Benemérita Universidad Autónoma de

Puebla
Facultad de Medicina
Infectología

Enfermedades por
micobacterias
Tuberculosis pulmonar y
extrapulmonar
Equipo 5
● Chavez Garcia Amina
● González Santiago Eufracio
● Juarez Cruz Mauricio Josafat
● Rojas Mendez Marvin
● Solís Cespedes Bertha Mariana
Tuberculosis
pulmonar
 Tuberculosis
extrapulmonar
 Tuberculosis osteoarticular
Epidemiología y Patogenia
10-35%: Casos de tuberculosis
extrapulmonar
2%: De todos los casos de
tuberculosis.

● Zonas con alta endemia: Se

desarrolla en el 1° año después
de la infección pulmonar primaria 1. Columna
- Jóvenes vertebral
● Países industrializados: torácica o
lumbar
Reactivación tardía y pacientes
2. Cadera
adultos 3. Rodilla
4. Hombro
Espondilitis tuberculosa
Diagnóstico:
Sitios: ● ½ de los casos
● Clínico: Difícil - Retraso
● Vértebras torácicas inferiores y
● Resonancia magnética
lumbares superiores
○ Útil en etapa temprana
● Afectación del cuerpo vertebral
● Hallazgos:
adyacente al disco
○ Edema de la médula ósea
● Diseminación a vértebras
superiores e inferiores
Hallazgos significativos:

Complicaciones: ● Diseminación subligamentosa

● Localización paraespinal
● Colapso vertebral ● Absceso circunscrito con edema
○ Cifosis → Absceso frío
○ Deformidad de Gibbus
 Diagnóstico diferencial:
● Infecciones piógenas
○ Brucelosis
○ Infección micótica
○ Tumores metastásicos
○ Sarcoidosis
○ Staphylococcus aureus

Columna lumbar

Menos de 2 niveles vertebrales

Destrucción del cuerpo vertebral y disco

intervertebral
Artritis tuberculosa
Generalidades:
● 2° manifestación más común
● Síntomas inespecíficos
○ Consecuencia de inflamación
del revestimiento sinovial
Hallazgos radiográficos:
Sitios:
● Articulación sacroilíaca
● Caderas
● Rodillas
● Monoarticular
Fisiopatología
● Dada por osteomielitis o diseminación
hematógena
○ Vasos sanguíneos sinoviales
● Congestión persistente
● Engrosamiento de la membrana sinovial
● Derrame articular
● Imágenes normales
● Osteoporosis periarticular
● Erosión del hueso marginal - Periferia
● Estrechamiento del espacio articular
● Sinovitis significativa → Etapa
temprana
Diagnóstico diferencial:
○ Cartílago articular: Intacto ● Artropatías inflamatorias
○ Artritis reumatoide
● Anquilosis ○ Gota
● Degeneración ● Celulitis o miositis → Artritis séptica
bacteriana
Osteomielitis tuberculosa
Radiografía simple:
Sitios:
● Osteopenia en la metáfisis
● Fémur, tibia, huesos de las manos ● Lesiones líticas
y pies ● Esclerosis mínima
● Unifocal
● Multifocal: Pediátricos
Resonancia magnética:
Fisiopatología:
● Edema de la médula
● Bacilos → Metáfisis de huesos ● Abscesos intraóseos
largos ● Centro caseoso
● Lesiones granulomatosas → ● Anomalías de músculos adyacentes y
Nódulos casificantes → tejidos blandos extraóseos
Necróticos
● Reabsorción trabecular
Osteomielitis tuberculosa
Tratamiento y seguimiento:
● No existen pautas específicas
● Quimioterapia antituberculosa:
6-18 meses
● Reparación quirúrgica de la cifosis
● Abscesos: Drenaje externo guiado
por ecografía o tomografía
computarizada
● No es necesario una biopsia o
evaluación bacteriológica →
Respuesta al tratamiento
● Respuesta: Hallazgos clínicos y
radiológicos
 Tuberculosis miliar
Definición:
● Enfermedad clínica resultante de la
diseminación hematógena
● “Miliar”
○ 1700 - John Jacobus Manget
■ Comparó el pulmón con
nódulos blancos firmes con
semillas de mijo
● Surge por
○ Infección primaria progresiva
○ Reactivación de un foco latente
● TB progresiva y ampliamente diseminada ¿Pulmonar o extrapulmonar?
Epidemiología: Factores de riesgo:
● 2018 - Informe Global Tuberculosis
● Edad: Adultos jóvenes y
de la OMS: 10 millones de
adolescentes; Ancianos
personas desarrollaron TB
○ Masculino
● 1.3 millones de muertes
● Condiciones médicas:
● 1-2% de los casos de tuberculosis
● 20% de todas las formas en
inmunocompetentes
Patogenia:
Enfermedad primaria progresiva
Diseminación: Hígado, bazo,
médula ósea y cerebro
Patrones clínicopatológicos:
Miliar aguda (Generalizada)
Periodo posprimario o
niños/adultos
inmunocomprometidos
2-6 meses después “Rápido”
Reacción granulomatosa
caseificante
Reactivación de un foco latente
Erosión en vasos sanguíneos o
linfáticos
Años o décadas
Generalizada tardía
Después del periodo primario
Asociada a Tuberculosis
pulmonar crónica
Infección iatrogénica
Raro
Anérgica (No reactiva)
Ausencia de granulomas
Diagnóstico: Tinciones de tejido
y cultivos
Poco común
Manifestaciones clínicas: ● Inespecíficas y variadas
● Retraso en el crecimiento ● Subagudas o crónicas
● Fiebre de origen desconocido
● Disfunción de los sistemas
● Sudores nocturnos
● Anorexia
● Pérdida de peso
● Tos. disnea
● Dolor abdominal, náusea, vómito y
diarrea
Diagnóstico: Criterios:

1. Presentación clínica compatible

Laboratorio:
2. Patrón miliar clásico en Rx de tórax
● Pancitopenia, anemia, 3. Lesiones pulmonares
leucopenia, leucocitosis reticulonodulares difusas,
● Anemia en la bilaterales
enfermedad crónica 4. Evidencia
● Elevación de VSG y PCR

Radiografía de tórax:
● Lesiones en forma de mijo, tamaño
discreto, distribuidas en todo el
pulmón
● Primeras etapas: Tomografía
 Tuberculosis miliar
Diagnóstico definitivo: Tratamiento:
● Aislamiento y detección de
micobacterias aisladas
● Muestra clínica
● Inoculación en agar
● Medios líquidos con
fluorescencia

● Duración: Grupo de edad y sitio de

enfermedad primaria
● Pacientes anteriormente tratados:
Muestras para cultivo y pruebas de
susceptibilidad
● Cribado de diabetes y VIH
Referencias:
Baykan, A. H. (2022, 7 marzo). Extrapulmonary tuberculosıs: an old but resurgent problem - Insights into Imaging. SpringerOpen.

https://insightsimaging.springeropen.com/articles/10.1186/s13244-022-01172-0

Rodriguez-Takeuchi, S., Eduardo Renjifo, M., & José Medina, F. (2019, 7 noviembre). Extrapulmonary Tuberculosis: Pathophysiology

and Imaging Findings. RadioGraphics. Recuperado 29 de marzo de 2023, de

https://pubs.rsna.org/doi/full/10.1148/rg.2019190109

Bernardo, J. (2021, 22 diciembre). Epidemiology and pathology of miliary and extrapulmonary tuberculosis. UpToDate. Recuperado 29

de marzo de 2023, de

https://uptodate.bibliotecabuap.elogim.com/contents/epidemiology-and-pathology-of-miliary-and-extrapulmonary-tuberculosis?s

ource=history_widget#

Bernardo, J. (2022, 21 octubre). Clinical manifestations, diagnosis, and treatment of miliary tuberculosis. UpToDate. Recuperado 29 de

marzo de 2023, de

https://uptodate.bibliotecabuap.elogim.com/contents/clinical-manifestations-diagnosis-and-treatment-of-miliary-tuberculosis?sea

rch=tuberculosis%20miliar&source=search_result&selectedTitle=1~49&usage_type=default&display_rank=1
 Tuberculosis infographics
Tuberculosis infection: How does it spread?
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 Tuberculosis infographics

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 Tuberculosis infographics
Treatment for tuberculosis

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 Tuberculosis infographics
The symptoms of tuberculosis

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What is the global impact of tuberculosis?

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 Tuberculosis infographics
Several tests are used to diagnose tuberculosis

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 Tuberculosis infographics
Overview

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 Tuberculosis infographics
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Tuberculosis infographics
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 Tuberculosis infographics
Who is the most susceptible to tuberculosis?

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Venus has a beautiful Mercury is the closest
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 Tuberculosis infographics
What causes tuberculosis?

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 Tuberculosis infographics

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Mercury is the closest Venus has a beautiful
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 Tuberculosis infographics
Countries with high TB rates

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 Tuberculosis infographics

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 Tuberculosis infographics
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 Tuberculosis infographics

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 Tuberculosis infographics
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Tuberculosis prevention

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 Tuberculosis infographics

Dos during treatment Don’ts during treatment

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Venus has a beautiful name and is the
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Mercury is the closest planet to the Sun
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planet in the Solar System
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Tuberculosis infographics

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 Tuberculosis infographics
Pulmonary TB and TB outside the lungs

Step 1 Step 2 Step 3 Step 4 Step 5

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 Tuberculosis infographics
Testing for latent tuberculosis
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Despite being red, 1 2 Neptune is the fourth-largest
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Venus has a beautiful name, 4 3 Earth is the third planet from
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Saturn is a gas giant and has 5 6 Mercury is the smallest
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 Tuberculosis infographics

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Neptune is the
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 Tuberculosis infographics
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Mercury is the closest
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Mercury is the closest Neptune is the farthest
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Despite being red, Mars is Venus is the second planet
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It’s a gas giant and the Saturn is the ringed planet.
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 Tuberculosis infographics

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Venus has a beautiful name and is the 1,200
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Mercury is the closest planet to the 3,400
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Jupiter is a gas giant and the biggest 5,600
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