Características clínicas, epidemiológicas y microbiológicas de una cohorte de pacientes con tuberculosis pulmonar en Cali, Colombia
Keywords:
tuberculosis pulmonar, resultado del tratamiento, curación, Colombia
Abstract
Introducción. El tratamiento acortado estrictamente supervisado hace parte de una estrategia multifactorial adoptada por la Organización Mundial de la Salud para controlar la tuberculosis y en Colombia alcanza una cobertura de 70%.Objetivo. Establecer las características clínicas, epidemiológicas y microbiológicas y el desenlace de la terapia antituberculosa, en una cohorte de pacientes nuevos con diagnóstico de tuberculosis pulmonar con baciloscopia positiva en Cali, Colombia.
Materiales y métodos. Se llevó a cabo un estudio descriptivo, anidado en un ensayo clínico de multicéntrico, en el que se incluyeron 106 pacientes con tuberculosis pulmonar con baciloscopia positiva entre abril de 2005 y junio de 2006, a través de instituciones de salud de la red pública de Cali que administraron el tratamiento antituberculoso.
Se practicó baciloscopia seriada, cultivo para micobacterias, prueba de sensibilidad a medicamentos antituberculosos de primera línea, radiografía de tórax postero-anterior y lateral y prueba ELISA para VIH. Se recolectó información clínica y epidemiológica, y se hizo seguimiento por 30 meses, haciendo uso de incentivos de transporte y alimentación.
Resultados. La mayoría de los pacientes fueron hombres jóvenes, con diagnóstico hecho más de nueve semanas después del inicio de los síntomas y con baciloscopia muy positiva (2+ o 3+). La resistencia a cualquier medicamento fue de 7,5% y la resistencia inicial a los medicamentos de primera línea fue de 1,9%. La incidencia de efectos secundarios asociados al tratamiento fue de 8,5%. La infección concomitante con VIH fue de 5,7%. El 86,8% de los pacientes completó la terapia con diagnóstico de curación.
Conclusiones. El período tan amplio comprendido entre el inicio de los síntomas y el diagnóstico de la enfermedad, se ha identificado previamente como factor de riesgo para el abandono de terapia. Las características epidemiológicas son similares a las descritas para los pacientes con tuberculosis pulmonar. Los hallazgos radiográficos indicativos de tuberculosis son diversos y no corresponden en su mayoría a cavernas. La infección concomitante con VIH fue identificada como parte del abordaje de la enfermedad por micobacterias en todos los casos.
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References
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21. Laserson KF, Osorio L, Sheppard JD, Hernández H, Benítez AM, Brim S, et al. Clinical and programmatic mismanagement rather than community outbreak as the cause of chronic, drug-resistant tuberculosis in Buenaventura, Colombia, 1998. Int J Lung Dis. 2000:4:673-83.
22. Moreira CA, Hernández HL, Arias NL, Castaño MC, Ferro BE, Jaramillo E. Resistencia inicial a drogas antituberculosas en Buenaventura, Colombia. Biomédica. 2004;24(Suppl.1):73-9.
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25. Thomas A, Gopi PG, Santha T, Chandrasekaran V, Subramani R, Selvakumar N, et al. Predictors of relapse among pulmonary tuberculosis patients treated in a DOTS programme in South India. Int J Tuberc Lung Dis. 2005;9:556-61.
26. Cáceres F, Orozco LC. Incidencia y factores asociados al abandono del tratamiento antituberculoso. Biomédica. 2007;27:498-504.
27. Maher D, Gupta R, Uplekar M, Dye C, Raviglione M. Directly observed therapy and treatment adherence. Lancet. 2000;356:1031-2.
28. Blomberg B, Spinaci S, Fourie B, Laing R. The rationale for recommending fixed-dose combination tablets for treatment of tuberculosis. Bull World Health Organ. 2001;79:61-8.
2. World Health Organization. The Stop TB Strategy: Building on and enhancing DOTS to meet the TB-related Millennium Development Goals. Geneva: World Health Organization; 2008.
3. Secretaría de Salud Pública Municipal de Cali. Boletín Epidemiológico. Santiago de Cali: Secretaría de Salud Pública Municipal de Cali; 2007.
4. Rieder H, van Deun A, Kam KM, Kim SJ, Chonde TM, Trébucq A, et al. Priorities for tuberculosis bacteriology services in low-income countries. Second edition. Paris: International Union Against Tuberculosis and Lung Disease; 2007.
5. Kent P, Kubica G. Public health mycobacteriology: a guide for the level III laboratory. Atlanta: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control; 1985.
6. Caminero JA. Tuberculosis guide for specialist physicians. Paris: International Union Against Tuberculosis and Lung Disease; 2004.
7. Pirkis JE, Speed BR, Yung AP, Dunt DR, MacIntyre CR, Plant AJ. Time to initiation of anti-tuberculosis treatment. Tuber Lung Dis. 1996;77:389-90.
8. Cáceres-Manrique F, Orozco-Vargas LC. Demora en el diagnóstico de tuberculosis pulmonar en una región de Colombia. Rev Salud Pública. 2008;10:94-104.
9. Rajeswari R, Chandrasekaran V, Suhadev M, Sivasubramaniam S, Sudha G, Renu G. Factors associated with patient and health system delays in the diagnosis of tuberculosis in South India. Int J Tuberc Lung Dis. 2002;6:789-95.
10. Godfrey-Faussett P, Kaunda H, Kamanga J, van Beers S, van Cleeff M, Kumwenda-Phiri R, et al. Why do patients with a cough delay seeking care at Lusaka urban health centres? A health systems research approach. Int J Tuberc Lung Dis. 2002;6:796-805.
11. Lönnroth K, Thuong LM, Linh PD, Diwan VK. Delay and discontinuity -a survey of TB patients' search of a diagnosis in a diversified health care system. Int J Tuberc Lung Dis. 1999;3:992-1000.
12. Salaniponi FM, Harries AD, Banda HT, Kang'ombe C, Mphasa N, Mwale A, et al. Care seeking behaviour and diagnostic processes in patients with smear-positive pulmonary tuberculosis in Malawi. Int J Tuberc Lung Dis. 2000;4:327-32.
13. Sarmiento K, Hirsch-Moverman Y, Colson PW, El-Sadr W. Help-seeking behavior of marginalized groups: a study of TB patients in Harlem, New York. Int J Tuberc Lung Dis. 2006;10:1140-5.
14. Selvam JM, Wares F, Perumal M, Gopi PG, Sudha G, Chandrasekaran V, et al. Health-seeking behaviour of new smear-positive TB patients under a DOTS programme in Tamil Nadu, India, 2003. Int J Tuberc Lung Dis. 2007;11:161-7.
15. Ward J, Siskind V, Konstantinos A. Patient and health care system delays in Queensland tuberculosis patients, 1985-1998. Int J Tuberc Lung Dis. 2001;5:1021-7.
16. Daley CK, Gotway MB, Jasmer RB. Radiographic manifestations of tuberculosis: A primer for clinicians. Second edition. San Francisco: Francis J. Curry National Tuberculosis Center; 2006. p. 2-23.
17. World Health Organization. Global Tuberculosis Control, Surveillance, Planning, Financing. WHO Report 2008 (WHO/HTM/TB/2008.393): Geneva: World Health Organization; 2008.
18. Williams G. Best practice for the care of patients with tuberculosis. A guide for low-income countries. Paris: International Union Against Tuberculosis and Lung Disease; 2007.
19. World Health Organization. Treatment of tuberculosis: Guidelines for national programmes. Third edition. Geneva: World Health Organization; 2003.
20. Garzón MC, Angée DY, Llerena C, Orjuela DL, Victoria JE. Vigilancia de la resistencia del Mycobacterium tuberculosis a los fármacos antituberculosos, Colombia 2004-2005. Biomédica. 2008;28:319-26.
21. Laserson KF, Osorio L, Sheppard JD, Hernández H, Benítez AM, Brim S, et al. Clinical and programmatic mismanagement rather than community outbreak as the cause of chronic, drug-resistant tuberculosis in Buenaventura, Colombia, 1998. Int J Lung Dis. 2000:4:673-83.
22. Moreira CA, Hernández HL, Arias NL, Castaño MC, Ferro BE, Jaramillo E. Resistencia inicial a drogas antituberculosas en Buenaventura, Colombia. Biomédica. 2004;24(Suppl.1):73-9.
23. Farmer P, Kim JY. Community based approaches to the control of multidrug resistant tuberculosis: introducing "DOTS-plus". BMJ. 1998;317:671-4.
24. Bao QS, Du YH, Lu CY. Treatment outcome of new pulmonary tuberculosis in Guangzhou, China 1993-2002: a register-based cohort study. BMC Public Health. 2007;7:344.
25. Thomas A, Gopi PG, Santha T, Chandrasekaran V, Subramani R, Selvakumar N, et al. Predictors of relapse among pulmonary tuberculosis patients treated in a DOTS programme in South India. Int J Tuberc Lung Dis. 2005;9:556-61.
26. Cáceres F, Orozco LC. Incidencia y factores asociados al abandono del tratamiento antituberculoso. Biomédica. 2007;27:498-504.
27. Maher D, Gupta R, Uplekar M, Dye C, Raviglione M. Directly observed therapy and treatment adherence. Lancet. 2000;356:1031-2.
28. Blomberg B, Spinaci S, Fourie B, Laing R. The rationale for recommending fixed-dose combination tablets for treatment of tuberculosis. Bull World Health Organ. 2001;79:61-8.
How to Cite
1.
Rojas CM, Villegas SL, Piñeros HM, Chamorro EM, Durán CE, Hernández EL, et al. Características clínicas, epidemiológicas y microbiológicas de una cohorte de pacientes con tuberculosis pulmonar en Cali, Colombia. Biomed. [Internet]. 2010 Dec. 1 [cited 2025 Apr. 5];30(4):482-91. Available from: https://revistabiomedicaorg.biteca.online/index.php/biomedica/article/view/286
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Published
2010-12-01
Issue
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Original articles
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