Tuberculosis extrapulmonar. Una perspectiva desde un hospital de tercer nivel

Introduction: the prevalence of tuberculosis (TB) continues to be high, and shows an important increase in patients with HIV/AIDS. The relevance of extrapulmonary forms of the disease has likewise become increasingly greater. Approximately 9 million new cases of tuberculosis are reported every year, with more than one and a half million deaths due to the disease during the same period of time. Objectives: to evaluate and present the data of a third-level hospital with regard to extrapulmonary tuberculosis, and to give some general recommendations for its diagnosis and treatment.  Design, Materials and Methods: the clinical charts and the epidemiologic databases of the tuberculosis program carried out over the past 12 years at a third-level hospital of Bogota, Colombia (Hospital Santa Clara E.S.E.) were evaluated, and a review of the literature concerning tuberculosis and its extrapulmonary presentation was carried out. Results: The consolidated data of cases of extrapulmonary tuberculosis among the population of the Hospital Santa Clara E.S.E. over a 12-year period: 30% of extrapulmonary cases were found in non-HIV/AIDS-infection patients and 47% in patients with AIDS. The most common forms of extrapulmonary presentation were: of the lymph nodes, of the central nervous system, and of the miliary type. Conclusions: An important incidence of extrapulmonary cases was found. The challenge with regard to extrapulmonary tuberculosis lies on clinical suspicion and on the selection of the method for diagnostic confirmation. These forms are paucibacillary and not very contagious, but can produce high morbidity and mortality rates, especially in patients with HIV/AIDS.