DIFERENCIAS ENTER LA TUBERCULOSIS PULMONAR CON BACILOSCOPIA POSITIVA Y NEGATIVA

MARCELO FERNANDEZ CASARES, EDUARDO DEL VALLE, GRACIELA PELUFFO, ALFREDO MONTEVERDE

Sección Neumonología. Departamento de Medicina. hospital Posadas, Buenos Aires.

Palabras calve: tuberculosis, baciloscopia positiva, baciloscopia negativa

Resumen

En el análisis de 318 pacientes con tuberculosis (TB) pulmonar activa, tratados entre enero de 1980 y diciembre de 1990, en un Hospital General del Gran Buenos Aires, el grupo (n = 48) con baciloscopía negativa (D-) tuvo diferencias clínicas y radiológicas significativas con respecto al grupo (n = 270) con baciloscopía positivia (D+).
Estas diferencias fueron la mayor edad, la mayor fecuencia de otras enfermedades
pulmonars y de Rx "secuela", con menos antecedentes clínicos y cavidades pulmonares
radioógicas. Dos subgrupos se distinguen en el grupo D-, de acuerdo a la iniciación empírica del tratamiento. Por un lado un subgrupo con característica similars al grupo D+, lo que facilitó la decisión de comenzarlo aún con la bacilocopía negativa (D-TI). El otro subgrupo tuvo características totalmente diferentes al grupo D+, lo que hizo pensar en otros diagnósticos, difiriendo así la decisión del tratamiento hasta la obtención del cultivo (D-TD).

Resumen

Differences between smear positive and negative pulmonary tuberculosis.The decision related to treatment initiation in smear-negative pulmonary TB is controverted. To determine differences between characteristics smear-negative, culture- positive pulmonary TB (Group D-) cases we compared them with those patients who presented positive smear microscopy and cultures (Group D+).
In addition, we compared characteristics found in Group D cases, in whom the treatment was started before confirmation by culture (subgroup D-TI) wih those that were treated only after a positive culture was obtained (subgroup D-TD).
We compared 270 patients of Group D+ with 48 of Group D-. The subgroups of Group D- (D- TI and D-TD) were compared with Group D+.
Clinical symptoms, history, X-rays, other lung diseases and related extrapulmonary diseases were analysed significant diffrences between groups D+ and D- rlated to age, history, X-rays and other lung diseases were found. There were no significant differences between Group D+ and subgroup D-TI, except the age.
The same and even accentuated differences between Group D+ and D- were found between Group D+ and subgroup D-TD. Conclusions: Group D- was divided into to subgroups: *D-TI, similar to D+, it determined the dcision to immediately start the treatment * D-TD, completely different; other posible diagnoses were considered and decision of treatment was delayed until a positive culture was obtaiend.
This conduct proved to be a correct one in these cases where the diagnostic by culture was available.

Recibido: 19-VII-1995  Aceptado: 19-IV-1996

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