Vol. 13. Núm. 53.
Páginas 3088-3099 (Abril 2022)

Tuberculosis extrapulmonar. Formas clínicas en pacientes en situaciones especiales

Extrapulmonary tuberculosis. Clinical forms in patients in special situations

E. Ruíz BlascoE. Segura FernándezJ. Lanseros TenlladoM.T. Fábregas Ruano
Doi : https://10.1016/j.med.2022.03.020
Opciones
Resumen

El término tuberculosis extrapulmonar se usa para describir la afectación por M. tuberculosis de cualquier órgano, sin afectación pulmonar demostrada. En ocasiones se produce afectación simultánea pulmonar y extrapulmonar, en cuyo caso se clasifica como pulmonar. A nivel mundial, supone el 20% del total de casos de tuberculosis. Su incidencia ha aumentado desde los años 80 del siglo pasado a raíz de la infección por el VIH. Las zonas afectadas con más frecuencia son: pleura, ganglios linfáticos, riñón y vías urinarias, huesos y articulaciones, sistema nervioso central (SNC) y abdomen. La clínica dependerá del órgano afectado. Siempre es necesario descartar una infección pulmonar concomitante. Para el diagnóstico hay que demostrar la existencia de la micobacteria en muestras obtenidas por punción o por biopsia mediante tinción, cultivos o técnicas de amplificación de ácidos nucleicos. También puede diagnosticarse al demostrar la existencia de granulomas caseificantes con necrosis caseosa central. El tratamiento en general es el mismo que el de la tuberculosis pulmonar, salvo en la afectación del SNC y osteoarticular, que precisan una prolongación en el tiempo de tratamiento. En la afectación del SNC es preciso además asociar corticoides.

Palabras clave
Tuberculosis extrapulmonar
Clínica
Diagnóstico
Tratamiento
Tuberculosis miliar
Abstract

The term extrapulmonary tuberculosis is used to describe M. tuberculosis infection of any organ without demonstrated pulmonary involvement. On occasion, simultaneous pulmonary and extrapulmonary infection occurs, in which case it is classified as pulmonary tuberculosis. It represents 20% of all tuberculosis cases worldwide. Its incidence has increased since the 1980s as a result of HIV infection. The most frequently affected areas are the pleura, lymph nodes, kidney and urinary tracts, bones and joints, central nervous system (CNS), and abdomen. Symptoms will depend on the organ involved. It is always necessary to rule out concomitant lung infection. In order to diagnose it, the existence of mycobacteria must be demonstrated through staining, cultures, or nucleic acid amplification techniques in samples obtained via puncture or biopsy. It can also be diagnosed by means of caseating granulomas with central caseous necrosis. Treatment is generally the same as that of pulmonary tuberculosis except when there is CNS or bone and joint involvement, which require a longer treatment time. When there is CNS involvement, glucocorticoids must also be administered.

Keywords
Extrapulmonary tuberculosis
Symptoms
Diagnosis
Treatment
Miliary tuberculosis

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