tailieunhanh - Hospital Control and Multidrug-Resistant Pulmonary Tuberculosis in Female Patients, Lima, Peru

Events following entry of bacilli: Phagocytosis of by alveolar macrophages is the firstevent in the host-pathogen relationship that decidesoutcome of infection. Within 2 to 6 wk of infection,cell-mediated immunity (CMI) develops, and thereis an influx of lymphocytes and activatedmacrophages into the lesion resulting in granulomaformation. The exponential growth of the bacilli ischecked and dead macrophages form a caseum. Thebacilli are contained in the caseous centers of thegranuloma. The bacilli may remain forever withinthe granuloma, get re-activated later or may getdischarged into the airways after enormous increasein number, necrosis of bronchi and represents the last-ditch defense mechanismof the host,. | Research Hospital Control and Multidrug-Resistant Pulmonary Tuberculosis in Female Patients Lima Peru Field F. Willingham ti Tracy L. Schmitz i Macbeth Contreras i Sheela E. Kalangi i Aldo M. Vivar i Luz Caviedes Eduardo Schiantarelli Paola Maurtua Neumann ĩí Caryn Bern ii Robert H. Gilman ti and the Working Group on TB in Peru1 University of Maryland School of Medicine Baltimore Maryland USA Johns Hopkins University School of Hygiene and Public Health Baltimore Maryland USA ịProyectos en Informatica Salud Medicina y Agricultura PRISMA Lima Peru Tufts University School of Medicine Boston Massachusetts USA University of Arizona School of Public Health Phoenix Arizona USA Universidad Peruana Cayetano Heredia Lima Peru Arzobispo Loayza Hospital Lima Peru ịịCenters for Disease Control and Prevention Atlanta Georgia USA. We examined the prevalence of tuberculosis TB rate of multidrug-resistant MDR TB and characteristics of TB on a female general medicine ward in Peru. Of 250 patients 40 16 were positive by sputum culture and 27 11 by smear and 8 3 had MDRTB. Thirteen 33 of 40 culture-positive patients had not been suspected of having TB on admission. Six 46 of 13 patients whose TB was unsuspected on admission had MDRTB compared with 2 7 of 27 suspected cases p . Five 63 of 8 MDRTB patients were smear positive and therefore highly infective. In developing countries hospital control a simple method of reducing the spread of MDRTB is neglected. From 1990 to 2000 tuberculosis TB caused an estimated 88 million new infections and 30 million deaths worldwide 1 . In Peru tuberculosis is highly endemic a shantytown in Lima had an annual incidence of pulmonary tuberculosis of 364 per 100 000 population 2 . Despite the implementation of community-based treatment and control programs in Peru 3 management of the disease has been complicated by high rates of multidrug-resistant MDR TB. In one study in Peru of all reported cases were resistant to isoniazid and rifampin 4 . .

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