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Abstract(s)
Introdução: A Tuberculose, causada pelo Mycobacterium tuberculosis, é uma infecção crónica recorrente, de atingimento multissistémico e distribuição mundial. Clinicamente inespecífica e variável, os meios complementares de diagnóstico e um elevado índice de suspeição desempenham um papel primordial no diagnóstico precoce e correcto. Embora curável quando tratada correta e atempadamente, pode evoluir desfavoravelmente, particularmente em doentes imunodeprimidos. Assim, propôs-se estudar o comportamento e evolução da doença, de acordo com o estado imunitário, num grupo de doentes internados.
Materiais e métodos: Estudo retrospectivo, transversal e descritivo, onde se analisou um conjunto de variáveis, através da consulta de processos clínicos de uma amostra seleccionada de 158 doentes, internados com diagnóstico de tuberculose activa nos Serviços de Pneumologia, Infecciologia e Medicina Interna do Centro Hospitalar Cova da Beira entre 2006 e 2013. Para tratamento estatístico dos dados recorreu-se ao software SPSS 21.0 e, no âmbito da análise estatística inferencial, aos testes de Qui-Quadrado e t-Student, definindo-se um nível de significância de 0,05.
Resultados: Os 158 doentes estudados, 113 do género masculino e 45 do género feminino, apresentaram uma média de idades de 52 anos. O número de casos notificados evidenciou uma tendência decrescente no decorrer dos anos considerados neste estudo. Dentro do espectro de comorbilidades, encontradas em 87,3% dos doentes, tabagismo, hipertensão arterial, alcoolismo, diabetes mellitus e insuficiência cardíaca constituíram as mais frequentes. A frequência de co-infecção Tuberculose/Vírus da Imunodeficiência Humana foi de 8,9%. Cem doentes apresentavam pelo menos um factor de imunodepressão. Tuberculose pulmonar foi a forma clínica predominante (67,1%) seguida de pleural e ganglionar. Tosse, febre, expectoração, astenia, emagrecimento, sudorese nocturna e anorexia constituíram as manifestações clínicas mais comuns. Laboratorialmente, anemia normocrómica normocítica, leucocitose, hiponatremia, hipoalbuminemia, hiperglicemia e elevação dos parâmetros inflamatórios foram frequentes. Opacidades, infiltrados e derrame pleural constituíram os achados mais consistentes na radiografia de tórax, realizada em 89,2% doentes. Exames micobacteriológicos, directo e cultural, foram solicitados, respectivamente, em 96,2% e 94,3% doentes. Estudo bioquímico de líquidos biológicos e estudo anatomopatológico de lesões suspeitas foram outros meios complementares de diagnóstico requisitados. Resistência a pelo menos um antibacilar estava presente em 15,2%, não sendo identificados casos de tuberculose multi ou extensivamente resistente. No âmbito do tratamento, em 20,9% dos doentes foi utilizado um esquema diferente do padronizado. Apenas 9,5% dos casos evoluíram desfavoravelmente, todos eles evidenciando factores de imunodepressão. Comparação entre os dois grupos revelou maior frequência de antecedentes de tuberculose nos imunodeprimidos (p=0,044) e maior mortalidade (p=0,002), sem diferenças estatisticamente significativas nos demais aspectos.
Conclusões: A Tuberculose constitui uma doença, na sua generalidade, curável, com evolução favorável na maioria dos doentes. Indivíduos imunodeprimidos revelam evoluções desfavoráveis, devido à presença de factores que, por determinarem uma acentuada redução do grau de imunidade, comprometem o sucesso do tratamento conduzindo, eventualmente, à morte.
Introduction: Tuberculosis, caused by Mycobacterium tuberculosis, is a recurrent chronic infection, with multisystemic repercussions and worldwide distribution. Clinically nonspecific and variable, complementary diagnostic means and a high index of suspicion play a key role in the early and correct diagnosis. Although curable if treated promptly and correctly, it can evolve unfavorably, particularly in immunocompromised patients. Therefore, this study aims to analyze the behavior and the course of the disease, according to the immune status, in a group of hospitalized patients. Materials and methods: Retrospective, cross-sectional and descriptive study, where a set of variables was analyzed, through the consult of medical records of a selected sample of 158 patients, admitted with a diagnosis of active tuberculosis in Pulmonology, Infectious Diseases and Internal Medicine Departments of Cova da Beira Hospital Center between 2006 and 2013. The SPSS 21.0 software was used for statistical treatment of the data, and the Chi-square test and Student’s t-test were used for inferential statistical analysis, having defined a 0,05 level of significance. Results: The 158 patients object of this study, 113 of them male and 45 female, had an average age of 52 years old. The number of reported cases showed a decreasing trend over the years considered in this study. Within the spectrum of co-morbidities, found in 87,3% of the patients, smoking, hypertension, alcoholism, diabetes mellitus and heart failure were the most frequent. The frequency of Tuberculosis/Human Immunodeficiency Virus co-infection was 8,9%. One hundred patients had at least one factor of immunodepression. Pulmonary tuberculosis was the predominant clinical presentation (67,1%) followed by pleural and lymph node. Cough, fever, sputum, weakness, weight loss, night sweats and anorexia were the most common clinical manifestations. Laboratory findings, such as normocytic normochromic anemia, leukocytosis, hyponatremia, hypoalbuminemia, hyperglycemia and elevated inflammatory parameters were frequent. Opacities, infiltrates and pleural effusion were the most consistent findings on chest radiography, performed in 89,2% patients. Mycobacteriological exams, smear and cultural-isolation, were performed, respectively, 96,2% and 94,3% patients. Biochemical study of biological fluids and pathological study of suspicious lesions were other complementary diagnostic means required. Resistance to at least one antibacilar drug was present in 15,2% and no cases of multi or extensively drug-resistant tuberculosis was identified. Concerning the treatment, in 20,9% of patients a non-standard regimen was used. Only 9,5% of cases evolved unfavorably, all of them having factors of immunodepression. Comparison between the two groups revealed greater frequency of tuberculosis history in the immunocompromised (p = 0,044) and higher mortality (p = 0.002), with no statistically significant differences regarding the other aspects. Conclusions: Tuberculosis, in general, is a curable disease that progresses favorably in most patients. Immunocompromised individuals reveal unfavorable progression, due to the presence of factors that, by causing a marked reduction in the degree of immunity, compromise treatment success eventually leading to death.
Introduction: Tuberculosis, caused by Mycobacterium tuberculosis, is a recurrent chronic infection, with multisystemic repercussions and worldwide distribution. Clinically nonspecific and variable, complementary diagnostic means and a high index of suspicion play a key role in the early and correct diagnosis. Although curable if treated promptly and correctly, it can evolve unfavorably, particularly in immunocompromised patients. Therefore, this study aims to analyze the behavior and the course of the disease, according to the immune status, in a group of hospitalized patients. Materials and methods: Retrospective, cross-sectional and descriptive study, where a set of variables was analyzed, through the consult of medical records of a selected sample of 158 patients, admitted with a diagnosis of active tuberculosis in Pulmonology, Infectious Diseases and Internal Medicine Departments of Cova da Beira Hospital Center between 2006 and 2013. The SPSS 21.0 software was used for statistical treatment of the data, and the Chi-square test and Student’s t-test were used for inferential statistical analysis, having defined a 0,05 level of significance. Results: The 158 patients object of this study, 113 of them male and 45 female, had an average age of 52 years old. The number of reported cases showed a decreasing trend over the years considered in this study. Within the spectrum of co-morbidities, found in 87,3% of the patients, smoking, hypertension, alcoholism, diabetes mellitus and heart failure were the most frequent. The frequency of Tuberculosis/Human Immunodeficiency Virus co-infection was 8,9%. One hundred patients had at least one factor of immunodepression. Pulmonary tuberculosis was the predominant clinical presentation (67,1%) followed by pleural and lymph node. Cough, fever, sputum, weakness, weight loss, night sweats and anorexia were the most common clinical manifestations. Laboratory findings, such as normocytic normochromic anemia, leukocytosis, hyponatremia, hypoalbuminemia, hyperglycemia and elevated inflammatory parameters were frequent. Opacities, infiltrates and pleural effusion were the most consistent findings on chest radiography, performed in 89,2% patients. Mycobacteriological exams, smear and cultural-isolation, were performed, respectively, 96,2% and 94,3% patients. Biochemical study of biological fluids and pathological study of suspicious lesions were other complementary diagnostic means required. Resistance to at least one antibacilar drug was present in 15,2% and no cases of multi or extensively drug-resistant tuberculosis was identified. Concerning the treatment, in 20,9% of patients a non-standard regimen was used. Only 9,5% of cases evolved unfavorably, all of them having factors of immunodepression. Comparison between the two groups revealed greater frequency of tuberculosis history in the immunocompromised (p = 0,044) and higher mortality (p = 0.002), with no statistically significant differences regarding the other aspects. Conclusions: Tuberculosis, in general, is a curable disease that progresses favorably in most patients. Immunocompromised individuals reveal unfavorable progression, due to the presence of factors that, by causing a marked reduction in the degree of immunity, compromise treatment success eventually leading to death.
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Keywords
Evolução Imunodeprimidos Mycobacterium Tuberculosis Tuberculose Vírus da Imunodeficiência Humana