Síguenos en:

Síguenos en Twitter Siguenos en Facebook Siguenos en Google+ Siguenos en por RSS

viernes, 14 de diciembre de 2012

Generalidades y actualización en tuberculosis (TB)

Actualización: La Organización Mundial de la Salud (OMS) estima que 2 millones de personas han tenido TB latente y que a nivel mundial, en 2009, la enfermedad mató a 1,7 millones de personas. Los nuevos tratamientos de TB se están desarrollando y  nuevas vacunas de TB se encuentran bajo investigación.


Autor(es): Thomas E Herchline, MD; Chief Editor: Michael Stuart Bronze, MD 

 Resumen




  • La resistencia a múltiples fármacos ha surgido de un mal cumplimiento con las terapias de TB, lo que resulta en dificultades para controlar la enfermedad. En consecuencia, una amenaza de pandemia mundial se produjo a finales de 1980 y principios de 1990. 
  • La Organización Mundial de la Salud elaboró ​​un plan para tratar de identificar el 70% de los casos mundiales de tuberculosis y para tratar completamente al menos el 85% de estos casos en el año 2000. Fuera de estos objetivos han nacido grandes programas de vigilancia de la tuberculosis y el concepto de la terapia de observación directa (DOT), que obliga a un tercero para presenciar el cumplimiento de la farmacoterapia. Con los esfuerzos de todo el mundo, la detección global de casos con baciloscopia positiva pasó de 11% (1991) a 45% (2003), con 71-89% de los casos sometidos a tratamiento completo.
  • La incidencia mundial de la tuberculosis aumenta con la densidad de población y el desarrollo urbano, a fin de que por la Revolución Industrial en Europa (1750), fue responsable de más del 25% de las defunciones de adultos. En efecto, en el siglo 20, TB fue la causa principal de muerte en los Estados Unidos. (Ver Etiología y Epidemiología, a continuación).
                                                                                                                                                                




  •  Artículos relacionados
Traducción y resumen:  Dr. Rafael Perez Garcia vía Emergency & Critical Care  

  •  Referencias bibliográficas 



El actual tema ha sido extraído de publicaciones de organismos y revistas médicas mundiales y nacionales. Se recomienda la visita a sus respectivos portales y/o cuentas correspondientes y seleccionar el tema "Tuberculosis". Cabe resaltar que de acuerdo a su ubicación territorial cada organismo público maneja sus respectivas estadísticas y traza sus diferentes pautas a seguir como medidas preventivas y de erradicacion de la correspondiente enfermedad.


*Se recomiendan las lecturas de los artículos  relacionados a con las instituciones de la foto superior por considerarse de actualización a Enero del 2013 y fortalecer el conocimiento y aporte del mismo de 2012.

  1. Ayieko J, Abuogi L, Simchowitz B, Bukusi EA, Smith AH, Reingold A. Efficacy of isoniazid prophylactic therapy in prevention of tuberculosis in children: a meta-analysis. BMC Infect Dis. Feb 20 2014;14:91.[Medline][Full Text].
  2. [Guideline] Treatment of tuberculosis. MMWR Recomm Rep. Jun 20 2003;52:1-77. [Medline].
  3. Swaminathan S, Narendran G, Venkatesan P, Iliayas S, Santhanakrishnan R, Menon PA, et al. Efficacy of a 6-month versus 9-month intermittent treatment regimen in HIV-infected patients with tuberculosis: a randomized clinical trial. Am J Respir Crit Care Med. Apr 1 2010;181(7):743-51. [Medline].
  4. Centers for Disease Control and Prevention. Managing Drug Interactions in the Treatment of HIV-Related Tuberculosis. CDC. Available at http://www.cdc.gov/tb/TB_HIV_Drugs/default.htm. Accessed 08/20/2008.
  5. [Best Evidence] Abdool Karim SS, Naidoo K, Grobler A, Padayatchi N, Baxter C, Gray A, et al. Timing of initiation of antiretroviral drugs during tuberculosis therapy. N Engl J Med. Feb 25 2010;362(8):697-706.[Medline][Full Text].
  6. Török ME, Farrar JJ. When to start antiretroviral therapy in HIV-associated tuberculosis. N Engl J Med. Oct 20 2011;365(16):1538-40. [Medline].
  7. Targeted tuberculin testing and treatment of latent tuberculosis infection. American Thoracic Society.MMWR Recomm Rep. Jun 9 2000;49:1-51. [Medline].
  8. CDC. Recommendations for use of an isoniazid-rifapentine regimen with direct observation to treat latent Mycobacterium tuberculosis infection. MMWR. 2011;60:1650-1653.
  9. Extensively Drug-Resistant Tuberculosis (XDR TB). Centers for Disease Control and Prevention. Available at http://www.cdc.gov/tb/publications/factsheets/drtb/xdrtb.htm. Accessed November 7, 2012.
  10. Asensio JA, Arbués A, Pérez E, Gicquel B, Martin C. Live tuberculosis vaccines based on phoP mutants: a step towards clinical trials. Expert Opin Biol Ther. Feb 2008;8(2):201-11. [Medline].
  11. Wells CD, Cegielski JP, Nelson LJ, Laserson KF, Holtz TH, Finlay A, et al. HIV infection and multidrug-resistant tuberculosis: the perfect storm. J Infect Dis. Aug 15 2007;196 Suppl 1:S86-107. [Medline].
  12. [Best Evidence] Burman WJ, Goldberg S, Johnson JL, Muzanye G, Engle M, Mosher AW, et al. Moxifloxacin versus ethambutol in the first 2 months of treatment for pulmonary tuberculosis. Am J Respir Crit Care Med. Aug 1 2006;174(3):331-8. [Medline].
  13. WHO. Fact Sheet 104. World Health Organization. Available athttp://www.who.int/mediacentre/factsheets/fs104/en/index.html. Accessed October 13, 2010.
  14. CDC. Plan to combat extensively drug-resistant tuberculosis: recommendations of the Federal Tuberculosis Task Force. MMWR Recomm Rep. Feb 13 2009;58:1-43. [Medline].
  15. Drug-resistant tuberculosis. World Health Organization. Available athttp://www.who.int/tb/challenges/mdr/tdrfaqs/en/index.html. Accessed November 26, 2012.
  16. Mlambo CK, Warren RM, Poswa X, Victor TC, Duse AG, Marais E. Genotypic diversity of extensively drug-resistant tuberculosis (XDR-TB) in South Africa. Int J Tuberc Lung Dis. Jan 2008;12(1):99-104.[Medline].
  17. World Health Organization. Antituberculosis drug resistance in the world. The WHO/IUATLD global project on anti-tuberculosis drug resistance surveillance WHO. Geneva. 2008;1-120. [Full Text].
  18. CDC. Trends in Tuberculosis – United States, 2011. Available athttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm6111a2.htm?s_cid=mm6111a2_w.
  19. Sokolove PE, Lee BS, Krawczyk JA, Banos PT, Gregson AL, Boyce DM, et al. Implementation of an emergency department triage procedure for the detection and isolation of patients with active pulmonary tuberculosis. Ann Emerg Med. Apr 2000;35(4):327-36. [Medline].
  20. Moran GJ, McCabe F, Morgan MT, Talan DA. Delayed recognition and infection control for tuberculosis patients in the emergency department. Ann Emerg Med. Sep 1995;26(3):290-5. [Medline].
  21. Menzies D, Joshi R, Pai M. Risk of tuberculosis infection and disease associated with work in health care settings. Int J Tuberc Lung Dis. Jun 2007;11(6):593-605. [Medline].
  22. Verhagen LM, van den Hof S, van Deutekom H, Hermans PW, Kremer K, Borgdorff MW, et al. Mycobacterial factors relevant for transmission of tuberculosis. J Infect Dis. May 2011;203(9):1249-55.[Medline].
  23. Leung CC, Lam TH, Chan WM, Yew WW, Ho KS, Leung G, et al. Lower risk of tuberculosis in obesity.Arch Intern Med. Jun 25 2007;167(12):1297-304. [Medline].
  24. Slama K, Chiang CY, Enarson DA, Hassmiller K, Fanning A, Gupta P, et al. Tobacco and tuberculosis: a qualitative systematic review and meta-analysis. Int J Tuberc Lung Dis. Oct 2007;11(10):1049-61.[Medline].
  25. Keane J, Gershon S, Wise RP, Mirabile-Levens E, Kasznica J, Schwieterman WD, et al. Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent. N Engl J Med. Oct 11 2001;345(15):1098-104. [Medline].
  26. Brassard P, Suissa S, Kezouh A, Ernst P. Inhaled Corticosteroids and Risk of Tuberculosis in Patients with Respiratory Diseases. Am J Respir Crit Care Med. Oct 1 2010;[Medline].
  27. Bellamy R, Ruwende C, Corrah T, McAdam KP, Whittle HC, Hill AV. Variations in the NRAMP1 gene and susceptibility to tuberculosis in West Africans. N Engl J Med. Mar 5 1998;338(10):640-4. [Medline].
  28. Cervino AC, Lakiss S, Sow O, Hill AV. Allelic association between the NRAMP1 gene and susceptibility to tuberculosis in Guinea-Conakry. Ann Hum Genet. Nov 2000;64:507-12. [Medline].
  29. Searle S, Blackwell JM. Evidence for a functional repeat polymorphism in the promoter of the human NRAMP1 gene that correlates with autoimmune versus infectious disease susceptibility. J Med Genet. Apr 1999;36(4):295-9. [Medline][Full Text].
  30. Tosh K, Campbell SJ, Fielding K, Sillah J, Bah B, Gustafson P, et al. Variants in the SP110 gene are associated with genetic susceptibility to tuberculosis in West Africa. Proc Natl Acad Sci U S A. Jul 5 2006;103(27):10364-8. [Medline][Full Text].
  31. Khor CC, Vannberg FO, Chapman SJ, Guo H, Wong SH, Walley AJ, et al. CISH and susceptibility to infectious diseases. N Engl J Med. Jun 3 2010;362(22):2092-101. [Medline].
  32. Intemann CD, Thye T, Niemann S, Browne EN, et al. Autophagy gene variant IRGM -261T contributes to protection from tuberculosis caused by Mycobacterium tuberculosis but not by M. africanum strains. PLoS Pathog. Sep 2009;5(9):e1000577. [Medline][Full Text].
  33. Rossouw M, Nel HJ, Cooke GS, van Helden PD, Hoal EG. Association between tuberculosis and a polymorphic NFkappaB binding site in the interferon gamma gene. Lancet. May 31 2003;361(9372):1871-2.[Medline].
  34. Levin M, Newport MJ, D'Souza S, Kalabalikis P, Brown IN, Lenicker HM, et al. Familial disseminated atypical mycobacterial infection in childhood: a human mycobacterial susceptibility gene?. Lancet. Jan 14 1995;345(8942):79-83. [Medline].
  35. Newport MJ, Huxley CM, Huston S, Hawrylowicz CM, Oostra BA, Williamson R, et al. A mutation in the interferon-gamma-receptor gene and susceptibility to mycobacterial infection. N Engl J Med. Dec 26 1996;335(26):1941-9. [Medline].
  36. Khor CC, Chapman SJ, Vannberg FO, Dunne A, Murphy C, Ling EY, et al. A Mal functional variant is associated with protection against invasive pneumococcal disease, bacteremia, malaria and tuberculosis.Nat Genet. Apr 2007;39(4):523-8. [Medline][Full Text].
  37. Barreiro LB, Neyrolles O, Babb CL, Tailleux L, Quach H, McElreavey K, et al. Promoter variation in the DC-SIGN-encoding gene CD209 is associated with tuberculosis. PLoS Med. Feb 2006;3(2):e20. [Medline].[Full Text].
  38. CDC. Tuberculosis (TB). Data and Statistics. Available at http://www.cdc.gov/tb/statistics/default.htm. Accessed June 7, 2012.
  39. WHO. Global tuberulosis control 2008: surveillance, planning, financing. World Health Organization. Available at http://www.who.int/topics/tuberculosis/en/. Accessed October 13, 2010.
  40. Cox HS, Morrow M, Deutschmann PW. Long term efficacy of DOTS regimens for tuberculosis: systematic review. BMJ. Mar 1 2008;336(7642):484-7. [Medline][Full Text].
  41. Jasmer RM, Bozeman L, Schwartzman K, Cave MD, Saukkonen JJ, Metchock B, et al. Recurrent tuberculosis in the United States and Canada: relapse or reinfection?. Am J Respir Crit Care Med. Dec 15 2004;170(12):1360-6. [Medline].
  42. van Rie A, Warren R, Richardson M, Victor TC, Gie RP, Enarson DA, et al. Exogenous reinfection as a cause of recurrent tuberculosis after curative treatment. N Engl J Med. Oct 14 1999;341(16):1174-9.[Medline].
  43. Waitt CJ, Peter K Banda N, White SA, Kampmann B, Kumwenda J, Heyderman RS, et al. Early deaths during tuberculosis treatment are associated with depressed innate responses, bacterial infection, and tuberculosis progression. J Infect Dis. Aug 2011;204(3):358-62. [Medline][Full Text].
  44. Mazurek GH, Jereb J, Lobue P, Iademarco MF, Metchock B, Vernon A. Guidelines for using the QuantiFERON-TB Gold test for detecting Mycobacterium tuberculosis infection, United States. MMWR Recomm Rep. Dec 16 2005;54:49-55. [Medline].
  45. Ang M, Htoon HM, Chee SP. Diagnosis of tuberculous uveitis: clinical application of an interferon-gamma release assay. Ophthalmology. Jul 2009;116(7):1391-6. [Medline].
  46. Schuurmans MM, Ellmann A, Bouma H, Diacon AH, Dyckmans K, Bolliger CT. Solitary pulmonary nodule evaluation with 99mTc-methoxy isobutyl isonitrile in a tuberculosis-endemic area. Eur Respir J. Dec 2007;30(6):1090-5. [Medline].
  47. Sonnenberg P, Glynn JR, Fielding K, Murray J, Godfrey-Faussett P, Shearer S. How soon after infection with HIV does the risk of tuberculosis start to increase? A retrospective cohort study in South African gold miners. J Infect Dis. Jan 15 2005;191(2):150-8. [Medline].
  48. Muga R, Ferreros I, Langohr K, de Olalla PG, Del Romero J, Quintana M, et al. Changes in the incidence of tuberculosis in a cohort of HIV-seroconverters before and after the introduction of HAART. AIDS. Nov 30 2007;21(18):2521-7. [Medline].
  49. Sterling TR, Lau B, Zhang J, Freeman A, Bosch RJ, Brooks JT, et al. Risk Factors for Tuberculosis After Highly Active Antiretroviral Therapy Initiation in the United States and Canada: Implications for Tuberculosis Screening. J Infect Dis. Sep 2011;204(6):893-901. [Medline][Full Text].
  50. Bassett IV, Wang B, Chetty S, Giddy J, Losina E, Mazibuko M, et al. Intensive tuberculosis screening for HIV-infected patients starting antiretroviral therapy in Durban, South Africa. Clin Infect Dis. Oct 1 2010;51(7):823-9. [Medline].
  51. [Guideline] Jensen PA, Lambert LA, Iademarco MF, Ridzon R. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR Recomm Rep. Dec 30 2005;54:1-141. [Medline].
  52. Brown M, Varia H, Bassett P, Davidson RN, Wall R, Pasvol G. Prospective study of sputum induction, gastric washing, and bronchoalveolar lavage for the diagnosis of pulmonary tuberculosis in patients who are unable to expectorate. Clin Infect Dis. Jun 1 2007;44(11):1415-20. [Medline].
  53. [Best Evidence] Jafari C, Thijsen S, Sotgiu G, Goletti D, Domínguez Benítez JA, Losi M, et al. Bronchoalveolar lavage enzyme-linked immunospot for a rapid diagnosis of tuberculosis: a Tuberculosis Network European Trialsgroup study. Am J Respir Crit Care Med. Oct 1 2009;180(7):666-73. [Medline].[Full Text].
  54. Tan SH, Tan BH, Goh CL, Tan KC, Tan MF, Ng WC, et al. Detection of Mycobacterium tuberculosis DNA using polymerase chain reaction in cutaneous tuberculosis and tuberculids. Int J Dermatol. Feb 1999;38(2):122-7. [Medline].
  55. Vieites B, Suárez-Peñaranda JM, Pérez Del Molino ML, Vázquez-Veiga H, Pardo F, Del Rio E, et al. Recovery of Mycobacterium tuberculosis DNA in biopsies of erythema induratum--results in a series of patients using an improved polymerase chain reaction technique. Br J Dermatol. Jun 2005;152(6):1394-6.[Medline].
  56. [Guideline] Updated guidelines for the use of nucleic acid amplification tests in the diagnosis of tuberculosis. MMWR Morb Mortal Wkly Rep. Jan 16 2009;58(1):7-10. [Medline].
  57. Reuters Health Information. Direct nucleic acid amplification testing improves TB diagnosis. Medscape Medical News [serial online]. June 6, 2013;Accessed June 17, 2013. Available athttp://www.medscape.com/viewarticle/805413.
  58. Marks SM, Cronin W, Venkatappa T, Maltas G, Chon S, Sharnprapai S, et al. The Health-System Benefits and Cost-effectiveness of Using Mycobacterium Tuberculosis Direct Nucleic Acid Amplification Testing to Diagnose Tuberculosis Disease in the United States. Clin Infect Dis. May 22 2013;[Medline].
  59. Badak FZ, Kiska DL, Setterquist S, Hartley C, O'Connell MA, Hopfer RL. Comparison of mycobacteria growth indicator tube with BACTEC 460 for detection and recovery of mycobacteria from clinical specimens. J Clin Microbiol. Sep 1996;34(9):2236-9. [Medline][Full Text].
  60. [Best Evidence] Choi JH, Lee KW, Kang HR, Hwang YI, Jang S, Kim DG, et al. Clinical efficacy of direct DNA sequencing analysis on sputum specimens for early detection of drug-resistant Mycobacterium tuberculosis in a clinical setting. Chest. Feb 2010;137(2):393-400. [Medline].
  61. Boehme CC, Nabeta P, Hillemann D, Nicol MP, Shenai S, Krapp F, et al. Rapid molecular detection of tuberculosis and rifampin resistance. N Engl J Med. Sep 9 2010;363(11):1005-15. [Medline][Full Text].
  62. Boehme CC, Nicol MP, Nabeta P, et al. Feasibility, diagnostic accuracy, and effectiveness of decentralised use of the Xpert MTB/RIF test for diagnosis of tuberculosis and multidrug resistance: a multicentre implementation study. Lancet. Apr 30 2011;377(9776):1495-505. [Medline].
  63. Minion J, Leung E, Menzies D, Pai M. Microscopic-observation drug susceptibility and thin layer agar assays for the detection of drug resistant tuberculosis: a systematic review and meta-analysis. Lancet Infect Dis. Oct 2010;10(10):688-98. [Medline].
  64. CDC. Classification of Tuberculin Skin Reactions. Available athttp://www.cdc.gov/tb/publications/LTBI/diagnosis.htm#3. Accessed June 11, 2012.
  65. [Guideline] Mazurek GH, Jereb J, Vernon A, LoBue P, Goldberg S, Castro K. Updated guidelines for using Interferon Gamma Release Assays to detect Mycobacterium tuberculosis infection - United States, 2010.MMWR Recomm Rep. Jun 25 2010;59:1-25. [Medline].
  66. Manuel O, Humar A, Preiksaitis J, Doucette K, Shokoples S, Peleg AY, et al. Comparison of quantiferon-TB gold with tuberculin skin test for detecting latent tuberculosis infection prior to liver transplantation. Am J Transplant. Dec 2007;7(12):2797-801. [Medline].
  67. Mazurek GH, Weis SE, Moonan PK, Daley CL, Bernardo J, Lardizabal AA, et al. Prospective comparison of the tuberculin skin test and 2 whole-blood interferon-gamma release assays in persons with suspected tuberculosis. Clin Infect Dis. Oct 1 2007;45(7):837-45. [Medline].
  68. Chang KC, Leung CC. Systematic review of interferon-gamma release assays in tuberculosis: focus on likelihood ratios. Thorax. Mar 2010;65(3):271-6. [Medline].
  69. Leung CC, Yam WC, Yew WW, Ho PL, Tam CM, Law WS, et al. T-Spot.TB outperforms tuberculin skin test in predicting tuberculosis disease. Am J Respir Crit Care Med. Sep 15 2010;182(6):834-40. [Medline].
  70. Diel R, Loddenkemper R, Niemann S, Meywald-Walter K, Nienhaus A. Negative and positive predictive value of a whole-blood interferon-? release assay for developing active tuberculosis: an update. Am J Respir Crit Care Med. Jan 1 2011;183(1):88-95. [Medline].
  71. Kim SH, Lee SO, Park JB, Park IA, Park SJ, Yun SC, et al. A prospective longitudinal study evaluating the usefulness of a T-cell-based assay for latent tuberculosis infection in kidney transplant recipients. Am J Transplant. Sep 2011;11(9):1927-35. [Medline].
  72. [Best Evidence] Lin HC, Lin HC, Chen SF. Increased risk of low birthweight and small for gestational age infants among women with tuberculosis. BJOG. Apr 2010;117(5):585-90. [Medline].
  73. Sirturo (bedaquiline) prescribing information [package insert]. Titusville, NJ: Janssen Therapeutics, Division of Johnson & Johnson; December, 2012. [Full Text].
  74. Tucker ME. FDA approves bedaquiline for resistant TB treatment. Medscape Medical News. Dec 31, 2012. Available at http://www.medscape.com/viewarticle/776901. Accessed January 8, 2013.
  75. [Best Evidence] Diacon AH, Pym A, Grobusch M, Patientia R, Rustomjee R, Page-Shipp L, et al. The diarylquinoline TMC207 for multidrug-resistant tuberculosis. N Engl J Med. Jun 4 2009;360(23):2397-405.[Medline].
  76. Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. Provisional CDC Guidelines for the Use and Safety Monitoring of Bedaquiline Fumarate (Sirturo) for the Treatment of Multidrug-Resistant Tuberculosis. MMWR Recomm Rep. Oct 25 2013;62:1-12. [Medline].
  77. Barclay L. MDR TB: CDC Issues Guidelines for Use of New Drug. Medscape [serial online]. Available at http://www.medscape.com/viewarticle/813151. Accessed October 28, 2013.
  78. Kurbatova EV, Cavanaugh JS, Dalton T, Click E, Cegielski JP. Epidemiology of pyrazinamide-resistant tuberculosis in the United States, 1999-2009. Clin Infect Dis. Jul 9 2013;[Medline].
  79. Boggs W. Increasing Prevalence of Pyrazinamide-Resistant Tuberculosis. Medscape [serial online]. Available at http://www.medscape.com/viewarticle/808192. Accessed July 29, 2013.
  80. Sterling TR, Villarino ME, Borisov AS, Shang N, Gordin F, Bliven-Sizemore E, et al. Three months of rifapentine and isoniazid for latent tuberculosis infection. N Engl J Med[Medline].
  81. Becerra MC, Appleton SC, Franke MF, Chalco K, Arteaga F, Bayona J, et al. Tuberculosis burden in households of patients with multidrug-resistant and extensively drug-resistant tuberculosis: a retrospective cohort study. Lancet. Jan 8 2011;377(9760):147-52. [Medline].
  82. Weir RE, Gorak-Stolinska P, Floyd S, Lalor MK, Stenson S, Branson K, et al. Persistence of the immune response induced by BCG vaccination. BMC Infect Dis. Jan 25 2008;8:9. [Medline][Full Text].