[The hepatotoxicity of tuberculosis treatment]. / Hepatotoxicidad del tratamiento de la tuberculosis.

BACKGROUND: The hepatic toxicity of antituberculous drugs used for the therapy of initial cases was evaluated, assessing the incidence and severity and its relation with each drug, age, other associated hepatic risks and the chronological time of therapy. METHODS: 1235 patients with tuberculosis were prospectively assessed with a protocol including periodical clinical and laboratory controls. RESULTS: Hepatic toxicity was found in overall 16.5%, with 3.5% of severe forms and need for a definitive change in therapy in 1.5%. Differences in toxicity between the 6-month and the 9-month schedules were not found. The most commonly incriminated drugs was isoniazid followed by pyrazinamide. All severe forms presented with symptoms, although some were nonspecific and insidious. Other associated hepatic risks implied an increased frequency of iatrogenic reactions. Age did not have a determining influence in severe forms, which predominantly developed within the first two months of therapy. CONCLUSIONS: Moderate, transient and asymptomatic increase in transaminase activity not requiring a change a therapy is common. Severe and dangerous forms are uncommon and predominate at the beginning of therapy and in persons with associated hepatic risk factors. Therefore, although the clinical controls should be maintained throughout treatment, laboratory controls should only be carried out during the first two months, except when symptoms are present or in patients with associated hepatic risk factors, where they should be more frequent and carried out throughout treatment.

[Familial microepidemics of tuberculosis]. / Microepidemia familiar de tuberculosis.

We report a microepidemic of tuberculosis (TBC) in a family of 12 members, 4 of which were parenteral drug abusers and 3 had anti-human immunodeficiency virus (HIV) antibodies. Four new cases were simultaneously diagnosed in the investigation of the contacts of a patient with extrapulmonary tuberculosis and acquired immunodeficiency syndrome. We review the requirements for the development of these epidemic outbreaks, both in noninfected communities and in the family contacts, where positive anti-HIV antibodies may increase the risk. We emphasize the importance of a systematic study of contacts in these families and the indication of chemoprophylaxis in all those sharing the same household, without age limit.

[Pleural sarcoidosis: report of five cases (author's transl)]. / Sarcoidosis pleural: descripción de cinco casos.

From a series of 110 patients with sarcoidosis seen at our hospital from October 1971 to September 1979, five cases were found with histologically proven pleural sarcoidosis, an incidence of 4.6%. Pleural involvement was not described in the surgical or autopsy protocols. Infiltration by sarcoid granulomas was found in the visceral and/or parietal layers in five cases of seven in whom pleural tissue was available for examination. The layer affected depended directly on the available sample. Only one patient had pleural effusion, which was an exudate with a high lymphocyte count; the case corresponded to a stage II sarcoidosis. The number of histologically proven cases of pleural sarcoidosis reported in the medical literature is very small, only 52 cass, including our own. In conclusion, it appears that the frequency of pleural sarcoidosis is falsely low, and that the availability of pleural tissue in patients with sarcoidosis undergoing thoracotomy might rise the figures heretofore encountered.

[Isolation of M. tuberculosis in abdominal specimens]. / Aislamiento de M. tuberculosis en muestras de origen abdominal.

The isolation of mycobacteria in abdominal specimens during a 10 years period is presented. Twenty-three clinical cases have been reviewed; patients were divided in three groups: 1) Peritoneal and intestinal tuberculosis. 2) Pulmonary tuberculosis with isolation of M. tuberculosis in feces, and 3) Miliary tuberculosis. We emphasize the low yielding of bacilloscopy, the low number of colonies in cultures and the importance of the microbiological study of abdominal specimens in the confirmatory diagnosis. The predominant symptoms of peritoneal tuberculosis were abdominal pain and distention and fever. The study of the ascitic fluid showed in most of the cases lymphocytic exudate and the pathological study of biopsies showed granulomas with caseous necrosis. Three patients had another associated abdominal disease. Isolation of M. tuberculosis in feces does not invariably mean the presence of intestinal tuberculosis. We confirm the frequent association of disseminated tuberculosis and HIV1 infection.