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Vol. 37. Issue 1.
Pages 27-34 (January 2001)
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Vol. 37. Issue 1.
Pages 27-34 (January 2001)
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Enfermedad pulmonar por Mycobacterium kansasii. Análisis de 39 casos
Lung disease due to Mycobacterium kansasii: analysis of 39 cases
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J. Garrós Garay*, F. García Cebrián, J.J. Lorza Blasco, E. Ruiz De Gordejuela
Servicios de Neumología Hospital de Santa Marina. Bilbao
G. Martín Saco*
* Microbiología. Hospital de Santa Marina. Bilbao
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Objetivo

Determinar las características epidemiológicas, clínicas, radiológicas, evolutivas y de respuesta al tratamien-to en pacientes con enfermedad pulmonar por Mycobacte-rium kansasii.

Métodos

Se incluyeron en el estudio todos los pacientes diagnosticados de enfermedad pulmonar por M. kansasii entre los años 1993 y 1998 en el Hospital de Santa Marina de Bilbao.

Resultados

Encontramos a 39 pacientes con enfermedad pulmonar por M. kansasii que cumplían para su diagnóstico los criterios de la ATS. La incidencia de la enfermedad en nuestro medio es creciente. El predominio de afección del sexo masculino fue muy notable (97,4%). La media de edad de los pacientes fue de 55,9 años. Entre los antecedentes per-sonales destacan la tuberculosis pulmonar (38,4%), la OCFA (28,2%) y el tabaquismo (87%). La mayoría de los pacientes procedían del medio urbano (94,8%). Entre los síntomas des-tacaron por su frecuencia la tos (87%) y el síndrome general (72%). La hemoptisis se dio en el 31% de los pacientes. En la radiografía del tórax predominó el patrón alveolar localizado (69%). La presencia de cavitación se dio en el 76,9% de los casos. La baciloscopia directa fue positiva en el 76,9% de los pacientes. Los antibiogramas (sobre 30 casos) indicaron las siguientes resistencias: rifampicina, 3,3%; isoniacida (1 μg/ml), 10%; isoniacida (0,2 μg/ml), 100%; etambutol, 6,6%; estreptomicina, 90%; pirazinamida, 90%. Fallecieron 8 pa-cientes (22%, sobre 36 pacientes), todos con graves enferme-dades asociadas. En la evolución radiológica destacamos que en el 33% de las formas cavitarias no se consiguió el cierre de las mismas (sobre 21 pacientes). En la evolución microbiológi-ca destaca un caso de fracaso bacteriológico (2,7%, sobre 36 pacientes) y 4 casos de recaída (15,3%, sobre 26 pacientes).

Conclusiones

El número de pacientes con enfermedad pulmonar por Mycobacterium kansasiiha aumentado en los últimos años de forma significativa en nuestro hospital. La mortalidad en los pacientes con esta enfermedad fue alta, pero parece explicarse por la gravedad de las enfermedades asociadas que padecían. La tasa de recaídas, del 15,3%, obli-ga al seguimiento posterior a largo plazo de estos pacientes.

Palabras clave:
Micobacteriosis
Micobacterium kansasii
Diag-nóstico
Evolución
Objective

To study the epidemiological, clinical, radiolo-gical, and microbiological characteristics as well as clinical course and response to treatment of patients with lung dise-ase due to Mycobacterium kansasii.

Methods

All cases of lung disease caused by M. kansasii diagnosed between 1993 and 1998 in Santa Marina Hospital in Bilbao (Spain) were reviewed.

Results

The nurse identified 39 cases of lung disease caused by M. kansasii. The incidence in our practice is gro-wing. Most patients were men (97.4%). Mean patient age was 55.9 years. Relevant features of patients' case histories were lung tuberculosis (38.4%), chronic airflow limitation (28.2%) and smoking (87%). Most patients lived in urban settings (94.8%). The most frequent symptoms were cough (87%) and general malaise (72%). Hemoptysis occurred in 31%. Chest images showed mainly a localized alveolar pat-tern (69%). Cavitation was present in 76.9%. Bacilli were observed in 76.9%. Antibiograms (for 30 cases) showed re-sistance to the following drugs: rifampicin 3.3%, isoniazid (1 μg/ml 10%, isoniazid (0.2 μg/ml 100%, ethambutol 6.6%, streptomycin 90%, pyrazinamide 90%. Eight patients (22% of 36) died; all had severe associated disease. In 33% of the 21 patients with cavitation, closure was not achieved accor-ding to follow-up images. Follow-up microbiological tests re-vealed one case (2.7% of 36 patients) of treatment failure and four cases (15.3% of 26 patients) of relapse.

Conclusions

The number of patients with lung disease due to M. kansasii has increased significantly in recent years in our hospital. The mortality rate in these patients was high, but we believe it is explained by the severity of associa-ted disease. The 15.3% rate of relapse calls for long-term fo-llow-up of such patients.

Keywords:
Mycobacterium kansasii
Diagnosis
Course
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