Tuberculosis extrapulmonar, un reto clínico vigente.
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ago 30, 2020
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Sandra Amado Garzon
https://orcid.org/0000-0002-7756-1805
Sebastián Moreno Mercado
https://orcid.org/0000-0002-4385-5063
Samuel Martínez Vernaza
https://orcid.org/0000-0001-5363-5729
Javier Iván Lasso
https://orcid.org/0000-0002-3061-5212
Andres Laserna
https://orcid.org/0000-0002-2071-3142
https://orcid.org/0000-0002-7756-1805
Sebastián Moreno Mercado
https://orcid.org/0000-0002-4385-5063
Samuel Martínez Vernaza
https://orcid.org/0000-0001-5363-5729
Javier Iván Lasso
https://orcid.org/0000-0002-3061-5212
Andres Laserna
https://orcid.org/0000-0002-2071-3142
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Resumen
Los dos tipos de manifestación clínica de la tuberculosis (TB) son la pulmonar y la extrapulmonar siendo la primera la más frecuente. No obstante, si bien se ha logrado disminuir la prevalencia en general, las cifras de la tuberculosis extrapulmonar (TBEP) se mantienen estables; se notificaron 896.000 casos nuevos en el mundo en 2017. Por lo general, se presenta por diseminación hematógena o linfática del bacilo del complejo Mycobacterium tuberculosis a otros órganos. Los sitios de compromiso más frecuentes son pleural, ganglionar, tracto gastrointestinal y osteoarticular. Otros menos habituales son el sistema nervioso central, piel, tracto genitourinario y vías aéreas superiores.
Las manifestaciones clínicas de la TBEP son variables por su naturaleza paucibacilar y constituye un verdadero reto para los clínicos. La aproximación diagnóstica depende del sitio de compromiso, la facilidad de toma de la muestra, la sensibilidad de las pruebas y la distribución de la micobacteria en el tejido. La enfermedad usualmente responde al tratamiento estándar para TB y el tiempo ideal del régimen varía según el sitio afectado. El propósito de esta revisión es describir la presentación clínica y el proceso diagnóstico de la TBEP.
Palabras clave:
Keywords
Tuberculosis, extrapulmonar, pleural, osteoarticular, pericárdica
References
Referencias
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2. World Health Organization. Global tuberculosis report 2018. Geneva: World Health Organization; 2018. 683–690 p.
3. World Health Organization. Definitions and reporting framework for tuberculosis – 2013 revision. World Health Organization. 2014. 1–47 p.
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5. Guler SA, Bozkus F, Inci MF, Kokoglu OF, Ucmak H, Ozden S, et al. Evaluation of pulmonary and extrapulmonary tuberculosis in immunocompetent adults: a retrospective case series analysis. Med Princ Pract Med Princ Pract. 2015;24(1):75–9.
6. Sunnetcioglu A, Sunnetcioglu M, Binici I, Baran AI, Karahocagil MK, Saydan MR. Comparative analysis of pulmonary and extrapulmonary tuberculosis of 411 cases. Ann Clin Microbiol Antimicrob. 2015;14(1):34.
7. Sreeramareddy CT, Panduru K V, Verma SC, Joshi HS, Bates MN. Comparison of pulmonary and extrapulmonary tuberculosis in Nepal- a hospital-based retrospective study. BMC Infect Dis. 2008;8(1):8.
8. Peto HM, Pratt RH, Harrington TA, LoBue PA, Armstrong LR. Epidemiology of Extrapulmonary Tuberculosis in the United States, 1993–2006. Clin Infect Dis. 2009;49(9):1350–7.
9. Musellim B, Erturan S, Sonmez Duman E, Ongen G. Comparison of extra- pulmonary and pulmonary tuberculosis cases: factors influencing the site of reactivation. Int J Tuberc Lung Dis. 2005;9:1220–3.
10. Lee JY. Diagnosis and treatment of extrapulmonary tuberculosis. Tuberc Respir Dis (Seoul). 2015;78(2):47–55.
11. Polo CL. Tuberculosis en Colombia : análisis de la situación epidemiológica , año 2006. Infectio. 2008;(571):159–73.
12. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J. Harrison Principles of Internal Medicine. 18th edition United States of America: McGraw-Hill Companies, Inc; 2012.
13. CDC. Reported Tuberculosis in The United States. CDC. Atlanta, GA; 2014.
14. Montufar Andrade FE, Aguilar Londoño C, Saldarriaga Acevedo C, Quiroga Echeverri A, Builes Montaño CE, Mesa Navas MA, et al. Clinical features, risk factors and susceptibility profile of mycobacterial infections documented by culture in a university hospital of high complexity in Medellin (Colombia). Rev Chil infectología órgano Of la Soc Chil Infectología. 2014;31(6):735–42.
15. López MP. Informe evento Tuberculosis a periodo XI -2018. Instituto Nacional de Salud. 2018;1–2.
16. Pai M, Behr MA, Dowdy D, Dheda K, Divangahi M, Boehme CC, et al. Tuberculosis. Nat Rev Dis Prim. 2016;2(1):16076.
17. Bennett JE, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 8th edition. Vol. 8 Philadelphia:Elsevier Health Sciences; 2015. 3904 p.
18. Cardona PJ. Reactivation or reinfection in adult tuberculosis: Is that the question? Int J Mycobacteriology. 2016;5(4):400–7.
19. Norbis L, Alagna R, Tortoli E, Codecasa LR, Miglori GB, Cirillo DM. Challenges and perspectives in the diagnosis of extrapulmonary tuberculosis. Expert Rev Anti Infect Ther. 2014;633–47.
20. Ramírez-Lapausa M, Menéndez-Saldana A, Noguerado-Asensio A. Extrapulmonary tuberculosis:an overview. Rev Española Sanid Penit. 2015;17:3–11.
21. Meghdadi H, Khosravi AD, Ghadiri AA, Sina AH, Alami A. Detection of Mycobacterium tuberculosis in extrapulmonary biopsy samples using PCR targeting IS6110, rpoB, and nested-rpoB PCR Cloning. Front Microbiol. 2015;6(JUL):1–8.
22. Maynard-Smith L, Larke N, Peters JA, Lawn SD. Diagnostic accuracy of the Xpert MTB/RIF assay for extrapulmonary and pulmonary tuberculosis when testing non-respiratory samples: A systematic review. BMC Infect Dis. 2014;14(1).
23. Osman M, Simpson JA, Caldwell J, Bosman M, Nicol MP. GeneXpert MTB/RIF version g4 for identification of rifampin-resistant tuberculosis in a programmatic setting. J Clin Microbiol. 2014;52(2):635–7.
24. Horne DJ, Kohli M, Zifodya JS, Schiller I, Dendukuri N, Tollefson D, et al. Xpert MTB/RIF and Xpert MTB/RIF ultra for pulmonary tuberculosis and rifampicin resistance in adults. Cochrane Database Syst Rev. 2019;2019(6).
25. Shin JA, Chang YS, Kim HJ, Ahn CM, Byun MK. Diagnostic utility of interferon-gamma release assay in extrapulmonary tuberculosis. Diagn Microbiol Infect Dis. 2015;82(1):44–8.
26. Rumende CM, Hadi EJ, Tanjung G, Saputri IN, Sasongko R. The Benefit of Interferon-Gamma Release Assay for Diagnosis of Extrapulmonary Tuberculosis. Acta Med Indones. 2018;50(2):138–43.
27. Arias-Guillén M. Avances en el diagnóstico de la infección tuberculosa. Arch Bronconeumol. 2011;47(10):521–30.
28. Cataño JC, Robledo J. Tuberculous Lymphadenitis and Parotitis. Tuberc Nontuberculous Mycobact Infect Seventh Ed. 2017;343–54.
29. Graham-Duarte M, Rendon R, Adrian GB. Tuberculosis. European Respiratory Society; 2018. 474 p.
30. Ketata W, Rekik WK, Ayadi H, Kammoun S. Les tuberculoses extrapulmonaires. Rev Pneumol Clin. 2015;71(2–3):83–92.
31. Grzybowski S, Allen EA. History and importance of scrofula. Lancet. 1995;346(8988):1472–4.
32. Polesky A, Grove W, Bhatia G. Peripheral tuberculous lymphadenitis: Epidemiology, diagnosis, treatment, and outcome. Medicine (Baltimore). 2005;84(6):350–62.
33. Shaw JA, Irusen EM, Diacon AH, Koegelenberg CF. Pleural tuberculosis: A concise clinical review. Clin Respir J. 2018;12(5):1779–86.
34. Yang Z, Kong Y, Wilson F, Foxman B, Fowler AH, Marrs CF, et al. Identification of risk factors for extrapulmonary tuberculosis. Clin Infect Dis. 2004;38:199–205.
35. Ruan SY, Chuang YC, Wang JY, Lin JW, Chien JY, Huang CT, et al. Revisiting tuberculous pleurisy: Pleural fluid characteristics and diagnostic yield of mycobacterial culture in an endemic area. Thorax. 2012;67(9):822–7.
36. Houston A. Extrapulmonary tuberculosis. Medicine (Baltimore). 2014;42(1):18–22.
37. Dunn RN, Husien NB. Spinal tuberculosis review of current management. Boint Joint J. 2018;100(4).
38. Faroug R, Psyllakis P, Gulati A, Makvana S, Pareek M, Mangwani J. Diagnosis and treatment of tuberculosis of the foot and ankle—A literature review. Foot. 2018;37:105–12.
39. Gambhir S, Ravina M, Rangan K, Dixit M, Barai S, Bomanji J. Imaging in extrapulmonary tuberculosis. Int J Infect Dis. 2017 Mar 1;56:237–47.
40. Bolukbas C, Bolukbas FF, Kendir T, Dalay RA, Akbayir N, Sokmen MH, et al. Clinical presentation of abdominal tuberculosis in HIV seronegative adults. BMC Gastroenterology 2005;8:1–8.
41. Fiske CT, Griffin MR, Erin H, Warkentin J, Lisa K, Arbogast PG, et al. Black race, sex, and extrapulmonary tuberculosis risk: an observational study. BMC Infect Dis. 2010;10:16.
42. Kedia S, Das P, Madhusudhan KS, Dattagupta S, Sharma R, Sahni P, et al. Differentiating Crohn’s disease from intestinal tuberculosis. World J Gastroenterol 2019;25(4):418–32.
43. Debi U, Ravisankar V, Prasad KK, Sinha SK, Sharma AK. Abdominal tuberculosis of the gastrointestinal tract: Revisited. World J Gastroenterol. 2014;20(40):14831–40.
44. Hopewell PC, Kato-Maeda M, Ernst JD. 35 - Tuberculosis. In: Broaddus VC, Mason RJ, Ernst JD, King TE, Lazarus SC, Murray JF, et al. Philadelphia: W.B. Saunders; 2016. p. 593-628.e20.
45. Leonard JM. Central nervous system tuberculosis. Microbiol Spectrum. 2017;5(2):TNMI7-0044-2017
46. Prasad K, Singh MB, Ryan H. Corticosteroids for managing tuberculous meningitis. Cochrane Database of Systematic Reviews. 2016, Issue 4.
47. Srivanitchapoom C, Sittitrai P. Nasopharyngeal Tuberculosis: Epidemiology, Mechanism of Infection, Clinical Manifestations, and Management. Int J Otolaryngol. 2016;2016(Table 1):1–6.
48. Angeline Grace G, Bella Devaleenal D, Natrajan M. Genital tuberculosis in females. Indian Journal of Medical Research. 2017. Apr; 145(4): 425–436.
49. Sharma JB, Sharma E, Sharma S, Dharmendra S. Female genital tuberculosis: Revisited. Indian J Med Res. 2018 Dec;148(Suppl):S71–83.
50. Arenas R. Capítulo 83: Tuberculosis cutánea. Dermatología: atlas, diagnóstico y tratamiento. Sexta edición:México; McGraw-Hill Interamericana editores, 2015.
51. Kumar B, Dogra S. Cutaneous tuberculosis. Ski Infect Diagnosis Treat. 2009;59–75.
52. Ntsekhe M, Mayosi BM. Tuberculous pericarditis with and without HIV. Heart Fail Rev. 2013;18(3):367–73.
1. Furin J, Cox H, Pai M. Tuberculosis. Lancet. 2019 Apr 20;393(10181):1642–56.
2. World Health Organization. Global tuberculosis report 2018. Geneva: World Health Organization; 2018. 683–690 p.
3. World Health Organization. Definitions and reporting framework for tuberculosis – 2013 revision. World Health Organization. 2014. 1–47 p.
4. Metaferia Y, Seid A, Fenta GM, Gebretsadik D. Assessment of Extrapulmonary Tuberculosis Using Gene Xpert MTB/RIF Assay and Fluorescent Microscopy and Its Risk Factors at Dessie Referral Hospital, Northeast Ethiopia. Biomed Res Int. 2018;201
5. Guler SA, Bozkus F, Inci MF, Kokoglu OF, Ucmak H, Ozden S, et al. Evaluation of pulmonary and extrapulmonary tuberculosis in immunocompetent adults: a retrospective case series analysis. Med Princ Pract Med Princ Pract. 2015;24(1):75–9.
6. Sunnetcioglu A, Sunnetcioglu M, Binici I, Baran AI, Karahocagil MK, Saydan MR. Comparative analysis of pulmonary and extrapulmonary tuberculosis of 411 cases. Ann Clin Microbiol Antimicrob. 2015;14(1):34.
7. Sreeramareddy CT, Panduru K V, Verma SC, Joshi HS, Bates MN. Comparison of pulmonary and extrapulmonary tuberculosis in Nepal- a hospital-based retrospective study. BMC Infect Dis. 2008;8(1):8.
8. Peto HM, Pratt RH, Harrington TA, LoBue PA, Armstrong LR. Epidemiology of Extrapulmonary Tuberculosis in the United States, 1993–2006. Clin Infect Dis. 2009;49(9):1350–7.
9. Musellim B, Erturan S, Sonmez Duman E, Ongen G. Comparison of extra- pulmonary and pulmonary tuberculosis cases: factors influencing the site of reactivation. Int J Tuberc Lung Dis. 2005;9:1220–3.
10. Lee JY. Diagnosis and treatment of extrapulmonary tuberculosis. Tuberc Respir Dis (Seoul). 2015;78(2):47–55.
11. Polo CL. Tuberculosis en Colombia : análisis de la situación epidemiológica , año 2006. Infectio. 2008;(571):159–73.
12. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J. Harrison Principles of Internal Medicine. 18th edition United States of America: McGraw-Hill Companies, Inc; 2012.
13. CDC. Reported Tuberculosis in The United States. CDC. Atlanta, GA; 2014.
14. Montufar Andrade FE, Aguilar Londoño C, Saldarriaga Acevedo C, Quiroga Echeverri A, Builes Montaño CE, Mesa Navas MA, et al. Clinical features, risk factors and susceptibility profile of mycobacterial infections documented by culture in a university hospital of high complexity in Medellin (Colombia). Rev Chil infectología órgano Of la Soc Chil Infectología. 2014;31(6):735–42.
15. López MP. Informe evento Tuberculosis a periodo XI -2018. Instituto Nacional de Salud. 2018;1–2.
16. Pai M, Behr MA, Dowdy D, Dheda K, Divangahi M, Boehme CC, et al. Tuberculosis. Nat Rev Dis Prim. 2016;2(1):16076.
17. Bennett JE, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 8th edition. Vol. 8 Philadelphia:Elsevier Health Sciences; 2015. 3904 p.
18. Cardona PJ. Reactivation or reinfection in adult tuberculosis: Is that the question? Int J Mycobacteriology. 2016;5(4):400–7.
19. Norbis L, Alagna R, Tortoli E, Codecasa LR, Miglori GB, Cirillo DM. Challenges and perspectives in the diagnosis of extrapulmonary tuberculosis. Expert Rev Anti Infect Ther. 2014;633–47.
20. Ramírez-Lapausa M, Menéndez-Saldana A, Noguerado-Asensio A. Extrapulmonary tuberculosis:an overview. Rev Española Sanid Penit. 2015;17:3–11.
21. Meghdadi H, Khosravi AD, Ghadiri AA, Sina AH, Alami A. Detection of Mycobacterium tuberculosis in extrapulmonary biopsy samples using PCR targeting IS6110, rpoB, and nested-rpoB PCR Cloning. Front Microbiol. 2015;6(JUL):1–8.
22. Maynard-Smith L, Larke N, Peters JA, Lawn SD. Diagnostic accuracy of the Xpert MTB/RIF assay for extrapulmonary and pulmonary tuberculosis when testing non-respiratory samples: A systematic review. BMC Infect Dis. 2014;14(1).
23. Osman M, Simpson JA, Caldwell J, Bosman M, Nicol MP. GeneXpert MTB/RIF version g4 for identification of rifampin-resistant tuberculosis in a programmatic setting. J Clin Microbiol. 2014;52(2):635–7.
24. Horne DJ, Kohli M, Zifodya JS, Schiller I, Dendukuri N, Tollefson D, et al. Xpert MTB/RIF and Xpert MTB/RIF ultra for pulmonary tuberculosis and rifampicin resistance in adults. Cochrane Database Syst Rev. 2019;2019(6).
25. Shin JA, Chang YS, Kim HJ, Ahn CM, Byun MK. Diagnostic utility of interferon-gamma release assay in extrapulmonary tuberculosis. Diagn Microbiol Infect Dis. 2015;82(1):44–8.
26. Rumende CM, Hadi EJ, Tanjung G, Saputri IN, Sasongko R. The Benefit of Interferon-Gamma Release Assay for Diagnosis of Extrapulmonary Tuberculosis. Acta Med Indones. 2018;50(2):138–43.
27. Arias-Guillén M. Avances en el diagnóstico de la infección tuberculosa. Arch Bronconeumol. 2011;47(10):521–30.
28. Cataño JC, Robledo J. Tuberculous Lymphadenitis and Parotitis. Tuberc Nontuberculous Mycobact Infect Seventh Ed. 2017;343–54.
29. Graham-Duarte M, Rendon R, Adrian GB. Tuberculosis. European Respiratory Society; 2018. 474 p.
30. Ketata W, Rekik WK, Ayadi H, Kammoun S. Les tuberculoses extrapulmonaires. Rev Pneumol Clin. 2015;71(2–3):83–92.
31. Grzybowski S, Allen EA. History and importance of scrofula. Lancet. 1995;346(8988):1472–4.
32. Polesky A, Grove W, Bhatia G. Peripheral tuberculous lymphadenitis: Epidemiology, diagnosis, treatment, and outcome. Medicine (Baltimore). 2005;84(6):350–62.
33. Shaw JA, Irusen EM, Diacon AH, Koegelenberg CF. Pleural tuberculosis: A concise clinical review. Clin Respir J. 2018;12(5):1779–86.
34. Yang Z, Kong Y, Wilson F, Foxman B, Fowler AH, Marrs CF, et al. Identification of risk factors for extrapulmonary tuberculosis. Clin Infect Dis. 2004;38:199–205.
35. Ruan SY, Chuang YC, Wang JY, Lin JW, Chien JY, Huang CT, et al. Revisiting tuberculous pleurisy: Pleural fluid characteristics and diagnostic yield of mycobacterial culture in an endemic area. Thorax. 2012;67(9):822–7.
36. Houston A. Extrapulmonary tuberculosis. Medicine (Baltimore). 2014;42(1):18–22.
37. Dunn RN, Husien NB. Spinal tuberculosis review of current management. Boint Joint J. 2018;100(4).
38. Faroug R, Psyllakis P, Gulati A, Makvana S, Pareek M, Mangwani J. Diagnosis and treatment of tuberculosis of the foot and ankle—A literature review. Foot. 2018;37:105–12.
39. Gambhir S, Ravina M, Rangan K, Dixit M, Barai S, Bomanji J. Imaging in extrapulmonary tuberculosis. Int J Infect Dis. 2017 Mar 1;56:237–47.
40. Bolukbas C, Bolukbas FF, Kendir T, Dalay RA, Akbayir N, Sokmen MH, et al. Clinical presentation of abdominal tuberculosis in HIV seronegative adults. BMC Gastroenterology 2005;8:1–8.
41. Fiske CT, Griffin MR, Erin H, Warkentin J, Lisa K, Arbogast PG, et al. Black race, sex, and extrapulmonary tuberculosis risk: an observational study. BMC Infect Dis. 2010;10:16.
42. Kedia S, Das P, Madhusudhan KS, Dattagupta S, Sharma R, Sahni P, et al. Differentiating Crohn’s disease from intestinal tuberculosis. World J Gastroenterol 2019;25(4):418–32.
43. Debi U, Ravisankar V, Prasad KK, Sinha SK, Sharma AK. Abdominal tuberculosis of the gastrointestinal tract: Revisited. World J Gastroenterol. 2014;20(40):14831–40.
44. Hopewell PC, Kato-Maeda M, Ernst JD. 35 - Tuberculosis. In: Broaddus VC, Mason RJ, Ernst JD, King TE, Lazarus SC, Murray JF, et al. Philadelphia: W.B. Saunders; 2016. p. 593-628.e20.
45. Leonard JM. Central nervous system tuberculosis. Microbiol Spectrum. 2017;5(2):TNMI7-0044-2017
46. Prasad K, Singh MB, Ryan H. Corticosteroids for managing tuberculous meningitis. Cochrane Database of Systematic Reviews. 2016, Issue 4.
47. Srivanitchapoom C, Sittitrai P. Nasopharyngeal Tuberculosis: Epidemiology, Mechanism of Infection, Clinical Manifestations, and Management. Int J Otolaryngol. 2016;2016(Table 1):1–6.
48. Angeline Grace G, Bella Devaleenal D, Natrajan M. Genital tuberculosis in females. Indian Journal of Medical Research. 2017. Apr; 145(4): 425–436.
49. Sharma JB, Sharma E, Sharma S, Dharmendra S. Female genital tuberculosis: Revisited. Indian J Med Res. 2018 Dec;148(Suppl):S71–83.
50. Arenas R. Capítulo 83: Tuberculosis cutánea. Dermatología: atlas, diagnóstico y tratamiento. Sexta edición:México; McGraw-Hill Interamericana editores, 2015.
51. Kumar B, Dogra S. Cutaneous tuberculosis. Ski Infect Diagnosis Treat. 2009;59–75.
52. Ntsekhe M, Mayosi BM. Tuberculous pericarditis with and without HIV. Heart Fail Rev. 2013;18(3):367–73.
Cómo citar
Amado Garzon, S., Moreno Mercado, S., Martínez Vernaza, S., Lasso, J. I., & Laserna, A. (2020). Tuberculosis extrapulmonar, un reto clínico vigente. Universitas Medica, 61(4). https://doi.org/10.11144/Javeriana.umed61-4.reto
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