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Vol. 32. Issue 10.
Pages 500-504 (December 1996)
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Vol. 32. Issue 10.
Pages 500-504 (December 1996)
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Tomografía computarizada y reacción en cadena de la polimerasa en la infección tuberculosa de la infancia
Computerized tomography and polymerase chain reaction in pediatric tuberculosis infection
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D. Gómez-Pastrana Durán*,1, P. Caro Mateo**, R. Torronteras Santiago***, M.L. Anguita Quesada**, A.M. López Barrio**, A. Andrés Martín*, J. Navarro González*
* Sección de Neumología Pediátrica. Hospital Infantil Universitario Virgen del Rocío. Sevilla
** Servicio de Radiología. Hospital Infantil Universitario Virgen del Rocío. Sevilla
*** Sección de Microbiología. Hospital Infantil Universitario Virgen del Rocío. Sevilla
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La diferencia entre infección y enfermedad tuberculosa puede ser difícil de establecer en la edad pediátrica. En ocasiones, puede estar presente una mínima enfermedad activa, y no ser reconocida por la radiografía de tórax ni los métodos microbiológicos habituales. Hemos realizado una tomografía computarizada a 22 niños con infección tuberculosa, radiografía de tórax normal y bacteriología negativa. En 16 de ellos, además, se realizó amplificación de ADN mediante la reacción en cadena de la polimerasa en muestras de aspirado gástrico.

Encontramos un aumento de los ganglios linfáticos mediante la tomografía computarizada en 14 de los 22 niños estudiados (63%). Las adenopatías fueron más frecuentes en los menores de 8 años y en las cadenas paratraqueales derechas. La reacción en cadena de la polimerasa fue positiva en 4 de 8 niños con tomografía patológica y fue negativa en los 8 niños con tomografía normal.

El hallazgo de enfermedad activa no reconocida por los métodos diagnósticos tradicionales plantea la cuestión del tratamiento correcto de los niños con infección tuberculosa. La asociación de un segundo fármaco a la isoniacida sería lo más adecuado en niños menores de 8 años.

Palabras clave:
Infección tuberculosa
Tomografía computarizada
Reacción en cadena de la polimerasa

The recognition of children with tuberculous infection without disease is often difficult. Minimal active disease may be present in many cases but unrecognised on chest radiography or by microbiologic methods. We have performed computed tomography in 22 children with tuberculous infection, a normal chest radiograph and negative micobacterial culture. In 16 children we also performed DNA amplification by polymerase chain reaction in gastric aspirates.

It was found that 14 of 22 (63%) infected children had enlarged lymph nodes. Adenopathies were more frequent in children less than 8 years-old and in the right paratracheal positions. Polymerase chain reaction was positive in 4 of 8 studied children with abnormal computed tomography and in none of the children with normal computed tomography.

The demonstration of unrecognised active disease raises the question of the adequate treatment for the children with tuberculous infection. It is proposed that a two drug regimen would be more appropriate than isoniazid alone in children less than 8 years old.

Key words:
Tuberculous infection
Computed tomography
Polymerase chain reaction
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Copyright © 1996. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología
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