecuadorian province of Riobamba, for presenting productive cough in the morning, mucoid of yellowish white coloration, bad general state, evening fever, appetite and weight loss. According to the radiographic and topographic results, he had suggestive signs of lung tuberculosis; direct BAAR sputa and negative cultures. The pathological findings allowed to confirm the diagnosis of idiopathic lung fibrosis.

Systemic spread of tuberculosis after surgery for a splenic tuberculous abscess without postoperational antituberculosis treatment: a case report.

Solitary splenic tuberculosis (TB) is rare, with less than ten cases ever being reported. The diagnosis is established by the pathological analysis of a biopsy from a surgical operation or from a fine-needle aspiration sample. Manifestations of splenic TB include low-grade fever, weight loss, abdominal pain, and diarrhea. This case, however, has no obvious symptoms, and multiple splenic tubercles were discovered during a routine physical examination. Splenic abscesses from TB were diagnosed after the operation. Postoperative spread of TB lead to cerebral tuberculous abscesses and pulmonary TB. Resolution was achieved with anti-TB therapy.

Tuberculosis mimicking lung cancer.

Tuberculosis (TB) is well known as a diagnostic chameleon and can resemble malignancy. In thorax TB can be manifested as pulmonary infiltrates and/or mediastinal lymphadenopathy. In low incident countries with high incidence of lung cancer and varying clinical presentations, TB often gets misdiagnosed with the result of delayed treatment start and unnecessary diagnostic procedures. Our case report presents two patients, who were referred to the Thorax diagnostic centre at the Department of Respiratory Medicine, Odense University Hospital, with presumptive diagnosis of neoplasm and had proved lung TB with no evidence of malignancy instead. In the first case diagnosis was confirmed after thoracotomy, in the second case after bronchoscopy.

Coexistencia entre sida y tuberculosis pulmonar en un adulto joven / Coexistence between AIDS and lung tuberculosis in a young adult

Se presenta el caso clínico de un paciente de 31 años de edad, con el diagnóstico del virus de la inmunodeficiencia humana/sida, atendido en el Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba por presentar, desde hacía un mes aproximadamente, fiebre en el horario de la tarde, tos escasa, con poca expectoración y secreción blanquecina, inapetencia, así como pérdida de peso, sin precisar cuantía. Los resultados de los exámenes efectuados confirmaron el diagnóstico de tuberculosis pulmonar, con un patrón radiográfico atípico.

The case report of a 31 years patient is presented, with the diagnosis of the virus of the human immunodeficiency/aids, assisted in "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba for presenting, since approximately a month ago, fever during the afternoon, scarce cough, with little expectoration and whitish secretion, inappetence, as well as weight lost, without specifying quantity. The results of the examinations confirmed the diagnosis of lung tuberculosis, with a atypical radiographical pattern.

Caracterización clinicoepidemiológica de pacientes con tuberculosis diagnosticada en el Hospital Provincial "Celia Sánchez Manduley" / Clinical and epidemiological characterization of patients with tuberculosis diagnosed in "Celia Sánchez Manduley" Provincial Hospital

Se realizó un estudio descriptivo, retrospectivo y longitudinal de 63 pacientes con tuberculosis, atendidos en el Hospital Clinicoquirúrgico Docente Universitario "Celia Sánchez Manduley" de Manzanillo, provincia de Granma, desde el 2009 hasta el 2011, con vistas a caracterizarles según factores clinicoepidemiológicos de interés. Entre las variables analizadas figuraron: edad, sexo, procedencia, factores de riesgo, formas clínicas de la tuberculosis, tipo de tuberculosis extrapulmonares y categoría de casos. En la casuística predominaron el sexo masculino, los grupos etarios de 45-65 años, procedentes en su mayoría de zonas rurales; la ingestión de alcohol como factor de riesgo asociado y las formas pulmonares con baciloscopia positiva como las formas clínicas más frecuentes. La mayoría de los casos notificados fueron nuevos.

A descriptive, retrospective and longitudinal study of 63 patients with tuberculosis, assisted in "Celia Sánchez Manduley" Teaching Clinical-Surgical University Hospital, Manzanillo, Granma province was carried out from the 2009 to 2011, aimed at characterizing them according to interesting clinical and epidemiological factors. Among the analyzed variables there were: age, sex, origin, risk factors, clinical forms of tuberculosis, type of extrapulmonary tuberculosis and cases category. Male sex, the age groups 45-65, most of them coming from rural areas; alcohol consumption as associated risk factor and the pulmonary forms with positive bacilloscopy as the most frequent clinical forms prevailed in the case material. Most of the confirmed cases were new.

Hidroneumotórax por tuberculosis en una mujer adulta / Hydropneumothorax due to tuberculosis in an adult woman

Se presenta el caso clínico de una paciente de 28 años de edad, que fuera remitida al Servicio de Neumología del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba por presentar síntomas respiratorios (tos húmeda y expectoración mucosa) durante un período aproximado de 6 meses, además de síndrome general y, en ocasiones, febrícula. Posteriormente manifestó una disnea progresiva, que se volvió moderada ante los pequeños esfuerzos, unido a dolor torácico agudo en el lado izquierdo. Se determinó clínica y radiológicamente la existencia de hidroneumotórax; por lo que se le realizó una pleurotomía mínima baja y se inició el tratamiento antibacilar. Igualmente se efectuó la prueba de esputo para la búsqueda de bacilos ácido-alcohol resistentes, y se obtuvo codificación 8, de modo que fue confirmado el diagnóstico de tuberculosis pulmonar.

The case report of a 28 year-old patient is presented who was remitted to the Pneumology Service of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba for presenting breathing symptoms (humid cough and mucous expectoration) during an approximate period of 6 months, besides general syndrome and, in occasions, slight fever. Later on she complained of progressive dyspnea which became moderate when making other small efforts, together with acute thoracic pain in the left side. It was determined clinically and radiologically the existence of an hydropneumothorax; for which a low minimum pleurotomy was carried out and the antibacillar treatment was applied. Equally the sputum test was carried out for finding acid-alcohol resistant bacilli, and code 8 was obtained, so the diagnosis of lung tuberculosis was confirmed.

Control de la calidad del seguimiento de contactos de tuberculosis en Camagüey / Quality control of follow-up of people in contact with tuberculosis carriers in Camagüey

Se efectuó un estudio descriptivo de corte transversal de 898 contactos de pacientes con tuberculosis, pertenecientes al municipio de Camagüey de la provincia de igual nombre, desde el 2008 hasta el 2009, a fin de evaluar el seguimiento a dichos contactos e identificar las principales debilidades de este proceso. Se empleó el formulario de seguimiento de los contactos con tuberculosis pulmonar y baciloscopia positiva, los cuales fueron inicialmente investigados y tratados con quimioterapia; solo en 35 de ellos no se completó la investigación de acuerdo con los lineamientos del Programa Nacional de Control de la Tuberculosis; por tanto, se constató el cumplimiento de los citados lineamientos para el seguimiento de los contactos de casos positivos con esta afección, que fue más riguroso en las edades tempranas y laboralmente activas (25-54 años). Durante el proceso no se observaron debilidades; sin embargo, se debe sensibilizar a la población para que cumpla con los exámenes correspondientes.

A descriptive and cross-sectional study of 898 contacts of patients with tuberculosis, belonging to Camagüey municipality, in Camagüey was carried out from 2008 to 2009, in order to evaluate the follow-up to their contacts and to identify the main weaknesses of this process. The follow-up prescription of the contacts with lung tuberculosis and positive bacilloscopy was used, which were initially investigated and treated with chemotherapy; only in 35 of them the investigation was not completed according to the guidelines of the National Program of Tuberculosis Control; therefore, the implementation of the mentioned guidelines was verified for the follow-up of the contacts of positive cases with this affection, which was more rigorous in the early and active working ages (25-54 years). During the trial weaknesses were not observed; however, the population should be sensitized so that they fulfil the corresponding examinations.

Mycobacteriosis pulmonar. Presentación de dos casos quirúrgicos / Lung mycobacteriosis. Presentation of two surgical cases

Introducción: la Mycobacteriosis es una enfermedad producida por Mycobacterias ambientales, su diagnóstico hasta hace pocos años era un hecho ocasional, actualmente ha pasado a ser una patología relativamente frecuente, sobre todo en los pacientes SIDA y asociada a enfermedades pulmonares crónicas. Requiere tratamientos agresivos y prolongados, así como la exéresis quirúrgica en casos de afección pulmonar localizada. Objetivo: determinar la importancia de la cirugía como tratamiento alternativo en caso de fracaso del tratamiento farmacológico. Presentación de los casos: se presentan dos casos con diagnóstico de Mycobacteriosis ambiental, por Mycobacterium Avium. Pacientes con síntomas respiratorios de larga fecha de evolución, principalmente tos y expectoración, asociado a fiebre. En el segundo caso se recoge el antecedente de neumonías frecuentes durante la infancia, con diagnóstico de Bronquiectasias. En ambos se les aisló en el cultivo del esputo un Mycobacterium Avium, la prueba de Mantoux resultó negativa (0 mm) y en los estudios imagenológicos se presentan las formas típicas de esta enfermedad, dadas por lesiones fibrocavitarias en los lóbulos superiores. Conclusiones: en los casos presentados, hubo fracaso en el tratamiento farmacológico recomendados en la actualidad, manteniendo cultivos de esputo positivos a Mycobacterium Avium. Se realizó tratamiento quirúrgico, obteniendo resultados positivos, con esputos negativos y mejoría del estado clínico.

Introduction. Mycobacteriosis is a disease caused by environmental mycobacteria, until a few years ago its diagnosis was an occasional event. Today it has become a relatively frequent pathology, mainly in patients with AIDS and associated to chronic lung diseases. It requires aggressive treatments as well as surgical exeresis in the event of localized lung affections. Objective. determine the importance of the surgery as an alternative treatment when the pharmacological treatment fails. Case Presentation. two cases were presented with a diagnosis of environmental mycobacteriosis, caused by Mycobacterium Avium. Patients had respiratory symptoms of long evolution, mainly cough, expectoration, and associated fever. In the second case there were records of frequent pneumonias during childhood with diagnosed bronchiecstasias. In both cases in the sputum culture the Mycobacterium Avium was isolated, the Mantoux test was negative (0 mm) and in the radiological studies there were shapes that are usually seen in this disease caused by fibrocavitary lesions in the upper lobes. Conclusions. in the cases that were presented the pharmacological treatment normally recommended at present times failed, and the sputum cultures positive to Mycobacterium Avium persisted. Surgical treatment was conducted with positive results, negative sputums and improvement in the clinical condition.

Mycobacteriosis pulmonar. Presentación de dos casos quirúrgicos / Lung mycobacteriosis. Presentation of two surgical cases

Introducción: la Mycobacteriosis es una enfermedad producida por Mycobacterias ambientales, su diagnóstico hasta hace pocos años era un hecho ocasional, actualmente ha pasado a ser una patología relativamente frecuente, sobre todo en los pacientes SIDA y asociada a enfermedades pulmonares crónicas. Requiere tratamientos agresivos y prolongados, así como la exéresis quirúrgica en casos de afección pulmonar localizada. Objetivo: determinar la importancia de la cirugía como tratamiento alternativo en caso de fracaso del tratamiento farmacológico.Presentación de los casos: se presentan dos casos con diagnóstico de Mycobacteriosis ambiental, por Mycobacterium Avium. Pacientes con síntomas respiratorios de larga fecha de evolución, principalmente tos y expectoración, asociado a fiebre. En el segundo caso se recoge el antecedente de neumonías frecuentes durante la infancia, con diagnóstico de Bronquiectasias. En ambos se les aisló en el cultivo del esputo un Mycobacterium Avium, la prueba de Mantoux resultó negativa (0 mm) y en los estudios imagenológicos se presentan las formas típicas de esta enfermedad, dadas por lesiones fibrocavitarias en los lóbulos superiores.Conclusiones: en los casos presentados, hubo fracaso en el tratamiento farmacológico recomendados en la actualidad, manteniendo cultivos de esputo positivos a Mycobacterium Avium. Se realizó tratamiento quirúrgico, obteniendo resultados positivos, con esputos negativos y mejoría del estado clínico(AU)

Introduction. Mycobacteriosis is a disease caused by environmental mycobacteria, until a few years ago its diagnosis was an occasional event. Today it has become a relatively frequent pathology, mainly in patients with AIDS and associated to chronic lung diseases. It requires aggressive treatments as well as surgical exeresis in the event of localized lung affections. Objective. determine the importance of the surgery as an alternative treatment when the pharmacological treatment fails. Case Presentation. two cases were presented with a diagnosis of environmental mycobacteriosis, caused by Mycobacterium Avium. Patients had respiratory symptoms of long evolution, mainly cough, expectoration, and associated fever. In the second case there were records of frequent pneumonias during childhood with diagnosed bronchiecstasias. In both cases in the sputum culture the Mycobacterium Avium was isolated, the Mantoux test was negative (0 mm) and in the radiological studies there were shapes that are usually seen in this disease caused by fibrocavitary lesions in the upper lobes. Conclusions. in the cases that were presented the pharmacological treatment normally recommended at present times failed, and the sputum cultures positive to Mycobacterium Avium persisted. Surgical treatment was conducted with positive results, negative sputums and improvement in the clinical condition(AU)

The Clinical Observation on the Curative Effect of Integrated Traditional Chinese and Western Medicine Treating 152 Cases of Lung Tuberculosis / 国际中医中药杂志

Objective To investigate the therapeudc effect of treating lung mbereulosis with integrated traditional Chinese and western medicine. Methods 152 patients with lung tuberculosis aging from 25 to 35 years were randomly recruited into 2 groups. Western medicine and integrated traditional Chinese and western medicine were applied to each group respectively. Observe the therapeutic effects after the treatment. Results The group treated with integrated traditional Chinese and western medicine was significantly better than the group treated with western medicine in terms of therapeutic effect speaking, with P＜0.05. Conclusion The therapy of integrated traditional Chinese and western medicine has good effect in treating lung tuberculosis.

Evaluation of Drug-resistance to Antituberculosis Drugs in Shenzhen / 中国药房

OBJECTIVE:To evaluate the initial and acquired resistance level of lung tuberculosis in Shenzhen.METHODS:Culture-positive of sputum specimens of1948cases of lung tuberculosis were collected in Shenzhen from1999to2002and the resistance of tubercle bacillus in sputum-positive to four anti-tuberculosis drugs(isonicotinylhydrazide INH,streptomycin SM,rifampin RFP,Ethambutol EMB)were tested by WHO guideline.RESULTS:The total rate of tubercle bacillus to drug resistance was35.06%,initial drug resistance rate34.01%,initial multi-drug resistance rate4.97%,acquired re?sistance rate45.51%,and acquired multi-drug resistance rate12.92%.Acquired resistance rate of tubercle bacillus to each of4drugs was on the rise to different extents as compared with initial resistance rate.The rise was39.91%for SM,94.07%for INH,44.04%for EMB,and118.18%for RFP.CONCLUSIONS:The initial drug resistance rate ranks higher in Shenzhen as compared with the average level in the whole nation,resistance rates of RFP and INH double after combined administration.