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Introducción. La tuberculosis es una enfermedad infecciosa. Un tercio de la población mundial está infectada y cada año ocurren en el mundo nueve millones de casos, un millón en menores de 15 años y 719 en Colombia para el año 2008. Objetivo. Describir el comportamiento de la resistencia de Mycobacterium tuberculosis en menores de 15 años en Colombia. Materiales y métodos. Se analizó la información de las pruebas de sensibilidad de M. tuberculosis a los fármacos, realizadas desde 2001 hasta el 30 de junio de 2009 registradas en el Instituto Nacional de Salud. Se evaluó la distribución de casos por sexo, edad, localización de la enfermedad, tipo de muestra, infección concomitante tuberculosis/VIH, proporción de fármacorresistencia. Resultados. Se incluyeron 128 pacientes, 66 (52%) de sexo femenino y 62 (48%) masculino. En el grupo de edad de 0 a 5 años, hubo 59 (46%) casos, 21 (16,4%) de 6 a 10 y 48 (37,5%) de 11 a 14. Las formas de la enfermedad fueron: 89 (69,6%) pulmonar, 34 (26,4%) extrapulmonar y 5 (3,94%) casos sin dato. Se encontraron 7 (5,4%) casos con infección concomitante tuberculosis/VIH. Los casos no tratados fueron 123 (96%) y 5 (3,9%) fueron previamente tratados. La resistencia global en no tratados fue de 21,1% y la MDR-TB (multidrug-resistant tuberculosis) de 6,5%. Conclusiones. Este análisis demuestra que existen debilidades en el cumplimiento de las normas, lo que dificulta el diagnóstico y la identificación de los patrones de resistencia en menores de 15 años. Éste es un tema en el cual se debe explorar más.

Introduction. Tuberculosis is a widespread and increasingly important infectious disease. A third of the world-wide population is infected. Every year nine million cases occur in the world, one million of them appearing in children under 15 years old. In Colombia alone, 719 cases were reported for the year 2008. Objective. The incidence of Mycobacterium tuberculosis resistant forms was characterized in children under 15 years old in Colombia.Materials and methods. Mycobacterium tuberculosis drug susceptibility test data from 2001 to mid year 2009 were analyzed at the Laboratorio Nacional de Referencia, Instituto Nacional de Salud, Bogotá, Colombia. Cases were evaluated by patient age, disease geographic location, and type of sample, as well as the proportions of TB/HIV coinfections and drug resistance. Results. Of the 128 patients examined, 66 were female (52%) and 62 were male (48%). The age group 0 to 5 years old consisted of 59 cases (46%), 21 cases were 6 to 10 years old (16%) and 48 cases 11 to 14 years old (37.5%). The types of disease were 89 (69.6%) pulmonary, 34 (26.4%) extrapulmonary, and 5 (3.9%) cases without data. TB/VIH coinfection cases were 7(5.4%). 123 (96%) untreated cases and 5 (2.34%) cases previously treated. Global resistance among the untreated cases was 21.1% and MDR-TB was 6.5%. Conclusion. This analysis demonstrated weaknesses in following established procedures in the TB treatment process, thereby impeding the diagnosis and the identification of drug resistance s in children under 15 years old. Approaches to improving treatment standards is a topic which requires further exploration.

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Las micobacterias de rápido crecimiento son microorganismos pertenecientes a las micobacterias no tuberculosas que tienen amplia distribución ambiental. Aunque usualmente no son patógenas para los humanos, en condiciones desfavorables, pueden causar enfermedad en la población general o en huéspedes inmunocomprometidos, por lo cual se consideran oportunistas. Mycobacterium preregrinum es una micobacteria de rápido crecimiento perteneciente al complejo fortuitum que ha sido reportado como responsable de casos de micobacteriosis en humanos.Se presenta el caso de una micobacteriosis por M. peregrinum de tipo III, el primero reportado en Colombia, en una paciente de 17 años de edad con una endocarditis de una válvula aórtica protésica, implantada inicialmente por estenosis subaórtica congénita con insuficiencia y, posteriormente, por estenosis aórtica relacionada con la válvula inicialmente implantada. Un año después del segundo implante, presentó sintomas respiratorios y pérdida de peso sugestivos de tuberculosis pulmonar.Las coloraciones de Ziehl-Neelsen del esputo fueron positivas aunque la radiografía de tórax no mostró compromiso del parénquima. En el ecocardiograma se encontró una vegetación en la válvula aórtica. En las muestras de sangre y de esputo, se identificó M. peregrinum de tipo III por cultivo, pruebas bioquímicas y análisis molecular del gen hsp65 por PCR-restriction pattern analysis (PRA). La paciente se sometió a cambio de válvula y recibió tratamiento combinado contra la micobacteria, con rápida recuperación. Las muestras tomadas del sistema respiratorio y sanguíneo se tornaron negativas para micobacterias.

Rapidly growing mycobacteria are non-tuberculous mycobacteria amply present in the environment. Although they are not usually pathogenic for humans, they are opportunistic in that they can cause disease in people with disadvantageous conditions or who are immunocompromised. Mycobacterium peregrinum, an opportunistic, rapidly growing mycobacteria, belongs to the M. fortuitum group and has been reported as responsible for human cases of mycobacteriosis. A case of M. peregrinum type III is herein reported as the first in Colombia. It presented as a disseminated disease involving a prosthetic aortic valve (endocarditis) in a seventeen-year-old girl with a well-established diagnosis of prosthetic aortic valve endocarditis who was referred for a surgical replacement. Due to a congenital heart disease (subaortic stenosis with valve insufficiency), she had two previous aortic valve implantation surgeries. One year after the second implantation, the patient presented with respiratory symptoms and weight lost indicative of lung tuberculosis. A chest X-ray did not show parenchymal compromise but several Ziehl-Neelsen stains were positive. An echocardiography showed a vegetation on the prosthetic aortic valve. In blood and sputum samples, M. peregrinum type III was identified through culture, biochemical tests and hsp65 gene molecular analysis (PRA). The patient underwent a valve replacement and received a multidrug antimycobacterial treatment. Progressive recovery ensued and further samples from respiratory tract and blood were negative for mycobacteria.

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Introducción. La tuberculosis cutánea secundaria a la inyección con agujas es rara; se presenta en personal médico y de laboratorio, y en pacientes que reciben tratamientos percutáneos.Objetivo. Presentar seis pacientes con tuberculosis cutánea secundaria a tratamiento por mesoterapia.Materiales y métodos. Entre 1 y 4 meses después de la inyección en la piel glútea y abdominal de material no precisado, como tratamiento para la obesidad y la celulitis, cinco mujeres y un hombre desarrollaron pápulas, nódulos y senos de drenaje de material seroso en los sitios de inoculación, interpretados clínicamente como infección por micobacterias no tuberculosas. Se practicaron cultivos de las secreciones y de las biopsias de piel para la identificación fenotípica y estudio de histopatología. Con los resultados iniciales se realizaron pruebas moleculares de PRA (PCR-restriction pattern analysis) en las biopsias de piel y estudio ampliado de los pacientes.Resultados. Se demostró Mycobacterium tuberculosis en los cultivos, hallazgo confirmado por la técnica de PRA en las biopsias incluidas en parafina. Los pacientes no habían padecido tuberculosis. Las placas de tórax fueron normales y la tuberculina midió entre 17 y 20 mm. Cinco curaron con terapia antituberculosa y otro curó espontáneamente luego de la resección-biopsia de la lesión más grande. No se encontraron adenopatías satélites ni recurrencias. Conclusiones. Se demostró una nueva forma de adquirir la tuberculosis cutánea. Esta es la segunda demostración de tuberculosis cutánea por mesoterapia en Colombia. El estudio de las lesiones de la piel en el sitio de la inyección cutánea debe incluir pruebas para detectar micobacterias, entre ellas M. tuberculosis. Las autoridades sanitarias deben prestar atención y prevenir esta modalidad de adquirir la tuberculosis.

Introduction. Cutaneous tuberculosis as a result of a needle injection is a rare event; it generally occurs among medical and laboratory personnel and among patients receiving percutaneous treatment. Objective. Six patients are presented who developed cutaneous tuberculosis after mesotherapy cosmetic treatment. Material and methods. One to four months after injection of an unknown product as treatment for obesity and cellulites, five women and a man developed papules, nodules and drainage of wax like material at the inoculated sites; this was interpreted clinically as a non tuberculous mycobacterium infection. Skin biopsies were taken for a histopathologic study; the biopsy and exudates were cultured to make a phenotypic identification. Polymerase chain reaction and restriction enzyme pattern analyses (PCR-restriction pattern analysis)) procedures were applied to the skin biopsies. Results. Mycobacterium tuberculosis was confirmed in the culture and by PRA analysis in the paraffin-embedded biopsies. The patients had never had tuberculosis. Their thoracic X rays were normal and the size of the tuberculin reaction was 17 to 20 mm. Five patients recovered with antituberculosis treatment and the sixth spontaneously healed after the removal of the largest cutaneous module. No satellite adenopathy or recurrences were observed. Conclusions. A previously undescribed mode of acquisition cutaneous tuberculosis was described. This was the second incident of a demonstrated cutaneous tuberculosis following mesotherapy in Colombia. Skin lesions induced by injections must be tested to detect mycobacterias to include M. tuberculosis.

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INTRODUCTION: Cutaneous tuberculosis as a result of a needle injection is a rare event; it generally occurs among medical and laboratory personnel and among patients receiving percutaneous treatment. OBJECTIVE: Six patients are presented who developed cutaneous tuberculosis after mesotherapy cosmetic treatment. MATERIAL AND METHODS: One to four months after injection of an unknown product as treatment for obesity and cellulites, five women and a man developed papules, nodules and drainage of wax like material at the inoculated sites; this was interpreted clinically as a non tuberculous mycobacterium infection. Skin biopsies were taken for a histopathologic study; the biopsy and exudates were cultured to make a phenotypic identification. Polymerase chain reaction and restriction enzyme pattern analyses (PCR-restriction pattern analysis)) procedures were applied to the skin biopsies. RESULTS: Mycobacterium tuberculosis was confirmed in the culture and by PRA analysis in the paraffin-embedded biopsies. The patients had never had tuberculosis. Their thoracic X rays were normal and the size of the tuberculin reaction was 17 to 20 mm. Five patients recovered with antituberculosis treatment and the sixth spontaneously healed after the removal of the largest cutaneous module. No satellite adenopathy or recurrences were observed. CONCLUSIONS: A previously undescribed mode of acquisition cutaneous tuberculosis was described. This was the second incident of a demonstrated cutaneous tuberculosis following mesotherapy in Colombia. Skin lesions induced by injections must be tested to detect mycobacterias to include M. tuberculosis.

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Rapidly growing mycobacteria are non-tuberculous mycobacteria amply present in the environment. Although they are not usually pathogenic for humans, they are opportunistic in that they can cause disease in people with disadvantageous conditions or who are immunocompromised. Mycobacterium peregrinum, an opportunistic, rapidly growing mycobacteria, belongs to the M. fortuitum group and has been reported as responsible for human cases of mycobacteriosis. A case of M. peregrinum type III is herein reported as the first in Colombia. It presented as a disseminated disease involving a prosthetic aortic valve (endocarditis) in a seventeen-year-old girl with a well-established diagnosis of prosthetic aortic valve endocarditis who was referred for a surgical replacement. Due to a congenital heart disease (subaortic stenosis with valve insufficiency), she had two previous aortic valve implantation surgeries. One year after the second implantation, the patient presented with respiratory symptoms and weight lost indicative of lung tuberculosis. A chest X-ray did not show parenchymal compromise but several Ziehl-Neelsen stains were positive. An echocardiography showed a vegetation on the prosthetic aortic valve. In blood and sputum samples, M. peregrinum type III was identified through culture, biochemical tests and hsp65 gene molecular analysis (PRA). The patient underwent a valve replacement and received a multidrug antimycobacterial treatment. Progressive recovery ensued and further samples from respiratory tract and blood were negative for mycobacteria.

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INTRODUCTION: Tuberculosis is a widespread and increasingly important infectious disease. A third of the world-wide population is infected. Every year nine million cases occur in the world, one million of them appearing in children under 15 years old. In Colombia alone, 719 cases were reported for the year 2008. OBJECTIVE: The incidence of Mycobacterium tuberculosis resistant forms was characterized in children under 15 years old in Colombia. MATERIALS AND METHODS: Mycobacterium tuberculosis drug susceptibility test data from 2001 to mid year 2009 were analyzed at the Laboratorio Nacional de Referencia, Instituto Nacional de Salud, Bogotá, Colombia. Cases were evaluated by patient age, disease geographic location, and type of sample, as well as the proportions of TB/HIV coinfections and drug resistance. RESULTS: Of the 128 patients examined, 66 were female (52%) and 62 were male (48%). The age group 0 to 5 years old consisted of 59 cases (46%), 21 cases were 6 to 10 years old (16%) and 48 cases 11 to 14 years old (37.5%). The types of disease were 89 (69.6%) pulmonary, 34 (26.4%) extrapulmonary, and 5 (3.9%) cases without data. TB/VIH coinfection cases were 7(5.4%). 123 (96%) untreated cases and 5 (2.34%) cases previously treated. Global resistance among the untreated cases was 21.1% and MDR-TB was 6.5%. CONCLUSION: This analysis demonstrated weaknesses in following established procedures in the TB treatment process, thereby impeding the diagnosis and the identification of drug resistance s in children under 15 years old. Approaches to improving treatment standards is a topic which requires further exploration.

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Introducción. Las micobacterias no tuberculosas pueden ser saprofitas, patógenas u oportunistas; las enfermedades más comunes producidas por estos microorganismos son las infecciones posquirúrgicas, principalmente por procedimiento estéticos, infecciones asociadas con catéteres, enfermedades cutáneas diseminadas, enfermedades pulmonares y del sistema nervioso central que afectan especialmente a pacientes infectados con el virus de la inmunodeficiencia humana. La identificación fenotípica de las micobacterias no tuberculosas incluye pruebas microbiológicas y bioquímicas, las cuales pueden tomar varias semanas y algunas veces no logran diferenciar entre los miembros de un complejo. Objetivo. El objetivo fue evaluar la metodología de reacción en cadena de la polimerasaanálisis de restricción, como método de identificación genotípica de micobacterias no tuberculosas aisladas de muestras clínicas que pertenecen a la colección del Instituto Nacional de Salud. Materiales y métodos. Se estudiaron 70 aislamientos clínicos de micobacterias no tuberculosas, criopreservados en glicerol al 50 por ciento e identificados mediante metodologías fenotípicas. La identificación genotípica se realizó por reacción en cadena de la polimerasa-análisis de restricción y se evaluó la concordancia entre las metodologías. Resultados. Se obtuvo una concordancia del 100 por ciento en la identificación de Mycobacterium terrae, M. szulgai, M. avium, M. chelonae y M. scrofulaceum, en las especies M. fortuitum, M. abscessus M. gordonae y M. intracellulare varió de 44 por ciento a 89 por ciento; no se obtuvo concordancia en la identificación de las especies M. flavescens y M. malmoense. Conclusiones. El análisis de restricción es una alternativa para la identificación de especies de micobacterias no tuberculosas, rápida, económica y segura para la identificación, que permite la diferenciación entre especies de un complejo y la determinación del subtipo de cada especie.

Introduction. Nontuberculous mycobacteria can be saprophytic, pathogenic or opportunistic. The most common diseases produced by these microorganisms are the post-surgical infections due to anesthetic procedures, infections associated with catheters, disseminated cutaneous diseases and pulmonary and central nervous system diseases that especially affect HIV patients. Identification of the nontuberculous mycobacteria can take several weeks and even then, differentiation of complex members is not possible. Objective. The PCR-restriction analysis (PRA) technique was evaluated as a method for genotypic identification of nontuberculous mycobacteria isolated of clinical samples located in the culture collection of the Instituto Nacional de Salud (National Institute of Health), Bogotá, Colombia. Materials and methods. Seventy clinical isolates of nontuberculous mycobacteria stored in 50% glycerol at -70°C were identified by phenotypic techniques. The genotypic identification was made using the PCR-restriction analysis (PRA) using the restriction enzymes BstEII and HseIII, the restriction products were visualized on gels of agarose to 3%, and the concordance between the methodologies was evaluated. Results. A matching of 100% was obtained in the identification of Mycobacterium terrae, M. szulgai, M. avium, M. chelonae and M. scrofulaceum, the matching between M. fortuitum species, M. abscessus, M. gordonae and M. intracellulare varied from 44 to 89%; there was no concurrence in the identification of species M. flavescens and M. malmoense. Conclusions. PRA provided a fast, inexpensive and accurate alternative for the identification of nontuberculous mycobacteria that permited the differentiation among species of a complex and determining the subtype of each species sample.

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INTRODUCTION: Nontuberculous mycobacteria can be saprophytic, pathogenic or opportunistic. The most common diseases produced by these microorganisms are the post-surgical infections due to anesthetic procedures, infections associated with catheters, disseminated cutaneous diseases and pulmonary and central nervous system diseases that especially affect HIV patients. Identification of the nontuberculous mycobacteria can take several weeks and even then, differentiation of complex members is not possible. OBJECTIVE: The PCR-restriction analysis (PRA) technique was evaluated as a method for genotypic identification of nontuberculous mycobacteria isolated of clinical samples located in the culture collection of the Instituto Nacional de Salud (National Institute of Health), Bogotá, Colombia. MATERIALS AND METHODS: Seventy clinical isolates of nontuberculous mycobacteria stored in 50% glycerol at -70 degrees C were identified by phenotypic techniques. The genotypic identification was made using the PCR-restriction analysis (PRA) using the restriction enzymes BstEII and HseIII, the restriction products were visualized on gels of agarose to 3%, and the concordance between the methodologies was evaluated. RESULTS: A matching of 100% was obtained in the identification of Mycobacterium terrae, M. szulgai, M. avium, M. chelonae and M. scrofulaceum, the matching between M. fortuitum species, M. abscessus, M. gordonae and M. intracellulare varied from 44 to 89%; there was no concurrence in the identification of species M. flavescens and M. malmoense. CONCLUSIONS: PRA provided a fast, inexpensive and accurate alternative for the identification of nontuberculous mycobacteria that permited the differentiation among species of a complex and determining the subtype of each species sample.

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