A. Cabarcos Ortiz de Barrón

Clinical presentation of tuberculosis and the degree of immunodeficiency in patients with HIV infection.

A retrospective study of 80 HIV patients diagnosed with tuberculosis was carried out in order to evaluate the clinical presentation of tuberculosis (CPT) in relation to the degree of HIV-induced immunodeficiency, as determined by the CD4 lymphocyte count and reactivity to the tuberculin and delayed-type hypersensitivity reaction (DHR) skin tests by applying 2TU of RT-23 tuberculin, and the Muiltest IMC Merieux, respectively. CPT classification was undertaken on the basis of the location of the disease: pulmonary tuberculosis (PT), distinguishing between typical pulmonary (TP) and atypical (AP) according to the radiological pattern; extrapulmonary (ET); mixed tuberculosis (MT) pulmonary and extrapulmonary; and miliary tuberculosis. The CD4 lymphocyte count was 264.6 +/- 226.8, the TP had the highest number (505), MT had 132 (p < 0.001) and the miliary tuberculosis had 148 (p < 0.001), the lowest. The tuberculin skin test was positive in 35%, of which 11% were MT (p < 0.05). In the delayed-type hypersensitivity reaction, 67% were non-normoergic, of which 95% and 100% were MT and miliary tuberculosis, respectively (p < 0.05). There was a good overlap between CD4 depletion and skin tests. TP exhibited moderate immunodeficiency, AP severe immunodeficiency, and mixed and miliary TB extremely high immunodeficiency.

Bronchoesophageal Fistulae Secondary to Tuberculosis

An elderly patient with a bronchoesophageal fistula secondary to tuberculosis and a 3-month history of cough and dysphagia worsening with deglutition was admitted to hospital. Radiological examination and CT of the thorax revealed mediastinal adenopathy. Bronchoscopy, esophagoscopy and esophagraphy confirmed the presence of a bronchoesophageal fistula. Histological examination of the esophagus and bronchial biopsy specimens revealed nonnecrotic granulomas, and the acid-fast bacilli tested positive for Mycobacterium tuberculosis in respiratory secretions. Antituberculous treatment was started after diagnosis of intrathoracic lymph node tuberculosis with bronchoesophageal fistulization. A month and a half after initiating treatment, paroxistic coughing during deglutition persisted. An esophagoscopy was performed, and the orifice was closed with a fibrin tissue. After 9 months of treatment, the patient was asymptomatic and in good health.An elderly patient with a bronchoesophageal fistula secondary to tuberculosis and a 3-month history of cough and dysphagia worsening with deglutition was admitted to hospital. Radiological examination and CT of the thorax revealed mediastinal adenopathy. Bronchoscopy, esophagoscopy and esophagraphy confirmed the presence of a bronchoesophageal fistula. Histological examination of the esophagus and bronchial biopsy specimens revealed nonnecrotic granulomas, and the acid-fast bacilli tested positive for Mycobacterium tuberculosis in respiratory secretions. Antituberculous treatment was started after diagnosis of intrathoracic lymph node tuberculosis with bronchoesophageal fistulization. A month and a half after initiating treatment, paroxistic coughing during deglutition persisted. An esophagoscopy was performed, and the orifice was closed with a fibrin tissue. After 9 months of treatment, the patient was asymptomatic and in good health.

Tratamiento actual de la tuberculosis

Tuberculosis (TB) is a growing national and international health concern today. A revision of pharmacological treatment of TB is done in this issue. Regimens for TB disease and latent TB treatment are described. Common adverse reactions and drug interactions of first and second-line antituberculosis drug are summarized in tables. Management strategies to improve treatment adherence and TB control, treat special situations like immunodeficiences, pregnancy, hepatic and renal impairment and multidrug resistant TB are presented. In a next future the prospects for using more effective and shorter new treatments to fight against this disease are not very promising.

Prevalencia de hipertensión arterial en población mayor de 65 años ingresada en un Servicio de Medicina Interna

Objetivos: Conocer la prevalencia de hipertension arterial y de hipertension sistolica aislada en los pacientes mayores de 65 anos ingresados en un Servicio de Medicina Interna. Material y metodos: Estudio descriptivo trasversal, en el que se incluyeron los pacientes mayores de 65 anos que ingresaron durante el ano 2002 en el Servicio de Medicina Interna del Hospital Clinico Universitario de Santiago de Compostela. Las variables recogidas fueron: sexo, edad, tiempo de ingreso, factores de riesgo cardiovascular, cifras de presion arterial (PA), cifras de glucemia, cifras de colesterolemia, patologia cardiovascular coexistente, exitus intrahospitalario y tratamientos al alta. Se emplearon indices estadisticos descriptivos de variables cualitativas y cuantitativas, Chi-cuadrado, Mann-Withney-Wilcoxon y Regresion logistica. Resultados: Se obtuvo una poblacion de 770 pacientes. La prevalencia de hipertension arterial (HTA) fue de 37,0% y la de hipertension sistolica aislada (HSA) de 25,9%. La prevalencia de HSA es mayor en los pacientes con mal control de PA (67,5 vs. 8,9%), p < 0,01. El 78% de los pacientes hipertensos presentaron asociado al menos un factor de riesgo cardiovascular y el 60,9% presentaron asociada alguna patologia cardiovascular. Se encontro en los pacientes hipertensos una mayor prevalencia de diabetes mellitus (66,7 vs. 58,8%), hipercolesterolemia (15,8 frente 5,5%) y de cardiopatia isquemica (21,7% frente 13,0%) que en los que tenian una HSA. Se administro tratamiento farmacologico en el 49,8% de los HTA y en el 61,8% de los HSA. No hubo diferencias entre los dos grupos en cuanto al uso de farmacos antihipertensivos, salvo en el grupo de diureticos de asa (41,2 frente a 30,2%) e IECA (17,6 frente a 9,5%), que se emplearon mas en los HSA. Conclusiones: Las prevalencias de HTA y de HSA son bajas para el grupo de poblacion estudiado. La prevalencia de cardiopatia isquemica es superior en pacientes con HTA que HSA, y es la patologia cardiovascular asociada a mayor mortalidad en hipertensos. El tratamiento farmacologico empleado en la HSA y en los pacientes con otras patologias concomitantes no se adecuan en general a las recomendaciones de los actuales consensos.

Tuberculosis en pacientes ancianos: Formas de presentación

Objetive: To analyse the distribution of the forms of presentation of tuberculosis (TPF) in elderly patients. Material and methods: The medical records of patients diagnosed with tuberculosis attending the Tuberculosis Prevention and Control Unit of the Santiago Health District were reviewed over of six years period. The classification of TPF was: pulmonary forms (P), disease confined to the lung; extrapulmonary forms (EF), disease outside the lung; mixed forms (MF), the presence of both pulmonary and extrapulmonary tuberculosis; disseminated forms (DF), the pressence of two or more extrapulmonary locations; and miliary TB, which was definied by a diffuse pulmonary radiographic pattern or diagnosis was undertaken by necropsy. Results: A total of 278 tuberculosis infected patients were observed, 156 (56.2%) were men and 122 (43.8%) women, their mean age was 75.3 years (range 65-95). The distribution of TPF was: 155 (55.8%) P forms; 66 (23.7%) EF, of which 27 (41.0%) were ganglionary location, 12 (18.2%) bone and joint, 8 (12.0%) intestinal, 6 (9.1%) peritoneal, 5 (7.6%) meningeal, and other locations 8 (12.1%); MF 47 cases (16.9%); miliary TB 7 cases (2.5%) and. DF 3 cases (1.1%). None case was observed of HIV infected patient. Conclusions: Our findings confirm high incidence of extrapulmonary TB in elderly patients. Our experience shows a modification to the classical presentation of the disease, and thus the need for sensitivity in locating the disease.

Peritonitis tuberculosa: Aportación de tres casos

They are revised the clinical and diagnostics manifestations of the tuberculous peritonitis. For this, it is provided our experience in three cases: 2 women and 1 male with ages understood among 49 and 79 years old. The more frecuent clinical manifestations were general syndrome and ascitis in all the cases (100%) and fever in 2 (66%). The mantoux was positive in two cases. The peritoneal fluid presented dates of linphocitic exudate and determinatiOn of adenosine deaminase increased in all the cases. The diagnostic was performed through laparoscopy with peritoneal biopsy with presence of necrotic granulomas. Only in a case, is identificated growth of Mycobacterium tuberculosis in peritoneal fluid. All the patients answered positively to the especific treatment.

Análisis epidemiológico de los pacientes ingresados en un servicio de Medicina Interna

Objetives: To study the characteristics of the entered patients in an Internal Medicine department. Patients and Methods: Descriptive and observational study with the admissions elder than 65 years old in an Internal Medicine Department during the year 2002. The variables analized were: age, sex, intake date, discharge date, days of hospital stay, chronic disease previous, reason for admission (guide symptom), deceased and diagnosis at discharge. The statistical analysis was performed with measures of central tendency and of standard deviation, Chi-cuadrado, Mann-Whitney-Wilcoxon. Results: 770 patients were accepted for the study. The distribution in sex is similar, although the women show bigger median age. The most frequent chronic disease was isquemic hipertensive heart disease (25.7%) and the 64.9% of the patients have someone cardiovascular risk factor. The men show more cardiovascular risk factor and more chronic disease (p < 0.01). The most frequent was the dyspnea (42.7%). The most frequent diagnosis was the cardiac failure (20.6%). The 16.6% of the patients died in the hospital, and the most frequent diagnosis was respiratory tract infection (49.5%). Conclusions: The most frequents pathologies are the cardiopulmonary chronic disease of developed countries. The primary and secondary prevention and an improvement of chronic cardiopulmonary disease would be an effective way of cost control in these disease.

A propósito de un caso de neumonía por Arcanobacterium pyogenes

: Arcanobacterium pyogenes is an anaerobic Gram-positive bacilli and it is a part of the normal flora in many domestic animals. A. pyogenes is a rare cause of pyogenic infections in humans and most of cases reported are questionable since there was failure to definitively identify the pathogen. A man with no past medical history presented with respiratory infection. The blood sample collected confirmed an Arcanobacterium pyogenes. It was necessary the addition of clarytromycin to the initial empirical treatment with cefotaxime, to the complete recovery. This case provide further evidence that A. pyogenes can be a pathogen in humans even in absence of predisposing illness.

Análisis de la mortalidad en ancianos en un Servicio de Medicina Interna

Backgroud. To establish the characteristics of the deceased and the death causes. Methodology: Transversal study descriptive, with intake patients elder than 65 years old in an Internal Medicine Department. The variables analized were: age, sex, intake date, discharge date, days of hospital stay, chronic disease previous, admission cause, deceased, diagnoses. The statistical analysis was performed with measures of central tendency and of standard deviation, Chi-cuadrado, Mann-Whitney-Wilcoxon and Kruskal-Wallis. Results: During the revised year, there are 770 patients intaked in Internal Medicine Department and 128 exitus (16.6%). The global average death age was 78.3 ± 1.3 years: 53.1% (0.44-0.62; p = 0.48) were men and 46.9% were women. The average death intake days was 13.3 ± 1.7 days (p < 0.001), 3.9% died in less than forty-eight hours after hospitalization. The most frequent admission cause was: dyspnea (46.1%). The most frequent chronic diseases were: ischemic and hypertensive heart disease (18.8%) and chronic obstructive pulmonary disease. The most frequent death cause was respiratory tract infection (43.8%). Conclusions: The prevalence cardiac and pulmonary disease prevalence is high, these diseases are the of the most frequent causes hospital mortality.

Sífilis: perspectivas terapéuticas actuales

Despite many years of study questions regarding the appropriate therapy for syphilis still remain. Alternatives to penicillin for the treatment of syphilis continue to be sought. This article examines the studies relating to syphilis treatment published during the last years and also the new treatment guidelines for every stage of this sexually transmitted disease.