Two cases of Chronic Pulmonary Histoplasmosis are reported and other eleven cases, collected from Brazilian literature, are commented. After being clinically cured, one of our patients presented an Aspergillus fungus ball inside a cavitation in the wall of which H. capsulatum was disclosed. Comments are also done on the diagnosis of the mycosis.

Objetivo: Avaliar o desempenho do esquema SHM (estreptomicina, isoniazida e etambutol), na rotina de trabalho de uma unidade ambulatorial de tratamento da tuberculose. Método: Setenta e oito pacientes tuberculosos, cujo tratamento prévio com o esquema RHZ (seis meses de rifampicina, isoniazida e pirazinamida) teve de ser interrompido devido a efeitos adversos, ou que não puderam receber o esquema RHZ por serem de alto risco para hepatotoxicidade a esse esquema, foram tratados ambulatorialmente com o esquema de 12 meses de SHM, de 1986 a 1994, em Porto Alegre, Rio Grande do Sul, Brasil. Resultados: Em três pacientes houve necessidade de troca de esquema por toxicidade (3,8%). Nos 75 restantes observaram-se 58 curas (77,3%), oito abandonos (10,7%), cinco falências (6,7%) e quatro óbitos (5,3%). A taxa teórica de cura, que é o percentual de cura entre os bacilíferos que fizeram tratamento regular, foi de 95,3%. Reações adversas ocorreram em 32 pacientes (41%), sendo as mais freqüentes as manifestações de dano vestibular, em 18 (23,1%). Esses resultados foram comparados com os obtidos no mesmo ambulatório com o esquema de 12 meses de RHM (rifampicina, isoniazida e etambutol) e de seis meses de RHZ. Conclusão: O esquema SHM pode ser recomendado como alternativa para o tratamento da tuberculose quando o esquema RHZ não pode ser indicado.

The involvement of the esophagus in tuberculosis (TB) is extremely rare. This is a case report of an immunocompetent male patient, who presented ganglionary TB reactivation, with the development of extensive esophageal ulcers. The endoscopic approach made the diagnosis possible and there was a total resolution of the symptoms after the treatment.

Objective: To describe the differences in the clinical and radiological presentation of tuberculosis in the presence or absence of HIV infection. Methods: A sample of 231 consecutive adults with active pulmonary tuberculosis admitted to a tuberculosis hospital were studied, assessing HIV infection, AIDS, and associated factors, as well as re-evaluating chest X-rays. Results: There were 113 HIV-positive patients (49%) Comparing the 113 HIV-positive patients (49%) to the 118 HIV-negative patients (51%), the former presented a higher frequency of atypical pulmonary tuberculosis (pulmonary lesions accompanied by intrathoracic lymph node enlargement), hematogenous tuberculosis, and pulmonary tuberculosis accompanied by superficial lymph node enlargement, as well as presenting less pulmonary cavitation. The same was found when HIV-positive patients with AIDS were compared to those without AIDS. There were no differences between the HIV-positive patients without AIDS and the HIV-negative patients. Median CD4 counts were lower in HIV-positive patients with intrathoracic lymph node enlargement and pulmonary lesions than in the HIV-positive patients with pulmonary lesions only (47 vs. tive sputum smear microscopy; having undergone HIV testing; and having undergone simple anteroposterior and lateral chest X-ray.The data were obtained through the re-evaluation of chest X-rays and the review of medical charts. The variables analyzed were as follows: age; gender; alcoholism; use of illicit drugs; corticosteroid use; duration of symptoms; presence of multifocal disease, diabetes mellitus, neoplasias, and opportunistic diseases; results of HIV testing; number of CD4 T lymphocytes; and radiological findings.Sputum smear microscopy was performed using the Ziehl-Neelsen technique. The HIV testing was performed using the ELISA method, and positive results were confirmed by Western blot. The CD4 counts were obtained using flow cytometry. Alcoholism and drug addiction were considered present when they had been registered on the medical chart by the treatment team. Multifocal disease was defined by the presence of superficial lymph node enlargement in patients with pulmonary TB.The chest X-rays were independently evaluated by two radiologists, who had no knowledge of the results of HIV testing, in order to identify the types of TB; the location of the lesions in the lung segments; and the presence of cavitary lesions, hilar or mediastinal lymph node enlargement, and pleural effusion. In case of inconsistency between the evaluations, the chest X-rays were jointly examined and, in the event of the inconsistency persisting, a third radiologist was consulted so that a consensus could be reached. The types of TB were characterized using the following classification: 1) Classic pulmonary TB: pulmonary lesions unaccompanied by hilar or mediastinal lymph node enlargement; 2) Tuberculous pneumonia: homogeneous consolidation with air bronchograms, with or without intrathoracic lymph node enlargement; 3) Hematogenous TB: diffuse pulmonar...

Objective: To describe the outcomes of retreatment in tuberculosis patients receiving the regimen known, in Brazil, as regimen 3 (streptomycin, ethambutol, ethionamide, and pyrazinamide for 3 months + ethambutol and ethionamide for 9 months) after treatment failure with the basic regimen (rifampin, isoniazid, and pyrazinamide for 2 months + rifampin and isoniazid for 4 months). Methods: A descriptive, uncontrolled, historical cohort study involving adult tuberculosis patients treated with regimen 3. We evaluated adverse drug effects, recurrence, treatment outcomes, and associated factors. Results: The study included 229 patients. The overall cure rate was 62%. For the patients who used the medications regularly and those who did not, the cure rate was 88% and 31%, respectively. Adverse events occurred in 95 patients (41.5%), and most of those events were related to the gastrointestinal tract. In the five-year follow-up period, relapse occurred in 17 cases (12.0%). Conclusions: Overall, the outcomes of treatment with regimen 3 were unsatisfactory, in part because this regimen was administered to a selected population of patients at high risk for noncompliance with treatment, as well as because it presents high rates of adverse effects, especially those related to the gastrointestinal tract, which might be caused by ethionamide. However, for those who took the medications regularly, the cure rate was satisfactory. The recurrence rate was higher than that recommended in international consensus guidelines, which might be attributable to the short (12-month) treatment period. We believe that regimen 3, extended to 18 months, represents an option for patients with proven treatment compliance.Keywords: Tuberculosis, pulmonary/therapy; Treatment outcome; Retreatment. ResumoObjetivo: Descrever os desfechos do retratamento de pacientes com tuberculose com o uso do esquema 3 (estreptomicina, etambutol, etionamida e pirazinamida por 3 meses + etambutol e etionamida por 9 meses) devido à falência do tratamento com o esquema básico (rifampicina, isoniazida e pirazinamida por 2 meses + rifampicina e isoniazida por 4 meses). Métodos: Estudo descritivo de coorte histórica, não controlada, com adultos que foram tratados com o esquema 3. Foram avaliados os desfechos desse tratamento, as reações adversas aos fármacos, as recidivas e os fatores associados. Resultados: Foram incluídos no estudo 229 pacientes. A taxa de cura geral foi de 62%. Entre os pacientes que usaram a medicação regularmente e aqueles que a usaram irregularmente, a taxa de cura foi de 88% e 31%, respectivamente. Observaram-se reações adversas em 95 pacientes (41,5%), principalmente digestivas. Ocorreram 17 recidivas (12,0%) nos cinco anos de seguimento. Conclusões: Os desfechos com o uso do esquema 3, em geral, não foram satisfatórios, pois esse esquema foi aplicado em uma população selecionada com alto risco de não adesão ao tratamento e apresenta altas taxas de reações adversas, especialmente as de tipo digestivo, possivelmente causadas pela etionamida....