Tuberculose extrapulmonar : considerações clinicas sobre a doença em 293 pacientes adultos

Abstract

Resumo: O objetivo deste estudo foi determinar as caracteristicas clinicas e laboratoriais da tuberculose extrapulmonar, os metodos diagnosticos e as variaveis prognosticas em pacientes adultos com tuberculose extrapulmonar. Os criterios diagnosticos incluiram demonstracao do bacilo atraves de cultura ou bacterioscopia e/ou granuloma com necrose caseosa. Foram estudados 293 pacientes adultos, internados consecutivamente no Hospital de Clinicas da Universidade Fereral do Parana, no periodo de janeiro de 1976 a dezembro de 1990. Cento e oitenta pacientes eram homens e cento e treze, mulheres. A idade variou entre 14 e 77 anos, com media de 35,9 }15,4 anos. A localizacao principal da doenca foi pleural em 122 pacientes, abdominal em 39 pacientes, ganglionar em 33 pacientes, osteoarticular em 28 pacientes, genitourinaria em 23 pacientes e outras localizacoes em 14 pacientes. Noventa e nove pacientes tiveram tuberculose localizada exclusivamente em orgaos ou estruturas extratoracicas . Cento e vinte e cinco pacientes tiveram tuberculose em estruturas intra-toracicas associadas ou nao a comprometimento de estruturas extratoracicas, porem sem comprometimento pulmonar. Em 66 pacientes havia tuberculose pulmonar ativa associada. A analise permitiu concluir que as manifestacoes clinicas da tuberculose extrapulmonar sao significativamente influenciadas pela localizacao principal da doenca e pela localizacao intra ou extratoracica dos orgaos comprometidos. Por outro lado, nao observamos influencia significativa, sobre as manifestacoes clinicas da doenca, da idade, numero de orgaos comprometidos ou condicoes associadas. Assim, as chamadas manifestacoes "classicas da doenca" estarao ausentes em grande parte dos casos, sem constituir contudo, manifestacao atipica da doenca, mas apenas, uma de suas muitas formas de apresentacao.

Abstract: The purpose of this study was to determine the clinical and laboratory characteristics, diagnostic methods, and prognostic variables in adult patients with extrapulmonary tuberculosis. The diagnostic criteria included the demonstration of the bacillus by means of culture or bacterioscopy and/or by the presence of granuloma with caseous necrosis in tissue examination. Two hundred and ninety three patients admitted to the University Hospital of the Federal University of Paraná, between January of 1976 and December of 1990, met the diagnostic criteria and were retrospectively reviewed. There were 180 males and 113 females. The median age was 35.9 ± 15.4 years (range 14 - 77 years). The main localization of the disease was pleural in 122 patients, abdominal in 39 patients, lymph nodal in 33 patients, osteoarticular in 28 patients, genitourinary in 23 patients, and other sites in 14 patients. Ninety nine patients had tuberculosis exclusively extrathoracic. One hundred and twenty five patients had intrathoracic tuberculosis, associated or not with extrathoracic disease, but without pulmonary involvement. In 66 patients active pulmonary tuberculosis was present. In conclusion, the clinical manifestations of extrapulmonary tuberculosis are significantly affected by the main localization of the disease and by the presence of intra or extrathoracic involvement. On the other hand, age, number of sites involved or associated diseases, did not significantly influenced the clinical manifestations. Therefore, the so-called "classical" manifestations of the disease will be absent in the great majority of cases, without being atypical, but rather one of its many clinical facets.