Consensus document
Consensus Document on the Diagnosis, Treatment and Prevention of Tuberculosis
Documento de consenso sobre diagnóstico, tratamiento y prevención de la tuberculosis
Julià González-Martína,
, José María García-Garcíab, Luis Anibarroc, Rafael Vidald, Jaime Estebane, Rafael Blanquerf, Santiago Morenog, Juan Ruiz-Manzanoh
Corresponding author
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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class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">g</span>" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">h</span>" "identificador" => "aff0040" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Documento de consenso sobre diagnóstico, tratamiento y prevención de la tuberculosis" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-02-08" "fechaAceptado" => "2010-02-10" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec156029" "palabras" => array:4 [ 0 => "Tuberculosis" 1 => "Diagnosis" 2 => "Treatment" 3 => "Prevention" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec156030" "palabras" => array:4 [ 0 => "Tuberculosis" 1 => "Diagnóstico" 2 => "Tratamiento" 3 => "Prevención" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">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.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">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.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">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.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">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.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">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.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">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.</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Document published simultaneously in Infectious diseases and microbiology.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara">Joint consensus document from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and the Spanish Society of Pneumology and Thoracic Surgery (SEPAR).</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:72 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "WHO Report 2009. Global Tuberculosis Control: epidemiology, strategy, financing. World Health Organization. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 2 | 8 |
| 2024 October | 36 | 32 | 68 |
| 2024 September | 32 | 42 | 74 |
| 2024 August | 50 | 58 | 108 |
| 2024 July | 29 | 21 | 50 |
| 2024 June | 52 | 45 | 97 |
| 2024 May | 50 | 44 | 94 |
| 2024 April | 21 | 27 | 48 |
| 2024 March | 30 | 19 | 49 |
| 2024 February | 16 | 23 | 39 |
| 2024 January | 0 | 2 | 2 |
| 2023 November | 0 | 1 | 1 |
| 2023 August | 0 | 1 | 1 |
| 2023 March | 4 | 4 | 8 |
| 2023 February | 24 | 21 | 45 |
| 2023 January | 25 | 30 | 55 |
| 2022 December | 24 | 30 | 54 |
| 2022 November | 34 | 27 | 61 |
| 2022 October | 40 | 40 | 80 |
| 2022 September | 36 | 34 | 70 |
| 2022 August | 25 | 40 | 65 |
| 2022 July | 30 | 43 | 73 |
| 2022 June | 24 | 34 | 58 |
| 2022 May | 40 | 43 | 83 |
| 2022 April | 32 | 33 | 65 |
| 2022 March | 54 | 49 | 103 |
| 2022 February | 26 | 16 | 42 |
| 2022 January | 48 | 39 | 87 |
| 2021 December | 44 | 53 | 97 |
| 2021 November | 52 | 64 | 116 |
| 2021 October | 39 | 56 | 95 |
| 2021 September | 30 | 66 | 96 |
| 2021 August | 28 | 64 | 92 |
| 2021 July | 14 | 27 | 41 |
| 2021 June | 29 | 37 | 66 |
| 2021 May | 18 | 31 | 49 |
| 2021 April | 46 | 29 | 75 |
| 2021 March | 18 | 24 | 42 |
| 2021 February | 20 | 21 | 41 |
| 2021 January | 20 | 19 | 39 |
| 2020 December | 16 | 18 | 34 |
| 2020 November | 22 | 24 | 46 |
| 2020 October | 23 | 15 | 38 |
| 2020 September | 11 | 7 | 18 |
| 2020 August | 19 | 18 | 37 |
| 2020 July | 17 | 22 | 39 |
| 2020 June | 20 | 10 | 30 |
| 2020 May | 23 | 19 | 42 |
| 2020 April | 17 | 13 | 30 |
| 2020 March | 20 | 21 | 41 |
| 2020 February | 14 | 15 | 29 |
| 2020 January | 20 | 24 | 44 |
| 2019 December | 24 | 21 | 45 |
| 2019 November | 14 | 29 | 43 |
| 2019 October | 13 | 24 | 37 |
| 2019 September | 12 | 20 | 32 |
| 2019 August | 15 | 14 | 29 |
| 2019 July | 15 | 16 | 31 |
| 2019 June | 8 | 12 | 20 |
| 2019 May | 16 | 9 | 25 |
| 2019 April | 10 | 17 | 27 |
| 2019 March | 14 | 30 | 44 |
| 2019 February | 9 | 22 | 31 |
| 2019 January | 7 | 9 | 16 |
| 2018 December | 13 | 23 | 36 |
| 2018 November | 32 | 15 | 47 |
| 2018 October | 42 | 17 | 59 |
| 2018 September | 13 | 19 | 32 |
| 2018 May | 2 | 1 | 3 |
| 2018 April | 17 | 10 | 27 |
| 2018 March | 2 | 10 | 12 |
| 2018 February | 8 | 9 | 17 |
| 2018 January | 11 | 13 | 24 |
| 2017 December | 7 | 6 | 13 |
| 2017 November | 3 | 7 | 10 |
| 2017 October | 8 | 10 | 18 |
| 2017 September | 6 | 10 | 16 |
| 2017 August | 5 | 22 | 27 |
| 2017 July | 17 | 20 | 37 |
| 2017 June | 14 | 36 | 50 |
| 2017 May | 7 | 12 | 19 |
| 2017 April | 20 | 16 | 36 |
| 2017 March | 8 | 17 | 25 |
| 2017 February | 8 | 15 | 23 |
| 2017 January | 2 | 13 | 15 |
| 2016 December | 11 | 14 | 25 |
| 2016 November | 19 | 9 | 28 |
| 2016 October | 29 | 26 | 55 |
| 2016 September | 27 | 17 | 44 |
| 2016 August | 14 | 6 | 20 |
| 2016 July | 11 | 3 | 14 |
| 2016 May | 2 | 0 | 2 |
| 2016 April | 1 | 0 | 1 |
| 2016 March | 8 | 0 | 8 |
| 2016 February | 4 | 0 | 4 |
| 2016 January | 6 | 0 | 6 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 92 | 23 | 115 |
| 2015 September | 108 | 19 | 127 |
| 2015 August | 116 | 22 | 138 |
| 2015 July | 194 | 26 | 220 |
| 2015 June | 124 | 10 | 134 |
| 2015 May | 106 | 38 | 144 |
| 2015 April | 79 | 28 | 107 |
| 2015 March | 100 | 8 | 108 |
| 2015 February | 132 | 23 | 155 |
| 2015 January | 69 | 22 | 91 |
| 2014 December | 71 | 21 | 92 |
| 2014 November | 73 | 18 | 91 |
| 2014 October | 105 | 24 | 129 |
| 2014 September | 94 | 24 | 118 |
| 2014 August | 100 | 38 | 138 |
| 2014 July | 92 | 15 | 107 |
| 2014 June | 144 | 18 | 162 |
| 2014 May | 127 | 33 | 160 |
| 2014 April | 156 | 29 | 185 |
| 2014 March | 153 | 24 | 177 |
| 2014 February | 133 | 20 | 153 |
| 2014 January | 120 | 23 | 143 |
| 2013 December | 88 | 27 | 115 |
| 2013 November | 84 | 22 | 106 |
| 2013 October | 98 | 26 | 124 |
| 2013 September | 78 | 27 | 105 |
| 2013 August | 89 | 34 | 123 |
| 2013 July | 75 | 31 | 106 |
| 2013 June | 52 | 24 | 76 |
| 2013 May | 56 | 22 | 78 |
| 2013 April | 50 | 11 | 61 |
| 2013 March | 16 | 9 | 25 |
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