Utilidad del cultivo en el diagnóstico de la tuberculosis pulmonar en un servicio de urgencias
Abstract
Para propósitos del control en la tuberculosis, un caso, es un individuo que disemina bacilos de M.
Tuberculosis, en la mayoría de los países, especialmente en los que están en vías de desarrollo,
la baciloscopia es la principal herramienta para la detección oportuna de esta enfermedad, sin
embargo, esta forma de detección tiene variables que pueden interferir con el resultado. Con la
finalidad de demostrar, que el uso del cultivo en el diagnóstico de la tuberculosis en departamentos
de urgencias proporciona casos adicionales a los que se detectan solamente mediante la utilización
del examen microscópico directo se revisaron 86 muestras de esputo, se les realizó un estudio
microscópico directo o baciloscopia por extensión con coloración de Zhiel–Neelsen; se utilizó el
sistema automatizado de cultivo MB/Bact, previa descontaminación con Hidróxido de Sodio al 4%.
Los cultivos positivos fueron identificados mediante pruebas bioquímicas. Los resultados obtenidos
fueron los siguientes: 55 muestras (63.9%) con baciloscopia negativa y cultivo negativo, 24 (27.9%)
con baciloscopia positiva y cultivo positivo, 7 (8.13%) con baciloscopia negativa y cultivo positivo.
No se encontraron muestras con baciloscopia positiva y cultivo negativo. El promedio en días, en
que los cultivos positivos y baciloscopia positiva (24) fueron detectados por el sistema automatizado
fue de 9.0 días Ic95(7.27,10.79), los cultivos positivos y con baciloscopia negativa (7) se
desarrollaron en promedio a los 13.3 días Ic95 (8.51,18.09). La sensibilidad de la baciloscopia fue
del 77.4% Ic95 (58.4; 89.7), la especificidad del 100% y la eficiencia del 91.8% Ic95(83.4;96.3). El
valor predictivo positivo para la baciloscopia fue de 100%, mientras que el valor predictivo negativo
fue de 88.7% Ic95 (77.5; 94.9). El número de casos de Tuberculosis Pulmonar que se diagnostican
con el uso del cultivo sumado a la baciloscopia es mayor que el número de casos diagnosticados
solamente por baciloscopia (p= 0.0307).
Abstract
For purposes of the control in the tuberculosis, a case, is an individual that disseminates bacilluses
of M. tuberculosis, in most of the countries, especially in those that are developing, the direct
microscopic exam is the main tool for the opportune detection of this illness, however, this detection
form has variables that can interfere with the result. With the purpose of demonstrating that the use
of the cultivation in the diagnosis of the tuberculosis in departments of emergency provides
additional cases to those that are only detected by means of the use of the direct microscopic exam.
86 sputum samples were analysed, they were made by a direct microscopic study; the automated
system of cultivation MB/Bact was used. The positive cultivations were identified by means of
biochemical tests. The obtained results were the following ones: 55 samples (63.9%) with negative
direct microscopic exam and negative cultivation, 24 (27.9%) with positive direct microscopic exam
and positive cultivation, 7 (8.13%) with negative direct microscopic exam and positive cultivation.
They didn't find samples with positive direct microscopic exam and negative cultivation. The average
in days in that the positive cultivations and positive direct microscopic exam (24) were detected by
the automated system was of 9.0 days Ic95 (7.27,10.79), the positive cultivations and with negative
direct microscopic exam (7) were developed on the average of 13.3 days Ic95 (8.51,18.09). The
sensibility of the direct microscopic exam was of 77.4% Ic95 (58.4; 89.7), the specificity of 100%
and the efficiency of 91.8% Ic95 (83.4;96.3). The value positive predictive for the direct microscopic
exam was of 100%, while the value negative predictive was of 88.7% Ic95 (77.5; 94.9). The number
of cases of Lung Tuberculosis that are diagnosed with the use of the cultivation added to the direct
microscopic exam is bigger than the number of cases only diagnosed by direct microscopic exam
(p = 0.0307).
Palabras clave: Tuberculosis, baciloscopia, cultivo, Tuberculosis, direct microscopic exam, cultive
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References
Secretaría de Salud 1999. Programa Nacional de Prevención y Control de la Tuberculosis,
Manual de Procedimientos, México , 1-10 pp
Secretaría de Salud. 1999a. Programa Nacional de Control y Prevención de la Tuberculosis,
Curso Gerencial para Jefes de Laboratorio de Tuberculosis, 25-42 pp
Secretaria de Salud. 1999, op. cit.
Toman, K. 1980. Tuberculosis, Detección de Casos y Quimioterapia. Preguntas y
Respuestas, Publicación Científica Núm.392. OPS. 3-55 pp
Secretaría de Salud. 1999a, op. cit.
Secretaria de Salud. Norma Oficial Mexicana NOM-006-SSA2-1993 para la Prevención y Control
de la Tuberculosis en la Atención Primaria a la Salud. DOF
Secretaria de Salud. 1999, op. cit.
Toman, K., op.cit.
Secretaría de Salud. 1999a, op. cit.
OPS 1988. Manual de Normas y Procedimientos Técnicos para la Bacteriología de
la Tuberculosis, Parte I La Muestra. El Examen Microscópico, OPS Nota Técnica Núm. 26/Rev. I
Toman, K., op.cit.
.OPS. 1988a. Manual de Normas y Procedimientos Técnicos para la Bacteriología de la
Tuberculosis, Parte I. El Cultivo, OPS Nota Técnica Núm. 27/Rev. I
Couchot, K. and R. Talbot. 1996. Direct DNA Probe of MB/Bact Mycobacterial Culture System
Bottles for Mycobacterium avium complex and Mycobacterium tuberculosis complex, Annual
Meeting of the American Society for Microbiology , A Collection of Abstracts and Articles: 55-58 pp
Wanger, A., R. Clarck, J. Bua, A. Eduards, and J. Ho. 1996 Comparasion of MB/Bact and
conventional methods for detection of Mycobacterium species., Annual Meeting of the American
Society for Microbiology , A Collection of Abstracts and Articles:7-11 pp
Lipsky, B.A; J. Gates, F.C. Tenover, and J.J. Piorde.1984. Factors affecting the clinical value of
microscopy for acid-fast bacilli., Rev infect Dis Mar-Apr 6(2):214-22
Secretaría de Salud 1999a, op. cit.
OPS. 1988, op.cit.
OPS. 1988a, op.cit.
OPS. 1988b Manual de Normas y Procedimientos Técnicos para la Bacteriología de la
Tuberculosis, Parte II. La identificación bioquímica y Sensibilidad, OPS Nota Técnica Núm. 27/Rev.I
Collins, C.H., J.M. Grense and M.D. Yates. 1997. Tuberculosis Bacteriology: Organization an
Pratice, Ed. Buttetrworth Heineman, Scond Edition 78-82 pp
OPS. 1996. Tuberculosis Bacteriology Laboratory Services and Incremental Protocols for
Developing Countries, Clinics in Laboratory Medicine, 16(3) 687-715 pp
Anderson, S. And S. Cockayne1995. Química Clínica, Ed. Interamericana. 68:70 pp
Couchot, K. and R. Talbot. 1996, op. cit.
Anderson, S. and S. Cockayne1995., op.cit.
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