Transmisión materno-fetal del bacilo de Koch en una paciente inmunocompetente admitida en una unidad de terapia intensiva con diagnóstico de shock séptico
Primer caso demostrado en Uruguay
Palabras clave:
TUBERCULOSIS, TRANSMISIÓN VERTICAL DE ENFERMEDAD INFECCIOSA
Resumen
La tuberculosis es una patología cuya incidencia mundial se ha incrementado sensiblemente en los últimos años. El cuadro clínico de sepsis severa y shock séptico puede ser desencadenado por cualquier microorganismo. Sin embargo, algunos de ellos, como el complejo Micobacterium tuberculosum, solo excepcionalmente lo provocan, por lo cual su diagnóstico constituye un verdadero desafío para el equipo sanitario. Se presenta un caso clínico de una mujer de 23 años de edad, inmunocompetente, que cursando una gestación de 28 semanas ingresó a la unidad de terapia intensiva por un cuadro de insuficiencia respiratoria. Se realizo diagnóstico de shock séptico respiratorio bacteriémico debido a complejo Micobacterium tuberculosum y se confirmó la transmisión materno-fetal del microorganismo. La enferma falleció a las 48 horas de la admisión con hipoxemia extrema y shock refractario.
Citas
(1) World Health Organization. WHO report 2011: global tuberculosis control. Disponible en: http://www.who.int/tb/publications/global_report/2011/gtbr11_full.pdf. Consulta: 30 octubre 2011.
(2) Coitinho C, San Martín R, Mier C, Rodríguez R, Zunino Torres S, Rivas C. Utilidad de la dosificación de adenosin deaminasa en el diagnóstico de la tuberculosis pleural. Primera experiencia nacional. Rev Méd Urug 2007; 23(1): 19-24.
(3) Comisión Honoraria para la Lucha Antituberculosa y Enfermedades Prevalentes. Disponible en: http://www.chlaep.org.uy/index.php. Consulta: 31 enero 2011.
(4) Purtscher H, Mansilla M, Dutra A, Braselli A. Tuberculosis e infección VIH en Uruguay. Rev Méd Urug 1995; 2(1): 37-45.
(5) American Thoracic Society. Centers for Disease Control and Prevention. Targeted tuberculin testing and treatment of latent tuberculosis infection. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. This is a Joint Statement of the American Thoracic Society (ATS) and the Centers for Disease Control and Prevention (CDC). This statement was endorsed by the Council of the Infectious Diseases Society of America. (IDSA), September 1999, and the sections of this statement. Am J Respir Crit Care Med 2000; 161(4 Pt 2): S221-47.
(6) Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008; 36(1): 296-327.
(7) Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44(Suppl 2): S27-72.
(8) Martin G, Brunkhorst F, Janes J, Reinhart K, Sundin D, Garnett K, et al. The international PROGRESS registry of patients with severe sepsis: drotrecogin alfa (activated) use and patient outcomes. Critical Care 2009; 13(3): R103.
(9) Bunin KV. First description of acute tuberculous sepsis; historical survey. Probl Tuberk 1954; 3: 73-4.
(10) Erbes R, Oettel K, Raffenberg M, Mauch H, Schmidt-Ioanas M, Lode H. Characteristics and outcome of patients with active pulmonary tuberculosis requiring intensive care. Eur Respir J 2006; 27(6): 1223-8.
(11) Raoof S, Mehrishi S, Prakash UB. Role of bronchoscopy in modern medical intensive care unit. Clin Chest Med 2001; 22(2): 241-61.
(12) Pereira WJr, Kovnat DM, Snider GL. A prospective cooperative study of complications following flexible fiberoptic bronchoscopy. Chest 1978; 73(6): 813-6.
(13) Prakash UB, Offord KP, Stubbs SE. Bronchoscopy in North America: The ACCP survey. Chest 1991; 100(6): 1668-75.
(14) Albertini R, Harrel JH, Moser KM. Hypoxemia during fiberoptic bronchoscopy. Chest 1974; 65(1): 117-22.
(15) Matsushima Y, Jones RL, King EG, Moysa G, Alton JD. Alterations in pulmonary mechanics and gas exchange during routine fiberoptic bronchoscopy. Chest 1984; 86(2): 184-8.
(16) Pirozynski M, Sliwinski P, Radwan L, Zielinski J. Bronchoalveolar lavage: comparison of three commonly used procedures. Respiration 1991; 58(2): 72-6.
(17) Cardinal-Fernández P, Rieppi G, Bengochea M. Medicina genómica aplicada a la neumonía aguda comunitaria. Rev Méd Urug 2011; 27(1): 42-9.
(18) Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, et al. The American/European Consensus Conference on ARDS: definitions, mechanisms, relevant outcomes and clinical trial coordination. Am J Respir Crit Care Med 1994; 49(3 Pt 1): 818-24.
(19) Hassan G, Qureshi W, Kadri SM. Congenital Tuberculosis. JK Science 2006; 8(4): 193-4.
(20) Uruguay. Ministerio de Salud Pública. Diagnóstico precoz y oportuno de Tuberculosis. Disponible en: http://www.msp.gub.uy/ucepidemiologia_4802_1.html Consulta: 5 de abril de 2011.
(21) Rivas C. - Comunicación personal - Jefe del Laboratorio de Bacteriología - CHLA - 1/4/2011
(22) Cabrera S, Medina JC, Salaberryborda AM, Librán MJ, González HM, Savio E. Dificultad en el diagnóstico de tuberculosis en pacientes infectados por el virus de inmunodeficiencia humana (VIH). Rev Méd Urug 2007; 23(3): 164-72.
(23) Cardinal-Fernández P, Nin N, Lorente JA. Genómica de la lesión pulmonar aguda y el síndrome de distres. Med Intensiva 2011; 35(6): 361-72.
(24) Fernando SL, Saunders BM, Sluyter R, Skarratt KK, Goldberg H, Marks GB, et al. A polymorphism in the P2X7 gene increases susceptibility to extrapulmonary tuberculosis. Am J Respir Crit Care Med 2007; 175(4): 360-6.
(25) Sharma S, Kumar V, Khosla R, Kajal N, Sarin B, Sehajpal P. Association of P2X7 receptor +1513 (A->C) polymorphism with tuberculosis in a Punjabi population. Int J Tuberc Lung Dis 2010; 14(9): 1159-63.
(26) Khor CC, Chapman SJ, Vannberg FO, Dunne A, Murphy C, Ling EY, et al. Mal functional variant is associated with protection against invasive pneumococcal disease, bacteremia, malaria and tuberculosis. Nat Genet 2007; 39(4): 523-8.
(27) Cardinal-Fernández PA, Olano E, Acosta C, Bertullo H, Albornoz H, Bagnulo H. Prognostic value of lactate clearance in the first 6 hours of intensive medicine course. Med Intensiva 2009; 33(4): 166-70.
(28) Polzin A, Pletz M, Erbes R, Raffenberg M, Mauch H, Wagner S, et al. Procalcitonin as a diagnostic tool in lower respiratory tract infections and tuberculosis. Eur Respir J 2003; 21(6): 939-43.
(29) Lawn SD, Obeng J, Acheampong JW, Griffin GE. Serum procalcitonin concentrations in patients with pulmonary tuberculosis. Trans R Soc Trop Med Hyg 1998; 92(5): 540-1.
(30) Schleicher GK, Herbert V, Brink A, Martin S, Maraj R, Galpin JS, et al. Procalcitonin and Creactive protein levels in HIV-positive subjects with tuberculosis and pneumonia. Eur Respir J 2005; 25(4): 688-92.
(31) Kang YA, Kwon SY, Yoon HI, Lee JH, Lee CT. Role of C-reactive protein and procalcitonin in differentiation of tuberculosis from bacterial community acquired pneumonia. Korean J Intern Med 2009; 24(4): 337-42.
(2) Coitinho C, San Martín R, Mier C, Rodríguez R, Zunino Torres S, Rivas C. Utilidad de la dosificación de adenosin deaminasa en el diagnóstico de la tuberculosis pleural. Primera experiencia nacional. Rev Méd Urug 2007; 23(1): 19-24.
(3) Comisión Honoraria para la Lucha Antituberculosa y Enfermedades Prevalentes. Disponible en: http://www.chlaep.org.uy/index.php. Consulta: 31 enero 2011.
(4) Purtscher H, Mansilla M, Dutra A, Braselli A. Tuberculosis e infección VIH en Uruguay. Rev Méd Urug 1995; 2(1): 37-45.
(5) American Thoracic Society. Centers for Disease Control and Prevention. Targeted tuberculin testing and treatment of latent tuberculosis infection. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. This is a Joint Statement of the American Thoracic Society (ATS) and the Centers for Disease Control and Prevention (CDC). This statement was endorsed by the Council of the Infectious Diseases Society of America. (IDSA), September 1999, and the sections of this statement. Am J Respir Crit Care Med 2000; 161(4 Pt 2): S221-47.
(6) Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008; 36(1): 296-327.
(7) Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44(Suppl 2): S27-72.
(8) Martin G, Brunkhorst F, Janes J, Reinhart K, Sundin D, Garnett K, et al. The international PROGRESS registry of patients with severe sepsis: drotrecogin alfa (activated) use and patient outcomes. Critical Care 2009; 13(3): R103.
(9) Bunin KV. First description of acute tuberculous sepsis; historical survey. Probl Tuberk 1954; 3: 73-4.
(10) Erbes R, Oettel K, Raffenberg M, Mauch H, Schmidt-Ioanas M, Lode H. Characteristics and outcome of patients with active pulmonary tuberculosis requiring intensive care. Eur Respir J 2006; 27(6): 1223-8.
(11) Raoof S, Mehrishi S, Prakash UB. Role of bronchoscopy in modern medical intensive care unit. Clin Chest Med 2001; 22(2): 241-61.
(12) Pereira WJr, Kovnat DM, Snider GL. A prospective cooperative study of complications following flexible fiberoptic bronchoscopy. Chest 1978; 73(6): 813-6.
(13) Prakash UB, Offord KP, Stubbs SE. Bronchoscopy in North America: The ACCP survey. Chest 1991; 100(6): 1668-75.
(14) Albertini R, Harrel JH, Moser KM. Hypoxemia during fiberoptic bronchoscopy. Chest 1974; 65(1): 117-22.
(15) Matsushima Y, Jones RL, King EG, Moysa G, Alton JD. Alterations in pulmonary mechanics and gas exchange during routine fiberoptic bronchoscopy. Chest 1984; 86(2): 184-8.
(16) Pirozynski M, Sliwinski P, Radwan L, Zielinski J. Bronchoalveolar lavage: comparison of three commonly used procedures. Respiration 1991; 58(2): 72-6.
(17) Cardinal-Fernández P, Rieppi G, Bengochea M. Medicina genómica aplicada a la neumonía aguda comunitaria. Rev Méd Urug 2011; 27(1): 42-9.
(18) Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, et al. The American/European Consensus Conference on ARDS: definitions, mechanisms, relevant outcomes and clinical trial coordination. Am J Respir Crit Care Med 1994; 49(3 Pt 1): 818-24.
(19) Hassan G, Qureshi W, Kadri SM. Congenital Tuberculosis. JK Science 2006; 8(4): 193-4.
(20) Uruguay. Ministerio de Salud Pública. Diagnóstico precoz y oportuno de Tuberculosis. Disponible en: http://www.msp.gub.uy/ucepidemiologia_4802_1.html Consulta: 5 de abril de 2011.
(21) Rivas C. - Comunicación personal - Jefe del Laboratorio de Bacteriología - CHLA - 1/4/2011
(22) Cabrera S, Medina JC, Salaberryborda AM, Librán MJ, González HM, Savio E. Dificultad en el diagnóstico de tuberculosis en pacientes infectados por el virus de inmunodeficiencia humana (VIH). Rev Méd Urug 2007; 23(3): 164-72.
(23) Cardinal-Fernández P, Nin N, Lorente JA. Genómica de la lesión pulmonar aguda y el síndrome de distres. Med Intensiva 2011; 35(6): 361-72.
(24) Fernando SL, Saunders BM, Sluyter R, Skarratt KK, Goldberg H, Marks GB, et al. A polymorphism in the P2X7 gene increases susceptibility to extrapulmonary tuberculosis. Am J Respir Crit Care Med 2007; 175(4): 360-6.
(25) Sharma S, Kumar V, Khosla R, Kajal N, Sarin B, Sehajpal P. Association of P2X7 receptor +1513 (A->C) polymorphism with tuberculosis in a Punjabi population. Int J Tuberc Lung Dis 2010; 14(9): 1159-63.
(26) Khor CC, Chapman SJ, Vannberg FO, Dunne A, Murphy C, Ling EY, et al. Mal functional variant is associated with protection against invasive pneumococcal disease, bacteremia, malaria and tuberculosis. Nat Genet 2007; 39(4): 523-8.
(27) Cardinal-Fernández PA, Olano E, Acosta C, Bertullo H, Albornoz H, Bagnulo H. Prognostic value of lactate clearance in the first 6 hours of intensive medicine course. Med Intensiva 2009; 33(4): 166-70.
(28) Polzin A, Pletz M, Erbes R, Raffenberg M, Mauch H, Wagner S, et al. Procalcitonin as a diagnostic tool in lower respiratory tract infections and tuberculosis. Eur Respir J 2003; 21(6): 939-43.
(29) Lawn SD, Obeng J, Acheampong JW, Griffin GE. Serum procalcitonin concentrations in patients with pulmonary tuberculosis. Trans R Soc Trop Med Hyg 1998; 92(5): 540-1.
(30) Schleicher GK, Herbert V, Brink A, Martin S, Maraj R, Galpin JS, et al. Procalcitonin and Creactive protein levels in HIV-positive subjects with tuberculosis and pneumonia. Eur Respir J 2005; 25(4): 688-92.
(31) Kang YA, Kwon SY, Yoon HI, Lee JH, Lee CT. Role of C-reactive protein and procalcitonin in differentiation of tuberculosis from bacterial community acquired pneumonia. Korean J Intern Med 2009; 24(4): 337-42.
Publicado
2012-07-31
Cómo citar
1.
Cardinal-Fernández P, Galiana A, Lassere P, Larrañaga E, Porteiro G, Montes De Oca O. Transmisión materno-fetal del bacilo de Koch en una paciente inmunocompetente admitida en una unidad de terapia intensiva con diagnóstico de shock séptico. Rev. Méd. Urug. [Internet]. 31 de julio de 2012 [citado 25 de noviembre de 2024];28(2):142-7. Disponible en: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/353
Sección
Casos Clínicos
