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Escrófula, forma frecuente de tuberculosis extrapulmonar. Presentación de un caso

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Paciente masculino de 65 años de edad, alcohólico crónico y fumador, empezó a presentar un aumento de volumen en la región lateral derecha del cuello que fue creciendo progresivamente; además de tos húmeda con expectoración blanquecina, disfagia a los  alimentos sólidos, astenia, anorexia y pérdida de peso. Al examen físico se evidencian múltiples adenopatías cervicales supurativas, la mayor de 6cm y estertores crepitantes en tercio superior de hemitórax derecho. La prueba de Mantoux fue positiva y la radiografía de tórax sugestiva de TB pulmonar. El paciente fue egresado por alta a petición con tratamiento antituberculoso y antibiótico ambulatorio, los cuales fueron abandonados por parte del paciente. Es ingresado en segunda ocasión en el Servicio de Geriatría por ulceración de la lesión mayor del cuello donde fallece al tercer día por una sepsis generalizada.

Palma López ME. Escrófula, forma frecuente de tuberculosis extrapulmonar. Presentación de un caso. Rev haban cienc méd [Internet]. 2017 [citado 25 Ene 2018];16(3)

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Treatment of Tuberculosis

Tuberculosis, a scourge since prehistoric times, affects more than 9 million people and causes the death of 1.5 million people each year. Effective treatment has been available for 60 years, but such treatment takes at least 6 months, and resistance to the drugs, which is increasing throughout the world, threatens the effectiveness of treatment. This review summarizes the theoretical principles of tuberculosis treatment, current therapeutic approaches, areas of uncertainty, and persistent challenges.

Citado: Horsburgh CR Jr, Barry CE 3rd, Lange C. Treatment of Tuberculosis. N Engl J Med. 2015 Nov 26;373(22)

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Latent Mycobacterium tuberculosis Infection

The natural history of tuberculosis begins with the inhalation of Mycobacterium tuberculosis organisms; a period of bacterial replication and dissemination ensues, followed by immunologic containment of viable bacilli. The result of this process is asymptomatic latent tuberculosis infection, which is defined as a state of persistent bacterial viability, immune control, and no evidence of clinically manifested active tuberculosis. Currently, it is not possible to directly diagnose M. tuberculosis infection in humans; therefore, latent tuberculosis infection is diagnosed by response to in vivo or in vitro stimulation by M. tuberculosis antigens with the use of the tuberculin skin test or interferon-γ release assays (IGRAs). Studies suggest that active tuberculosis will develop in 5 to 15% of persons with latent infection during their lifetimes (and a higher percentage if the persons are immunocompromised); thus, persons with latent infection serve, according to Osler, as the “seedbeds” of tuberculosis in the community. This article will review the pathogenesis, epidemiology, diagnosis, and treatment of latent tuberculosis infection. It will address critical gaps in the understanding of this complex condition and propose the necessary research agenda.

Citado: Getahun H, Chaisson RE, Raviglione M. Latent Mycobacterium tuberculosis Infection. N Engl J Med. 2015 Sep 17;373(12)

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