RESUMEN
Asbesto, también conocido en España como amianto, es el término utilizado para nombrar a un conjunto de silicatos minerales que suelen romperse en fibras. Su uso ha comportado la aparición de numerosas enfermedades, especialmente pleuropulmonares, todas ellas caracterizadas por su prolongada latencia. El asbesto es, además, un carcinógeno del grupo IA reconocido por la OMS desde 1987. En España está prohibido desde 2002. La publicación en 2013 de la 3.ª edición del protocolo de vigilancia sanitaria específica del amianto junto con la aparición de nuevas técnicas diagnósticas han motivado al grupo EROM de SEPAR a promover la elaboración de esta normativa que revisa aspectos clínicos, radiológicos y funcionales de las diferentes enfermedades relacionadas. También establece recomendaciones para el diagnóstico y seguimiento de los pacientes expuestos. Dichas recomendaciones han sido establecidas mediante sistema GRADE.(AU)
Asbestos is the term used for a set of mineral silicates that tend to break up into fibers. Its use has been associated with numerous diseases affecting the lung and pleura in particular, all of which are characterized by their long period of latency. Asbestos, moreover, has been recognized by the WHO as a Group IA carcinogen since 1987 and its use was banned in Spain in 2002. The publication in 2013 of the 3rd edition of the specific asbestos health monitoring protocol, together with the development of new diagnostic techniques, prompted the SEPAR EROM group to sponsor publication of guidelines, which review the clinical, radiological and functional aspects of the different asbestos-related diseases. Recommendations have also been made for the diagnosis and follow-up of exposed patients. These recommendations were drawn up in accordance with the GRADE classification system.(AU)
Asunto(s)
Humanos , Enfermedades Pleurales/diagnóstico , Amianto/toxicidad , Biomarcadores , Enfermedades Pulmonares/diagnóstico , Enfermedades Pleurales/etiología , Exposición Profesional , Enfermedades Pulmonares/etiología , Enfermedades Profesionales/etiologíaAsunto(s)
Amianto/efectos adversos , Asbestosis , Exposición a Riesgos Ambientales/efectos adversos , Enfermedades Pulmonares/etiología , Neoplasias Pulmonares/etiología , Mesotelioma/etiología , Exposición Profesional/efectos adversos , Enfermedades Pleurales/etiología , Neoplasias Pleurales/etiología , Asbestosis/diagnóstico , Asbestosis/diagnóstico por imagen , Asbestosis/epidemiología , Líquido del Lavado Bronquioalveolar , Broncoscopía , Interpretación Estadística de Datos , Diagnóstico Diferencial , Femenino , Humanos , Incidencia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/cirugía , Masculino , Mesotelioma/diagnóstico , Mesotelioma/cirugía , Oportunidad Relativa , Neoplasias Pleurales/diagnóstico , Neoplasias Pleurales/cirugía , Prevalencia , Atelectasia Pulmonar/etiología , Fibrosis Pulmonar/diagnóstico , Radiografía Torácica , Factores de Riesgo , Factores Sexuales , EspañaRESUMEN
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Asunto(s)
Humanos , Biomarcadores de Tumor , Derrame Pleural Maligno , Neoplasias PleuralesRESUMEN
Recent studies in populations with a high prevalence of tuberculosis and HIV infection report that tuberculous pleurisy occurs in approximately 30% of patients with tuberculosis. However, the fraction of patients with tuberculosis who have tuberculous pleurisy is comparable in HIV-positive and HIV-negative individuals. It appears that tuberculous pleurisy mostly develops in patients with HIV who have CD4 counts above 200/microL. Primary tuberculous pleurisy is thought to occur as a result of a delayed hypersensitivity reaction to mycobacterial antigens. Recent studies highlight the way in which pleural cells become activated and produce cytokines as a response to mycobacteria. Intramacrophage and direct cytotoxic elimination of mycobacteria, granuloma formation, and fibrosis are the main facets of this reaction. Many studies have investigated the usefulness of measuring different parameters in pleural fluid for an early diagnosis of tuberculous pleurisy. It has been shown that the most useful diagnostic tests are the levels of adenosine deaminase and interferon gamma in the pleural fluid. Elevation of either of these compounds in lymphocytic pleural effusions is virtually diagnostic of tuberculous pleurisy. Although theoretically, detection of mycobacterial DNA in the pleural fluid by the polymerase chain reaction would appear to be useful, the usefulness of this test still needs further demonstration. Patients with tuberculous pleurisy must receive antituberculous treatment. The current recommendation for immunocompetent patients is a 6-month regimen of isoniazid and rifampin supplemented in the first 2 months by pyrazinamide. HIV-infected patients should be treated with this same regimen for a longer time period. Serial thoracentesis or corticosteroid treatment are not warranted for the majority of patients.