Mycobacterium tuberculosis is the bacterium that as a single agent is known to cause the infection with the most morbidity and mortality around the world. It is known to cause pulmonary infection in immunocompetent patient, but its dissemination outside the lungs has been linked to a high degree of cellular immunosuppression as seen in the advance stages of human immunodeficiency virus infection, and after chemotherapy. Despite extensive research, screening, education, and continuous efforts to try to eradicate and control the infection, tuberculosis is still one of the most prevalent infections throughout the world. Even the cases of extra pulmonary dissemination are seen to have increased. Extra pulmonary tuberculous dissemination has a very variable presentation that depends on the organ involved. The diagnosis is difficult and many times a long time passes between diagnosis and initial presentation. In this chapter, we will review how tuberculosis infection presents when the bacilli invades any tissue outside the pulmonary parenchyma, what the literature recommends for the proper work up and diagnosis, and general treatment for major organ system infection.
There is a significant heterogeneity in the current clinical practice. The main barriers identified to achieve current recommendations were lack of institutional policies, awareness of current guideline, formal training in management of OSA, and access to a sleep specialist.
History hallmarks different out brakes events during the last century. Being caught in the in the middle of the catastrophic COVID-19 pandemic, that initiated in 2019 makes possible to forget other causalities. Tuberculosis makes the case. The pathogen has been present more than hundredth years. Relevance rest in worldwide prevalence, pathogen spread, treatment resistance and the need for eradication. Drug treatment resistance is considered as one of the criteria to prioritize a country in the World Health Organization’s intention to eradicate tuberculosis infection in the world. For decades in Latin America, including the Caribbean, there have been a persistent high rate of drug resistance with an overall prevalence to one or more drug rounds 13.0%. Approximately 30% of previously treated cases have a multidrug resistance. In this chapter, we intend to review the epidemiology of resistant tuberculosis, and the causes of resistance associated to the community of people in the Latin American and the Caribbean. We intend to describe the genetic response of Mycobacterium tuberculosis from its migratory journey throughout decades from areas of Europa and Asia to Latin America, its genetic transformation secondary to inadequate drug exposure and the characteristics of the infected host, and how a change in the healthcare system and tuberculosis control strategies access are needed to change the surge of multidrug resistance tuberculosis.
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