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Tuberculose laríngea
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Abstract(s)
O presente artigo de revisão pretende sensibilizar os profissionais de saúde, para que equacionem a Tuberculose (TB) laríngea nos seus diagnósticos diferenciais e, assim, possam prevenir o contágio e morbilidade associados ao frequente atraso diagnóstico e terapêutico. A TB laríngea é uma doença infecciosa, causada pelo Mycobacterium tuberculosis, muito rara, mas que tem vindo a aumentar de incidência. As suas características epidemiológicas e clínicas modificaram-se muito ao longo do século XX, graças à implementação dos antibacilares. Deste modo, um vasto número de médicos, hoje em dia, não está devidamente familiarizado com a sua nova forma de apresentação e o nível de sensibilidade para com esta entidade é reduzido. Os fatores de risco para esta doença são semelhantes aos da TB pulmonar. A clínica atual assenta, sobretudo, em alterações locais: disfonia com várias semanas de evolução e lesões laríngeas inespecíficas e variáveis na laringoscopia. O diagnóstico é, muitas vezes, difícil e requer um elevado grau de suspeição. O erro diagnóstico mais comum deve-se à semelhança clínica e endoscópica entre a TB laríngea e o carcinoma da laringe. Alguns exames complementares de diagnóstico, caso positivos, são uma boa ferramenta para direcionar o diagnóstico, nomeadamente testes imunológicos, radiografia simples de tórax e análises laboratoriais à expetoração. Um resultado negativo destes exames não exclui o diagnóstico. O diagnóstico é confirmado através da avaliação histopatológica das lesões laríngeas, sendo fundamental a biópsia das mesmas por via laringoscópica. O relatório anatomopatológico permite, ainda, excluir etiologia maligna. O tratamento é idêntico ao da TB pulmonar com habitual remissão completa do quadro, após terapêutica com antibacilares. Mais estudos e com maiores amostras devem ser feitos, de modo a caracterizar, mais fidedignamente, o padrão clínico desta entidade.
This review article intends to raise healthcare professionals’ awareness, so they can more easily consider laryngeal tuberculosis (TB) in their differential diagnoses and, thus, avoiding the contagion and morbidity associated with frequently delayed diagnosis and treatment. Laryngeal TB is a very rare infectious disease caused by Mycobacterium tuberculosis, but with an increasing incidence. Its epidemiological and clinical characteristics have changed throughout the 20th century, thanks to the implementation of the antituberculous therapy. In this way, a large number of doctors, today, is not properly familiarized with its new form of presentation and their level of sensitivity for this entity is reduced. The risk factors for this disease are similar to those of pulmonary TB. The current clinic is based mainly on local changes: dysphonia with several weeks of evolution and nonspecific and variable laryngeal lesions on laryngoscopy. Diagnosis is often difficult and requires a high degree of suspicion. The most common diagnostic error occurs due to the clinical and endoscopic similarities between laryngeal TB and laryngeal carcinoma. Some complementary diagnostic tests, if positive, are useful tools to better guide the diagnosis, especially immunological tests, simple chest radiography and laboratory analysis of sputum. A negative result on these tests does not exclude the diagnosis. Since the diagnosis is confirmed through the histopathological evaluation of the laryngeal lesions, biopsy of these lesions is mandatory during laryngoscopy. The anatomopathological report also allows the exclusion of malignant aetiology. The treatment is identical to that of pulmonary TB, generally with complete remission, after antituberculous therapy. Further and larger studies are needed, in order to better characterize the clinical pattern of this entity.
This review article intends to raise healthcare professionals’ awareness, so they can more easily consider laryngeal tuberculosis (TB) in their differential diagnoses and, thus, avoiding the contagion and morbidity associated with frequently delayed diagnosis and treatment. Laryngeal TB is a very rare infectious disease caused by Mycobacterium tuberculosis, but with an increasing incidence. Its epidemiological and clinical characteristics have changed throughout the 20th century, thanks to the implementation of the antituberculous therapy. In this way, a large number of doctors, today, is not properly familiarized with its new form of presentation and their level of sensitivity for this entity is reduced. The risk factors for this disease are similar to those of pulmonary TB. The current clinic is based mainly on local changes: dysphonia with several weeks of evolution and nonspecific and variable laryngeal lesions on laryngoscopy. Diagnosis is often difficult and requires a high degree of suspicion. The most common diagnostic error occurs due to the clinical and endoscopic similarities between laryngeal TB and laryngeal carcinoma. Some complementary diagnostic tests, if positive, are useful tools to better guide the diagnosis, especially immunological tests, simple chest radiography and laboratory analysis of sputum. A negative result on these tests does not exclude the diagnosis. Since the diagnosis is confirmed through the histopathological evaluation of the laryngeal lesions, biopsy of these lesions is mandatory during laryngoscopy. The anatomopathological report also allows the exclusion of malignant aetiology. The treatment is identical to that of pulmonary TB, generally with complete remission, after antituberculous therapy. Further and larger studies are needed, in order to better characterize the clinical pattern of this entity.
Description
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
Keywords
Tuberculose laríngea Disfonia Abordagem diagnóstica Biópsia Otorrinolaringologia