Genetic polymorphisms (FTO rs9939609 and TMEM18 rs6548238), adipokines (leptin and adiponectin) and adiposity in children and adolescents with asthma.

OBJECTIVE: To describe independent factors related to the interaction of FTO rs9939609, TMEM18 rs6548238, leptin, and adiponectin in children/adolescents with asthma, under the influence of obesity. METHODS: The authors performed a cross-sectional study with 57 children/adolescents, ages 8-19 years, at a tertiary hospital, from 2017 to 2018. Participants were classified by nutritional status, performed spirometry with a bronchodilator test and completed an asthma questionnaire, higher scores indicated more asthma symptoms. Two asthma groups were formed: Group 1(G1)-normal-weight; Group 2(G2)-overweight/obese. Serum was collected for adipokines (n = 32) and genetic polymorphisms (n = 53) dosages. RESULTS: Age and body mass index (BMI) correlated directly in normal-weight (p = 0.009) and obese participants (p = 0.004). Girls reported more asthma complaints (p = 0.044). Participants with negative bronchodilator responses presented lower BMI (14.55-17.16) than responders (19.4-26.84) (p = 0.049). Leptin dosages are related directly to BMI (5,34-40 ng/ml in obese × 0,54-42 ng/ml in nonobese) (p = 0.003). Levels were high in girls (4.78-17.55 µg/ml) (p = 0.029) and low in nonobese boys (0.54-6.92 µg/ml) (p = 0.006). In obese, low leptin levels (< 10 ng/ml) were found in small airway dysfunction carriers (p = 0.025); elevated adiponectin (> 5 µg/ml) correlated with FEV1/FVC > 80 % (p = 0.035) and positive bronchodilator tests (8.84-13 µg/ml) (p = 0.039); and FTO A allele correlated with low adiponectin 0-8.84 µg/ml (p = 0.021) and low FEV1/FVC (46 %-88 %) (p = 0.023). CONCLUSION: BMI correlated directly with age and leptin levels. Obese participants presented high serum levels of leptin and FTO A allele correlated with low FEV1/FVC. Larger cohorts are necessary for better elucidation of the role of adipokines and polymorphisms in the pathophysiology of asthma and obesity.

Unfavorable Outcomes in Tuberculosis: Multidimensional Factors among Adolescents in Rio de Janeiro, Brazil.

Since 2018, adolescents have been included as a target group for tuberculosis (TB) surveillance by the WHO. However, they are considered a neglected population, as there are considerable gaps in information about them. We aimed to analyze the risk factors for unfavorable TB treatment outcomes among adolescents in Rio de Janeiro, a Brazilian city with a high burden of TB. This is a retrospective study of adolescents (10-18 years) with TB notified in Rio de Janeiro, from four national database systems, covering 2014-2016. "Extreme vulnerability" was defined as adolescents who presented one of the following characteristics: homelessness, incarceration, tobacco use, illicit drug use, or alcohol abuse. Logistic regression analysis was used to identify factors associated with favorable (cure/completed treatment) and unfavorable outcomes (lost to follow-up, death, and treatment failure). A total of 725 adolescents with TB were included: 610 (84.1%) were cured, 94 (13%) were lost to follow-up, six (0.8%) died because of TB, 13 (1.8%) died because of other causes, and two (0.3%) failed treatment. Unfavorable outcomes were associated with retreatment (adjusted odds ratio [aOR]: 4.51; 95% CI: 2.23-9.17), TB-HIV coinfection (aOR: 10.15; 95% CI: 4.15-25.34), extreme vulnerability (aOR: 3.01; 95% CI: 1.70-5.33), and living in the two districts (3.1 and 3.3) with worst conditions: large population and rates of homicides and shantytowns (aOR: 4.11; 95% CI: 1.79-9.46 and aOR: 5.35; 95% CI: 2.20-13.03, respectively). Our findings underscore the need for strengthening early identification and interventions for adolescents at high risk of unfavorable outcomes, especially those living in shantytowns.

A comparison of tuberculosis diagnostic systems in a retrospective cohort of HIV-infected children in Rio de Janeiro, Brazil.

OBJECTIVES: The diagnosis of pediatric tuberculosis (TB) presents many challenges, and is further complicated in HIV-infected patients. While many diagnostic systems have been proposed, there is no pediatric TB diagnosis gold standard. The outcomes of four TB diagnostic systems in HIV-infected children were compared in this study. METHODS: A retrospective cohort study was conducted at a TB/HIV reference hospital in Rio de Janeiro. HIV-infected pediatric patients evaluated for TB from 1998 to 2010 were reassessed using four diagnostic systems: Kenneth Jones, 1969; Tidjani, 1986; Ben Marais, 2006; Brazilian Ministry of Health, 2010. Results were compared to standardized diagnoses made by an expert panel of physicians. RESULTS: Of the 121 patients in the study cohort, the expert panel diagnosed 64 as TB and 57 as not TB cases. The Tidjani system showed the highest diagnostic accuracy, with and without the inclusion of microbiological data. The Tidjani and Kenneth Jones systems produced fewer false-positives, and the Ben Marais and Ministry of Health fewer false-negatives. Across systems, there was little agreement between TB diagnoses. CONCLUSIONS: In HIV-infected pediatric patients, the Ben Marais and Ministry of Health systems are useful for TB diagnostic screening, whereas the Tidjani and Kenneth Jones systems are best used in a reference center setting.

[Tuberculosis contact tracing among children and adolescents, Brazil]. / Controle de crianças e adolescentes comunicantes de tuberculosos, Rio de Janeiro, RJ.

OBJECTIVE: To detect tuberculosis (TB) disease or infection among contacts of pulmonary TB patients. METHODS: Cross-sectional study in a Primary Healthcare unit in Rio de Janeiro (Brazil) with 184 child and adolescent contacts of pulmonary TB patients between March 1995 and March 1997. Subjects underwent clinical evaluation, chest radiographs, and tuberculin skin tests (TST); sputum smears were performed whenever possible. TB cases found were submitted to treatment and infected patients to chemoprophylaxis. Tuberculin converters, who tested positive for TST eight weeks after an initial negative result, received chemoprophylaxis. RESULTS: The sample included 98 boys and 86 girls; age ranged from 0 to 15 years; 26.9% were malnourished according to the Gomez criteria. Concerning the source of infection, 170 cases (92.4%) had household contacts, of which 66.5% were the child's parents. BCG vaccination was verified in 98.4% of children, and 14.7% of children had been revaccinated. Strong TST reactions were observed in 110/181 children. Seventy-six children (41.3%) were considered as infected by M. tuberculosis and 25 cases (13.6%) of TB were detected, of which seven (28%) were asymptomatic. There was greater occurrence of disease when the contact lived with more than one source of infection (p=0.02). CONCLUSIONS: The detection of TB disease and infection was high in the studied population. Contact control must be emphasized, for it allows for the diagnosis of TB in children who are still asymptomatic, in addition to identifying infected subjects who may profit from chemoprophylaxis.

Tuberculin skin test and ELISPOT/T. SPOT.TB in children and adolescents with juvenile idiopathic arthritis.

BACKGROUND: There are controversies regarding the accuracy of the tuberculin skin test (TST) and methods based on the production of interferon gamma by sensitized T cells for the diagnosis of latent tuberculosis infection (LTBI) in pediatrics and immunosuppressed patients. Our objectives are to study TST and ELISPOT/T. SPOT.TB in the diagnosis of LTBI in children and adolescents with JIA undergoing methotrexate, the correlation between both and the sensitivity and specificity of T. SPOT.TB. METHODS: This is an observational prospective longitudinal study in which children and adolescents with JIA undergoing methotrexate therapy were assessed for clinical and epidemiological data for LTBI, in addition to performing TST and T. SPOT.TB at baseline and after 3 and 12months. RESULTS: There were 24 patients. The prevalence of LTBI at inclusion was 20.8%, the incidence after initiation of immunosuppressions 26.3% and the prevalence at the end of the study 41.6%. Epidemiological history positive for TB showed a relative risk of 2.0 for the development of LTBI. Only 2 patients had positive T. SPOT.TB but only in one it was useful for detecting early LTBI. T. SPOT.TB presented a sensitivity of 10%, specificity of 92.8%, and low correlation with TST. No patient developed TB disease at a mean follow-up of 47months. CONCLUSIONS: We found a high prevalence of ILTB that doubled with immunosuppression and that epidemiological history was an important relative risk. T. SPOT.TB showed low sensitivity and high specificity, and no superiority over TST. There was low agreement and little influence of immunosuppression on the results of both tests.

Lethality by pneumonia and factors associated to death.

OBJECTIVE: To describe the case-fatality rate (CFR) and risk factors of death in children with community-acquired acute pneumonia (CAP) in a pediatric university hospital. METHOD: A longitudinal study was developed with prospective data collected from 1996 to 2011. Patients aged 1 month to 12 years were included in the study. Those who left the hospital against medical orders and those transferred to ICU or other units were excluded. Demographic and clinical-etiological characteristics and the initial treatment were studied. Variables associated to death were determined by bivariate and multivariate analysis using logistic regression. RESULTS: A total of 871 patients were selected, of whom 11 were excluded; thus 860 children were included in the study. There were 26 deaths, with a CFR of 3%; in 58.7% of these, penicillin G was the initial treatment. Pneumococcus was the most common pathogen (50.4%). From 1996 to 2000, there were 24 deaths (93%), with a CFR of 5.8% (24/413). From 2001 to 2011, the age group of hospitalized patients was older (p = 0.03), and the number of deaths (p = 0.02) and the percentage of disease severity were lower (p = 0.06). Only disease severity remained associated to death in the multivariate analysis (OR = 3.2; 95%CI: 1.2-8.9; p = 0.02). CONCLUSION: When the 1996-2000 and 2001-2011 periods were compared, a significant reduction in CFR was observed in the latter, as well as a change in the clinical profile of the pediatric inpatients at the institute. These findings may be related to the improvement in the socio-economical status of the population. Penicillin use did not influence CFR.

The challenge of pediatric tuberculosis in face of new diagnostic techniques.

OBJECTIVES: To present an updated review concerning new assays for diagnosing tuberculosis based on in vitro interferon-gamma production by host T cells, and compare them with tuberculin skin test. METHODS: A literature review was carried out based on Medline and LILACS databases (2000-2008) searching for the following keywords: tuberculosis, interferon-gamma, quantiFERON, ELISPOT and T-SPOT.TB. RESULTS: These new assays proved to have, in general, equal or superior sensitivity and specificity than the tuberculin skin test not only in adults but also in children and immunosuppressed patients for the diagnosis of both latent tuberculosis infection or active disease, with some advantages such as less cross-reactivity as a result of previous BCG vaccination, less influence of anergy and better accuracy in small children. In the United States, these assays have been used instead of the tuberculin skin test and, although still very expensive, the World Health Organization will be making its economic viability a priority. CONCLUSIONS: Always having in mind the importance of clinical and epidemiological histories, these new assays based on interferon-gamma release present promising results and should be considered in tuberculosis investigation procedures for all patients, however with a special concern in the risk groups (i.e., children and immunosuppressed patients).

Lethality by pneumonia and factors associated to death / Letalidade por pneumonia e fatores associados ao óbito

OBJECTIVE: To describe the case-fatality rate (CFR) and risk factors of death in children with community-acquired acute pneumonia (CAP) in a pediatric university hospital. METHOD: A longitudinal study was developed with prospective data collected from 1996 to 2011. Patients aged 1 month to 12 years were included in the study. Those who left the hospital against medical orders and those transferred to ICU or other units were excluded. Demographic andclinical-etiological characteristics and the initial treatment were studied. Variables associated to death were determined by bivariate and multivariate analysis using logistic regression. RESULTS: A total of 871 patients were selected, of whom 11 were excluded; thus 860 children were included in the study. There were 26 deaths, with a CFR of 3%; in 58.7% of these, penicillin G was the initial treatment. Pneumococcus was the most common pathogen (50.4%). From 1996 to 2000, there were 24 deaths (93%), with a CFR of 5.8% (24/413). From 2001 to 2011, the age group of hospitalized patients was older (p = 0.03), and the number of deaths (p = 0.02) and the percentage of disease severity were lower (p = 0.06). Only disease severity remained associated to death in the multivariate analysis (OR = 3.2; 95%CI: 1.2-8.9; p = 0.02). CONCLUSION: When the 1996-2000 and 2001-2011 periods were compared, a significant reduction in CFR was observed in the latter, as well as a change in the clinical profile of the pediatric in patients at the institute. These findings may be related to the improvement in the socio-economical status of the population. Penicillin use did not influence CFR. .

OBJETIVO: Descrever a taxa de letalidade (TL) e os fatores de risco de óbito em crianças com pneumonia grave adquirida na comunidade (CAP) em um hospital universitário pediátrico. MÉTODO: Foi desenvolvido um estudo longitudinal com dados prospectivos coletados de 1996 a2011. Foram incluídos no estudo pacientes com idade entre 1 mês e 12 anos de idade. Foram excluídos aqueles que deixaram o hospital desconsiderando as recomendações médicas e aqueles transferidos para UTI ou outras unidades. Foram estudadas as características demográficas, clínicas e etiológicas e o tratamento inicial. As variáveis associadas a óbito foram determinadas por análise bivariada e multivariada utilizando regressão logística. RESULTADOS: Foi selecionado um total de 871 pacientes, dos quais 11 foram excluídos; assim, foram incluídas no estudo 860 crianças. Houve 26 óbitos, com uma TL de 3%; em 58,7% desses, penicilina G foi o tratamento inicial. Pneumococo foi o patógeno mais comum (50,4%). De 1996 a 2000, houve 24 óbitos (93%), com uma TL de 5,8% (24/413). De 2001 a 2011, a faixa etária de pacientes internados foi mais velha (p = 0,03) e o número de óbitos (p = 0,02) e o percentual de gravidade das doenças foram menores (p = 0,06). Apenas a gravidade das doenças continuou associada a óbito na análise multivariada (RC = 3,2; IC de 95%: 1,2-8,9; p = 0,02). CONCLUSÃO: Quando os períodos de 1996-2000 e 2001-2011 foram comparados, foi observada uma redução significativa na TL no último período, bem como uma alteração no perfil clínico dos pacientes hospitalizados no instituto. Esses achados podem estar relacionados à melhora na situação socioeconômica da população. O uso de penicilina não influenciou a TL. .

Penicillin-resistant pneumococcus and risk of treatment failure in pneumonia.

OBJECTIVE: To determine whether the presence of in vitro penicillin-resistant Streptococcus pneumoniae increases the risk of clinical failure in children hospitalised with severe pneumonia and treated with penicillin/ampicillin. DESIGN: Multicentre, prospective, observational study. SETTING: 12 tertiary-care centres in three countries in Latin America. PATIENTS: 240 children aged 3-59 months, hospitalised with severe pneumonia and known in vitro susceptibility of S pneumoniae. INTERVENTION: Patients were treated with intravenous penicillin/ampicillin after collection of blood and, when possible, pleural fluid for culture. The minimal inhibitory concentration (MIC) test was used to determine penicillin susceptibility of the pneumococcal strains isolated. Children were continuously monitored until discharge. MAIN OUTCOME MEASURES: The primary outcome was treatment failure (using clinical criteria). RESULTS: Overall treatment failure was 21%. After allowing for different potential confounders, there was no evidence of association between treatment failure and in vitro resistance of S pneumoniae to penicillin according to the Clinical Laboratory Standards Institute (CLSI)/National Committee for Clinical Laboratory Standards (NCCLS) interpretative standards ((adj)RR = 1.03; 95%CI: 0.49-1.90 for resistant S pneumoniae). CONCLUSIONS: Intravenous penicillin/ampicillin remains the drug of choice for treating penicillin-resistant pneumococcal pneumonia in areas where the MIC does not exceed 2 microg/ml.

Diagnóstico da tuberculose na infância e na adolescência / Diagnosis of Tuberculosis among Children and Adolescents

Esta é uma revisão não sistemática da literatura sobre aspectos do diagnóstico da tuberculose pulmonar e extrapulmonar na infância e na adolescência. Para o diagnóstico da tuberculose pulmonar, deve-se separar os pacientes em duas faixas etárias: em crianças (<10 anos), emprega-se na prática o sistema de pontuação recomendado pelas normas do Ministério da Saúde; em adolescentes (≥10 anos), recomenda-se a realização de baciloscopia de escarro, além de dados clinico-radiológicos. Os aspectos radiológico sem ambos os grupos são diferentes e podem auxiliar no diagnóstico. As formas de tuberculose extrapulmonar necessitam, em geral, de diferentes recursos para o diagnóstico, como punções, biópsias, exames histopatológicos e outros testes, além de prova tuberculínica e radiografias. Discute-se também o diagnóstico de tuberculose em situações especiais: nos infectados por HIV, há a necessidade deamplo diagnóstico diferencial com outras pneumopatias (que podem mascarar ou estar associadas à tuberculose); e no período neonatal, necessita-se de alto grau de suspeição, principalmente quando a mãe está com tuberculose à época do parto. Na suspeita de tuberculose multirresistente, buscar associar a doença da criança com a da fonte de contágio

This was a non-systematic review of the literature on the diagnosis of pulmonary and extrapulmonary tuberculosis in children and adolescents. For the diagnosis of pulmonary tuberculosis, patients should be separated by age group: in children (< 10 years of age), the scoring system recommended by the Brazilian National Ministry of Health should be used; in adolescents (≥ 10 years of age), sputum smear microscopy is recommended in addition to clinic-radiologic features.. Radiological indings difer between the groups and can be useful in making the diagnosis. In general, diagnosing extrapulmonary tuberculosis requires diferent resources for the diagnosis, such as taps and biopsies, as well as histopathological examinations and tests, such as tuberculin skin tests and X-rays. We also discuss the diagnosis of tuberculosis in special settings: in HIV-infected patients, the diferential diagnosis should be broad, including other lung diseases (which can mask or be associated with tuberculosis); in neonates, a high level of suspicion is required, especially if the mother has tuberculosis at delivery. In suspected cases of multidrug-resistant tuberculosis, attempts should be made to identify the source of infection

[Tuberculin test in the diagnosis of childhood tuberculosis: Analysis of quantitative and qualitative features] / Prova tuberculínica no diagnóstico da tuberculose em crianças: Análise dos aspectos quantitativo e qualitativo.

OBJECTIVE: To evaluate the role of the tuberculin test in the diagnosis of tuberculosis in children. METHODS: Test diagnosis study; Tuberculin test with PPD Rt 23 (2 UT) was performed in 158 children, distributed in 2 groups: 101 no tuberculous, BCG vaccinated children and 57 tuberculous ones (diagnosis by clinical-radiological and epidemiological features). The interpretation of the tuberculin test was made by quantitative analysis (Mantoux test) and qualitative analysis (Koch and Listeria phenomena). RESULTS: Using cutoff = 10mm in Mantoux test, we found sensitivity of 85.9% and specificity of 86.1%. The qualitative analysis (Koch phenomenon), showed sensitivity of 77.2% and specificity of 98%. CONCLUSION: The qualitative analysis of the tuberculin test was useful in the diagnosis of tuberculosis in children, associated to the Mantoux test interpretation.

[Antituberculosis chemoprophylaxis in a public hospital - study of 100 children] / Estudo de 100 casos de quimioprofilaxia.

OBJECTIVE: To evaluate recommendations for antituberculosis chemoprophylaxis in children according to the guidelines of the National Tuberculosis Control Program, and in special situations, as very young children, BCG vaccinated children with positive tuberculin skin test and recent or current exposure to infected cases. METHODS: A retrospective cross-section study has been made of 100 children who underwent chemoprophylaxis at a public hospital in Rio de Janeiro. Variables analyzed were sex, age, BCG vaccination, nutritional status, tuberculin skin test, recent tuberculosis converters, infection source for tuberculosis, adherence to prevention, monotherapy failure and isoniazid side effects. RESULTS: The case history was made up of 57 males and 43 females, 62% were younger than five years of age, there was reference to previous BCG vaccination in 92%, malnutrition in 28% and recent tuberculosis converters in 9% of the cases. Parents represented 60% of infection source known, there was adherence to prevention in 73%, monotherapy failure in 1% and isoniazid side effects in 1% of the cases. CONCLUSIONS: It has been concluded that 15% followed the Health Department guidelines thoroughly, which included the 9 cases of recent tuberculosis converters; 85% of the recommended chemoprophylaxis were due to the coverage of high-risk groups to develop the disease.

[Antituberculosis chemoprophylaxis in children] / Quimioprofilaxia da tuberculose na infância.

OBJECTIVE: To present a review of the indications of antituberculosis chemoprophylaxis in childhood, based on Brazilian official rules of the National Program for the Control of Tuberculosis of the Ministry of Health and the new tendencies pointed by the Brazilian Consensus on Tuberculosis. METHODS: Articles on the theme were selected from Medline and publications of the Ministry of Health. RESULTS: The chemoprophylaxis is an effective and safe form of prevention of tuberculosis in childhood. It does not conflict with the BCG vaccination program, because it aims at avoiding that tuberculosis infection develops into disease. CONCLUSIONS: International proposals an recent national tendencies recommend the expansion of chemoprophylaxis indications in childhood. Thus measures that expand its use in our country are needed.

Profilaxis con isoniazida en niños y jóvenes con infección latente por Mycobacterium tuberculosis / Prophylaxis with isoniazid in children and youths with latent Mycobacterium tuberculosis infection

Se presenta una revisión no sistemática sobre el control de los contactos de tuberculosis (TB) y la terapia preventiva con isoniazida (TPI) para niños y adolescentes, basada en la literatura oficial de entidades internacionales, artículos relevantes y pautas de países latinoamericanos. La Organización Mundial dela Salud recomienda las dos estrategias presentadas como muy importantes en la prevención de la TB en áreas endémicas. El artículo destaca las indicaciones de control de contactos de TB y enfatiza la interpretación del test tuberculínico en algunos de los países de Latinoamérica. Las barreras actuales y las perspectivas de la TPI frente a la TB multirresistente también se analizan. El tratamiento de la infección latente por tuberculosis (ILTB) se hace en la mayoría de los países con isoniazida (H), de ahí la denominación de quimioprofilaxis o TPI. Hay consenso en la comunidad científica en relación con que los niños, adolescentes y adultos jóvenes con test de tuberculina positivo constituyen un grupo prioritario para la TPI. Las principales acciones de control de la TB acorde con las estrategias a nivel de las unidades básicas son: registrar el tratamiento de los casos de ILTB, mantener actualizado el sistema de información, verificar el stock de medicamentos y realizar el seguimiento mensual de las consultas y eventuales reacciones adversas a la isoniazida...

O desafio da tuberculose na faixa etária pediátrica frente a novas técnicas diagnósticas: [revisão] / The challenge of pediatric tuberculosis in face of new diagnostic techniques: [review]

OBJETIVOS: Apresentar uma revisão atualizada sobre os novos métodos para o diagnóstico da tuberculose baseados na produção in vitro de interferon-gama (IFN-γ) por células T dos pacientes sob investigação, comparando-os com a tradicional prova tuberculínica. FONTES DOS DADOS: Revisão de literatura utilizando os bancos de dados MEDLINE e LILACS (2000-2008) utilizando as palavras-chave tuberculose, interferon-gama, quantiFERON, ELISPOT e T-SPOT.TB. SÍNTESE DOS DADOS: Esses novos testes mostraram-se, de um modo geral, tão ou mais sensíveis e específicos que a prova tuberculínica, tanto em adultos como em crianças e imunossuprimidos, para o diagnóstico da infecção latente e da doença ativa, apresentando vantagens como a menor interferência da vacinação prévia pelo BCG, menor influência de estados anérgicos e melhor acurácia em crianças menores. Nos Estados Unidos, já estão sendo utilizados em substituição à prova tuberculínica, e apesar dos custos ainda elevados, a Organização Mundial de Saúde vai priorizar a sua viabilidade econômica. CONCLUSÕES: Sempre levando em conta a importância da história clínica e epidemiológica, os novos testes baseados na produção de IFN-γ apresentam resultados promissores e deverão ser considerados na investigação de tuberculose em qualquer paciente, mas especialmente nos grupos de risco, como as crianças e os imunossuprimidos.

OBJECTIVES: To present an updated review concerning new assays for diagnosing tuberculosis based on in vitro interferon-gamma production by host T cells, and compare them with tuberculin skin test. SOURCES: A literature review was carried out based on Medline and LILACS databases (2000-2008) searching for the following keywords: tuberculosis, interferon-gamma, quantiFERON, ELISPOT and T-SPOT.TB. SUMMARY OF THE FINDINGS: These new assays proved to have, in general, equal or superior sensitivity and specificity than the tuberculin skin test not only in adults but also in children and immunosuppressed patients for the diagnosis of both latent tuberculosis infection or active disease, with some advantages such as less cross-reactivity as a result of previous BCG vaccination, less influence of anergy and better accuracy in small children. In the United States, these assays have been used instead of the tuberculin skin test and, although still very expensive, the World Health Organization will be making its economic viability a priority. CONCLUSIONS: Always having in mind the importance of clinical and epidemiological histories, these new assays based on interferon-gamma release present promising results and should be considered in tuberculosis investigation procedures for all patients, however with a special concern in the risk groups (i.e., children and immunosuppressed patients).

[Recurrent pneumonia in a pediatric pulmonology outpatient unit: concept and prevalence] / Pneumonias de repetição em ambulatório de pneumologia pediátrica: conceito e prevalência.

OBJECTIVE: This study aimed to determine the prevalence of recurrent episodes of pneumonia in patients referred to the pulmonology outpatient unit at "Serviço de Pneumologia Pediatrica" of the Instituto de Puericultura e Pediatria Martagão Gesteira/UFRJ and to review the recurrent concept in accordance to medical references currently available. METHODS: Data were obtained by reviewing all documented initial appointments from January 1st, 1995 up to April 30th, 1997. RESULTS: One hundred and one visits out of six hundred and thirty eight appointments with suspected diagnosis of recurrent episodes of pneumonia were studied. In less than 40% of this population the initial diagnosis was in accordance with the criteria usually required in our unit to perform such diagnosis. CONCLUSIONS: We concluded that the recurrent nature of pneumonia episodes should be further clarified and discussed with pediatricians because it is up to them to refer such patients to specialists. Furthermore we emphasize the importance of normal chest roentgenograms taken between acute episodes so that "recurrent pneumonia" can be adequately characterized. This may help identify those patients who need subsequent evaluation by specialists regarding complementary diagnosis.

Controle de crianças e adolescentes comunicantes de tuberculosos, Rio de Janeiro, RJ / Tuberculosis contact tracing among children and adolescents, Brazil

OBJETIVO: Detectar doença ou infecção tuberculosa em comunicantes de pacientes com tuberculose pulmonar. MÉTODOS: Estudo descritivo, transversal, realizado em centro municipal de saúde da cidade do Rio de Janeiro, RJ, com 184 crianças e adolescentes, de 0 a 15 anos de idade, comunicantes de tuberculosos, no período de março de 1995 a março de 1997. Os comunicantes foram submetidos à avaliação clínico-radiológica, teste tuberculínico e baciloscopia de escarro, quando possível. Os doentes foram submetidos à quimioterapia anti-tuberculose e os infectados à quimioprofilaxia. Foi pesquisada a viragem tuberculínica nos comunicantes não reatores ao teste tuberculínico por meio de um segundo teste realizado após oito semanas e, quando presente, a quimioprofilaxia era instituída. RESULTADOS: A casuística foi composta por 98 meninos e 86 meninas, com idades variando entre 0 e 15 anos. Segundo o critério de Gomez, 26,9 por cento das crianças eram desnutridas. Em relação à fonte de infecção, 170 (92,4 por cento) foram intradomiciliares, das quais 66,5 por cento eram os pais. A vacinação BCG foi constatada em 98,4 por cento crianças e 14,7 por cento haviam sido revacinadas. O teste tuberculínico foi reator forte em 110/181 crianças. Consideraram-se infectadas pelo M. tuberculosis 76 (41,3 por cento) crianças e detectaram-se 25 (13,6 por cento) casos de tuberculose pulmonar, dos quais sete (28 por cento) estavam assintomáticos. Houve maior adoecimento quando o comunicante convivia com mais de uma fonte de infecção (p=0,02). CONCLUSÕES: A detecção de doença e de infecção tuberculosa foi elevada na população estudada. O controle de comunicantes deve ser enfatizado, pois permite o diagnóstico de tuberculose em crianças ainda assintomáticas e identifica infectados, os quais podem se beneficiar da quimioprofilaxia.