Información del artículo
Abstract
The susceptibility to infection, the pathogenesis and the clinical manifestations of tuberculosis (TB) depend on the immunological status of the host. Immunological status is largely determined by age and comorbidities, but is also affected by other less well known factors. In Spain, most incidental cases of TB arise from the reactivation of remotely acquired latent infections and are favored by the aging of the population and the use of aggressive immunosuppressive therapies. The diagnosis and management of TB in these circumstances is often challenging. On the one hand, the atypical presentation with extrapulmonary involvement may delay diagnosis, and on the other, the toxicity and interactions of the antituberculous drugs frequently make treatment difficult. Immigration from resource-poor, high incidence TB countries, where the social and economic conditions are often suboptimal, adds a new challenge to the control of the disease in Spain. This chapter summarizes our current knowledge of epidemiological, clinical and treatment aspects of TB in particularly susceptible populations.
Keywords:
Tuberculosis
Immunosupression
Comorbidity
Immigration
Resumen
La susceptibilidad a la infección, patogenia y manifestaciones clínicas de la tuberculosis (TB) dependen de la situación inmunológica del hospedador, lo cual, a su vez, está determinado en gran medida por la edad y las comorbilidades, pero también por otros factores no bien conocidos. La mayor parte de casos nuevos de TB en España tiene su origen en la reactivación de una infección remota latente, y es favorecida por el envejecimiento y las terapias inmunosupresoras agresivas. A menudo, el diagnóstico y tratamiento de la TB en este contexto representan un reto. Las presentaciones atípicas, con afectación extrapulmonar, pueden retrasar el diagnóstico, pero además la toxicidad y las interacciones de los fármacos antituberculosos, a menudo, dificultan el tratamiento. La inmigración de países en vías de desarrollo y alta incidencia de TB, frecuentemente con condiciones sociales y económicas desfavorables, añade un nuevo reto al control de la enfermedad en España. En este capítulo se resume el conocimiento actual acerca de los aspectos epidemiológicos, clínicos y terapéuticos de la TB en poblaciones especialmente susceptibles.
Palabras clave:
Tuberculosis
Inmunosupresión
Comorbilidad
Inmigración
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