Búsqueda Activa de Individuos con Tuberculosis Pulmonar y Extrapulmonar en Calarcá-Quindío, Colombia-2005

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Abstract

Objetivo Describir características socio demográficas en una muestra de 195 pacientes sintomáticos respiratorios y 18 pacientes tuberculosos de Calarcá - Quindío, Colombia en el 2005. Metodología Se realizó búsqueda activa de tuberculosos en tres zonas urbanas, la cárcel del municipio de Calarcá y el Hospital Universitario San Juan de Dios. Previo ingreso al estudio los pacientes diligenciaron una encuesta y un consentimiento informado. A cada paciente se le tomaron muestras de esputo para baciloscopia y cultivo en medio de Ogawa-Kudoh. Cuando se observó crecimiento se realizó identificación fenotípica por pruebas bioquímicas y genotipificación por spoligotyping. Resultados Se identificaron 195 pacientes sintomáticos respiratorios y 18 (9,2 %) pacientes tuberculosos, de ellos el 78 % corresponde al género masculino y 22 % al femenino con una edad promedio para ambos sexos de 40 años. Se procesaron un total de 174 muestras de esputo, 21 lavados bronco alveolares, una muestra de orina, una muestra de ganglio cervical y un liquido pleural. El 77 % de las muestras analizadas fueron positivos por examen directo y cultivo, 16,7 % por cultivo y el 5,5 % por baciloscopia únicamente. El promedio de baciloscopias por paciente fue 2,3. La prueba de spoligotyping realizada evidenció la presencia de los genotipos H1, T1, H3 y LAM9. Conclusión Los resultados obtenidos demuestran la importancia de realizar simultáneamente baciloscopia y cultivo para aumentar la detección de pacientes bacilíferos sintomáticos respiratorios, al igual que en el seguimiento y control de estos pacientes. Se demostró la presencia de cuatro genotipos diferentes de Mycobacterium tuberculosis en Calarcá .

Translated abstract

Objective Describing socio-demographic characteristics in a population of 195 respiratory symptomatic and 18 tuberculosis patients from Calarcá-Quindío , Colombia during 2005. Methods An active search for individuals having symptomatic tuberculosis was carried out in three urban areas, Calarca's municipal prison and the San Juan de Dios teaching hospital. Prior to entering the study, the patients were required to fill out an application form and sign an informed consent form. Sputum samples were taken from each patient for bacilloscopy and culture in Ogawa-Kudoh medium. Phenotypic and genotypic identification were made when growth was observed by using conventional and molecular methods. Results 18 (9 ,2 %) out of 195 individuals having respiratory symptoms were diagnosed as having tuberculosis. 78 % were male and 22 % female; the average age was 40 for both genders. 174 sputum, 21 bronchial lavage, one urine, one cervical ganglia and pleural liquid sample were analysed; 77 % proved positive by direct smear test and culture, 16,7 % by culture and only 5,5 % by direct smear test. Bacilloscopy average per patient was 2 ,3 . The presence of H1, T1, H3 and LAM9 genotypes was demonstrated by using the spoligotyping test. Conclusions The results confirmed the importance of using both direct smear test and/or culture for improving the early detection of pulmonary tuberculosis, its follow-up and control. The existence of four different Mycobacterium tuberculosis genotypes in Calarcá was established .

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Assessment by meta-analysis of PCR for diagnosis of smear-negative pulmonary tuberculosis.

K Weigle, Olga L. Sarmiento, Janet Alexander … (2003)

We conducted a meta-analysis to assess the performance of PCR for the diagnosis of smear-negative pulmonary tuberculosis (SPT) and to identify factors that account for differences in the diagnostic accuracy of different studies. Studies published before February 2002 were included if sensitivity and specificity of PCR in smear-negative respiratory or gastric-aspirate specimens could be calculated. Analysis was conducted by using summary receiver operating characteristics models. Sensitivity and specificity ranged from 9 to 100% and from 25 to 100%, respectively. Fewer than 40% of the 50 studies reported results by number of patients, reported clinical characteristics of patients, or used as a reference standard combined culture and clinical criteria. Studies that included bronchial specimens showed higher accuracy than studies that evaluated only sputum specimens or included gastric aspirates. Studies that did not report that tests were applied blindly showed higher accuracy than those reporting blind testing. Increased sensitivity due to the use of DNA purification methods was associated with decreased specificity. Studies published after 1995, using Amplicor or dUTP-UNG, were associated with an increase in specificity at the expense of lower sensitivity. We concluded that PCR is not consistently accurate enough to be routinely recommended for the diagnosis of SPT. However, PCR of bronchial specimens could be useful in highly suspicious SPT cases. Studies not reporting blind testing are likely to overestimate accuracy of PCR. Future evaluation of PCR accuracy should be conducted by patient and type of respiratory specimen, blindly, by using a reference standard that combines culture and clinical criteria and addresses the issue of how patient characteristics affect PCR accuracy.

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Interpretation of restriction fragment length polymorphism analysis of Mycobacterium tuberculosis isolates from a state with a large rural population.

Q. Z. Yang, William W. Stead, G Templeton … (1997)

Epidemiologic relatedness of Mycobacterium tuberculosis isolates from Arkansas residents diagnosed with tuberculosis in 1992-1993 was assessed using IS6110- and pTBN12-based restriction fragment length polymorphism (RFLP) and epidemiologic investigation. Patients with isolates having similar IS6110 patterns had medical records reviewed and were interviewed to identify epidemiologic links. Complete RFLP analyses were obtained for isolates of 235 patients; 78 (33%) matched the pattern of > or = 1 other isolate, forming 24 clusters. Epidemiologic connections were found for 33 (42%) of 78 patients in 11 clusters. Transmission of M. tuberculosis likely occurred many years in the past for 5 patients in 2 clusters. Of clusters based only on IS6110 analyses, those with > or = 6 IS6110 copies had both a significantly greater proportion of isolates that matched by pTBN12 analysis and patients with epidemiologic connections, indicating IS6110 patterns with few bands lack strain specificity. Secondary RFLP analysis increased specificity, but most clustered patients still did not appear to be epidemiologically related. RFLP clustering in rural areas may not represent recent transmission.