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Tuberculose - duas formas de apresentaĆ§Ć£o pouco habituais (casos clinicos)
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Abstract(s)
A OrganizaĆ§Ć£o Mundial de SaĆŗde (OMS) declarou a tuberculose como emergĆŖncia mĆ©dica global em 1993. De facto, nas Ćŗltimas dĆ©cadas, a tuberculose tem vindo a assumir uma relevĆ¢ncia crescente como um problema de saĆŗde pĆŗblica. Os autores apresentam dois casos clĆnicos com formas de apresentaĆ§Ć£o
que nĆ£o sĆ£o as mais usuais. O primeiro, refere-se a uma mulher de 32 anos que recorreu ao serviƧo de urgĆŖncia (SU) do Hospital Central do Funchal (HCF) por diminuiĆ§Ć£o sĆŗbita da acuidade visual Ć esquerda e adenopatia cervical ipislateral. ApĆ³s estudo apropriado, diagnosticou-se edema da papila Ć³ptica e tuberculose
ganglionar cervical, tendo sido medicada com corticoterapia e antibacilares. O segundo, refere-se a uma doente de 41 anos, internada na Unidade de DoenƧas Infecciosas do HCF por me ningite presumivelmente bacteriana. Durante o internamento, registou-se agravamento clĆnico com depressĆ£o do estado de
consciĆŖncia e actividade convulsiva, pelo que se repetiu a punĆ§Ć£o lombar, que permitiu o diagnĆ³stico de tuberculose menĆngea. Iniciou-se entĆ£o terapĆŖutica com tuberculostĆ”ticos. Como inter corrĆŖncias, salientam-se: acidente vascular cerebral isquĆ©mico e infecĆ§Ć£o respiratĆ³ria baixa, com insuficiĆŖncia respiratĆ³ria e
necessidade de suporte ventilatĆ³rio invasivo. ApĆ³s melhoria do quadro respiratĆ³rio, regressou Ć Unidade de DoenƧas Infecciosas, onde veio a falecer. Os autores pretendem chamar a atenĆ§Ć£o para o facto de que
a tuberculose estĆ” a assumir um papel importante actualmente, uma vez que nos inivĆduos āimunocompetentesā hĆ” mais de trĆŖs dĆ©cadas que- nos paĆses āmaisā desenvolvidos- se descrevem
formas de apresentaĆ§Ć£o ditas menos ātĆpicasā.
The World Health Organization declared tuberculosis as a medical global emergency in 1993. In fact, in the past decades it has assumed a crescent importance as a public health problem. The authors report two clinical cases with a typical presentation. The first one refers to a 32 year old woman, with no prior medical history, who went to the Emergency Department because of a sudden reduction of visual acuity at left. A left cervical mass was also detected. After the clinical examination and the adequate study, it was diagnosed left papilledema and lymph node tuber culosis. She was medicated with steroid and antibacillar therapy. The second one refers to a 41 year old woman, who was admitted to the Infectious Diseases Department with the diagnosis of presumable bacterial meningitis. There was a significant clinical worsening. The second examination of the liquor allowed the tuberculous meningitis diagnosis. She started antibacillar therapy. As intercurrences, she had a stroke and a low respiratory tract infection with respiratory insufficiency and need of invasive ven tilator support. After clinical stabilization concerning to respiratory distress, she went back to the Infectious Diseases Department, where she died. The authors pretend to stress out that tuberculosis is assuming an important role nowadays, sometimes with less typical presen tations and in patients with preserved immunity system
The World Health Organization declared tuberculosis as a medical global emergency in 1993. In fact, in the past decades it has assumed a crescent importance as a public health problem. The authors report two clinical cases with a typical presentation. The first one refers to a 32 year old woman, with no prior medical history, who went to the Emergency Department because of a sudden reduction of visual acuity at left. A left cervical mass was also detected. After the clinical examination and the adequate study, it was diagnosed left papilledema and lymph node tuber culosis. She was medicated with steroid and antibacillar therapy. The second one refers to a 41 year old woman, who was admitted to the Infectious Diseases Department with the diagnosis of presumable bacterial meningitis. There was a significant clinical worsening. The second examination of the liquor allowed the tuberculous meningitis diagnosis. She started antibacillar therapy. As intercurrences, she had a stroke and a low respiratory tract infection with respiratory insufficiency and need of invasive ven tilator support. After clinical stabilization concerning to respiratory distress, she went back to the Infectious Diseases Department, where she died. The authors pretend to stress out that tuberculosis is assuming an important role nowadays, sometimes with less typical presen tations and in patients with preserved immunity system
Description
Keywords
tuberculose ganglionar tuberculose menĆngea Madeira Island RegiĆ£o Autonoma da Madeira edema da papila lymph node tuberculosis tuberculous meningitis papilledema
Citation
Medicina Interna, VOL.17 | NĀŗ 2 | ABR/JUN 2010
Publisher
SPMI- Sociedade Pofrtuguesa de Medicina Interna