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                  "host" => array:1 [
                    0 => array:1 [
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                        "tituloSerie" => "J Infect Dis"
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                        "volumen" => "161"
                        "paginaInicial" => "977"
                        "paginaFinal" => "981"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2109022"
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                      "titulo" => "Rapid diagnosis of tuberculosis by amplification of mycobacterial DNA in clinical samples"
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                            0 => "A&#46; Brisson-Noel"
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                        "paginaFinal" => "1&#46;071"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26034780"
                            "web" => "Medline"
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                      "titulo" => "Diagnosis of tuberculosis by DNA amplification in clinical practice evaluation"
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                            0 => "A&#46; Brisson-Noel"
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                            2 => "C&#46; Chureau"
                            3 => "S&#46; Nguyen"
                            4 => "C&#46; Pierre"
                            5 => "M&#46; Bartoli"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
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                        "paginaInicial" => "364"
                        "paginaFinal" => "366"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1677709"
                            "web" => "Medline"
                          ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Nested amplification protocol for the detection of <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span>"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Narita"
                            1 => "Y&#46; Matsunzono"
                            2 => "M&#46; Shibata"
                            3 => "T&#46; Togashi"
                          ]
                        ]
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Acta Paediatr"
                        "fecha" => "1992"
                        "volumen" => "81"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1392355"
                            "web" => "Medline"
                          ]
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                ]
              ]
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            11 => array:3 [
              "identificador" => "bib0060"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Sequence analysis&#46;and amplification by polymerase chain reaction of a cloned DNA fragment for identification of <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span>"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46;J&#46; Patel"
                            1 => "W&#46;U&#46; Fries"
                            2 => "W&#46;F&#46; Piessens"
                            3 => "D&#46;F&#46; Wirth"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Microbiol"
                        "fecha" => "1990"
                        "volumen" => "28"
                        "paginaInicial" => "513"
                        "paginaFinal" => "518"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2108994"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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            12 => array:3 [
              "identificador" => "bib0065"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rapid and simple method for purification of nucleic acids"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46; Boom"
                            1 => "C&#46;J&#46;A&#46; Sol"
                            2 => "M&#46;M&#46;M&#46; Salimans"
                            3 => "C&#46;L&#46; Jansen"
                            4 => "P&#46;M&#46;E&#46; Werteheim-van Dillen"
                            5 => "J&#46; Van der Noordaa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Microbiol"
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                        "volumen" => "28"
                        "paginaInicial" => "495"
                        "paginaFinal" => "503"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1691208"
                            "web" => "Medline"
                          ]
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                    ]
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                ]
              ]
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            13 => array:3 [
              "identificador" => "bib0070"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Progress toward a simplified polymerase chain reaction and its application to diagnosis of tuberculosis"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46;M&#46; Wilson"
                            1 => "R&#46; McNerney"
                            2 => "P&#46;M&#46; Nye"
                            3 => "P&#46;D&#46; Godfrey-Faussett"
                            4 => "N&#46;G&#46; Stoker"
                            5 => "A&#46; Voller"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Clin Microbiol"
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                        "volumen" => "4"
                        "paginaInicial" => "776"
                        "paginaFinal" => "782"
                      ]
                    ]
                  ]
                ]
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            14 => array:3 [
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                    0 => array:2 [
                      "titulo" => "The utility of polymerase chain reaction &#40;PCR&#41; in the diagnosis of pulmonary tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;M&#46; Querol"
                            1 => "M&#46;A&#46; Farma"
                            2 => "D&#46; Granda"
                            3 => "C&#46; Gimeno"
                            4 => "J&#46; Garc&#237;a de Lomas"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
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                        "paginaInicial" => "1&#46;631"
                        "paginaFinal" => "1&#46;635"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7781379"
                            "web" => "Medline"
                          ]
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                ]
              ]
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            15 => array:3 [
              "identificador" => "bib0080"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Detection of mycobacterial DNA in pleural fluid from patients with tuberculous pleurisy by means of the polymerase chain reaction&#58; comparison of two protocols"
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                        0 => array:2 [
                          "etal" => false
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                            2 => "C&#46; Pierre"
                            3 => "J&#46; Cadranel"
                            4 => "M&#46; Stern"
                            5 => "A&#46;J&#46; Hance"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "1992"
                        "volumen" => "47"
                        "paginaInicial" => "265"
                        "paginaFinal" => "269"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1316638"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
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                ]
              ]
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            16 => array:3 [
              "identificador" => "bib0085"
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                    0 => array:2 [
                      "titulo" => "Rapid diagnosis of tuberculous meningitis by polymerase chain reaction"
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                          "autores" => array:6 [
                            0 => "P&#46; Shankar"
                            1 => "N&#46; Manjunath"
                            2 => "K&#46;K&#46; Mohan"
                            3 => "K&#46; Prasad"
                            4 => "M&#46; Behari"
                            5 => "Shriniwas"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
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                        "paginaInicial" => "5"
                        "paginaFinal" => "7"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1670668"
                            "web" => "Medline"
                          ]
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                ]
              ]
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            17 => array:3 [
              "identificador" => "bib0090"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis of primary tuberculosis in children by amplification and detection of mycobacterial DNA"
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                          "etal" => false
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                            0 => "C&#46; Pierre"
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                            2 => "D&#46; Lecossier"
                            3 => "Y&#46; Boussougant"
                            4 => "P&#46; Yeni"
                            5 => "A&#46;J&#46; Hance"
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                    0 => array:2 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "Am Rev Respir Dis"
                        "fecha" => "1993"
                        "volumen" => "147"
                        "paginaInicial" => "420"
                        "paginaFinal" => "424"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8430968"
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                          ]
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            18 => array:3 [
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                      "titulo" => "Use of polymerase chain reaction for improved diagnosis of tuberculosis in children"
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                            5 => "J&#46; De Blic"
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                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr"
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                        "paginaInicial" => "703"
                        "paginaFinal" => "709"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7751992"
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                    0 => array:2 [
                      "titulo" => "CT demonstration of calcified mediastinal limph nodes&#58; A guide to the new ATS classification"
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                        "tituloSerie" => "AJR"
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                        "paginaInicial" => "17"
                        "paginaFinal" => "20"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3487210"
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              "identificador" => "bib0105"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Computed tomography with normal chest radiography in tuberculous infection"
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                            3 => "J&#46; De Blic"
                            4 => "N&#46; Sayed"
                            5 => "D&#46; Lallemand"
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                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dis Child"
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                        "paginaInicial" => "430"
                        "paginaFinal" => "432"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8259872"
                            "web" => "Medline"
                          ]
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            21 => array:3 [
              "identificador" => "bib0110"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Use of a reamplification protocol improves sensitivity of detection of <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> in clinical samples by amplification of DNA"
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                            3 => "D&#46; Bocart"
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                            5 => "P&#46; Yeni"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
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                        "paginaInicial" => "712"
                        "paginaFinal" => "717"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1909710"
                            "web" => "Medline"
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            22 => array:3 [
              "identificador" => "bib0115"
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                    0 => array:2 [
                      "titulo" => "The value of flexible bronchoscopy in childhood pulmonary tuberculosis"
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                  "host" => array:1 [
                    0 => array:1 [
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                        "paginaInicial" => "688"
                        "paginaFinal" => "692"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1909618"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Detection of <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> complex in clinical specimens by a commercial polymerasa chain reaction kit"
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                          "etal" => false
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                            4 => "H&#46; Shinko"
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Clin Microbiol Infect Dis"
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                        "paginaFinal" => "1&#46;051"
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                          "colaboracion" => "American Thoracic Society"
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                        "tituloSerie" => "Am J Respir Crit Care Med"
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                        "paginaInicial" => "1&#46;359"
                        "paginaFinal" => "1&#46;374"
                        "link" => array:1 [
                          0 => array:2 [
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                      "titulo" => "Consenso nacional para el control de la tuberculosis en Espa&#241;a"
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                        "tituloSerie" => "Med Clin &#40;Barc&#41;"
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                        "volumen" => "98"
                        "paginaInicial" => "24"
                        "paginaFinal" => "31"
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            26 => array:3 [
              "identificador" => "bib0135"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tuberculosis pulmonar con radiograf&#237;a de t&#243;rax normal e infecci&#243;n por el virus de la inmunodeficiencia humana"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "J&#46; Guix"
                            2 => "G&#46; Juan"
                            3 => "A&#46; Nieto"
                            4 => "P&#46; Roig"
                            5 => "M&#46; Salavert"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Enferm Infecc Microbiol Clin"
                        "fecha" => "1991"
                        "volumen" => "9"
                        "paginaInicial" => "26"
                        "paginaFinal" => "29"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2029555"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "etiqueta" => "28&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chemotherapy and management of tuberculosis in the United Kingdom&#58; recommendations of the Joint Tuberculosis Committee of the British Thoracic Society"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "L&#46;P&#46; Ormerod"
                          ]
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "1990"
                        "volumen" => "45"
                        "paginaInicial" => "403"
                        "paginaFinal" => "408"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2382247"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0145"
              "etiqueta" => "29&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chemotherapy for tuberculosis in infants and children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "American Academy of Pediatrics"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "1992"
                        "volumen" => "89"
                        "paginaInicial" => "161"
                        "paginaFinal" => "165"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1728006"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
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              "etiqueta" => "30&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Why tuberculosis is not prevented"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Glassroth"
                            1 => "W&#46;C&#46; Bailey"
                            2 => "P&#46;C&#46; Hopewell"
                            3 => "G&#46; Schecter"
                            4 => "J&#46;W&#46; Harden"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Am Rev Respir Dis"
                        "fecha" => "1990"
                        "volumen" => "141"
                        "paginaInicial" => "I&#46;236"
                        "paginaFinal" => "1&#46;240"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nationwide survey of drug-resistant tuberculosis in the United States"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;B&#46; Bloch"
                            1 => "G&#46;M&#46; Cauthen"
                            2 => "I&#46;M&#46; Onorato"
                            3 => "K&#46;G&#46; Dansbury"
                            4 => "G&#46;D&#46; Kelly"
                            5 => "C&#46;R&#46; Driver"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "1994"
                        "volumen" => "271"
                        "paginaInicial" => "665"
                        "paginaFinal" => "671"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8080502"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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                    0 => array:2 [
                      "titulo" => "Situaci&#243;n actual de la tuberculosis en Espa&#241;a"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;A&#46; Caminero"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "1994"
                        "volumen" => "30"
                        "paginaInicial" => "371"
                        "paginaFinal" => "374"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7987542"
                            "web" => "Medline"
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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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Bibliografía
[1.]
A. Kochi.
The global tuberculosis situation and the new control strategy of the World Health Organization.
Tubercle, 72 (1991), pp. 1-6
[2.]
J.A. Caminero.
Estado de la infección y la enfermedad tuberculosa en España.
Resultado de las encuestas desarrolladas por el Area Tuberculosis e Infecciones Respiratorias de la Sociedad Española de Neumología y Cirugía Torácica. Documentos en repografía. Años 1988 a, (1993),
[3.]
J.R. Starke, R.F. Jacobs, J. Jereb.
Resurgence of tuberculosis in children.
J Pediatr, 120 (1992), pp. 839-855
[4.]
J.B. Bass Jr..
Tuberculin test, preventive therapy and elimination of tuberculosis.
Am Rev Respir Dis, 141 (1990), pp. 812-813
[5.]
American Thoracic Society.
Diagnostic standars and classification of tuberculosis.
Am Rev Respir Dis, 142 (1990), pp. 725-735
[6.]
J.G. Im, K.S. Song, H.S. Kang, J.H. Park, K.M. Yeon, M.Ch. Han, et al.
Mediastinal tuberculous lymphadenitis: CT manifestation.
Radiology, 164 (1987), pp. 115-119
[7.]
D.E. Snider Jr., H.L. Rieder, D. Combs, A.B. Bloch, C.H. Hayden, M.H.D. Smith.
Tuberculosis in children.
Pediatr Infect Dis J, 7 (1988), pp. 271-278
[8.]
K.D. Eisenach, M.D. Cave, J.H. Bates, J.T. Crawford.
Polymerase chain reaction amplification of a repetitive DNA sequence specific for Mycobacterium tuberculosis.
J Infect Dis, 161 (1990), pp. 977-981
[9.]
A. Brisson-Noel, B. Gicquel, D. Lecossier, V. Lévy-Frébault, X. Nassif, A.J. Hance.
Rapid diagnosis of tuberculosis by amplification of mycobacterial DNA in clinical samples.
Lancet, 2 (1989), pp. 1.069-1.071
[10.]
A. Brisson-Noel, C. Aznar, C. Chureau, S. Nguyen, C. Pierre, M. Bartoli, et al.
Diagnosis of tuberculosis by DNA amplification in clinical practice evaluation.
Lancet, 338 (1991), pp. 364-366
[11.]
M. Narita, Y. Matsunzono, M. Shibata, T. Togashi.
Nested amplification protocol for the detection of Mycobacterium tuberculosis.
Acta Paediatr, 81 (1992),
[12.]
R.J. Patel, W.U. Fries, W.F. Piessens, D.F. Wirth.
Sequence analysis.and amplification by polymerase chain reaction of a cloned DNA fragment for identification of Mycobacterium tuberculosis.
J Clin Microbiol, 28 (1990), pp. 513-518
[13.]
R. Boom, C.J.A. Sol, M.M.M. Salimans, C.L. Jansen, P.M.E. Werteheim-van Dillen, J. Van der Noordaa.
Rapid and simple method for purification of nucleic acids.
J Clin Microbiol, 28 (1990), pp. 495-503
[14.]
S.M. Wilson, R. McNerney, P.M. Nye, P.D. Godfrey-Faussett, N.G. Stoker, A. Voller.
Progress toward a simplified polymerase chain reaction and its application to diagnosis of tuberculosis.
J Clin Microbiol, 4 (1993), pp. 776-782
[15.]
J.M. Querol, M.A. Farma, D. Granda, C. Gimeno, J. García de Lomas.
The utility of polymerase chain reaction (PCR) in the diagnosis of pulmonary tuberculosis.
Chest, 107 (1995), pp. 1.631-1.635
[16.]
A. Lassence, D. Lecossier, C. Pierre, J. Cadranel, M. Stern, A.J. Hance.
Detection of mycobacterial DNA in pleural fluid from patients with tuberculous pleurisy by means of the polymerase chain reaction: comparison of two protocols.
Thorax, 47 (1992), pp. 265-269
[17.]
P. Shankar, N. Manjunath, K.K. Mohan, K. Prasad, M. Behari, Shriniwas, et al.
Rapid diagnosis of tuberculous meningitis by polymerase chain reaction.
Lancet, 337 (1991), pp. 5-7
[18.]
C. Pierre, C. Oliver, D. Lecossier, Y. Boussougant, P. Yeni, A.J. Hance.
Diagnosis of primary tuberculosis in children by amplification and detection of mycobacterial DNA.
Am Rev Respir Dis, 147 (1993), pp. 420-424
[19.]
D. Delacourt, J.D. Poveda, C. Chureau, N. Beydon, B. Mahut, J. De Blic, et al.
Use of polymerase chain reaction for improved diagnosis of tuberculosis in children.
J Pediatr, 126 (1995), pp. 703-709
[20.]
H.S. Glazer, D.J. Aronberg, S.S. Sagel, P.J. Friedman.
CT demonstration of calcified mediastinal limph nodes: A guide to the new ATS classification.
AJR, 147 (1986), pp. 17-20
[21.]
C. Delacourt, T. Mamou Mani, V. Bonnerot, J. De Blic, N. Sayed, D. Lallemand, et al.
Computed tomography with normal chest radiography in tuberculous infection.
Arch Dis Child, 69 (1993), pp. 430-432
[22.]
C. Pierre, D. Lecossier, Y. Boussougant, D. Bocart, V. Joly, P. Yeni, et al.
Use of a reamplification protocol improves sensitivity of detection of Mycobacterium tuberculosis in clinical samples by amplification of DNA.
J Clin Microbiol, 29 (1991), pp. 712-717
[23.]
J. Blic, I. Azevedo, C.P. Burren, M. Le Bourgeois, D. Lallemand, P. Scheinmann.
The value of flexible bronchoscopy in childhood pulmonary tuberculosis.
Chest, 100 (1991), pp. 688-692
[24.]
F. Stauffer, R. Mutschlechner, P. Hasenberger, S. Stadlbauer, H. Shinko.
Detection of Mycobacterium tuberculosis complex in clinical specimens by a commercial polymerasa chain reaction kit.
Eur J Clin Microbiol Infect Dis, 14 (1995), pp. 1.046-1.051
[25.]
American Thoracic Society.
Treatment of tuberculosis and tuberculosis infection in adults and children.
Am J Respir Crit Care Med, 149 (1994), pp. 1.359-1.374
[26.]
Grupo de Trabajo sobre Tuberculosis.
Consenso nacional para el control de la tuberculosis en España.
Med Clin (Barc), 98 (1992), pp. 24-31
[27.]
V. Navarro, J. Guix, G. Juan, A. Nieto, P. Roig, M. Salavert, et al.
Tuberculosis pulmonar con radiografía de tórax normal e infección por el virus de la inmunodeficiencia humana.
Enferm Infecc Microbiol Clin, 9 (1991), pp. 26-29
[28.]
L.P. Ormerod.
Chemotherapy and management of tuberculosis in the United Kingdom: recommendations of the Joint Tuberculosis Committee of the British Thoracic Society.
Thorax, 45 (1990), pp. 403-408
[29.]
American Academy of Pediatrics.
Chemotherapy for tuberculosis in infants and children.
Pediatrics, 89 (1992), pp. 161-165
[30.]
J. Glassroth, W.C. Bailey, P.C. Hopewell, G. Schecter, J.W. Harden.
Why tuberculosis is not prevented.
Am Rev Respir Dis, 141 (1990), pp. I.236-1.240
[31.]
A.B. Bloch, G.M. Cauthen, I.M. Onorato, K.G. Dansbury, G.D. Kelly, C.R. Driver, et al.
Nationwide survey of drug-resistant tuberculosis in the United States.
JAMA, 271 (1994), pp. 665-671
[32.]
J.A. Caminero.
Situación actual de la tuberculosis en España.
Arch Bronconeumol, 30 (1994), pp. 371-374
Copyright © 1996. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología
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