Tuberculose em adolescentes em duas capitais brasileiras / Tuberculosis among adolescents in two Brazilian State capitals / Tuberculosis en adolescentes de dos capitales brasileñas

Analisamos o perfil clínico-radiológico da tuberculose (TB) em adolescentes de duas capitais brasileiras, segundo a revisão de 2010 das normas do Programa Nacional de Controle da Tuberculose; estudo descritivo, retrospectivo, transversal de casos notificados de TB em Manaus e Salvador, de 1996 a 2003, em dois grupos: 10 a 14 anos e ≥ 15 a 19 anos com estatística descritiva. Havia 1.781 adolescentes [928 (52,1%) do sexo masculino]. A média de idade = 16 anos (mediana = 16; DP = 2,3). Encontramos 1.447 (82,9%) pacientes com TB pulmonar; 179 (10,3%) com TB pleural e 81 (4,6%) com ganglionar periférica. A tosse ocorreu mais no grupo ≥ 15 anos (p < 0,001). A baciloscopia foi positiva em 150 (72,1%) com TB pulmonar no grupo de 10 a 14 anos, e em 870 (84,4%) no grupo de ≥ 15 anos. Havia radiografias de tórax do tipo adulto em 1.088 (98.6%) no grupo de ≥ 15 anos, e em 58 (98.1%) no grupo < 15 anos (p < 0.0001). Houve tendência à maior ocorrência de TB bacteriológica do tipo adulto na medida em que o paciente aumentava de idade.

The study analyzed clinical, laboratory, and radiological characteristics of tuberculosis (TB) among adolescents from two Brazilian State capitals, according to the 2010 Updated Guidelines of the National TB Control Program (NTPC) through a descriptive, retrospective cross-sectional study of reported TB cases from Manaus and Salvador from 1996 to 2003. Patients were divided into two groups: 10 to 14 years and 15 to 19 years of age. Variables were studied through descriptive statistics; 1,781 adolescents were included; 928 (52.1%) were males. Median age was 16 years (SD = 2.3). Pulmonary TB (PTB) occurred in 1,447 patients (82.9%), pleural TB in 179 (10.3%), and peripheral adenopathy in 81 (4.6%). Cough was more frequent in the ≥ 15-year PTB group (p < 0.001). Chest x-rays were classified as: adult-type TB in 1,088 (98.6%) in the ≥-15 year group; 258 (98.1%) in the < 15-year group (p < 0.0001). Adult type bacteriological PTB increased in proportion to age.

Analizamos el perfil clínico-radiológico de la tuberculosis (TB) en adolescentes de dos capitales brasileñas, según la revisión de 2010 de las normas del Programa Nacional de Control de la Tuberculosis, estudio descriptivo, retrospectivo, transversal de casos notificados de TB en Manaus y Salvador, de 1996 a 2003, en dos grupos: 10 a 14 años y ≥ 15 a 19 años con estadística descriptiva. Había 1.781 adolescentes [928 (52,1%) del sexo masculino]. La media de edad = 16 años (mediana = 16; DP = 2,3). Encontramos 1.447 (82,9%) pacientes con TB pulmonar; 179 (10,3%) con TB pleural y 81 (4,6%) con ganglionar periférica. La tos ocurrió más en el grupo ≥ 15 años (p < 0,001). La baciloscopia fue positiva en 150 (72,1%) con TB pulmonar, en el grupo de 10 a 14 años, y en 870 (84,4%) en el grupo de ≥ 15 años. Había radiografías de tórax del tipo adulto en 1.088 (98.6%) en el grupo de ≥ 15 años, y en 58 (98.1%) en el grupo < 15 años (p < 0.0001). Hubo tendencia a una mayor ocurrencia de TB bacteriológica de tipo adulto, a medida que el paciente aumentaba de edad.

Radiologic findings of pulmonary tuberculosis in adolescents

OBJECTIVE: To describe radiologic findings of pulmonary tuberculosis (TB) in adolescents. METHODS: Retrospective, cross-sectional, observational study of 850 patients with TB, aged 10 to 19 years, and notified to the Brazilian Ministry of Health. Data were collected from the TB notification and medical records in the cities of Manaus, Amazonas State, and Salvador, Bahia State, in the 19962003 period. Data are shown in tables and analyzed using the chi-square and Mann-Whitney tests, with a 5 percent significance level. RESULTS: Mean age was 15.6 years; 443 (52.1 percent) patients were males. The most common radiologic lesion was the upper pulmonary lobe infiltrate (53.3 percent), and isolated cavitation was found in 32.4 percent of the patients. Both lungs were affected in 29.2 percent of the patients. The finding of bilateral radiologic lesions was significantly associated with longer disease duration (p = 0.0005). CONCLUSIONS: Pulmonary TB in adolescents has similar characteristics to TB in adults, evidencing the important role played by adolescents in community disease transmission.

Eficácia do sistema de pontuação, preconizado pelo Ministério da Saúde, para o diagnóstico de tuberculose pulmonar em crianças e adolescentes infectados ou não pelo HIV / Efficacy of the scoring system, recommended by the Brazilian National Ministry of Health, for the diagnosis of pulmonary tuberculosis in children and adolescents, regardless of their HIV status

OBJETIVO: Verificar a eficácia do sistema de pontuação, preconizado pelo Ministério da Saúde (MS), para o diagnóstico de TB pulmonar em crianças e adolescentes, infectadas ou não pelo HIV. MÉTODOS: Estudo analítico transversal realizado entre janeiro de 2002 e dezembro de 2006, no qual foram incluídos 239 indivíduos menores de 15 anos. Os pacientes foram divididos em quatro grupos: grupo TB latente (TBL; n = 81); grupo não TB (NTB; n = 41); grupo TB (n = 104); e grupo TB/HIV (n = 13). Foram estudadas as características clínicas, radiológicas e laboratoriais segundo o sistema de pontuação. RESULTADOS: Os relatos de febre, tosse, astenia e emagrecimento há mais de duas semanas foram significativamente maiores no grupo TB (p < 0,0001). No grupo TB, 95,0 por cento dos casos tinham história de contato com indivíduo com TB, sendo que em 86,1 por cento esse contato era intradomiciliar. No grupo TB/HIV, 75,0 por cento dos casos haviam entrado em contato com TB e, em 58,3 por cento, esse contato era intradomiciliar. Nos grupos TB e TB/HIV, respectivamente, 75,0 por cento e 53,9 por cento dos casos apresentaram alterações radiológicas parenquimatosas, enquanto 18,2 por cento e 30,8 por cento apresentaram alterações ganglionares e parenquimatosas. Os resultados da prova tuberculínica não apresentaram diferenças significativas entre os grupos. No grupo TB, 16,3 por cento dos pacientes estavam desnutridos (p < 0,005 vs. o grupo TBL). A pontuação média utilizando o sistema MS foi a seguinte: grupo TBL, 24,2; grupo NTB, 18,5; grupo TB, 45,3; e grupo TB/HIV, 41,5. CONCLUSÕES: Os pacientes dos grupos TB e TB/HIV apresentaram pontuação significativamente maior do que aqueles nos outros grupos. Portanto, esse sistema de pontuação foi válido para o diagnóstico de TB pulmonar nessa população, independentemente do status HIV.

OBJECTIVE: To determine the efficacy of the scoring system, recommended by the Brazilian National Ministry of Health (NMH), for the diagnosis of pulmonary tuberculosis (TB) in children and adolescents, regardless of their HIV status. METHODS: This was a cross-sectional analytical study carried out between January of 2002 and December of 2006, involving 239 individuals less than 15 years of age. The patients were divided into four groups: latent TB (LTB group; n = 81); no-TB (NTB group; n = 41); TB group (n = 104); and TB/HIV group (n = 13). We studied the clinical, radiological and laboratory findings according to the scoring system. RESULTS: Reports of fever, cough, asthenia and weight loss for at least two weeks were significantly higher in the TB group (p < 0.0001). The proportion of cases with a history of any contact and household contact with a TB patient was, respectively, 95.0 percent and 86.1 percent in the TB group, versus 75.0 percent and 58.3 percent in the TB/HIV group. In the TB and TB/HIV groups, respectively, chest X-rays revealed parenchymal alterations in 75.0 percent and 53.9 percent, revealing combined parenchymal/lymph node alterations in 18.2 percent and 30.8 percent. There were no significant differences among the groups regarding the tuberculin skin test results. In the TB group, 16.3 percent of the patients were malnourished (p < 0.005 vs. the LTB group). The mean NMH system scores in the LTB, NTB, TB and TB/HIV groups were, respectively, 24.2, 18.5, 45.3 and 41.5. CONCLUSIONS: The NMH system scores were significantly higher in the TB and TB/HIV groups than in the other two groups. Therefore, this scoring system was valid for the diagnosis of pulmonary TB in this population, regardless of HIV status.

A retrospective evaluation of a score system adopted by the Ministry of Health, Brazil in the diagnosis of pulmonary tuberculosis in childhood: a case control study

Based on a retrospective case-control study we evaluated the score system adopted by the Ministry of Health of Brazil (Ministério da Saúde - MS), to diagnose pulmonary tuberculosis (PTB) in childhood. This system is independent of bacteriological or histopathological data to define a very likely (> or = 40 points), possible (30-35 points) or unlikely (< or = 25 points) diagnosis of tuberculosis. Records of hospitalized non-infected HIV children at the Instituto de Puericultura e Pediatria Martagäo Gesteira of Federal University of Rio de Janeiro (IPPMG-UFRJ), were reviewed. Patients were adjusted for age and divided in two different groups: 45 subjects in the case group (culture-positive) [mean of age = 10.64 mo; SD 9.66]; and 96 in the control group (culture-negative and clinic criteria that dismissed the disease) [mean of age = 11.79 mo.; SD 11.31]. Among the variables analyzed, the radiological status had the greater impact into the diagnosis (OR = 25.39), followed by exposure to adult with tuberculosis (OR = 10.67), tuberculin skin test >10mm (OR = 8.23). The best cut-off point to the diagnosis of PTB was 30 points, where the score system was more accurate, with sensitivity of 88.9 percent and specificity of 86.5 percent

Pneumonia de repetiçäo: avaliaçäo prognóstica de fibrose cística

Os resultados estudaram as crianças com pneumonias recorrentes atendidas no Ambulatório de Pneumologia do IPPMG de 1981 a 1990, aplicando, retrospectivamente, a pontuaçäo de Shwachman, descrita para doentes com fíbrose cística (FC) ou mucoviscidose. Houve quatro casos de FC dos quais três tinham pontuaçäo inferior a 55. Os demais pacientes receberam pontuaçäo superior a esta. Propöe-se utilizaçäo deste sistema de pontos em crianças com pneumonias recorrentes visando identificar eventuais casos de FC