Arza FS, Coria LJJ, Gómez BD, López ECC

Language: Spanish
References: 18
Page: 11-15
PDF size: 77.53 Kb.

ABSTRACT

Introduction. The infections caused by M. bovis are described rarely, the cases of disseminate tuberculosis by the vaccine strain stock appear with a very low index.
Case report. Female of two years 7/12 with precedent of tuberculous lymphadenitis at six months of age. Sent to the Hospital Infantil de México “Federico Gómez” by new outbreak of lymphadenopathy. She was Handled with corticoid, isoniazid, clarithromycin and pyrazinamide six months, without improvement. The nodes biopsy reports granulomatous lymphadenitis, and positive culture for M. tuberculosis resistant to isoniazid and pyrazinamide. Fourth months later she was hospitalized by cervical and axillary nodes. Resistance possibility is evaluated, and M. bovis like causal agent was suspected, beginning ciprofloxacin, pyrazinamide, isoniazida, rifampicin and amikacyn. Two months after the entrance, the BAAR's in gastric fluid were positive +++ with growth of M. tuberculosis with equal pattern of resistance (reports of the [INDRE] National Institute of Reference Epidemiologist). The sample was sent to the [INCNN] National Institute of Medicas Sciences and Nutricion Salvador Subiran, were M. bovis (strains vaccine) with equal pattern of resistance and sensitivity of second line antifímicos was isolated. Given for this reason Levofloxacin, protionamide, amikacyn, and amoxicillin-clavulanate, and suspending isoniazid and pyrazinamide. The patient evolves favorably completing treatment for 3 months with directly observed therapy, withdrawing with handling route oral.
Commentaries. The finding of BAAR in a patient with lymphadenopathy granulomatous chronicle with negative epidemiologic for M. tuberculosis, absence of initial pulmonary affectation, presence of resistance to pyrazinamide in endemic countries as Mexico, must orient to etiologic diagnostic of M. bovis. The association between systemic disease and BCG (M. bovis attenuated) also must be considered if there are antecedents of no consumption of not pasteurized milky product.

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