Abordaje en el diagnóstico y tratamiento de la tuberculosis drogorresistente en el Hospital Infantil Dr. Robert Reid Cabral 2006-2015
Date
Subject
tuberculosis
Drug addiction
diagnosis
therapeutic.
tuberculosi
drogaresistencia
diagnóstico
terapéutico
Drug addiction
diagnosis
therapeutic.
tuberculosi
drogaresistencia
diagnóstico
terapéutico
Language:
Journal Title
Journal ISSN
Volume Title
Publisher
Intituto Tecnológico de Santo Domingo (INTEC)
En este trabajo se presenta la revisión de 95 casos de pacientes menores de 18 años, 61 de los cuales son menores de 5 años (64.2%). El 74% de ellos tuvo un tiempo de exposición mayor de un año a la tuberculosis antes de la evaluación; el 94.7% (90) refirió contacto drogoresistente, mientras el 92% (83) fue intradomiciliario. En cuanto a los resultados, hubo 5 casos de fracaso a tratamiento con drogas de primera línea, 20 pacientes sintomáticos respiratorios (tos, fiebre, dificultad respiratoria) (21%), así como con adenopatías cervicales y pérdida de peso. La prueba de tuberculina (PPD) aplicada a 71 pacientes (75%) reportó 44 resultados positivos (62%). De las radiografías de tórax al 100% de los pacientes, 14 de ellas fueron patológicas (14.7%). Hubo 9 baciloscopías positivas (26.4%) y 10 cultivos positivos (52%), 79 pacientes resultaron contactos sanos (83%) y 16 pacientes (17%) iniciaron su tratamiento con el diagnóstico de Tuberculosis Multidrogo Resistente (TB-MDR). De los casos de TB-MDR confirmadas o probables, aparecen 8 pacientes de 11 a 15 años (50%) y 2 menores de 1 año de edad; 9 pacientes (56.2%) TB-MDR nunca antes tratados (primarios) y 97 secundarios al uso de drogas de primera línea. Asimismo, PPD positiva en 10 pacientes y radiografía patológica en 15. La baciloscopía resultó positiva en 9 pacientes y el cultivo en 10. Resistencia a Isoniacida (H) y Rifampicina (R) observada en 10 pacientes (62%), patrones de resistencia similares al caso índice. Resumiendo, 14 casos fueron pulmonares (87.6%) y 2 ganglionares (12.5%). Los contactos sanos seguidos por dos años no desarrollaron la enfermedad; mientras que los pacientes con diagnóstico confirmado o presuntivo de TB-MDR recibieron tratamiento con el esquema estandarizado (inyectables, Pirazinamida, Etionamida, Cicloserina, Quinolonas) por 18 meses, mostrando una curación del 75% (12). Dos pacientes abandonaron el tratamiento antes de finalizar y solamente hubo un fracaso a tratamiento. A modo de conclusión, encontramos tardanza en la evaluación de los contactos; 17% de los pacientes evaluados fueron diagnosticados con TB-MDR; la curación se evidenció en el 75% de ellos; y, por último, los pacientes sanos seguidos sin tratamiento no desarrollaron la enfermedad, lo cual nos ubica dentro de lo esperado en manejo de TB-MDR a nivel mundial.
Tuberculosis (TB) Tuberculosis is a public health problem, affecting 9 million people worldwide per year. The challenge resides in the resistance to anti-TB drugs. A total of 95 patients under the age of 18 were reviewed, 61 (64.2%) were under the age of 5. Time of exposure to TB-MDR before the initial evaluation was at least 1 year in 74% (71) of patients. 94.7% (90) referred contact with TB-MDR, 92% (83) were household exposures and 5 cases of failed 1st line treatment. 21% (20) presented symptoms of cough, fever, respiratory distress, cervical adenopathy and weight loss. PPD test was conducted in 75% (71), 62% (44) returned positive. CRX performed in 100% of patients, 14.7% (14) resulted positive. 34 bacilloscopy samples collected yielded 26.4% (9) positive results. 19 cultures were collected, 52% (10) were positive. 83% (79) were diagnosed as healthy contacts and 17% (16) patients started treatment as MDR-TB. Healthy contacts with a 2-year follow up did not develop TB infection. Of the TB-MDR patients, 87.6% (14) were pulmonary cases and 12.5 % (2) were cervical TB. The most frequent age range affected was from 11-15 y/o(50%). 2 cases were reported in patients less than 1 y/o. Resistance to the anti-TB drugs were as follows: Isoniazin (H) and Rifampicin in 62% (10). Patients with confirmed or presumptive TB-MDR infection were treated with a standardized injected protocol consisting of: Pyrazinamide, Ethionamide, Cycloserine and Quinolones for 18 months yielding a cure rate of 75% (12) of patients. 2 patients abandoned the treatment and only one case of treatment failure. Conclusion: Detection of close contacts was delayed, 17% of patients were diagnosed with TB-MDR with a cure rate of 75% and healthy patients with no installed treatment did not contract the illness. These results are within the reported global margins of TB-MDR index.
Tuberculosis (TB) Tuberculosis is a public health problem, affecting 9 million people worldwide per year. The challenge resides in the resistance to anti-TB drugs. A total of 95 patients under the age of 18 were reviewed, 61 (64.2%) were under the age of 5. Time of exposure to TB-MDR before the initial evaluation was at least 1 year in 74% (71) of patients. 94.7% (90) referred contact with TB-MDR, 92% (83) were household exposures and 5 cases of failed 1st line treatment. 21% (20) presented symptoms of cough, fever, respiratory distress, cervical adenopathy and weight loss. PPD test was conducted in 75% (71), 62% (44) returned positive. CRX performed in 100% of patients, 14.7% (14) resulted positive. 34 bacilloscopy samples collected yielded 26.4% (9) positive results. 19 cultures were collected, 52% (10) were positive. 83% (79) were diagnosed as healthy contacts and 17% (16) patients started treatment as MDR-TB. Healthy contacts with a 2-year follow up did not develop TB infection. Of the TB-MDR patients, 87.6% (14) were pulmonary cases and 12.5 % (2) were cervical TB. The most frequent age range affected was from 11-15 y/o(50%). 2 cases were reported in patients less than 1 y/o. Resistance to the anti-TB drugs were as follows: Isoniazin (H) and Rifampicin in 62% (10). Patients with confirmed or presumptive TB-MDR infection were treated with a standardized injected protocol consisting of: Pyrazinamide, Ethionamide, Cycloserine and Quinolones for 18 months yielding a cure rate of 75% (12) of patients. 2 patients abandoned the treatment and only one case of treatment failure. Conclusion: Detection of close contacts was delayed, 17% of patients were diagnosed with TB-MDR with a cure rate of 75% and healthy patients with no installed treatment did not contract the illness. These results are within the reported global margins of TB-MDR index.
Description
Type
info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
info:eu-repo/semantics/publishedVersion
Source
Science and Health; Vol 1 No 1 (2017): Science and Health, september-december; 9-14
Ciencia y Salud; Vol. 1 Núm. 1 (2017): Ciencia y Salud, septiembre-diciembre; 9-14
2613-8824
2613-8816
10.22206/cysa.2017.v1i1
Ciencia y Salud; Vol. 1 Núm. 1 (2017): Ciencia y Salud, septiembre-diciembre; 9-14
2613-8824
2613-8816
10.22206/cysa.2017.v1i1