Tuberculosis e infección por VIH. Analisis de 36 casos

España Yandiola, P.P.; Salinas Solano, C.; Oribe Ibañez, M.; Aguirregomoscorta urquijo, J.I.; Capelastegui Saiz, A.

doi:10.1016/S0300-2896(15)31491-5

Archivos de Bronconeumología

ISSN: 0300-2896

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Vol. 27. Issue 5.

Pages 197-201 (June - July 1991)

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Arch Bronconeumol. 1991;27:38710.1016/S0300-2896(15)31407-1

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Se analizan 36 casos de pacientes hospitalizados con infección por virus de la inmunodeficiencia humana (VIH) y tuberculosis (TBC) en un período de 4 años. La presencia de adicción a drogas por vía parenteral (ADVP) fue el factor de riesgo más importante (97,2%). La presentación más frecuente fue la forma extrapulmonar-diseminada (TBC-ED 77,8%) con respecto a la pulmonar (TBC-P 22,2%). Hubo filiación bacteriológica en 33 casos (91,6%), tipándose en todos los casos M. tuberculosis. Todos los pacientes presentaron fiebre y la sintomatología respiratoria estuvo presente en el 61% de los casos. Predominaron patrones radiológicos pulmonares atípicos, siendo en 10 casos la Rx de ingreso normal (35,7%). La anergia tuberculínica se presentó en el 66% de los pacientes, siendo su relación con los niveles de linfocitos CD4 discriminativa entre los TBC-ED y TBC-P (p<0,05). La respuesta al tratamiento fue buena con escasa reacción adversa al mismo. Los controles analíticos de ácido úrico nos sirvieron como buen marcador de cumplimiento. Hubo 15 abandonos del tratamiento con ocho muertes, aunque sólo una de ellas se debió a la tuberculosis (4%).

This study reports data on 36 patients suffering infection produced by the human immunodeficiency virus and tuberculosis who were hospitalized during a period of 4 years. The most important risk factor in this series was parenteral drug addiction (97,2%). The most frequent clinical presentation was the disseminated extrapulmonary form of tuberculosis (77.8%) as compared with the pulmonary affection (22.2%). In 33 cases (91.6%) bacteriológical investigation revealed the presence of M. tuberculosis in all instances. All patients presented fever and in 61% of cases there were respiratory symptoms. Radiologic patterns were commonly atypical and in 35.7% of patients the chest radiograph on admision was normal. In 66% of cases there was a tuberculin anergia which in combination with the levels of CD4 lymphocites was discri-minative between disseminated extrapulmonary and pulmonary tuberculosis (p<0.05). The response to treatment was good and was not associated with secondary reactions. Plas-matic levels of uric acid were useful in assessing the degree of treatment fulfilment. There were 15 cases of abandonment of the treatment with 8 deaths. Only one death was due to tuberculosis (4%).

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