Pesquisa de tuberculose do trato genitourinário em pacientes com antecedente de Tuberculose

Abstract

Statistical data from the Ministry of Health shows that, from the different ways of Extrapulmonary Tuberculosis, the Genitourinary Tract has the fifth place in terms of incidence in Brazil (BRASIL SINAN 2003). In 1996, Wyner (1996) related that 1/6 (one sixth) of the Pulmonary Tuberculosis patients present concomitantly tuberculosis injuries in other organs or tissues and, 20% of them are developed in the urogenitary tract , being the kidneys the most affected organs by this sort of disease. As a consequence of kidney injury, 5 to 10% of patients present arterial hypertension, 25% present unilateral reduction of renal function, and in some cases, total kidney loss. In the state of Amazonas, the coefficient of incidence of all forms of disease, has been the 1st or 2nd in Brazil, for the last 10 years, however, it is still unknown if there is concomitancy of Pulmonary Tuberculosis and Urogenitary Tuberculosis, since these patients are diagnosed for its pulmonary form and never examined for the kidney disease concomitancy. In this sense, the present work aims at verify if patients with Pulmonary Tuberculosis background, diagnosed in 2006, above 60 years old, or, that had disease relapse in that year, independently of age, present radiological alterations compatible to Urinary Tuberculosis, seeking to propose changes on the diagnose approach and follow up of the disease. The expected casualties for the disease study, was of 296 patients, corresponding to 16, 13% of the total patients notified in 2006. The patients were selected in the data bank of Tuberculosis Programme Control of the state of Amazonas. After selection, correspondence (letter) was sent containing the research objective and requesting presentation at the Health Unit for orientation. To all patients who had turned up and through a Term of Free and Clarified Permission (TCLE), according to norms and approval by the Ethics Committee for Research in Human Beings (CEP), detailed information was given about the research and the activities developed towards the realization of the objective. In those patients who accepted taking part and being examined, an anamnese was carried out directed to the signs and clinical pulmonary and urological symptoms as well as physical exam. From those that remained in the study after the criteria of inclusion and exclusion, was requested an EAS, abdomen tomography, micro bacterial exams and PCR for M. Tuberculosis for the region IS6110. In a total of 254 possible patients, 35 participated effectively in the study. 29 patients did the EAS, the abdomen tomography and molecular and micro bacterial exams. The EAS didn t show hematuria in the exams (35), the abdomen tomography didn t emphasize suggestive alterations of genitourinary tuberculosis. The micro bacterial exams were negative for the research of BK, a female patient presented positive culture for M. intracellular. This patient did treatment for pulmonary tuberculosis 6 times. The PCR was positive for Genitourinary Tuberculosis in a male patient.