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Vol. 46. Issue 5.
Pages 255-274 (May 2010)
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Vol. 46. Issue 5.
Pages 255-274 (May 2010)
Consensus document
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Consensus Document on the Diagnosis, Treatment and Prevention of Tuberculosis
Documento de consenso sobre diagnóstico, tratamiento y prevención de la tuberculosis
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Julià González-Martína,
Corresponding author
gonzalez@clinic.ub.es

Corresponding author.
, José María García-Garcíab, Luis Anibarroc, Rafael Vidald, Jaime Estebane, Rafael Blanquerf, Santiago Morenog, Juan Ruiz-Manzanoh
a Servei de Microbiologia, Institut Clínic de Diagnòstic Biomèdic (CDB), Hospital Clínic, Institut Clínic de Diagnòstic Biomèdic August Pi Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
b Sección de Neumología, Hospital San Agustín, Avilés, Asturias, Spain
c Unidade de Tuberculose, Servicio de Medicina Interna, Complexo Hospitalario de Pontevedra, Pontevedra, Spain
d Servicio de Neumología, Hospital Vall d’Hebron, Barcelona, Spain
e Servicio de Microbiología, Fundación Jiménez-Díaz, Madrid, Spain
f Servicio de Neumología, Hospital Universitario Dr. Peset, Valencia, Spain
g Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, Spain
h Servicio de Neumología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
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Abstract

Pulmonary tuberculosis must be suspected in patients with respiratory symptoms longer than 2–3 weeks. Immunosuppression may modify the clinical and radiological presentation. The chest X-ray is highly suggestive of tuberculosis (TB), but is occasionally atypical. The complex radiological tests (CT scan, MRI) are more useful in extrapulmonary TB.

At least 3 consecutive representative samples from the clinical location are used for diagnosis, whenever possible. Bacilloscopy and liquid medium cultures are indicated in all cases. Genetic amplification techniques are coadjuvant in moderate or high suspicion of TB.

In new cases of TB, administration of isoniazid, rifampin, ethambutol, and pyrazinamide (HREZ) for 2 months and isoniazid plus rifampin for 4 months is recommended. For meningitis cases, treatment should continue for up to 12 months, and up to 9 months in spinal TB with neurological affectation and silicosis. Appropriate adjustments with antiretroviral treatment must be made in HIV patients. Combined therapy is recommended to prevent development of resistance. An antibiogram for first line drugs should be performed in all initial extractions from new patients. Treatment control is one of the most important activities in TB management.

The Tuberculin Skin Test (TST) is positive in TB infection when ≥ 5mm, and Interferon-Gamma Release Assays (IGRA) are recommended in combination with TST. The standard treatment schedule for infection is 6 months with isoniazid. In pulmonary TB, respiratory isolation is applied for 3 weeks or until 3 negative bacilloscopy samples are obtained.

Keywords:
Tuberculosis
Diagnosis
Treatment
Prevention
Resumen

Debe sospecharse tuberculosis pulmonar en pacientes con síntomas respiratorios durante más de 2–3 semanas. La inmunodepresión puede modificar la presentación clínica y radiológica. La radiografía de tórax presenta manifestaciones muy sugerentes de tuberculosis, aunque en ocasiones atípicas. Las pruebas radiológicas complejas (tomografía computarizada, resonancia magnética) son más útiles en la tuberculosis extrapulmonar.

En el diagnóstico, siempre que sea posible, se utilizarán al menos 3 muestras seriadas representativas de la localización clínica. La baciloscopia y el cultivo con medios líquidos deben realizarse en todos los casos. Las técnicas de amplificación genética son coadyuvantes en la sospecha moderada o alta de tuberculosis.

En los casos nuevos de tuberculosis, se recomienda administrar isoniacida, rifampicina, etambutol y piracinamida (HREZ) durante 2 meses e isoniacida más rifampicina durante 4 meses más, con las excepciones de los casos de meningitis, en que se alargará hasta 12 meses, y de la tuberculosis espinal con afección neurológica y la silicosis, hasta 9 meses. Se recomiendan las formulaciones combinadas. En pacientes con infección por el VIH deben realizarse los ajustes necesarios con el tratamiento antirretroviral. Debe realizarse antibiograma para fármacos de primera línea a todos los aislamientos iniciales de pacientes nuevos. El control del tratamiento es una de las actividades más importantes en el abordaje de la tuberculosis.

En la infección tuberculosa la prueba de tuberculina (PT) es positiva cuando es ≥ 5 mm y los métodos de detección de producción de interferón gamma (IGRA) se recomiendan en combinación con la prueba de la tuberculina. La pauta estándar de tratamiento de la infección es de 6 meses con isoniacida. En la tuberculosis pulmonar se aplicará aislamiento respiratorio durante 3 semanas o hasta obtener 3 muestras con baciloscopia negativa.

Palabras clave:
Tuberculosis
Diagnóstico
Tratamiento
Prevención
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Document published simultaneously in Infectious diseases and microbiology.

Joint consensus document from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and the Spanish Society of Pneumology and Thoracic Surgery (SEPAR).

Copyright © 2010. Sociedad Española de Neumología y Cirugía Torácica
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