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Vol. 31. Issue 10.
Pages 512-518 (December 1995)
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Vol. 31. Issue 10.
Pages 512-518 (December 1995)
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Características clínicas de la tuberculosis pleural en el paciente con y sin infección por el virus de la inmunodeficiencia humana
Clinical signs of pleural tuberculosis in patients with and without infection by human immunodeficiency virus
Visits
...
PJ. Cordero, V. Gil Suay*, J.V. Greses, JJ. Soler, M. Perpiñá, F. Sanchís, J. Sanchís
Servicio de Neumología. Hospital Universitario La Fe. Valencia
Article information
Objetivo

El objetivo del presente trabajo ha sido analizar si existen diferencias en las características de la tuberculosis pleural (TP) entre los pacientes con y sin infección por el virus de la inmunodeficiencia humana (VIH).

Métodos

Realizamos un estudio retrospectivo de las historias clínicas de los pacientes diagnosticados en nuestro hospital de TP durante los años 1986 a 1993.

Resultados

No observamos diferencias significativas en relación a la proporción de TP del total de los pacientes diagnosticados de tuberculosis entre los sujetos con o sin infección por VIH (8 frente a 11%). Se identificaron como TP, 119 casos de los cuales la infección por VIH coexistía en el 10% de los pacientes. Los pacientes con infección por VIH se caracterizaron por presentar formas más graves de TP que los sujetos sin infección por VIH, con una presencia significativamente mayor de derrames pleurales grandes (58 frente a 19%, p < 0,01), un mayor porcentaje de aislamientos de Mycobacterium tuberculosis en esputo y líquido pleural (LP) (42 y 45% frente a 13 y 15%, p < 0,05) y una proporción mayor de fallecimientos antes de finalizar el tratamiento (17 frente a 1%, p < 0,05). Sin embargo, los sujetos con infección por VIH mostraron una menor proporción de positividad en la intradermorreacción de Mantoux (17 frente a 67%, p < 0,01) y una menor rentabilidad de la biopsia pleural (BP) (36 frente a 84% de positividad para granulomas, p < 0,01).

Conclusiones

En nuestro medio la TP se produjo con una frecuencia similar entre los sujetos con o sin infección por VIH. En los pacientes con infección por VIH y TP, el cultivo del LP y del esputo aporta un mayor rendimiento diagnóstico que la BP, por lo que debe enfatizarse su realización.

Palabras clave:
Tuberculosis pleural
Derrame pleural
Síndrome de inmunodeficiencia humana
Virus de la inmunodeficiencia humana
Objective

To determine whether or not there are differences in the characteristics of pleural tuberculosis (PT) related to whether patients are or are not infected by human immunodeficiency virus (HIV).

Methods

We conducted a retrospective study of the medical histories of patients diagnosed of PT in our hospital between 1986 and 1993.

Results

We found no significant differences in the proportions of tuberculosis patients with or without HIV infection (8% versus 11%) who were diagnosed of PT. Of the 119 patients diagnosed of PT, 10% were also HIV positive. The HIV patients had more serious forms of PT, and among them there was a higher incidence of pleural discharge, more isolations of Mycobacterium tuberculosis in sputum and pleural fluid (42% and 45% versus 13% and 15%, p < 0.05), and more deaths before end of treatment (17% versus 1%, p < 0.05). The HIV patients had a lower rate of positive results in Mantoux's intradermal reaction test (17% versus 67%, p < 0.01), however, and fewer positive results for pleural biopsy (36% versus 84% positivity for granulomas, p < 0.01).

Conclusions

The frequency of PT was similar for subjects with and without HIV infection in our study. In patients with both HIV and PT pleural fluid and sputum cultures are more useful diagnostic tools than pleural biopsy, and the former tests should therefore be stressed.

Key words:
Pleural tuberculosis
Pleural discharge
Acquired immunodeficiency syndrome
Human immunodeficiency virus
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Copyright © 1995. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología

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