Prueba de tuberculina en tuberculosis pulmonar activa

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Abstract

Se realizó un estudio descriptivo para conocer el comportamiento de la prueba de tuberculina en pacientes portadores de tuberculosis pulmonar activa confirmada por baciloscopia que ingresaron en el servicio de Neumología del Hospital provincial Docente Amalia Simoni de la ciudad de Camagüey, desde el 1ro de mayo de 2000 al 30 de abril de 2001.En los 50 enfermos estudiados, prevalecieron los grupos de edades de 25 a 34 años (28 %); el sexo masculino fue el más representado con 40 pacientes (80 %); la cicatriz vacunal no apareció en 31 pacientes y predominaron las baciloscopias con codificación nueve en 24 (48 %); la senilidad fue el factor anergizante más frecuente en el 40 % de los casos. La prueba de tuberculina fue positiva en el 78 %, así como en el 94, 7 % de los pacientes con cicatriz vacunal; los resultados de la misma aumentan a mayor positividad de la baciloscopia.

Translated abstract

A descriptive study was performed to know the behavior of tuberculin test in patients admitted in the Neumology service of Amalia Simoni teaching Hospital of Camagüey city, from May 1st, 2000 to April 30, 2001, who were carriers of active pulmonary tuberculosis confirmed by baciloscopy. In the 50 cases studied, age groups from 35 to 44 years ( 28 %) prevailed, masculine sex was highly represented with 40 sick (80 %); vaccinal scar appeared in 31 patients and baciloscopy with codification 9 in 24 (48 %) prevailed; being senility the anergic factor most frequent in the 40 % of cases. The tuberculin test was positive in the 78 %, as well as in the 95 % of patients with vaccinal scar; the results of it increase at higher positivity of baciloscopy.

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Most cited references 28

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Clinically significant interactions with drugs used in the treatment of tuberculosis.

W W Yew (2001)

Clinically significant interactions occurring during antituberculous chemotherapy principally involve rifampicin (rifampin), isoniazid and the fluoroquinolones. Such interactions between the antituberculous drugs and coadministered agents are definitely much more important than among antituberculous drugs themselves. These can be associated with consequences even amounting to therapeutic failure or toxicity. Most of the interactions are pharmacokinetic rather than pharmacodynamic in nature. The cytochrome P450 isoform enzymes are responsible for many interactions (especially those involving rifampicin and isoniazid) during drug biotransformation (metabolism) in the liver and/or intestine. Generally, rifampicin is an enzyme inducer and isoniazid acts as an inhibitor. The agents interacting significantly with rifampicin include anticoagulants, anticonvulsants, anti-infectives, cardiovascular therapeutics, contraceptives, glucocorticoids, immunosuppressants, psychotropics, sulphonylureas and theophyllines. Isoniazid interacts principally with anticonvulsants, theophylline, benzodiapines, paracetamol (acetaminophen) and some food. Fluoroquinolones can have absorption disturbance due to a variety of agents, especially the metal cations. Other important interactions of fluoroquinolones result from their enzyme inhibiting potential or pharmacodynamic mechanisms. Geriatric and immunocompromised patients are particularly at risk of drug interactions during treatment of their tuberculosis. Among the latter, patients who are HIV infected constitute the most important group. This is largely because of the advent of new antiretroviral agents such as the HIV protease inhibitors and the non-nucleoside reverse transcriptase inhibitors in the armamenterium of therapy. Compounding the complexity of drug interactions, underlying medical diseases per se may also contribute to or aggravate the scenario. It is imperative for clinicians to be on the alert when treating tuberculosis in patients with difficult co-morbidity requiring polypharmacy. With advancement of knowledge and expertise, it is hoped that therapeutic drug monitoring as a new paradigm of care can enable better management of these drug interactions.