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Vol. 30. Issue 4.
Pages 181-184 (April 1994)
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Vol. 30. Issue 4.
Pages 181-184 (April 1994)
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Valoración del hemocultivo en la micobacteriosis diseminada
Evaluation of blood culture in disseminated mycobacteremia
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M.C. Nogales1, R. Aretio, E. Martín
Servicio de Microbiología. Hospital Universitario de Valme. Sevilla
A. Beiztegui*, F. Muñoz*
* Servicio de Neumología. Hospital Universitario de Valme. Sevilla
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El objetivo del estudio es evaluar la rentabilidad del hemocultivo en el diagnóstico de micobacteriosis diseminada (MBD).

Se llevó a cabo un estudio prospectivo desde enero 1991 a julio de 1992, de todos los hemocultivos realizados a enfermos con fiebre y sospecha de MBD.

Se realizaron un total de 57 hemocultivos pertenecientes a 16 enfermos, 14 VIH positivos (87,5%), diagnosticados de MBD. Los hemocultivos se procesaron por la técnica de lisiscentrifugación. La identificación de las micobacterias se realizó por técnica de hibridación con sonda de ADN.

Se detectó crecimiento de micobacterias en 5 hemocultivos (8,7%), pertenecientes a 4 enfermos (25%) (3 VIH+). En tres de ellos se aisló M. tuberculosis y en uno M. avium. El tiempo medio de aislamiento fue de 46 días. En todos los casos se aislaron micobacterias con anterioridad al hemocultivo en otras muestras, M. tuberculosis en 2 broncoaspirados (BAS), en 2 biopsias hepáticas (BH), 2 biopsias de bazo (BB), un lavado broncoalveolar (LBA), un esputo, un LCR y una orina; M. avium se aisló en esputo y LBA. Los 3 enfermos con aislamiento de M. tuberculosis fallecieron a los 1, 4 y 32 días del ingreso. De las 12 MBD con hemocultivos negativos (11 VIH+, 92%), se aisló M. tuberculosis en el 100% de las muestras de ganglio y BB, 90% de las orinas, 69% de esputos, 67% de LBA y BH, 63% en BAS y 33% en LCR. Ninguno de estos enfermos falleció durante el ingreso.

Detectamos una baja rentabilidad del hemocultivo en el diagnóstico de MBD. El examen de otras muestras proporciona un diagnóstico más rápido. La positividad del hemocultivo podría ser un marcador pronóstico.

The objective of this study was to evaluate the usefulness of blood culture in the diagnosis of disseminated mycobacteremia (DMB).

This prospective study included all blood cultures done for patients with fever and under suspicion of having DMB between January 1991 and July 1992.

Fifty-seven blood samples from 16 patients were cultured; 14 (87.5%) patients were HIV positive and all were diagnosed as having DMB. The cultures were processed by lysiscentrifugation and identification of mycobacteria was by hybridization with a DNA probe.

Mycobacterial growth was detected in 5 cultures (8.7%) from 4 patients (25%) (3 HIV positive). M. tuberculosis was isolated in 3 and M. avium in 1. Mean time until isolation was 46 days. In all cases mycobacteria were isolated in other samples before they were found in cultures: M. tuberculosis was isolated in 2 bronchial aspirates (BAS), 2 in liver tissue (L), 2 in spleen tissue (S), one in alveolar bronchial lavage, one in sputum, one in spinal fluid (SF) and one in uriñe. M. avium was isolated in sputum and ALB. The three patients in whom M. tuberculosis was found died 1.4 and 32 days after admission. In samples from the 12 DMB patients with negative cultures (11 HIV positive, 92%), M. tuberculosis was isolated in 100% of ganglion and S samples, 90% in uriñe, 69% in sputum, 67% in ABL and LB, 63% in BAS and 33% in SF. None of these patients died in hospital.

We find blood culture to be of little use in the diagnosis of DMB. Analysis of other samples leads to faster diagnosis. A positive blood culture may be a prognositic indicator.

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Copyright © 1994. Sociedad Española de Neumología y Cirugía Torácica
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