<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2312-3893</journal-id>
<journal-title><![CDATA[Revista Virtual de la Sociedad Paraguaya de Medicina Interna]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. virtual Soc. Parag. Med. Int.]]></abbrev-journal-title>
<issn>2312-3893</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Paraguaya de Medicina Interna]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2312-38932026000100301</article-id>
<article-id pub-id-type="doi">10.18004/rvspmi/2312-3893/2026.e13142601</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Coinfección pulmonar cavitada por enterobacterias productoras de carbapenemasa y Mycobacterium tuberculosis en huésped inmunocompetente]]></article-title>
<article-title xml:lang="en"><![CDATA[Cavitary pulmonary coinfection caused by carbapenemase-producing Enterobacteriaceae and Mycobacterium tuberculosis in an immunocompetent host]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Montiel Alfonso]]></surname>
<given-names><![CDATA[Miguel Angel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Alfonso Viveros]]></surname>
<given-names><![CDATA[Karina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Chaves Ocampos]]></surname>
<given-names><![CDATA[Jimena María José]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad Católica Nuestra Señora de la Asunción Hospital Central del Instituto de Previsión Social Departamento de Medicina Interna]]></institution>
<addr-line><![CDATA[Asunción ]]></addr-line>
<country>Paraguay</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,niversidad Católica Nuestra Señora de la Asunción Hospital Central del Instituto de Previsión Social Servicio de Medicina Familiar]]></institution>
<addr-line><![CDATA[Asunción ]]></addr-line>
<country>Paraguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2026</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2026</year>
</pub-date>
<volume>13</volume>
<numero>1</numero>
<fpage>301</fpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_arttext&amp;pid=S2312-38932026000100301&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_abstract&amp;pid=S2312-38932026000100301&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_pdf&amp;pid=S2312-38932026000100301&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN Las infecciones pulmonares cavitadas suelen asociarse a patógenos anaerobios en pacientes con factores predisponentes. La coinfección por enterobacterias multirresistentes y Mycobacterium tuberculosis en huéspedes inmunocompetentes es excepcional y plantea desafíos diagnósticos y terapéuticos relevantes. Se presenta caso de varón de 77 años, sin inmunosupresión conocida, con cuadro respiratorio subagudo y hallazgos imagenológicos de cavitación pulmonar. Se aislaron secuencialmente Pseudomonas sp., Stenotrophomonas maltophilia y Escherichia coli productora de carbapenemasa. El estudio molecular por GeneXpert confirmó coinfección por M. tuberculosis. El paciente respondió favorablemente a tratamiento antibiótico dirigido seguido de esquema antituberculoso. La coexistencia de patógenos multirresistentes y tuberculosis en un huésped inmunocompetente sugiere alteraciones locales de la inmunidad pulmonar. La sospecha clínica ampliada y el uso de herramientas moleculares fueron claves para el diagnóstico oportuno y el abordaje terapéutico individualizado. Este caso destaca la importancia de considerar coinfecciones en cuadros pulmonares cavitados persistentes, incluso en pacientes sin inmunosupresión, y de integrar estudios microbiológicos avanzados en contextos de alta resistencia bacteriana.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT Cavitated lung infections are usually associated with anaerobic pathogens in patients with predisposing factors. Coinfection with multidrug-resistant Enterobacteriaceae and Mycobacterium tuberculosis in immunocompetent hosts is rare and poses significant diagnostic and therapeutic challenges. We present the case of a 77-year-old man with no known immunosuppression, presenting with subacute respiratory symptoms and imaging findings of pulmonary cavitation. Pseudomonas sp., Stenotrophomonas maltophilia, and carbapenemase-producing Escherichia coli were sequentially isolated. Molecular testing by GeneXpert confirmed coinfection with M. tuberculosis. The patient responded favorably to targeted antibiotic treatment followed by an antituberculosis regimen. The coexistence of multidrug-resistant pathogens and tuberculosis in an immunocompetent host suggests local alterations in pulmonary immunity. Expanded clinical suspicion and the use of molecular tools were key to timely diagnosis and individualized therapeutic approach. This case highlights the importance of considering coinfections in persistent cavitary pulmonary conditions, even in patients without immunosuppression, and of integrating advanced microbiological studies in contexts of high bacterial resistance.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[tuberculosis pulmonar]]></kwd>
<kwd lng="es"><![CDATA[Enterobacteriaceae]]></kwd>
<kwd lng="es"><![CDATA[coinfección]]></kwd>
<kwd lng="es"><![CDATA[técnicas de diagnóstico molecular]]></kwd>
<kwd lng="es"><![CDATA[sistema inmunológico]]></kwd>
<kwd lng="en"><![CDATA[pulmonary tuberculosis]]></kwd>
<kwd lng="en"><![CDATA[Enterobacteriaceae]]></kwd>
<kwd lng="en"><![CDATA[coinfection]]></kwd>
<kwd lng="en"><![CDATA[molecular diagnostic techniques]]></kwd>
<kwd lng="en"><![CDATA[immune system]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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