RESUMO
Introduction. Multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) is difficult to control, has high morbidity and mortality, and demands priority public health intervention. In Colombia, MDR/RR-TB has been becoming more widespread annually. Before the COVID-19 pandemic, over an 8-year period, the number of cases of multidrug-resistant tuberculosis in Colombia was close to a thousand cases. Timely identification of the different risk factors for MDR/RR-TB will contribute fundamentally to the systematic management. Objective. To determine which risk factors were associated with the presentation of MDR in Colombia between 2013 and 2018. Materials and methods. A retrospective case-control study was carried out, for which the data from the routine surveillance of MDR/events in the country were used. Results. The cases of multidrug-resistant tuberculosis were mainly in young people, Afrodescendants, and males. Of the clinical conditions, comorbidities such as malnutrition, diabetes, and HIV, presence of at least one factor, such as drug dependence, taking immunosuppressive medications, belonging to the black race, afro, and living in an area of high disease burden were risk factors. Conclusion. In addition to the diagnosis and timely provision of MDR-TB treatment, it is necessary that public health programs at the local level pay special attention to patients with the identified risk factors.
Introducción. La tuberculosis multirresistente-resistente a la rifampicina (TB-MDR/RR) es difícil de controlar, tiene una alta morbilidad y mortalidad y exige una intervención prioritaria en salud pública. En Colombia, la TB-MDR/RR se ha ido extendiendo cada año. Antes de la pandemia de COVID-19, en un periodo de 8 años, el número de casos de TB-MDR/RR en Colombia se acercaba a los mil. La identificación oportuna de los diferentes factores de riesgo de TB-MDR/RR contribuirá de manera fundamental al manejo sistemático de la enfermedad. Objetivo. Determinar los factores de riesgo que se asociaron a la presentación de la TB- MDR/RR en Colombia entre 2013 y 2018. Materiales y métodos. Se realizó un estudio retrospectivo de casos y controles, para el cual se utilizaron los datos de la vigilancia rutinaria de eventos de TB MDR/RR en el país. Resultados. Los casos de TB MDR se presentaron principalmente en jóvenes, afrodescendientes y varones. De las condiciones clínicas, fueron factores de riesgo las comorbilidades como la desnutrición, la diabetes y el VIH, y la presencia de, al menos, un factor como la farmacodependencia, el consumo de medicamentos inmunosupresores, el ser de raza negra o afro y el vivir en una zona del país de alta carga de tuberculosis. Conclusiones. Además del diagnóstico y la provisión oportuna del tratamiento de la TB MDR, es necesario que los programas de salud pública a nivel local presten especial atención a los pacientes con los factores de riesgo identificados.
Assuntos
Tuberculose , Estudos de Casos e Controles , Comorbidade , Estudos Retrospectivos , Fatores de Risco , Resistência a Múltiplos Medicamentos , População NegraRESUMO
INTRODUCTION: Multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) is difficult to control, has high morbidity and mortality, and demands priority public health intervention. In Colombia, MDR/RR-TB has been becoming more widespread annually. Before the COVID-19 pandemic, over an 8-year period, the number of cases of multidrug-resistant tuberculosis in Colombia was close to a thousand cases. Timely identification of the different risk factors for MDR/RR-TB will contribute fundamentally to the systematic management. OBJECTIVE: To determine which risk factors were associated with the presentation of MDR in Colombia between 2013 and 2018. MATERIALS AND METHODS: A retrospective case-control study was carried out, for which the data from the routine surveillance of MDR/events in the country were used. RESULTS: The cases of multidrug-resistant tuberculosis were mainly in young people, Afrodescendants, and males. Of the clinical conditions, comorbidities such as malnutrition, diabetes, and HIV, presence of at least one factor, such as drug dependence, taking immunosuppressive medications, belonging to the black race, afro, and living in an area of high disease burden were risk factors. CONCLUSION: In addition to the diagnosis and timely provision of MDR-TB treatment, it is necessary that public health programs at the local level pay special attention to patients with the identified risk factors.
Introducción: La tuberculosis multirresistente-resistente a la rifampicina (TB-MDR/RR) es difícil de controlar, tiene una alta morbilidad y mortalidad y exige una intervención prioritaria en salud pública. En Colombia, la TB-MDR/RR se ha ido extendiendo cada año. Antes de la pandemia de COVID-19, en un periodo de 8 años, el número de casos de TB-MDR/RR en Colombia se acercaba a los mil. La identificación oportuna de los diferentes factores de riesgo de TB-MDR/RR contribuirá de manera fundamental al manejo sistemático de la enfermedad. Objetivo: Determinar los factores de riesgo que se asociaron a la presentación de la TBMDR/RR en Colombia entre 2013 y 2018. Materiales y métodos: Se realizó un estudio retrospectivo de casos y controles, para el cual se utilizaron los datos de la vigilancia rutinaria de eventos de TB MDR/RR en el país. Resultados: Los casos de TB MDR se presentaron principalmente en jóvenes, afrodescendientes y varones. De las condiciones clínicas, fueron factores de riesgo las comorbilidades como la desnutrición, la diabetes y el VIH, y la presencia de, al menos, un factor como la farmacodependencia, el consumo de medicamentos inmunosupresores, el ser de raza negra o afro y el vivir en una zona del país de alta carga de tuberculosis. Conclusiones: Además del diagnóstico y la provisión oportuna del tratamiento de la TB MDR, es necesario que los programas de salud pública a nivel local presten especial atención a los pacientes con los factores de riesgo identificados.
Assuntos
Pandemias , Tuberculose Resistente a Múltiplos Medicamentos , Masculino , Humanos , Adolescente , Estudos de Casos e Controles , Estudos Retrospectivos , Colômbia/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologiaRESUMO
The infiltration of foreign materials not approved for medical purposes or of modeling substances used in soft tissue to modify the anatomical appearance for aesthetic purposes represents a serious health problem. These procedures lead to the development of delayed complications, including infections. The objective of this study was to characterize infections in patients with adverse reactions to the use of modeling substances in Cali, Colombia. A cross-sectional and descriptive study was used to determine the frequency of bacterial and fungal infections associated with complications from and adverse reactions to the use of modeling substances in 113 patients. We identified microorganisms in 22 patients and a frequency of 68.1% monomicrobial infections and 31.8% polymicrobial infections. The microorganisms identified in our study included Bacillus cereus, Mycobacterium fortuitum, and Pseudomonas stutzeri, among other microorganisms. The presence of adverse effects derived from the use of illegal modeling substances has been demonstrated; among these effects, infections occur with high frequency and place the health of the patient at risk and increase problems in health care.
Assuntos
Micoses , Infecções dos Tecidos Moles , Humanos , Colômbia/epidemiologia , Estudos Transversais , Bactérias , Infecções dos Tecidos Moles/epidemiologia , Infecções dos Tecidos Moles/etiologiaRESUMO
Introduction: The desire to improve one's physical appearance through simple and economical methods has resulted in the indiscriminate application of modeling substances. As a result, iatrogenic allogenosis has emerged as an increasingly prevalent disease in Latin America. Objective: To describe the epidemiological characteristics and adverse effects arising from the use of modeling substances in a group of patients from Cali, Colombia. Materials and methods: We conducted a retrospective review of the medical records of patients who consulted for complications arising from the use of modeling substances during a six-year period. Results: A total of 1,322 patients were included of whom 95.5% were women. Patients' ages ranged from 19 to 83 years, with an average of 39 years. The most infiltrated anatomical site showing adverse effects due to modeling substances was the buttocks. The asymmetry and increased volume of the infiltrated site were the most common signs while pain, mood disturbances, and depression or anxiety were the most commonly perceived symptoms. A total of 41.8% of patients ignored what substances they had received, and 28.5% received biopolymers; these procedures were mostly performed by non-qualified personnel. Conclusions: The care of these patients requires multidisciplinary teams to establish treatment alternatives to improve their quality of life. In addition, the regulation of establishments, as well as the surveillance, inspection, and control of the imports and use of these substances should be warranted.
Introducción. El deseo de mejorar la apariencia física mediante métodos sencillos y económicos, ha generado la aplicación indiscriminada de sustancias modelantes y, con ello, el surgimiento de la alogenosis iatrogénica, enfermedad cada vez más prevalente en Latinoamérica. Objetivo. Describir las características epidemiológicas y los efectos adversos de las sustancias modelantes en un grupo de pacientes de Cali, Colombia. Materiales y métodos. Se hizo una revisión retrospectiva de las historias clínicas de los pacientes que acudieron a consulta por complicaciones producidas por sustancias modelantes durante un sexenio. Resultados. Se incluyeron 1.322 pacientes, 95,5 % de ellos mujeres. Las edades oscilaron entre los 19 y los 83 años, con una media de 39 años. El sitio anatómico de infiltración con sustancias modelantes con mayor frecuencia de efectos adversos, fueron los glúteos. La asimetría y el aumento del volumen en el sitio infiltrado fueron los signos más comunes, en tanto que el dolor, las alteraciones del ánimo y la depresión o la ansiedad fueron los síntomas más percibidos. El 33,6 % de los pacientes desconocía la sustancia aplicada y el 28,1 % refirió haberse aplicado biopolímeros. La mayoría de estos procedimientos estuvo a cargo de personal sin la debida formación. Conclusiones. Estos pacientes requieren la atención de equipos multidisciplinarios para establecer alternativas de tratamiento que mejoren su calidad de vida. Además, se necesitan la regulación de los establecimientos, y las medidas de vigilancia, inspección y control en la importación y el uso de estas sustancias.
Assuntos
Técnicas Cosméticas/efeitos adversos , Preenchedores Dérmicos/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Colômbia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
Resumen | Introducción. El deseo de mejorar la apariencia física mediante métodos sencillos y económicos, ha generado la aplicación indiscriminada de sustancias modelantes y, con ello, el surgimiento de la alogenosis iatrogénica, enfermedad cada vez más prevalente en Latinoamérica. Objetivo. Describir las características epidemiológicas y los efectos adversos de las sustancias modelantes en un grupo de pacientes de Cali, Colombia. Materiales y métodos. Se hizo una revisión retrospectiva de las historias clínicas de los pacientes que acudieron a consulta por complicaciones producidas por sustancias modelantes durante un sexenio. Resultados. Se incluyeron 1.322 pacientes, 95,5 % de ellos mujeres. Las edades oscilaron entre los 19 y los 83 años, con una media de 39 años. El sitio anatómico de infiltración con sustancias modelantes con mayor frecuencia de efectos adversos, fueron los glúteos. La asimetría y el aumento del volumen en el sitio infiltrado fueron los signos más comunes, en tanto que el dolor, las alteraciones del ánimo y la depresión o la ansiedad fueron los síntomas más percibidos. El 33,6 % de los pacientes desconocía la sustancia aplicada y el 28,1 % refirió haberse aplicado biopolímeros. La mayoría de estos procedimientos estuvo a cargo de personal sin la debida formación. Conclusiones. Estos pacientes requieren la atención de equipos multidisciplinarios para establecer alternativas de tratamiento que mejoren su calidad de vida. Además, se necesitan la regulación de los establecimientos, y las medidas de vigilancia, inspección y control en la importación y el uso de estas sustancias.
Abstract | Introduction: The desire to improve one's physical appearance through simple and economical methods has resulted in the indiscriminate application of modeling substances. As a result, iatrogenic allogenosis has emerged as an increasingly prevalent disease in Latin America. Objective: To describe the epidemiological characteristics and adverse effects arising from the use of modeling substances in a group of patients from Cali, Colombia. Materials and methods: We conducted a retrospective review of the medical records of patients who consulted for complications arising from the use of modeling substances during a six-year period. Results: A total of 1,322 patients were included of whom 95.5% were women. Patients' ages ranged from 19 to 83 years, with an average of 39 years. The most infiltrated anatomical site showing adverse effects due to modeling substances was the buttocks. The asymmetry and increased volume of the infiltrated site were the most common signs while pain, mood disturbances, and depression or anxiety were the most commonly perceived symptoms. A total of 41.8% of patients ignored what substances they had received, and 28.5% received biopolymers; these procedures were mostly performed by non-qualified personnel. Conclusions: The care of these patients requires multidisciplinary teams to establish treatment alternatives to improve their quality of life. In addition, the regulation of establishments, as well as the surveillance, inspection, and control of the imports and use of these substances should be warranted.
Assuntos
Biopolímeros , Doença Iatrogênica , Procedimentos de Cirurgia Plástica , Estética , Contraindicações de ProcedimentosRESUMO
Resumen Definir la autoría en artículos y documentos científicos es un proceso esencial y complejo, que encierra subjetividad y depende de convenios establecidos en general de palabra, lo que puede ocasionar conflictos entre los investigadores. Se han publicado algunas guías con lineamientos generales para mejorar esta práctica, sin embargo son pocos los procedimientos cuantitativos para precisar autoría y coautoría de un escrito científico, y no hay consenso para definir los autores y el orden en que deben aparecer. Con este artículo intentamos rescatar algunos criterios y consideraciones para determinar el listado de autores en textos científicos.
Abstract Defining authorship in scientific articles and documents is an essential and complex process that involves subjectivity and depends on largely informal agreements, which may cause conflict among researchers. Although some guidelines have been published to improve this practice, there are few quantitative procedures in the literature to specify authorship and co-authorship of a scientific paper, and there is no consensus on the definition of authors and the order in which they should be listed. With this article we try to review a few criteria and considerations for determining author lists in scientific articles.
Resumo Definir a autoria de artigos e documentos científicos é um processo essencial e complexo, que envolve subjetividade e depende de acordos quase sempre informais, o que pode causar conflitos entre pesquisadores. Algumas diretrizes foram publicadas para aperfeiçoar esta prática, mas ainda são poucos os procedimentos quantitativos para estabelecer a autoria e a coautoria de textos científicos, e não há consenso para definir os autores e a ordem em que devem aparecer. Com este artigo, visamos recapitular alguns critérios e considerações para determinar a ordem de autoria em artigos científicos.
Assuntos
Humanos , Masculino , Feminino , Pesquisadores , Autoria , Ética em Pesquisa , Publicações Científicas e TécnicasRESUMO
Las micobacterias de rápido crecimiento son microorganismos pertenecientes a las micobacterias no tuberculosas que tienen amplia distribución ambiental. Aunque usualmente no son patógenas para los humanos, en condiciones desfavorables, pueden causar enfermedad en la población general o en huéspedes inmunocomprometidos, por lo cual se consideran oportunistas. Mycobacterium preregrinum es una micobacteria de rápido crecimiento perteneciente al complejo fortuitum que ha sido reportado como responsable de casos de micobacteriosis en humanos.Se presenta el caso de una micobacteriosis por M. peregrinum de tipo III, el primero reportado en Colombia, en una paciente de 17 años de edad con una endocarditis de una válvula aórtica protésica, implantada inicialmente por estenosis subaórtica congénita con insuficiencia y, posteriormente, por estenosis aórtica relacionada con la válvula inicialmente implantada. Un año después del segundo implante, presentó sintomas respiratorios y pérdida de peso sugestivos de tuberculosis pulmonar.Las coloraciones de Ziehl-Neelsen del esputo fueron positivas aunque la radiografía de tórax no mostró compromiso del parénquima. En el ecocardiograma se encontró una vegetación en la válvula aórtica. En las muestras de sangre y de esputo, se identificó M. peregrinum de tipo III por cultivo, pruebas bioquímicas y análisis molecular del gen hsp65 por PCR-restriction pattern analysis (PRA). La paciente se sometió a cambio de válvula y recibió tratamiento combinado contra la micobacteria, con rápida recuperación. Las muestras tomadas del sistema respiratorio y sanguíneo se tornaron negativas para micobacterias.
Rapidly growing mycobacteria are non-tuberculous mycobacteria amply present in the environment. Although they are not usually pathogenic for humans, they are opportunistic in that they can cause disease in people with disadvantageous conditions or who are immunocompromised. Mycobacterium peregrinum, an opportunistic, rapidly growing mycobacteria, belongs to the M. fortuitum group and has been reported as responsible for human cases of mycobacteriosis. A case of M. peregrinum type III is herein reported as the first in Colombia. It presented as a disseminated disease involving a prosthetic aortic valve (endocarditis) in a seventeen-year-old girl with a well-established diagnosis of prosthetic aortic valve endocarditis who was referred for a surgical replacement. Due to a congenital heart disease (subaortic stenosis with valve insufficiency), she had two previous aortic valve implantation surgeries. One year after the second implantation, the patient presented with respiratory symptoms and weight lost indicative of lung tuberculosis. A chest X-ray did not show parenchymal compromise but several Ziehl-Neelsen stains were positive. An echocardiography showed a vegetation on the prosthetic aortic valve. In blood and sputum samples, M. peregrinum type III was identified through culture, biochemical tests and hsp65 gene molecular analysis (PRA). The patient underwent a valve replacement and received a multidrug antimycobacterial treatment. Progressive recovery ensued and further samples from respiratory tract and blood were negative for mycobacteria.
Assuntos
Humanos , Endocardite , Mycobacterium , Infecções por MycobacteriumRESUMO
Rapidly growing mycobacteria are non-tuberculous mycobacteria amply present in the environment. Although they are not usually pathogenic for humans, they are opportunistic in that they can cause disease in people with disadvantageous conditions or who are immunocompromised. Mycobacterium peregrinum, an opportunistic, rapidly growing mycobacteria, belongs to the M. fortuitum group and has been reported as responsible for human cases of mycobacteriosis. A case of M. peregrinum type III is herein reported as the first in Colombia. It presented as a disseminated disease involving a prosthetic aortic valve (endocarditis) in a seventeen-year-old girl with a well-established diagnosis of prosthetic aortic valve endocarditis who was referred for a surgical replacement. Due to a congenital heart disease (subaortic stenosis with valve insufficiency), she had two previous aortic valve implantation surgeries. One year after the second implantation, the patient presented with respiratory symptoms and weight lost indicative of lung tuberculosis. A chest X-ray did not show parenchymal compromise but several Ziehl-Neelsen stains were positive. An echocardiography showed a vegetation on the prosthetic aortic valve. In blood and sputum samples, M. peregrinum type III was identified through culture, biochemical tests and hsp65 gene molecular analysis (PRA). The patient underwent a valve replacement and received a multidrug antimycobacterial treatment. Progressive recovery ensued and further samples from respiratory tract and blood were negative for mycobacteria.
Assuntos
Endocardite/microbiologia , Endocardite/cirurgia , Próteses Valvulares Cardíacas/microbiologia , Infecções por Mycobacterium/diagnóstico , Infecções por Mycobacterium/cirurgia , Mycobacterium/patogenicidade , Adolescente , Antibacterianos/uso terapêutico , Valva Aórtica/cirurgia , Colômbia , Endocardite/tratamento farmacológico , Feminino , Cardiopatias Congênitas/cirurgia , Implante de Prótese de Valva Cardíaca , Humanos , Infecções por Mycobacterium/tratamento farmacológicoRESUMO
Introducción. Las micobacterias no tuberculosas pueden ser saprofitas, patógenas u oportunistas; las enfermedades más comunes producidas por estos microorganismos son las infecciones posquirúrgicas, principalmente por procedimiento estéticos, infecciones asociadas con catéteres, enfermedades cutáneas diseminadas, enfermedades pulmonares y del sistema nervioso central que afectan especialmente a pacientes infectados con el virus de la inmunodeficiencia humana. La identificación fenotípica de las micobacterias no tuberculosas incluye pruebas microbiológicas y bioquímicas, las cuales pueden tomar varias semanas y algunas veces no logran diferenciar entre los miembros de un complejo. Objetivo. El objetivo fue evaluar la metodología de reacción en cadena de la polimerasaanálisis de restricción, como método de identificación genotípica de micobacterias no tuberculosas aisladas de muestras clínicas que pertenecen a la colección del Instituto Nacional de Salud. Materiales y métodos. Se estudiaron 70 aislamientos clínicos de micobacterias no tuberculosas, criopreservados en glicerol al 50 por ciento e identificados mediante metodologías fenotípicas. La identificación genotípica se realizó por reacción en cadena de la polimerasa-análisis de restricción y se evaluó la concordancia entre las metodologías. Resultados. Se obtuvo una concordancia del 100 por ciento en la identificación de Mycobacterium terrae, M. szulgai, M. avium, M. chelonae y M. scrofulaceum, en las especies M. fortuitum, M. abscessus M. gordonae y M. intracellulare varió de 44 por ciento a 89 por ciento; no se obtuvo concordancia en la identificación de las especies M. flavescens y M. malmoense. Conclusiones. El análisis de restricción es una alternativa para la identificación de especies de micobacterias no tuberculosas, rápida, económica y segura para la identificación, que permite la diferenciación entre especies de un complejo y la determinación del subtipo de cada especie.
Introduction. Nontuberculous mycobacteria can be saprophytic, pathogenic or opportunistic. The most common diseases produced by these microorganisms are the post-surgical infections due to anesthetic procedures, infections associated with catheters, disseminated cutaneous diseases and pulmonary and central nervous system diseases that especially affect HIV patients. Identification of the nontuberculous mycobacteria can take several weeks and even then, differentiation of complex members is not possible. Objective. The PCR-restriction analysis (PRA) technique was evaluated as a method for genotypic identification of nontuberculous mycobacteria isolated of clinical samples located in the culture collection of the Instituto Nacional de Salud (National Institute of Health), Bogotá, Colombia. Materials and methods. Seventy clinical isolates of nontuberculous mycobacteria stored in 50% glycerol at -70°C were identified by phenotypic techniques. The genotypic identification was made using the PCR-restriction analysis (PRA) using the restriction enzymes BstEII and HseIII, the restriction products were visualized on gels of agarose to 3%, and the concordance between the methodologies was evaluated. Results. A matching of 100% was obtained in the identification of Mycobacterium terrae, M. szulgai, M. avium, M. chelonae and M. scrofulaceum, the matching between M. fortuitum species, M. abscessus, M. gordonae and M. intracellulare varied from 44 to 89%; there was no concurrence in the identification of species M. flavescens and M. malmoense. Conclusions. PRA provided a fast, inexpensive and accurate alternative for the identification of nontuberculous mycobacteria that permited the differentiation among species of a complex and determining the subtype of each species sample.
Assuntos
Infecções por Mycobacterium não Tuberculosas , Técnicas de Diagnóstico Molecular , Infecções Oportunistas , Reação em Cadeia da Polimerase , Saúde PúblicaRESUMO
INTRODUCTION: Nontuberculous mycobacteria can be saprophytic, pathogenic or opportunistic. The most common diseases produced by these microorganisms are the post-surgical infections due to anesthetic procedures, infections associated with catheters, disseminated cutaneous diseases and pulmonary and central nervous system diseases that especially affect HIV patients. Identification of the nontuberculous mycobacteria can take several weeks and even then, differentiation of complex members is not possible. OBJECTIVE: The PCR-restriction analysis (PRA) technique was evaluated as a method for genotypic identification of nontuberculous mycobacteria isolated of clinical samples located in the culture collection of the Instituto Nacional de Salud (National Institute of Health), Bogotá, Colombia. MATERIALS AND METHODS: Seventy clinical isolates of nontuberculous mycobacteria stored in 50% glycerol at -70 degrees C were identified by phenotypic techniques. The genotypic identification was made using the PCR-restriction analysis (PRA) using the restriction enzymes BstEII and HseIII, the restriction products were visualized on gels of agarose to 3%, and the concordance between the methodologies was evaluated. RESULTS: A matching of 100% was obtained in the identification of Mycobacterium terrae, M. szulgai, M. avium, M. chelonae and M. scrofulaceum, the matching between M. fortuitum species, M. abscessus, M. gordonae and M. intracellulare varied from 44 to 89%; there was no concurrence in the identification of species M. flavescens and M. malmoense. CONCLUSIONS: PRA provided a fast, inexpensive and accurate alternative for the identification of nontuberculous mycobacteria that permited the differentiation among species of a complex and determining the subtype of each species sample.
Assuntos
Mycobacterium/genética , Reação em Cadeia da Polimerase/métodos , Técnicas de Tipagem Bacteriana , Criança , Genótipo , Humanos , Mycobacterium/classificação , Infecções por Mycobacterium/microbiologia , Polimorfismo de Fragmento de RestriçãoRESUMO
OBJECTIVE: The present work evaluated a multi-antigen printing immunoassay (MAPIA) for the serological diagnosis of tuberculosis. MATERIALS AND METHODS: Sera were obtained from 66 patients with tuberculosis, verified clinically and bacteriologically and from 47 healthy individuals (control group). Sample sera were used for detection of antibodies against 3 enriched mixtures of proteins and 5 unique recombinant antigens. The antigens were presented in a solid matrix. Sensitivity, specificity and predictive values were evaluated and confirmed by a logistic regression analysis. A prevalence value was calculated and used for the selection of the best antigenic combination. RESULTS: The sensitivity and specificity values of individual antigens varied between 5-83% and 9-100%. The enriched mixtures values were more accurate than those obtained with the recombinant antigens. Combinations of several antigens improved the sensitivity values up to the 81% level. In most cases, specificity values of 57% or less were obtained. CONCLUSIONS: These results suggested that the multiantigenic test can be a useful screening tool, to be used in conjunction with the more definitive diagnostic tests.
Assuntos
Antígenos de Bactérias/imunologia , Mycobacterium tuberculosis/imunologia , Tuberculose/diagnóstico , Anticorpos Antibacterianos/sangue , Anticorpos Antibacterianos/imunologia , Antígenos de Bactérias/sangue , Ensaio de Imunoadsorção Enzimática , Humanos , Sensibilidade e Especificidade , Testes Sorológicos/métodos , Tuberculose/sangue , Tuberculose/imunologiaRESUMO
Introducción. La heterogeneidad en el patrón de reconocimiento antigénico observado en los enfermos infectados con Mycobacterium tuberculosis hace evidente la necesidad de contar con una técnica rápida y accesible para el diagnóstico de la enfermedad. La disponibilidad de pruebas que empleen diferentes antígenos podría ser de utilidad para aumentar la sensibilidad de la detección.Objetivo. Evaluar el uso de una prueba multiantigénica (Mapia) de fácil manejo y evaluación visual en el diagnóstico serológico de la tuberculosis. Metodología. Se estudiaron 66 sueros de pacientes con enfermedad tuberculosa comprobada y 47 sueros de individuos no tuberculosos, y se detectó la presencia de anticuerpos para 8 antígenos: 3 mezclas enriquecidas en antígenos y 5 antígenos recombinantes, incluidos en una matriz sólida cuya lectura se realizó cualitativamente. Los antígenos fueron evaluados por sus características de sensibilidad, especificidad y valores predictivos, confirmados mediante análisis de regresión logística del cual se obtuvo la razón de prevalencia utilizada para la selección de la combinación antigénica mas adecuada. Resultados. Los valores de sensibilidad y especificidad de los antígenos individuales variaron entre 5 por ciento y 83 por ciento y 9 por ciento y 100 por ciento, respectivamente; los valores de las mezclas enriquecidas fueron mejores que los valores presentados por los antígenos recombinantes. La combinación de varios antígenos mejoró notablemente los valores de sensibilidad hasta 81 por ciento, pero en la mayoría de los casos se obtuvieron valores de especificidad menores al 57 por ciento