1648. Clinical expression of three different forms of tuberculosis in a tertiary-care center in Mexico: 1993-2011
Session: Poster Abstract Session: Mycobacterial Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Cartel ArmelleBIENNSZ.pdf (658.9 kB)
  • Background: Extrapulmonary TB can affect any organ and is becoming more prevalent. For a prompt diagnosis, it is necessary to know the clinical and laboratory findings most commonly observed in these conditions.

    Methods: We initially identified all culture-proven TB cases from 1993 to 2011. We described and compared clinical and laboratory data of different forms of TB, genitourinary (GUTB), pulmonary (PTB) and disseminated (DTB) diagnosed and treated in a tertiary-care hospital in Mexico City.

    Results: We identified 267 patients, 120 with PTB (45%), 109 DTB (40.9%) and 38 GUTB (14%). The median age of presentation was 46.5 years; a high proportion of women in the GUTB group (60.5%); diabetes mellitus (DM) in PTB (29.2%); immunosuppression (53.7%), systemic lupus erythematous (12%) and HIV/AIDS (37.6%) in DTB. GUTB patients referred a longer duration of symptoms (up to 48 months), with predominance of hematuria, frequency and dysuria. Fever, diaphoresis, weight loss, asthenia and adynamia were more frequent in PTB and DTB cases. The tuberculin skin test was positive in 94%, 88% and 76%, of GUTB, PTB and DTB cases, respectively. GUTB cases showed abnormalities in the urine exam, hematuria (71%) and pyuria (60.5%). The culture confirmation was obtained on a median of 31(12-123) days. Mycobacterium bovis was recovered in 25%, 18% and 6% of DTB, PTB and GUTB, respectively. Resistance to at least one of the first-line drugs was found in 20 % and the rate of INH-resistance was 10% with no statistical difference. We found only 5 cases of multidrug-resistant tuberculosis (1.5%), 4 in PTB and 1 in DTB.

    Conclusion: Our data suggest that, an association between the clinical manifestations and the presentation of the disease, which can be useful for early diagnosis, to stop transmission and improve outcomes; DM confers a higher risk for PTB and immunosuppression for DTB; the recovery of mycobacteria is an key element to confirm diagnosis and optimize treatment; M. bovis was a common culprit of DTB, and in our setting, resistance to at least one of the first line drugs was seen in 20% and INH-resistance in 10%.

    Armelle Perez Cortes, Fellow, Infectious Diseases, Insituto Nacional de Ciencias Medicas y Nutricion, Mexico City, Mexico, Arturo Galindo Fraga, MD MSc, National Institute of Medical Sciences and Nutrition, Mexico, Mexico, Alfredo Ponce De Leon, MD, Infectious Diseases Department, National Institute of Medical Sciences and Nutrition, Salvador Zubirán, Mexico City, Mexico, Miriam Bobadilla Del Valle, PhD, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico., Mexico, Mexico, Brabara Chavez Mazari, Insituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran", Mexico City, Mexico and José Sifuentes-Osornio, MD, Inst. Nac. Ciencias Médicas y Nutrición, Mexico, Mexico

    Disclosures:

    A. Perez Cortes, None

    A. Galindo Fraga, None

    A. Ponce De Leon, None

    M. Bobadilla Del Valle, None

    B. Chavez Mazari, None

    J. Sifuentes-Osornio, None

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