Tuberculosis

ROSEMBERG GALEANO

DESCRIPCION

Es una enfermedad infectocontagiosa causada por el grupo de bacterias del complejo M tuberculosis se adquiere principalmente por viacutea aeacuterea o digestiva

FUENTE Y CADENAS DE TRASMISION

Fuente Animales y personas infectadas Afecta principalmente los sistemas respiratorios linfaacutetico renal digestivo y el SNC

Cadena de trasmisioacutenAgente causalUn reservorio o fuente de infeccioacutenMecanismo de transmisioacutenUn hueacutesped susceptible de enfermar

FUENTE Y CADENA DE TRASMISION

EPIDEMIOLOGIA

La organizacioacuten mundial de la salud (OMS) sentildeala que un tercio de la poblacioacuten mundial esta infectada por M tuberculosis cada antildeo ocurre 8 millones de casos nuevos y tres millones de funciones por TBC Clasificaacutendola como una enfermedad re emergente y en algunas regiones del mundo consideraacutendole una enfermedad persistente

INDICADORES EPIDEMIOLOGICOS BASICOS

IncidenciaPrevaleciacuteaMortalidadRiesgo de infeccioacuten

SIGNOS Y SINTOMASPRIMARIOS El diagnostico de la tuberculosis

primaria progresiva puede ser difiacutecil Contrariamente el cuadro habitual del tipo adulto (o reactivacioacuten) de la tuberculosis (enfermedad apical con cavitacioacuten) la tuberculosis primaria progresiva se asemeja mas a menudo a una neumoniacutea bacteriana aguda con consolidacioacuten en los loacutebulos medio e inferior adenopatiacutea hiliar y derrame pleural la cavitacion es rara especialmente en pacientes con inmunosupresiograven intensa

SECUNDARIOS La tuberculosis secundaria es el patroacuten

de enfermedad que surge en un hueacutesped previamente sensibilizado puede seguir al poco tiempo de una tuberculosis primaria y sus siacutentomas son

Malestar Anorexia Perdida de peso Fiebre fatiga

APARIENCIA FISICA

ESPECTRO NATURAL DE LA TUBERCULOSIS

PATOGENIA

bull La patogenia de la tuberculosis en una persona previamente no expuesta inmunocompetente depende del desarrollo de una inmunidad celular antimicobacteriana la cual confiere resistencia a las bacterias y que da lugar al desarrollo de hipersensibilidad frente a los antiacutegenos tuberculosos

bull Las manifestaciones patoloacutegicas de la tuberculosis tales como granulomas caseosos y la formacioacuten de cavernas son el resultado de la hipersensibilidad que es una parte esencial de la respuesta inmunitaria del hueacutesped Como las ceacutelulas afectadas que median en la inmunidad tambieacuten median en la hipersensibilidad y la destruccioacuten tisular la aparicioacuten de hipersensibilidad tambieacuten sentildeala la adquisicioacuten de inmunidad frente al organismo

bull Los macroacutefagos son las ceacutelulas primarias infectadas por M tuberculosis Al principio de la infeccioacuten el bacilo tuberculoso se replica esencialmente de una manera incontrolada

bull Una vez dentro del macroacutefago se replica dentro del fagosoma con el liposoma este es un proceso activo ya que las microbacterias vivas pero no las muertas bloquean la formacioacuten del fago lisosoma M tuberculosis tiene varios mecanismos para bloquear la formacioacuten del fago lisosoma incluyendo la inhibicioacuten de las sentildeales de Ca2 y el bloqueo del reclutamiento y de la organizacioacuten de proteiacutenas que median en la fusioacuten fagosoma-lisosoma

bull Asiacute pues el estadio maacutes precoz de la tuberculosis primaria ( lsaquo 3 semanas) en el individuo no sensibilizado se caracteriza por la proliferacioacuten de las bacterias en los macroacutefagos alveolares pulmonares y en los espacios aeacutereos con la siguiente bacteriemia y la siembra en localizaciones muacuteltiples

ARTICULOS CIENTIFICOS

ARTICULO Nordm 1

Tuberculin-specific T cells are reduced in active pulmonary tuberculosis compared to LTBI or status post BCG vaccination

Streitz M Fuhrmann S Powell F Quassem A Nomura L Maecker H Martus P Volk HD Kern F

Abstract Functional characteristics of tuberculosis (TB)-specific CD4 T cells were

studied in clinically active pulmonary TB (nthinsp=thinsp21) and high TB exposure including LTBI (nthinsp=thinsp17) Following tuberculin stimulation activated CD4 T cells were identified by flow-cytometry (CD154 up-regulation degranulation interferon γ [IFN-γ] tumor necrosis factor α [TNF-α] and interleukin 2 [IL-2 production) Interestingly CD154 up-regulation accounted for sim80 of activated CD4 T cells in the active TB group but just 40 in the controls whereas IFN-γ accounted for only sim50 of activated cells in each group The frequencies of CD4 T cells displaying at least 1 activation marker discriminated better between the groups than those displaying degranulation or IFN-γ production alone

ldquoEn este documento destacamos la funcioacuten que tiene la parte molecular ante la tuberculosis y la accioacuten del INF gamma de actuar solo ante la enfermedadrdquo

ARTICULO Nordm2

Mycobacterium tuberculosis causing infection of an implantable biventricular defibrillator

bull Luckie M Zaidi A Woodhead M Garratt C Manchester Heart Centre Manchester Royal Infirmary UK

mluckiedoctorsnetuk

bull Abstract Mycobacterial infection of implantable cardiac devices is rare and

infection of pacing system components with M tuberculosis has been reported on only three previous occasions involving epicardial pacing systems in two cases We report here a pocket infection with M tuberculosis in a transvenous biventricular defibrillator

ldquoEl articulo trata de los implantes de dispositivos cardiacos y sus complicaciones de los cuales solo se han reportado 3 casos expuesto en el articulordquo

ARTICULO Nordm 3

Smoking prolongs the infectivity of patients with tuberculosis

bull Siddiqui UA OToole M Kabir Z Qureshi S Gibbons N Kane M Keane J

bull Trinity College Dublin Centre for Global Health 3-5 Foster Place Dublin 2 siddiquutcdie

bull Abstract We sought to establish if smokers on anti-tuberculosis treatment are

more likely to have a prolonged period of infectivity compared to non-smoking tuberculosis patients in a low tuberculosis prevalence country We conducted a cross-sectional retrospective study in Ireland that recruited 53 microbiologically confirmed cases of pulmonary tuberculosis (PTB) The age-sex adjusted odds ratios (AOR) suggest that the infectivity status of PTB on treatment was four times more likely to be prolonged beyond 6-8 weeks if the cases had a smoking history (AOR 442 95 CI 123 159) Smoking was associated with delayed sputum smear conversion in PTB patients on treatment

ldquoEl articulo muestra un experimento hecho en Irlanda con 53 personas las cuales estan diagnosticadas con tuberculosis pulmonar se trata de mostrar un cuadro comparativo entre las personas con tuberculosis no fumadoras con respecto a las fumadoras con tuberculosis y asi se demostro la incidencia de infectividad de los fumadores en un pais en el cual los casos

de tuberculosis son muy bajosrdquo

ARTICULO Nordm 4

Zinc and vitamin A supplementation fails to reduce sputum conversion time in severely malnourished pulmonary tuberculosis patients in Indonesia

bull Pakasi TA Karyadi E Suratih NM Salean M Darmawidjaja N Bor H van der Velden K Dolmans WM van der Meer JW

bull South East Asia Minister of Education Organization Tropical Medicine Regional Center for Community Nutrition University of Indonesia Jl Salemba Raya no 6 Jakarta Pusat 10420 Indonesia tpakasi_commedfkuiacid

bull Abstractbull BACKGROUND A previous study showed that combination of zinc and vitamin A reduced sputum conversion time

in pulmonary tuberculosis (TB) patients

bull OBJECTIVE We studied the efficacy of which single micronutrient contributed more to the sputum conversion time

bull METHODS In a double-blind randomized community trial newly sputum smear positive pulmonary TB patients were assigned randomly to receive zinc vitamin A zinc + vitamin A or placebo on top of TB treatment Patients were asked to deliver their sputum on weekly basis to measure positivity of the bacteria Nutritional status chest x-ray hemoglobin C-reactive protein (CRP) retinol and zinc level were examined prior to after 2 and 6 months of treatment

bull RESULTS Initially 300 patients were enrolled and 255 finished the treatment Most patients were severely malnourished (mean BMI 165 plusmn 22 Kgm2) Patients in the zinc + vitamin A group showed earlier sputum conversion time (mean 19 weeks) compared with that in the other groups however the difference was not significant Also no benefit could be demonstrated of any of the used supplementations on clinical nutritional chest x-ray or laboratory findings

bull CONCLUSIONS This study among severely malnourished TB patients did not confirm that single or combined supplementation of zinc and vitamin A significantly reduced sputum conversion time or had other significant benefit

ldquo el abstracto me parece muy bueno ya que muestra los beneficios con una terapia de la conbinacion del zinc y las vitaminas en tratamientos tales como la tuberculosis reduciendo la expectoracion en

esta enfermedadrdquo

ARTICULO Nordm 5

Rapid molecular detection of tuberculosis and rifampin resistance

bull Boehme CC Nabeta P Hillemann D Nicol MP Shenai S Krapp F Allen J Tahirli R Blakemore R Rustomjee R Milovic A Jones M OBrien SM Persing DH Ruesch-Gerdes S Gotuzzo E Rodrigues C Alland D Perkins MD

bull Abstractbull BACKGROUND Global control of tuberculosis is hampered by slow insensitive diagnostic methods

particularly for the detection of drug-resistant forms and in patients with human immunodeficiency virus infection Early detection is essential to reduce the death rate and interrupt transmission but the complexity and infrastructure needs of sensitive methods limit their accessibility and effect

bull METHODS We assessed the performance of Xpert MTBRIF an automated molecular test for Mycobacterium tuberculosis (MTB) and resistance to rifampin (RIF) with fully integrated sample processing in 1730 patients with suspected drug-sensitive or multidrug-resistant pulmonary tuberculosis Eligible patients in Peru Azerbaijan South Africa and India provided three sputum specimens each Two specimens were processed with N-acetyl-L-cysteine and sodium hydroxide before microscopy solid and liquid culture and the MTBRIF test and one specimen was used for direct testing with microscopy and the MTBRIF test

bull RESULTS Among culture-positive patients a single direct MTBRIF test identified 551 of 561 patients with smear-positive tuberculosis (982) and 124 of 171 with smear-negative tuberculosis (725) The test was specific in 604 of 609 patients without tuberculosis (992) Among patients with smear-negative culture-positive tuberculosis the addition of a second MTBRIF test increased sensitivity by 126 percentage points and a third by 51 percentage points to a total of 902 As compared with phenotypic drug-susceptibility testing MTBRIF testing correctly identified 200 of 205 patients (976) with rifampin-resistant bacteria and 504 of 514 (981) with rifampin-sensitive bacteria Sequencing resolved all but two cases in favor of the MTBRIF assay

bull CONCLUSIONS The MTBRIF test provided sensitive detection of tuberculosis and rifampin resistance directly from untreated sputum in less than 2 hours with minimal hands-on time (Funded by the Foundation for Innovative New Diagnostics)

ldquoeste estudio hecho con medicamentos tales como la rifanpicina y N- acetil-cisteina nos muestra la evolucioacuten de los pacientes con cada uno de los medicamentosrdquo

REFERENCIASbull ARTICULO Nordm 1bull J Infect Dis 2011 Feb 1203(3)378-82 Epub 2010 Dec 24bull Tuberculin-specific T cells are reduced in active pulmonary tuberculosis compared to LTBI or status post BCG vaccinationbull Streitz M Fuhrmann S Powell F Quassem A Nomura L Maecker H Martus P Volk HD Kern F

Institut fuumlr Medizinische Immunologie Chariteacute - Universitaumltsmedizin Berlin Campus Mitte Berlin Germany

bull httpwwwncbinlmnihgovpubmed21186260

bull ARTICULO Nordm 2bull Indian J Tuberc 2010 Oct57(4)213-5bull Mycobacterium tuberculosis causing infection of an implantable biventricular defibrillatorbull Luckie M Zaidi A Woodhead M Garratt C

Manchester Heart Centre Manchester Royal Infirmary UK mluckiedoctorsnetuk


bull ARTICULO Nordm3bull Ir Med J 2010 Oct103(9)278-80bull Smoking prolongs the infectivity of patients with tuberculosisbull Siddiqui UA OToole M Kabir Z Qureshi S Gibbons N Kane M Keane Jbull Trinity College Dublin Centre for Global Health 3-5 Foster Place Dublin 2 siddiquutcdie


bull ARTICULO Nordm 4bull Zinc and vitamin A supplementation fails to reduce sputum conversion time in severely malnourished pulmonary tuberculosis patients in

IndonesiaPakasi TA Karyadi E Suratih NM Salean M Darmawidjaja N Bor H van der Velden K Dolmans WM van der Meer JW


bull ARTICULO Nordm 5bull Rapid molecular detection of tuberculosis and rifampin resistance

Boehme CC Nabeta P Hillemann D Nicol MP Shenai S Krapp F Allen J Tahirli R Blakemore R Rustomjee R Milovic A Jones M OBrien SM Persing DH Ruesch-Gerdes S Gotuzzo E Rodrigues C Alland D Perkins MD


BIBLIOGRAFIA

REFERENCIA A LIBROS GRATUITOS EN LINEA

bull httpbooksgooglecomcobooksid=i2o24JW40wACamppg=PA385ampdq=patogenia+de+la+tuberculosisamphl=esampei=hTnGTKCDM8OB8gaN-rDvDwampsa=Xampoi=book_resultampct=resultampresnum=1ampved=0CCoQ6AEwAAv=onepageampq=patogenia20de20la20tuberculosisampf=false

bull httpbooksgooglecomcobooksid=fjEPSMLSBMICampprintsec=frontcoverampdq=tuberculosisamphl=esampei=YnVgTbuRCoSWtwfd4L26DAampsa=Xampoi=book_resultampct=book-thumbnailampresnum=5ampved=0CEIQ6wEwBAv=onepageampqampf=false

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DESCRIPCION

Es una enfermedad infectocontagiosa causada por el grupo de bacterias del complejo M tuberculosis se adquiere principalmente por viacutea aeacuterea o digestiva





EPIDEMIOLOGIA









APARIENCIA FISICA


PATOGENIA







ARTICULO Nordm 1






ARTICULO Nordm2



mluckiedoctorsnetuk




ARTICULO Nordm 3








ARTICULO Nordm 4












ARTICULO Nordm 5























BIBLIOGRAFIA




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EPIDEMIOLOGIA









APARIENCIA FISICA


PATOGENIA







ARTICULO Nordm 1






ARTICULO Nordm2



mluckiedoctorsnetuk




ARTICULO Nordm 3








ARTICULO Nordm 4












ARTICULO Nordm 5























BIBLIOGRAFIA




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APARIENCIA FISICA


PATOGENIA







ARTICULO Nordm 1






ARTICULO Nordm2



mluckiedoctorsnetuk




ARTICULO Nordm 3








ARTICULO Nordm 4












ARTICULO Nordm 5























BIBLIOGRAFIA




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PATOGENIA







ARTICULO Nordm 1






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ARTICULO Nordm 3








ARTICULO Nordm 4












ARTICULO Nordm 5























BIBLIOGRAFIA




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ARTICULO Nordm 1






ARTICULO Nordm2



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ARTICULO Nordm 3








ARTICULO Nordm 4












ARTICULO Nordm 5























BIBLIOGRAFIA




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ARTICULO Nordm2



mluckiedoctorsnetuk




ARTICULO Nordm 3








ARTICULO Nordm 4












ARTICULO Nordm 5























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Tuberculosis

Documents

Transcript of Tuberculosis