RESUMO
Background: The autoimmune/inflammatory syndrome induced by adjuvants (ASIA) comprises four entities, including the postvaccination phenomenon, which appears after being exposed to adjuvants in vaccines that increase the immune response. There is limited information about autoimmune endocrine diseases and ASIA after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. Patient's Findings: Two female health care workers received a SARS-CoV-2 vaccine, and three days later developed clinical manifestations of thyroid hyperactivity, with increased thyroid hormone levels on thyroid function tests, suppressed thyroid-stimulating hormone, and elevated antithyroid antibodies. Summary: Vaccines have been shown to trigger an immune response that leads to a broad spectrum of autoimmune diseases, including autoimmune thyroid disease. Our patients met the diagnostic criteria for ASIA; they were exposed to an adjuvant (vaccine), and they developed clinical manifestations of thyroid hyperfunction within a few days, with the appearance of antithyroid antibodies, despite being healthy before vaccination. Conclusion: Graves' disease can occur after SARS-CoV-2 vaccination.
Assuntos
Adjuvantes Imunológicos/efeitos adversos , Vacinas contra COVID-19/efeitos adversos , Doença de Graves/induzido quimicamente , Hormônios Tireóideos/sangue , Vacinação/efeitos adversos , Adulto , Autoanticorpos/sangue , Vacina BNT162 , Biomarcadores/sangue , Vacinas contra COVID-19/química , Composição de Medicamentos , Feminino , Doença de Graves/sangue , Doença de Graves/diagnóstico , Doença de Graves/imunologia , Humanos , Fatores de RiscoRESUMO
Background: Tuberculosis is a public health problem, extrapulmonary presentations have increased, it is difficult to diagnose because of the low bacillary load. Objective: To identify risk factors and to evaluate the efficiency of diagnostic methods in pleural, meningeal, peritoneal and pericardial tuberculosis. Methods: Prospective study of cases and controls. A multiple conditional logistic regression model was used to identify risk factors. Biopsy was performed and 7 mL of fluid was extracted from the affected site, Löwestein-Jensen and MGITI960 culture, Ziehl-Neelsen staining, adenosine deaminase and endpoint PCR directed to the insertion sequence 1S6110 for M. tuberculosis were performed. Results: 116 patients were included, in 58 M. tuberculosis was confirmed by positive culture (meningeal Tb 34 cases, pleural 14, peritoneal 8, pericardial 2 cases) and 58 serositis of non-tuberculous etiology. Being a carrier of HIV and living with people infected with tuberculosis were the main risk factors OR = 3.6 and OR = 6.8. The staining had sensitivity of 25.9%, PCR of 65.5% and adenosine deaminase with 82.8% Conclusions: Conventional diagnostic methods had low efficacy, adenosine deaminase and molecular biology techniques are the most useful, in our environment these tests should be performed immediately in patients with risk factors and suspected serositis of tuberculous origin.
Introducción: la tuberculosis es un problema de salud pública, las presentaciones extrapulmonares han aumentado, siendo de difícil diagnóstico por su baja carga bacilar. Objetivo: identificar los factores de riesgo y evaluar la eficacia de los métodos diagnósticos en la tuberculosis pleural, meníngea, peritoneal y pericárdica. Métodos: estudio prospectivo de casos y controles. Se empleó un modelo de regresión logística condicional múltiple para identificar factores de riesgo. Se realizó biopsia y se extrajeron siete mL de líquido presente del sitio afectado, se realizó cultivo Löwestein-Jensen y MGITI960, tinción Ziehl-Neelsen, adenosina deaminasa y PCR en punto final dirigida a la secuencia de inserción 1S6110 para M. tuberculosis. Resultados: se incluyeron 116 pacientes, en 58 se confirmó M. tuberculosis por cultivo positivo (Tb meníngea 34 casos, pleural 14, peritoneal 8, pericárdica 2 casos) y 58 serositis de etiología no tuberculosa. Ser portador de VIH y convivir con personas infectadas con tuberculosis fueron los mayores factores de riesgo OR = 3.6 y OR = 6.8. La tinción tuvo sensibilidad de 25.9%, PCR de 65.5% y adenosina deaminasa con 82.8%. Conclusiones: los métodos diagnósticos convencionales tuvieron baja eficacia, la adenosina deaminasa y las técnicas de biología molecular son los de mayor utilidad, en nuestro medio estos estudios deben realizarse de inmediato en pacientes con factores de riesgo y sospecha de serositis de origen tuberculoso.