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Aunque se conoce desde hace muchos siglos, la tuberculosis continúa siendo un motivo de preocupación. Cada año se diagnostican 10 millones de nuevos casos en todo el mundo.

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Realizado el 27 | 06 | 2007

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Fuentes: 'Infecciones en atención primaria, manual clínico'; 'Manual Merck'; www.monografias.com | Información: María Sainz y Raquel Barba | Gráfico: Gracia Pablos

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Se pueden observar secuelas de tuberculosis en momias egipcias, evidencia de que la enfermedad existía ya en la Antigüedad, aunque su primera cita bibliográfica pertenece al Antiguo Testamento.

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EVOLUCIÓN INDUSTRIAL

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Un 30% de las muertes ocurridas en Europa durante la Revolución Industrial se debió a la tuberculosis, en gran parte por culpa del hacinamiento que se produjo en las ciudades.

En 1882 Robert Koch consigue identificar el bacilo tuberculoso. Gracias a los avances en el conocimiento de la enfermedad se empieza a aislar a los enfermos para prevenir el contagio y ayudar a la curación.

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EGUNDA GUERRA MUNDIAL

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Los avances en el estudio de la tuberculosis muestran la eficacia de dos medicamentos: la estreptomicina primero y la isoniacida  después. La tuberculosis se convierte en una enfermedad curable en la mayoría de los casos.

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ÉCADA DE LOS 80

 w 66

Los distintos fármacos creados entre la década de los 50 y los 70 parecían haber vencido la infección pero no fue así. En los 80 resurgió la tuberculosis principalmente por la irrupción del sida, el exceso de población y las malas condiciones sanitarias.

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a tuberculosis es una enfermedad

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ligada a la historia de la humanidad.

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Pulse sobre cada período

histórico para saber más

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Información: María Sainz y Raquel Barba | Gráfico: Gracia Pablos | e-mail

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Aaaaat...

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F~'x7 $WVc,`X_zjrGwJfmwW[(ҭ&PNԂwiWaO4~ JfX16ˎ|s>عԓ%_%H%3ϖ +VMkZ#'xɒ/>P2AuOhbJU 7Q*N6Ьk:,dP諊~FIc!%i,Z~OzMX60l8@C@C/@   x 1D 0@ p2FD +.1@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@ i@@ i@@ i@h@ i@4@ i@@ i@@ i@@ i@h@ i@4@ i@@ i@@ i@@ i@h@ i@4@ i@@ i@@ i@@ i@h@ i@4@ i@@ i@@ i@@ i@h@ i@4@ i@@ i@@ i@@ i@h@ i@4@ i@@ i@@ i@@ i@h@ i@4@ i@@ i@@ i@@ i@h@ i@4@? i@@?!3x攐Xx攐Xxt`xt`<<%4ʌ3 *H3C4 "H3J0-*̫330-4ʌ3 *H3C4 "H3J0-*̫330-@oif$@TfiQ$E@ffa[UoVff`[@oif$@TfiQ$E@ffa[UoVff`[?!4x攐Xx攐Xxt`xt`<<%4ʌ3 *H3C4 "H3J0-*̫330-4ʌ3 *H3C4 "H3J0-*̫330-@oif$@TfiQ$E@ffa[UoVff`[@oif$@TfiQ$E@ffa[UoVff`[?!5x攐Xx攐Xxt`xt`<<%4ʌ3 *H3C4 "H3J0-*̫330-4ʌ3 *H3C4 "H3J0-*̫330-@oif$@TfiQ$E@ffa[UoVff`[@oif$@TfiQ$E@ffa[UoVff`[I6m#d4`:ԩj֚` Ru,,V.mRޠjiV@\7x攐Xxt`<%LZj3C4#3 Ҭ3Kx 333* x-324Ĉ  8o6fff

Gotitas de Pflüge

 9oOC6fff

El exterior de las gotas se evapora

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Los núcleos se dispersan en el aire, donde permanecerán suspendidos durante horas

 ;lN16fff

Cada gota transporta de uno a tres bacilos tuberculosos

 '<w R&Э6

Sólo los enfermos con la tuberculosis activa pueden contagiar la enfermedad a través de los estornudos, la tos o incluso el habla.

P=qla Fqm aF%ʠv)uDhE/_KX@B\gt}4 >?D @/@@@@-@ i@@ -@ i@T @i@@ -@ i@ @i@TA@ -- @i@@@@@@? ΄@ -i@@ -i@T@F1t -i@@UU@@F1t@UU ? ΄i@ @i@T@ i@T @i@@F 1t ? ΄i@ @@UЈ@*q@@}@UUKp@j5@@U*@j@ǺH@UՈ @I@AF!왗!A"@AUU@A@A#@AUU@A@A$@AUU@A@AA%@L&=+M'@@@@@@@FC(!HEXtB@JD2Xi@2K3@ Di@TK@@ Di@K@ Di@K@ Di@TK4@ Di@K@@ Di@K@ Di@TK@ Di@K5@ Di@K@@ Di@TK@ Di@K@KLM?B6.KNpD` DK7L8=>M9>N:>O;>P<$>Q=@6>estornudo_mc q?qS;6

La tuberculosis es una enfermedad infecciosa potencialmente mortal.

Éstos son los pasos del contagio:

S?{c@^s=[@M2T ^EiW߁' sZe g:4noiv(@o7CW5,x sVPb#2 *n4Yd%zt[>0sQ'Lc2P (13FL^2Ƃgy."OPhT @(5KVu$ғtAjoҹ @'Y9X&PPD%ւeY 1j&%QV)UacdI1P9u3A`U0 f3(x !BD @AH@TBŕ6ʛ4n˺CArialC@ Do6Cf3

ACILOS TUBERCULOSOS

WDR  EqS6

La tuberculosis se transmite de persona a persona principalmente a través de la vía aérea.

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 Ow gB6

El contagio dependerá de:

· las características del enfermo

· el número de bacilos expulsados

· el entorno y la duración de la exposición

· las condiciones del receptor (la diabetes aumenta el riesgo por tres y el VIH por más de 100)

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En el momento en que una persona inhala esas gotas comienza la infección tuberculosa.

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NFECCIÓN TUBERCULOSA

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Macrófago

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Monocito

 la6fff

Bacilo

 qSXB6

Los macrófagos (glóbulos blancos) detectan la presencia extraña de los bacilos y los fagocitan (engloban), alertando al mismo tiempo a otros macrófagos y monocitos (otra clase de glóbulos blancos), que fagocitan más bacilos.

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Linfocito CD4

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Necrosis caseosa

 5la6fff

Macrófago

 6qS9p6

Al multiplicarse, el bacilo mata al glóbulo blanco. Esta necrosis genera una especie de leche blanca (casium) que supone un medio desfavorable para el bacilo y que, además, alerta al linfocito CD4, una defensa más eficaz.

 7la6fff

Bacilos

 8h6fff

Granuloma

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Monocito

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NFECCIÓN TUBERCULOSA

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Ganglios linfáticos

 g= 6fff

Vasos linfáticos

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De forma simultánea, algunos de los macrófagos alveolares infectados pasan a los vasos linfáticos y a los ganglios linfáticos regionales. Desde allí pueden pasar a la sangre expandiéndose al resto del organismo.

 o 6fff

Ganglios linfáticos

 g= 6fff

Vasos linfáticos

<3GD G@+ i@ H@ ti@ P@]*ЈF>!A?왗FBWJC BNa8pi@FKWL@@k8;0ABCDE@ i@ i@ i@ ?i@@@@@@@ i@ i@ i@ ?i@@ i@ i@ i@ ?i@@   i@ ?i@F@ >?BCKL78SD. 75PN@7"n4n 7"n5,@R֥4lnj R֥5P @nB4jύ nB8@ƉԻ5HՍ ƉԻ8@ƥfI5F܍ ƥfI8k@50D 8+@܆5GB ܆8@@5^@ 9@@qG'Mشi@H'Mش/(GܸӰC'Qؔ{ 'Qؔ(F Hl IՁB&  JլDt&  KՁF|& LՋE& MD& N& O8& P& Q& Rt& SK& TդƐ& Uզt& VƐ& WG& X& Y|& ZԊ$& [Ԑ& \Ԝ& ]TR&  ^qW& !_5,& "`9& #aPh& $b_Y@& %cSY@& &d԰Y|& 'esh& (fԙ[p& )gsZ& *hs\& +ix[p& ,jԆ\T& -kو& .l& /m ZH& 0nZ& 1oZ& 2pGܜ& 3qU& 4re& 5s=^Xeڐ& 6t\& 7u & 8v΀& 9w=& :x6& ;yNJ& =zMޔ& >{Oe & ?|& @}o<& A~ & Bǐ`& C{`& DǗ& EǠ& F& Gp& HNJ& J`@& KǏ@& L & Mx& NR& Oֵl& PTd& Qx& RhV& S<& TV& UW& VsWp& WY& XT& Yٌ& Zۼ& [<& \.Zl& ]J& ^OY& _QZ& `Zp& bmZ& c׬[& dT& el]|& fYa& gbcP& h}|& iף@& j׼l & ksF,5& l׭P& m& n& otD& p& q<& rf$& s& txZ8& uN8& ve& wQ& xeL& yJ]& zLd& {֛& |հ& }hT& ~լ& h& Cj& #& բs& s& Ս& ]L& & Յ&  & ;& 3q& && 7& 2& & $& v& x`& ԩ& z& x& Ł& G& l & Ս& ի$& լ,& 'u& x& r& }pX& ֒q& ־,& ֥u& {d& & y\& {z& m@& _~(& +& '& & w& u& I|& ;& Q& && Ք& Ն& ՞& N& & R& Ս4& $ & 8& /& 6$$& t*& N& 3H& .6& ֛& Z@& ց& V 4& vX& ִ& ֕& ֐,$& ֵ& ;d& 7 & |& m/& ֺ7 & m4H& kӰB@ i@4 i@4  @ i@h i@h @ i@ i@ f&@ i@̉ i@̅ 33@ i@ i@ @@ L@ Y@ ff@ 3s@ @ ͌@ @ f@ 3@ @ @ @ f@ 3@     !"#$%&'()*+,-./0123456789:;=>?@ABCDEFGHJKLMNOPQRSTUVWXYZ[\]^_`bcdefghijklmnopqrstuvwxyz{|}~F` 9 uaIՁB& bJլDt& cKՁF|& dLՋE& eMD& fN& gO8& hP& iQ& jRt& kSK& lTդƐ& mUզt& nVƐ& oWG& pX& qY|& rZԊ$& s[Ԑ& t\Ԝ& u]TR& v^qW& w_5,& x`9& yaPh& zb_Y@& {cSY@& |d԰Y|& }esh& ~fԙ[p& gsZ& hs\& ix[p& jԆ\T& kو& l& m ZH& nZ& oZ& pGܜ& qU& re& s=^Xeڐ& t\& u & v΀& w=& x6& yNJ& zMޔ& {Oe & |& }o<& ~ & ǐ`& {`& Ǘ& Ǡ& & p& NJ& `@& Ǐ@&  & x& R& ֵl& Td& x& hV& <& V& W& sWp& Y& T& ٌ& ۼ& <& .Zl& J& OY& QZ& Zp& mZ& ׬[& T& l]|& Ya& bcP& }|& ף@& ׼l & sF,5& ׭P& & & tD& & <& f$& & xZ8& N8& e& Q& eL& J]& Ld& ֛& հ& hT& լ& h& Cj& #& բs& s& Ս& ]L& & Յ&  & ;& 3q& && 7& 2& & $& v& x`& ԩ& z& x& Ł& G& l & Ս& ի$& լ,& 'u& x& r& }pX& ֒q& ־,& ֥u& {d& & y\& {z& m@& _~(& +& '& & w& u& I|& ;& Q& && Ք&  Ն&  ՞&  N&  &  R& Ս4& $ & 8& /& 6$$& t*& N& 3H& .6& ֛& Z@& ց& V 4& vX& ִ& ֕& ֐,$& ֵ&  ;d& !7 & "|& #m/& $ֺ7 & %m4H& ӰB@G'Mشi@#H'Mش/(p  ӸG  ƙ# ڊ#@'MشY{'MشW(p @G@'Mش{'Mشo(p G@'Mشg'Mش/(p PG@'Mش{'Mش"(p G@'Mش;>'Mشfo(p `G@'Mش~'Mش/(p G@'Mش¾'Mش(p pG@'Mش>'Mش1o(p G@'MشI'Mشu/(p @1@'Mش卾'Mش(p 1@'Mش>'Mشo(p 1@'Mش'Mش@/(p 1@'MشX'Mش(p P1@'Mش>'Mشo(p 1@'Mش'Mشp 1F _^1@  @ @ f&@ 33@ @@ L@ Y@ ff@ 3s@ @ ͌@ @ f@ 3@ @ @ @ f@ 3@ ?F  0Ed`_cד8FƙFڊF@ 6@@fUHinhalacion4_mc o16Cf3

NFECCIÓN TUBERCULOSA

x -J- Rl,escena5_root gotoAndStopR@? escena7Ejk؎@jk؎@5#H_s|ǾO۬olC23jk@Q("xQ4n|XoffeiDkqkq5>Jq'q,=jy:v*2k\aQ(=xQ>Y|O|Y:{uӂ t Uj\!X,KoxQSnW+g5c^J*mG'h3>_L*a0'5S0f'լfq69${ } ׉T^fQ6BPw[فY,Pb4NcK*Q)6xS۬gP_Y,>h3>cL*ڷ=V+wS0ӂ t U| bV+vcT*X,lϭJ6cS"a0 h3?UT){G^T."YΦ}/_gP P]P(AxQ۬gA;iOc_>*h<,h<,5I_NC;GV-P\3,ӋM;JyhJжxh>[<[!g!.d{V(mSH=<ǤDWhR:,Q(xQ۬oQQ)U/xQ=MoYWgR)^]EDYXHS)g}UDVc'DbUm;?T*sUDGQHuU*UDb ͿXEk_V+UDJtk\&o&>GvW+UEQ h>?o&1c lyV+ TS?%TOa{uU*I__7]7U L=@%jRH+W+$6c]I^*Yqh;4Cqh;4C58qs4Jw'ƙpN~h ȣ3qH72BQ((EO˔i(O2.VjA'X,&L,cS*;i9LxQ۬g X,BLxQ۬gU, r E(Hr E(H%7)*I+,!r (KJ7c,DL*Ŭƿe"rHL^rHL^%)i "&gB,G@6p fbj9r J}U@t#qLm7c,DL*Ŭƿ| 9f8k%TN a;u;i*s%TMG8iGb0 Ơ^$rhQ^rhQ^%1iA~>U!mT es|xWi%rhP^U*0 I*ɬ ƿ| V+=i%TN bv[u3W+/s%TMX n=&qhhrqhhr5rXHjh5J7bGY'qv*o'Eky|6`x?xQ4 iwo%_,p[̈p[̈5A' 0/qj|6`x?xQ4 iwo%x4\|xQ=wxo'Du|Wt2YxQ=_j'Kxp0VĿ%Tow;u}_0pHl pHl 5'[֜h<1.աC5YANOg<1sԨ_rjxQF\"A@ 3ig&ζ诲Ο0-==11pj W+ k%TQ ZIǿWFKV+hxQ6 mLK u,UwOU*rxQ>v*oEyT*xoxQ4 a7o)S)|xQ=ywo'D|GR)xQ=_jo'Kx=Q) %To҂uo~Q("Am r+EL9}+VՇAvF  &{@`2p?ra0 ׭G,oP/ gcŹyGbL:PIh.Sԝ@jZg[QAhfR}ѫf! (j6ڣI86 Fܩ *A@ 5ig&ζ(rϣM>Z k*Z(V#Hǥz=4ͫX,.'O0ނ&:OShޕ{ G2֊@C>3X'<>O8Ҷ YiVդiA T#W 꺋";"NҼt~TB|i p P3w^mwP(-m/DgxتNxvUsX4oV @~oX,y%GAjr0%<'Bl>%uxC 5D 4@ 6w x6

La mayoría de las veces (90% de los casos) la lesión evoluciona hacia la curación.

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El mismo porcentaje de personas infectadas padecerá la tuberculosis en algún momento de la vida a causa de un foco antiguo.

 876

Un 5% de los infectados desarrolla la enfermedad en las semanas siguientes al contagio.

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ɎEcNO ɎEcNO ɎEcNO ɎEcNO ɎEcNO ɎEcNO ɎEcNO !ɎEcNO "ɎEcNO #ɎEcNO 'ɎEcNO (ɎEcNO )ɎEcNO +ɎEcNO .ɎEcNO 0ɎEcNO 3ɎEcNO 5ɎEcNO 7ɎEcNO 9ɎEcNO :ɎEcNO <ɎEcNO ?ɎEcNO AɎEcNO CɎEcNO EɎEcNO IɎEcNO KɎEcNO SɎEcNO VɎEcNOW6K X7I Y8H: FZ9̽Q\\Pd_[5#h @6:@O^ grafico_mc !;qS6

"primoinfección", ahora el infectado depende de sus propias defensas para desarrollar o no la tuberculosis.

;s <`>U (xݐ=`>U f3(xݐ .>D <@ Ĕd=@ $@>ŀ61\  ?w 6

n este punto termina la llamada

 ?ϔ -J- Rl ,escena6_root gotoAndStopR@ ?Tcinco_root iNavegacionNiEtiquetas_escenasN gotoAndStopR escena8 N@oG@jom:À'-G7}7$0`PbTS]5fAo o ʑ(333(fff-a&ΕȚm#`'l-m$Z{MIPoih?BdPHg>Z{7*( ʞɃ&08V! J\Ex@y kֵģDe|a⩜˧LSGyvsx|ὀR0XL2_UBю|jk YCdPdP̀-7 Ě |jR2-~:>Z{7*( ʞɃ&M^N7҇im4+Qi5egI&7u؍' QDWٱ6}\պQ3YkrÖ&7糀&Gjä5V?KȴYMiZ({`'*{&3bT_6Uy8J<ӆ?ʌFZ8Y]&?pb7Po7FM_OfsVFe˧7X Dw _NX6

CALCIFICACIÓN

El granuloma se calcifica y se considera que la lesión primaria se ha curado. Sin embargo, en ocasiones puede quedar algún bacilo activo en el interior del granuloma que en un futuro provoque la activación de la enfermedad.

1E|4*Āq|5jv(f3%|-F ]r?FdP̀Hg>Z{7*( ʞɃ&08V! J\Ex@¶Z[Y`YSs7S.2UMAfޫ 3K`3r`MU F;]zH@ xGw _NX6

CAVITACIÓN

El centro del granuloma (casium) se licúa y se vacía en un bronquio formando una úlcera hueca (cavitación).

Los macrófagos que estén activados son ineficaces, lo que favorece la multiplicación extracelular de los bacilos.

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Proceso de CALCIFICACIÓN

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Proceso de CAVITACIÓN

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n 10% de las personas infectadas

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INESPECÍFICOS

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· astenia (debilidad)

· pérdida de apetito

· disminución de peso

· sudoración nocturna

· febrícula (37º - 38º)

· escalofríos

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OCASIONALES

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· gripe

· catarro persistente

· fiebre de origen desconocido

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MÁS ESPECÍFICOS

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dolor torácico ·

tos duradera ·

esputo con sangre ·

esputo verde o amarillo ·

dificultad para respirar ·

líquido en la pleura ·

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En otros tipos de tuberculosis los síntomas varían. En la tuberculosis renal (la segunda más frecuente) aparecen cuadros de infección urinaria con cultivo negativo.

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unque la tuberculosis puede cursar

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l primer paso en el diagnóstico de la

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1. Radiología

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2. Examen de esputo

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3. Prueba de Mantoux

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4. Biopsia

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Biopsia

Consiste en la extracción de una muestra de tejido (de los pulmones si la tuberculosis es pulmonar o de los ganglios linfáticos si han aumentado de tamaño y son accesibles). La muestra será examinada para confirmar la presencia del bacilo tuberculoso.

En este tipo de prueba el hallazgo debe ser confirmado mediante un proceso similar al del examen de esputo (tinción de bacilos alcohol-resistentes).

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La prueba de la tuberculina o prueba de Mantoux

Este método se utiliza cuando se ha entrado en contacto con la enfermedad para detectar una posible infección.

Consiste en una inyección de tuberculina intradérmica que causa una inflamación en el plazo de 48 - 72 horas. Si su diámetro es igual o superior a 10 mm significa que existe infección.

No obstante, para confirmar un resultado positivo se necesitan otras pruebas que indiquen que el paciente ha desarrollado el trastorno. Sólo en ese caso debería recibir tratamiento.

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Foto: CDC Organization

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Examen de esputo

Es el único método que permite la confirmación de tuberculosis activa. Consiste en el análisis microscópico (baciloscopia) del esputo del paciente. Esta técnica está basada en el carácter ácido-alcohol resistente de los bacilos que los hace fácilmente diferenciables tras la tinción. Además se puede hacer cultivo del esputo.

Esta prueba no es totamente eficaz ya que sólo detecta la tuberculosis activa en un  60% - 70% de los pacientes que la padecen.

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Foto: CDC Organization

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En la primoinfección la radiografía de tórax suele ser normal (sin detectarse alteraciones).

Una vez desarrollada la enfermedad en la radiografía se pueden apreciar: lesiones primarias, un granuloma calcificado, algún infiltrado en las regiones medias del pulmón o incluso una cavitación.

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infiltrado

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cavitación

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Foto: CDC Organization

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Detecta los bacilos

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Detecta los bacilos

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Fagocita los bacilos

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Detecta los bacilos

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Fagocita los bacilos

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Multiplicación y necrosis

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Todos los fármacos menos el Etambutol (que impide la multiplicación de los bacilos) son bactericidas, matan a la bacteria.

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Es importante no abandonar la terapia antes de tiempo porque eso podrían quedar focos y/o que generarse resistencia a alguno de los fármacos administrados.

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Los fármacos también actúan de modo preventivo si se combinan con  el aislamiento de los pacientes con posibilidades de contagiar la enfermedad.

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Todos los fármacos menos el Etambutol (que impide la multiplicación de los bacilos) son bactericidas, matan a la bacteria.

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antibióticos. Los dos principales Isoniacida y Rifampicina, y Etambutol, Piracinamida y Estreptomicina.

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el tratamiento se basa en cinco

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Organización Mundial de la Salud

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