Death-Related Factors in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease Treated by Sequential Mechanical Ventilation / 中国医学科学院学报

Objective To analyze the death-related factors of elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) treated by sequential mechanical ventilation,so as to provide evidence for clinical practice. Methods The clinical data of 1204 elderly patients (≥60 years old) with AECOPD treated by sequential mechanical ventilation from June 2015 to June 2021 were retrospectively analyzed.The probability and influencing factors of death were analyzed. Results Among the 1204 elderly patients with AECOPD treated by sequential mechanical ventilation,167 (13.87%) died.Multivariate analysis showed that plasma procalcitonin ≥0.5 μg/L (OR=2.762, 95%CI=1.920-3.972, P<0.001),daily invasive ventilation time ≥12 h (OR=2.202, 95%CI=1.487-3.262,P<0.001),multi-drug resistant bacterial infection (OR=1.790,95%CI=1.237-2.591,P=0.002),oxygenation index<39.90 kPa (OR=2.447,95%CI=1.625-3.685,P<0.001),glycosylated hemoglobin >6% (OR=2.288,95%CI=1.509-3.470,P<0.001),and acute physiology and chronic health evaluation Ⅱ score ≥25 points (OR=2.126,95%CI=1.432-3.156,P<0.001) were independent risk factors for death in patients with AECOPD treated by sequential mechanical ventilation.Oral care>twice/d (OR=0.676,95%CI=0.457-1.000,P=0.048) and sputum excretion>twice/d (OR=0.492, 95%CI=0.311-0.776, P=0.002) were independent protective factors for death in elderly patients with AECOPD treated by sequential mechanical ventilation. Conclusions The outcomes of sequential mechanical ventilation in the treatment of elderly patients with AECOPD are affected by a variety of factors.To reduce the mortality,we put forward the following measures:attaching great importance to severe patients,restoring oxygenation function,shortening unnecessary invasive ventilation time,controlling blood glucose,preventing multidrug resistant bacterial infection,oral care twice a day,and sputum excretion twice a day.

Delineating asthma according to inflammation phenotypes with a focus on paucigranulocytic asthma / 中华医学杂志(英文版)

Asthma is characterized by chronic airway inflammation and airway hyper-responsiveness. However, the differences in pathophysiology and phenotypic symptomology make a diagnosis of "asthma" too broad hindering individualized treatment. Four asthmatic inflammatory phenotypes have been identified based on inflammatory cell profiles in sputum: eosinophilic, neutrophilic, paucigranulocytic, and mixed-granulocytic. Paucigranulocytic asthma may be one of the most common phenotypes in stable asthmatic patients, yet it remains much less studied than the other inflammatory phenotypes. Understanding of paucigranulocytic asthma in terms of phenotypic discrimination, distribution, stability, surrogate biomarkers, underlying pathophysiology, clinical characteristics, and current therapies is fragmented, which impedes clinical management of patients. This review brings together existing knowledge and ongoing research about asthma phenotypes, with a focus on paucigranulocytic asthma, in order to present a comprehensive picture that may clarify specific inflammatory phenotypes and thus improve clinical diagnoses and disease management.

Influencing factors of the adverse outcome of pulmonary tuberculosis among adolescents in Hangzhou City between 2005 and 2020: a school-based retrospective cohort study / 中华预防医学杂志

Objective: To explore the influencing factors of the adverse outcome of pulmonary tuberculosis (PTB) among adolescents in Hangzhou City between 2005 and 2020. Methods: A retrospective cohort study was used to collect the information of adolescent PTB patients with the onset of PTB occurring from January 1, 2005 to December 31 in 12 designated tuberculosis hospitals in Hangzhou, mainly including demographic, epidemiological, clinical manifestations, bacteriological characteristics and other data, through the China Management Information System for Infectious Disease Surveillance and Reporting and the follow-up survey. All patients were followed up and the end time was December 31, 2021. Multivariate Cox regression model was used to analyze the factors affecting the adverse outcome of these patients. Results: The mean age of 4 921 adolescent PTB patients was (18.9±3.6) years old, and the number of male and female patients were 3 074 and 1 847 respectively. The adverse outcome accounted for 14.7% (725) of all patients. Multivariate Cox regression model showed that eight risk factors, including management model from patients themselves or family members (HR=5.87, 95%CI: 4.55-7.64), molecular biology examination positive for PTB (HR=4.62, 95%CI: 2.98-7.19), the number of sputum smears-positive≥1 (HR=3.72, 95%CI: 2.87-4.83), non-standardized therapy regimens of PTB (HR=3.69, 95%CI: 2.95-4.64), history of retreated PTB (HR=2.22, 95%CI: 1.46-3.36), migrant adolescents (HR=1.89, 95%CI: 1.54-2.34), the number of chest X-ray scan (HR=1.83, 95%CI: 1.65-2.04), and severe PTB (HR=1.38, 95%CI: 1.02-2.05), were associated with the adverse outcome of adolescent PTB patients. Age (HR=0.94, 95%CI: 0.92-0.96), as the only protective factor, was associated with the adverse outcome of these patients. Conclusion: The management mode, molecular biological examination, chemotherapy program, history of tuberculosis, sputum smear examination, severity of tuberculosis, household residence, chest X-ray examination and age are associated with the adverse outcomes of adolescent PTB patients in Hangzhou.

Caracterización clínica y microbiológica de pacientes con trazas en Xpert MTB/RIF Ultra / Clinical and microbiological characterization of patients with Xpert MTB/RIF Ultra traces

INTRODUCCIÓN: El Xpert MTB/RIF Ultra (Ultra) ha mejorado dramáticamente el diagnóstico de la tuberculosis (TBC). Con él ha nacido la categoría de trazas, que es la menor carga bacilar detectable por este examen. OBJETIVO: Describir las características clínicas de los pacientes con presencia de trazas en el Ultra y evaluar la confirmación de la TBC como diagnóstico clínico. MATERIALES Y MÉTODOS: Estudio descriptivo de serie de casos. Se extrajo la información de fichas clínicas de pacientes con positividad a trazas. Se confrontaron datos clínicos, microbiológicos e histopatológicos. RESULTADOS: Se analizaron 21 pacientes. La edad promedio fue de 52 años. Todos los casos presentaron baciloscopias negativas. Cuatro cultivos en medio líquido MGIT fueron positivos, dos en pleura parietal, uno en líquido pleural y otro en expectoración. En pleura parietal, tres casos presentaron granulomas con necrosis caseosa y un granuloma esbozos de necrosis. En tejido pulmonar se observaron dos casos con granulomas con esbozos de necrosis y dos con granulomas no necrotizantes. Tres pacientes tenían el antecedente de TBC previa, se interpretó la positividad de trazas en ellos como falsos positivos. Finalmente se diagnosticaron 13 casos como TBC activa, donde cinco de ellos fueron TBC pleurales. La mayor concordancia clínica, microbiológica e histopatológica fue en muestras de líquido y tejido pleural. DISCUSIÓN: Se debe interpretar con cautela los hallazgos de esta prueba en muestras de vía aérea; el análisis multidisciplinario (clínica, imágenes, microbiología, histología) es crucial en las decisiones de nuestras conductas clínicas futuras. El hallazgo de trazas en pleura tiene, a nuestro parecer, un alto valor diagnóstico en el estudio de la tuberculosis en esta localización.

INTRODUCTION: Xpert MTB/RIF Ultra has dramatically changed the diagnosis of tuberculosis. A new category called traces appeared, which is the smallest amount of bacillar load detectable. OBJECTIVE: Describe the clinical characteristics of patients that present traces in Xpert MTB/RIF Ultra test, and to evaluate the confirmation of tuberculosis as clinical diagnosis. METHODS: We perform a descriptive case series study. Information was recovered from clinical records of patients with positive test for traces. Clinical, histopathological and microbiological results were confronted. RESULTS: Twenty one patients were analyzed. The mean age was 52 years-old. All cases had negative smear microscopy and four MGIT cultures were positive, two in pleural fluid and another in sputum. In parietal pleura, three cases presented granulomas with caseous necrosis, and one showed granuloma with very little necrosis. In pleural tissue we observed two cases of granulomas with traces of necrosis and two with non-necrotizing granulomas. Three patients had history of previous tuberculosis and positive traces, the test was interpreted as a false positive result. Finally, active tuberculosis was diagnosed in 13 cases, and five of them were pleural tuberculosis. The highest clinical, microbiological and histopathological agreement was in fluid and pleural tissue samples. DISCUSSION: The findings of Xpert MTB/RIF Ultra in airway samples must be interpreted carefully. Multi-disciplinary analysis is crucial in future clinical decisions. The finding of traces in pleura has, in our opinion, a high diagnostic value in the study of tuberculosis in this location.

Tuberculose pulmonar causada pelo uso de infliximab em paciente com Doença de Crohn / Pulmonary tuberculosis caused by the use of infliximab in a patient with Crohn's Disease

A doença de Crohn é uma patologia caracterizada pela inflamação transmural do trato gastrointestinal, compondo o espectro das doenças inflamatórias intestinais. Nos casos mais graves, dispõe de tratamento com uso de agentes biológicos e imunomoduladores que podem à reativação ou exacerbação de doenças infecciosas preexistentes. Este relato de caso trata de uma paciente do sexo feminino de 24 anos, diagnosticada com Doença de Crohn há 10 anos, evoluindo com necessidade de tratamento com infliximab e, após período de menos de 1 ano, apresentou odinofagia progressiva, dor abdominal e diarreia, além de perda ponderal, sudorese noturna e febre diária. Tomografia computadorizada de tórax evidenciou árvore em brotamento, sendo confirmado diagnóstico de tuberculose pulmonar pelo Teste Rápido Molecular no escarro e provável tuberculose laríngea e intestinal.

Crohn's disease is a pathology characterized by transmural inflammation of the gastrointestinal tract, comprising the spectrum of Inflammatory Bowel Diseases. In the most severe cases, treatment using biological agents and immunomodulators may be available, which can lead to the reactivation or exacerbation of preexisting infectious diseases. This case report is about a 24-year-old female patient, diagnosed with Crohn's disease 10 years ago, evolving in need of treatment with Infliximab and, after a period of less than 1 year, she presented progressive odynophagia, abdominal pain and diarrhea, in addition to weight loss, night sweats and daily fever. Chest computer tomography showed a tree in bud, and the diagnosis of pulmonary tuberculosis was confirmed by the Rapid Molecular Test in the sputum and probable laryngeal and intestinal tuberculosis.

Padronização da detecção molecular de Sars-Cov-2 em amostras de escarro de pacientes com suspeita de tuberculose em população privada de liberdade na região do ABC/SP / Standardization of molecular detection of Sars-Cov-2 in sputum samples from patients with suspected tuberculosis in a population deprived of liberty in the ABC/SP region

A tuberculose (TB) é das principais causas de morbidade e mortalidade no mundo, especialmente em países em desenvolvimento. O diagnóstico e o tratamento podem evitar milhões de mortes todos os anos. Há dois anos o SARS-CoV-2, um vírus que provoca uma infecção viral altamente transmissível e patogênica, que causa a doença denominada COVID-19 (relativa ao Coronavírus-19), causou a perda de um grande número de vidas em todo o mundo. Conforme a OMS, aproximadamente 80% dos acometidos pelo SARS-CoV-2 variaram de casos assintomáticos e manifestações clínicas leves a moderados, graves e críticos, e muitos foram a óbito. Sendo assim, é necessária atenção especial aos sinais e sintomas que indicam piora do quadro clínico e exijam a hospitalização. A infecção pelo Mycobacterium tuberculosis (MTB), principal agente da TB, que infecta de forma latente cerca de 25% da população global, incluindo a população privada de liberdade (PPL), pode ser um dos fatores agravantes da infecção pelo SARS-CoV-2. Esse estudo teve como objetivo padronizar, na plataforma GeneXpert, a utilização de amostras de escarro no diagnóstico molecular para detecção do SARS-CoV-2. A utilização do escarro para diagnóstico de SARS-CoV-2 poderá trazer benefícios ao paciente por ser uma coleta não invasiva, proporcionar a detecção de TB no mesmo material, permitindo o rápido isolamento do paciente para evitar transmissão e empregar o tratamento correto. Foram testadas 100 amostras de escarro de PPL para diagnóstico de TB e pesquisa de COVID-19 por metodologia padrão ouro (RT-qPCR) e teste rápido molecular (TRM-COVID). Destas, 12 amostras foram positivas para SARS-CoV-2 pela metodologia RT-qPCR e 13 amostras pelo TRM-COVID. Sete amostras foram positivas para o complexo Mycobacterium tuberculosis (CMTB) no TRM-TB e confirmadas pela cultura em meio líquido. Foi detectado um caso de coinfecção TB/COVID-19. O TRM-COVID apresentou sensibilidade de 90,9% quando utilizadas amostras de escarro para o diagnóstico da COVID-19. O teste pode agilizar o início do tratamento e os resultados rápidos permitem o 13 isolamento de indivíduos, a detecção de coinfecções TB/COVID-19 e o diagnóstico diferencial entre as doenças. (AU)

Tuberculosis (TB) is one of the main causes of morbidity and mortality in the world, especially in developing countries. Diagnosis and treatment can prevent millions of deaths every year. Two years ago, SARSCoV-2, a virus that causes a highly transmissible and pathogenic viral infection, which causes the disease called COVID-19 (relating to Coronavírus-19), caused the loss of a large number of lives throughout the world. According to the WHO, approximately 80% of those affected by SARS-CoV-2 ranged from asymptomatic cases and mild clinical manifestations to moderate, severe and critical, and many died. Therefore, special attention is needed to the signs and symptoms that indicate a worsening of the clinical condition and require hospitalization. Infection with Mycobacterium tuberculosis (MTB), the main agent of TB, which latently infects about 25% of the global population, including the population deprived of liberty, may be one of the aggravating factors of SARS-CoV-2 infection. This study aimed to standardize, on the GeneXpert platform, the use of sputum samples in molecular diagnosis for the detection of SARS-CoV-2. The use of sputum for diagnosis of SARS-CoV-2 may bring benefits to the patient as it is a non-invasive collection, providesthe detection of TB in the same material, allowing the rapid isolation of the patient to avoid transmission and employ the correct treatment. 100 sputum samples were tested from individuals deprived of liberty were tested for TB for TB diagnosis and COVID-19 research by gold standard methodology (RT-qPCR) and rapid molecular test (TRM-COVID). Of these, 12 samples were positive for SARSCoV- 2 by the RT-qPCR methodology and 13 samples by the TRM-COVID. Seven samples were positive for Mycobacterium tuberculosis complex (CMTB) on TRM-TB and confirmed by culture in liquid medium. One case of 15 TB/COVID-19 co-infection was detected. TRM-COVID showed a sensitivity of 90,9% when using sputum samples for the diagnosis of COVID-19. The test can expedite treatment initiation, and rapid results allow for isolation of individuals, detection of TB/COVID-19 co-infections, and differential diagnosis between diseases. (AU)

Pseudomonas aeruginosa associated pulmonary infections and in vitro amplification virulent rhamnolipid (rhlR) gene / Infecções pulmonares associadas a Pseudomonas aeruginosa e gene ramnolipídeo virulento (rhlR) da amplificação in vitro

Background: Pseudomonas aeruginosa is a common opportunistic pathogenic bacterium with the ability to develop a strong communication pathway by quorum sensing system and different virulent factors. Among the various important secretions of P. aeruginosa rhamnolipid is important biological detergent, believed to be involved in the development of the biofilm and intercellular communication. It readily dissolves the lung surfactants that are then easily catalyzed by the phospholipases and in this way is involved in the acute pulmonary infection. Objective: research work was designed to investigate virulence and gene associated with virulence in P. aeruginosa responsible for pulmonary infections. Methods: In current study polymerase chain reaction (PCR) was used for the detection of the rhlR (rhamnolipid encoding) gene of isolated strains. A number of assays were performed that ensured its virulent behavior. Disc diffusion method was used to check its antibiotic resistance. Isolated strains were resistant to a number of antibiotics applied. Result: It was found that males are more prone to respiratory infections as compared to females. Male members with age of 44-58 and 59-73 are at a higher risk, while females with age of 44-58 are also at a risk of pulmonary infections. Antibiotic resistance was observed by measuringzone of inhibition in strains GCU-SG-M4, GCU-SG-M3, GCU-SG-M5, GCU-SG-M2, GCU-SG-M1 and GCU-SG-M6. GCU-SG-M2 was resistant to fluconazole (FLU), clarithromycin (CLR), cefixime (CFM) and Penicillin (P10). No zone of inhibition was observed. But it showed unusual diffused zone around the Ak and MEM antibiotic discs. rhl R gene and 16s rRNA gene were characterized and analyzed. Conclusion: Findings from current study would help[...].

Antecedentes: Pseudomonas aeruginosa é uma bactéria patogênica oportunista comum, com a capacidade de desenvolver uma forte via de comunicação pelo sistema de detecção de quorum e diferentes fatores virulentos. Entre as várias secreções importantes de P. aeruginosa rhamnolipid, há um importante detergente biológico, que se acredita estar envolvido no desenvolvimento do biofilme e na comunicação intercelular. Dissolve rapidamente os surfactantes pulmonares que são facilmente catalisados pelas fosfolipases e, dessa maneira, estão envolvidos na infecção pulmonar aguda. Objetivo: O trabalho de pesquisa foi desenhado para investigar a virulência e o gene associado à virulência em P. aeruginosa responsável por infecções pulmonares. Métodos: No presente estudo, a reação em cadeia da polimerase (PCR) foi utilizada para a detecção do gene rhlR (codificação ramnolipídeo) de cepas isoladas. Foram realizados vários ensaios que garantiram seu comportamento virulento. O método de difusão em disco foi utilizado para verificar sua resistência a antibióticos. As estirpes isoladas foram resistentes a vários antibióticos aplicados. Resultado: Verificou-se que os homens são mais propensos a infecções respiratórias em comparação às mulheres. Membros do sexo masculino com idade entre 44 e 58 e 59 e 73 anos correm maior risco, enquanto mulheres com idade entre 44 e 58 anos também correm risco de infecções pulmonares. A resistência aos antibióticos foi observada medindo a zona de inibição nas cepas GCU-SG-M4, GCU-SG-M3, GCU-SG-M5, GCU-SG-M2, GCU-SG-M1 e GCU-SG-M6. O GCU-SG-M2 foi resistente ao fluconazol (FLU), claritromicina (CLR), cefixima (CFM) e penicilina (P10). Nenhuma zona de inibição foi observada. Mas se notou uma zona difusa incomum ao redor dos discos antibióticos Ak e MEM. Os genes rhl R e 16s rRNA foram caracterizados e analisados. Conclusão: As conclusões do presente estudo ajudariam a aumentar a conscientização sobre a resistência a antibióticos de, [...].

Educational technologies to guide pulmonary tuberculosis sputum collection: a systematic review / Tecnologías educativas para orientación de colecta de esputo de la tuberculosis pulmonar: revisión sistemática / Tecnologias educativas para orientação da coleta de escarro da tuberculose pulmonar: revisão sistemática

ABSTRACT Objective: To evaluate the contributions of educational technologies used during the guidelines for sputum collection from pulmonary tuberculosis. Method: Systematic review guided by Preferred Reporting items for Systematic Reviews with protocol registered in the database International Prospective Register of Systematic Reviews, with number CRD42020208162. The search was performed in the Cinahl, Scopus, PubMed, Web of Science, Embase, Lilacs, CENTRAL, CAPES, Proquest, OpenGrey databases and manual search in the reference list. The search, selection of studies, data extraction, and methodological evaluation using the Cochrane Risk-of-Bias tool were performed by two independent reviewers. Results: A total of 2,488 studies were evidenced, with seven being selected and analyzed, of which four used structured lectures; three, educational booklet; and one, an educational video, used alone or together, impacting the bacteriological confirmation of tuberculosis. The studies had a low risk of bias. Conclusion: Scientific evidence has shown that educational technologies contribute to increasing the quality, volume, and appearance of the sputum sample, which improves the bacteriological confirmation of the disease.

RESUMEN: Objetivo: Evaluar las contribuciones de las tecnologías educativas utilizadas durante las orientaciones para colecta de esputo de la tuberculosis pulmonar. Método: Revisión sistemática guiada por el Preferred Reporting items for Systematic Reviews con protocolo registrado en la base International Prospective Register of Systematic Reviews, bajo el número CRD42020208162. La búsqueda fue realizada en las bases de datos Cinahl, Scopus, PubMed, Web of Science, Embase, Lilacs, CENTRAL, CAPES, Proquest, OpenGrey y búsqueda manual en la lista de referencias. La búsqueda, selección de los estudios, extracción de los datos y evaluación metodológica por la herramienta del Riesgo de Sesgo Cochrane fueron realizadas por dos revisores independientes. Resultados: Se evidenciaron 2488 estudios, siendo siete seleccionados y analizados, de los cuales cuatro utilizaron palestras estructuradas, tres folder educativo y un vídeo educativo, utilizados de forma aislada o conjunta, impactando en la confirmación bacteriológica de la tuberculosis. Los estudios presentaron bajo riesgo de sesgo. Conclusión: Las evidencias científicas demostraron que las tecnologías educativas presentan como contribuciones el aumento de la calidad, volumen y aspecto de la muestra de esputo, lo que proporciona el perfeccionamiento de la confirmación bacteriológica de la enfermedad.

RESUMO Objetivo: Avaliar as contribuições das tecnologias educativas utilizadas durante as orientações para coleta de escarro da tuberculose pulmonar. Método: Revisão sistemática guiada pelo Preferred Reporting items for Systematic Reviews com protocolo registrado na base International Prospective Register of Systematic Reviews, sob o número CRD42020208162. A busca foi realizada nas bases de dados Cinahl, Scopus, PubMed, Web of Science, Embase, Lilacs, CENTRAL, CAPES, Proquest, OpenGrey e busca manual na lista de referências. A busca, seleção dos estudos, extração dos dados e avaliação metodológica pela ferramenta do Risco de Viés da Cochrane foram realizadas por dois revisores independentes. Resultados: Evidenciaram-se 2488 estudos, sendo sete selecionados e analisados, dos quais quatro utilizaram palestras estruturadas; três, folder educativo; e um, vídeo educativo. Todos foram utilizados de forma isolada ou em conjunto, impactando na confirmação bacteriológica da tuberculose. Os estudos apresentaram baixo risco de viés. Conclusão: As evidências científicas demonstraram que as tecnologias educativas apresentam como contribuições o aumento da qualidade, volume e aspecto da amostra de escarro, o que proporciona a melhoria da confirmação bacteriológica da doença.

Cord factor producer Mycobacterium abscessus subsp. bolletii in asymptomatic immunocompetent host sputa samples

Abstract We report a case of Mycobacterium abscessus subsp. bolletii colonization in upper respiratory tract of an immunocompetent patient, who was misdiagnosed as tuberculosis by Acid Fast Bacilli (AFB) and cord factor formation observed directly from the sputa culture in liquid medium. This fact reflected a significant impact on the individual case's life and showed the importance to identify the mycobacteria isolated from clinical sample at species level, and to determine the true implication of nontuberculous mycobacteria (NTM) detected in clinical samples.

Evaluación de spoligotyping a partir de baciloscopías como metodología alterna e independiente de cultivo para la genotipificación de Mycobacterium tuberculosis / Evaluation of spoligotyping-smear sputum as an alternative and culture-independent methodology for Mycobacterium tuberculosis genotyping

INTRODUCCIÓN: Tuberculosis (TBC) sigue siendo la segunda causa de muerte por una enfermedad infecto-contagiosa después del síndrome de inmunodeficiencia humana adquirida (SIDA). Actualmente, el escenario de técnicas y metodologías de laboratorio para la identificación y drogo-sensibilidad está cambiando gradualmente. Se han recomendado e introducido ensayos rápidos basados en la amplificación de ácidos nucleicos (NAAT's) que se desarrollan mediante la reacción de polimerasa en cadena (RPC). Bajo este principio, se destaca spoligotyping -una herramienta de genotipificación y epidemiología molecular en TBC- estandarizada a partir de aislados bacterianos, que permite el estudio del genoma de Mycobacterium mediante la amplificación de 43 secuencias cortas no repetitivas, localizadas en la región de repetición directa (RD1). OBJETIVO: Evaluación de spoligotyping a partir de baciloscopías, como una opción independiente de cultivo, para la caracterización de Mycobacterium tuberculosis a partir de muestras de esputo en pacientes del Instituto Nacional Cardiopulmonar de Tegucigalpa, Honduras. MÉTODO: De 37 pacientes con cultivo (y baciloscopía) positivos para M. tuberculosis, se obtuvieron 50 muestras de expectoración. Se realizó estudio microbiológico y molecular en muestras respiratorias conteniendo ADN de micobacterias, a partir de baciloscopías, concentrados y cultivo, para la identificación y análisis genotípico a través de la técnica de spoligotyping. RESULTADOS: El spoligotyping fue positivo en 37/37 de muestras de cultivo positivo (S: 100%), en 36/37 (S: 97,3%) de muestras con baciloscopía positiva y en 6/10 (S: 60%) de muestras de concentrado de esputo. La intensidad de la baciloscopía positiva tuvo una relación directa con la sensibilidad de spoligotyping. DISCUSIÓN: El fusionar el potencial de una herramienta útil en epidemiología molecular para analizar muestras de ADN proveniente de baciloscopías, visualiza una plataforma diagnóstica y genotípica para países en vías de desarrollo como una alternativa innovadora y altamente sensible en la hibridación de oligonucleótidos específicos a partir material genético en baciloscopías (P+, P++, P+++), pero requiere mejorar la concordancia entre patrones genéticos obtenidos, comparables con el uso estandarizado de aislados de cepas de M. tuberculosis.

BACKGROUND: Tuberculosis (TB) remains as the second cause of death by an infectious disease preceded by the acquired immune deficiency syndrome (AIDS). Currently, laboratory techniques and methodologies of diagnosis and drug susceptibility testing are constantly changing. Therefore, it has been recommended the introduction of rapid assays based on the amplification of nucleic acids test (NAAT's) through a polymerase chain reaction (PCR). Based on this principle, outstands spoligotyping - as a genotype and molecular epidemiology tool in tuberculosis - it is standardized to use isolated bacteria for the study of Mycobacterium genome through the amplification of 43 non-repetitive sequences, located at the direct repetitive region 1 (RD1). AIM Evaluation of spoligotyping from acid fast staining smears as an independent option from bacterial isolation to characterize Mycobacterium tuberculosis by using sputum samples from TB patients from National Cardiopulmonary Institute in Tegucigalpa, Honduras. METHOD: Of 37 patients with positive culture (and smear microscopy) for M. tuberculosis, 50 expectoration samples were obtained. Microbiological and molecular tests were performed in respiratory samples containing mycobacterial DNA from sputum smears, concentrates and solid culture, for identification and genotype analysis by spoligotyping technique. RESULTS: Spoligotyping was positive in 37/37 of positive culture samples (S: 100%), in 36/37 (S: 97.3%) of smear-positive samples and in 6/10 (S: 60%) of concentrate samples sputum. The intensity of positive smear microscopy had a direct relationship with the sensitivity of spoligotyping. DISCUSSION: This study combined the potential of a molecular epidemiology tool to analyse DNA from sputum samples in smears acid fast staining, it visualizes diagnosis and genotyping platform in developing countries gathering innovation and high sensitivity in the hibridization of specific olignonucleotides from positive smears (P+, P++, P+++). However, the low specificity showed the need to improve better agreement among genetic patterns compared to the standardized bacterial isolation from M. tuberculosis strains.

Diagnostic performance of the Xpert MTB/RIF assay in BAL fluid samples from patients under clinical suspicion of pulmonary tuberculosis: a tertiary care experience in a high-tuberculosis-burden area / Desempenho diagnóstico do teste Xpert MTB/RIF em amostras de LBA de pacientes com suspeita clínica de tuberculose pulmonar: experiência na atenção terciária em uma área com alta carga de tuberculose

ABSTRACT Objective: To assess the diagnostic performance of the Xpert MTB/RIF assay, a rapid molecular test for tuberculosis, comparing it with that of AFB staining and culture, in BAL fluid (BALF) samples from patients with clinically suspected pulmonary tuberculosis (PTB) who are sputum smear-negative or produce sputum samples of insufficient quantity. Methods: This was a retrospective study of 140 cases of suspected PTB in patients who were smear-negative or produced insufficient sputum samples and were evaluated at a tertiary teaching hospital in the city of Rio de Janeiro, Brazil. All of the patients underwent fiberoptic bronchoscopy with BAL. The BALF specimens were evaluated by AFB staining, mycobacterial culture, and the Xpert MTB/RIF assay. Results: Among the 140 patients, results for all three microbiological examinations were available for 73 (52.1%), of whom 22 tested positive on culture, 17 tested positive on AFB staining, and 20 tested positive on the Xpert MTB/RIF assay. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy for AFB staining were 68.1%, 96.1%, 88.2%, 87.5%, and 87.6%, respectively, compared with 81.8%, 96.1%, 90.0%, 92.4%, and 91.8%, respectively, for the Xpert MTB/RIF assay. The agreement between AFB staining and culture was 82.3% (kappa = 0.46; p < 0.0001), whereas that between the Xpert MTB/RIF assay and culture was 91.8% (kappa = 0.8; p < 0.0001). Conclusions: In BALF samples, the Xpert MTB/RIF assay performs better than do traditional methods, providing a reliable alternative to sputum analysis in suspected cases of PTB. However, the rate of discordant results merits careful consideration.

RESUMO Objetivo: Avaliar o desempenho diagnóstico do teste Xpert MTB/RIF - teste molecular rápido para tuberculose, comparando-o com o da pesquisa de BAAR e da cultura, em amostras de LBA de pacientes com suspeita clínica de tuberculose pulmonar (TBP) que apresentam baciloscopia de escarro negativa ou produzem amostras com quantidade insuficiente de escarro. Métodos: Estudo retrospectivo de 140 casos suspeitos de TBP em pacientes que apresentaram baciloscopia negativa ou produziram amostras de escarro insuficientes e foram avaliados em um hospital-escola terciário na cidade do Rio de Janeiro (RJ). Todos os pacientes foram submetidos à fibrobroncoscopia com LBA. Os espécimes de LBA foram avaliados por meio da realização de pesquisa de BAAR, cultura para micobactérias e teste Xpert MTB/RIF. Resultados: Entre os 140 pacientes, resultados de todos os três exames microbiológicos estavam disponíveis para 73 (52,1%), dos quais 22 apresentaram cultura positiva, 17, pesquisa de BAAR positiva, e 20, teste Xpert MTB/RIF positivo. A sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e precisão global da pesquisa de BAAR foram de 68,1%, 96,1%, 88,2%, 87,5% e 87,6%, respectivamente, contra 81,8%, 96,1%, 90,0%, 92,4% e 91,8%, respectivamente, do teste Xpert MTB/RIF. A concordância entre a pesquisa de BAAR e a cultura foi de 82,3% (kappa = 0,46; p < 0,0001), enquanto a concordância entre o teste Xpert MTB/RIF e a cultura foi de 91,8% (kappa = 0,8; p < 0,0001). Conclusões: Em amostras de LBA, o teste Xpert MTB/RIF tem melhor desempenho do que os métodos tradicionais, fornecendo uma alternativa confiável à análise do escarro em casos suspeitos de TBP. No entanto, a taxa de resultados discordantes merece uma reflexão cuidadosa.

Tuberculosis miliar / Miliary tuberculosis

Introducción: La tuberculosis es considerada como la enfermedad infecciosa más importante del mundo, a pesar de los esfuerzos que se han invertido para su control. Es producida por el complejo mycobacterium tuberculosis. El órgano más afectado es el pulmón, aunque puede tener repercusión extrapulmonar. Objetivo: Presentar el caso de un paciente diagnosticado de tuberculosis miliar a través del esputo posbroncoscopia. Caso clínico: Se expone el caso de un paciente diagnosticado de una tuberculosis miliar al cual se le realizó broncoscopia diagnóstica y lavado bronquial para bacilo ácido alcohol resistente (BAAR), el cual fue negativo. El diagnóstico se obtuvo por esputo BAAR posbroncoscopia. Conclusiones: El esputo posbroncoscopia es una opción con adecuada rentabilidad en el diagnóstico de esta enfermedad infecciosa(AU)

Introduction: Tuberculosis is considered the most important infectious disease in the world, despite the efforts that have been invested to control it. It is produced by the mycobacterium tuberculosis complex. The most affected organs are the lungs, although it can have extrapulmonary repercussions. Objective: To report the case of a patient diagnosed with miliary tuberculosis through post-bronchoscopy sputum. Clinical case report: The case of a patient diagnosed with miliary tuberculosis is reported. This patient underwent diagnostic bronchoscopy and bronchial lavage for acid-alcohol-resistant bacillus (ABB), which was negative. The diagnosis was obtained by postbronchoscopy ARB sputum. Conclusions: Post-bronchoscopy sputum is an option, with adequate profitability in the diagnosis of this infectious disease(AU)

Role and Significance of Bioactive Substances in Sputum in the Diagnosis of Lung Cancer / 中国肺癌杂志

The incidence rate of lung cancer is one of the highest incidence of malignancies in China. The gold standard for diagnosis requires pathological examination or cytological examination of biopsy. The invasive and sensitive nature of the two limits their use. Sputum contains a large number of nucleic acids and proteins, which is a good reflection of lung function. Lung cancer tissue will also affect the biological components in sputum. The detection of bioactive substances in sputum can contribute to the diagnosis of lung cancer. Based on the current research results at home and abroad, this paper reviews the bioactive substances in sputum that can be used for the diagnosis of lung cancer.
.

Isolation of and risk factors for airway infection with Pseudomonas aeruginosa in patients with non-cystic fibrosis bronchiectasis / Isolamento de Pseudomonas aeruginosa e fatores de risco de infecção das vias aéreas pela bactéria em pacientes com bronquiectasias não fibrocísticas

ABSTRACT Objective: To identify microorganisms in sputum samples of patients with stable non-cystic fibrosis bronchiectasis and to determine risk factors related to the isolation of Pseudomonas aeruginosa (PA) in those patients. Methods: Consecutive patients were recruited from a tertiary hospital outpatient clinic in the city of Fortaleza, Brazil. The patients were submitted to spirometry, six-minute walk test, HRCT, and sputum collection. Data on serum fibrinogen levels, disease severity, sputum color, and history of azithromycin treatment were collected. Results: The study included 112 patients, and females predominated (68%). The mean age was 51.6 ± 17.4 years. Most patients presented with mild-to-moderate disease (83%). The mean six-minute walk distance was 468.8 ± 87.9 m. Mean FEV1 and FVC, in % of predicted values, were 60.4 ± 21.8% and 69.9 ± 18.5%, respectively. The mean serum fibrinogen level was 396.1 ± 76.3 mg/dL. PA was isolated in 47 patients, other potentially pathogenic microorganisms (PPMs) were isolated in 31 patients, and non-PPMs were isolated in 34 patients. Purulent sputum was identified in 77 patients (68%). The patients with PA, when compared with those without it, presented with more severe disease, higher serum fibrinogen levels, and lower FVC%. In addition, purulent sputum and long-term azithromycin treatment were more common in those with PA. The multivariate regression analysis showed that the independent factors associated with PA were serum fibrinogen level > 400 mg/dL (OR = 3.0; 95% CI: 1.1-7.7) and purulent sputum (OR = 4.3; 95% CI: 1.6-11.3). Conclusions: In our sample, the prevalence of PA in sputum was 42%. Sputum color and inflammatory markers were able to predict the isolation of PA, emphasizing the importance of routine sputum monitoring.

RESUMO Objetivo: Identificar microrganismos em amostras de escarro de pacientes com bronquiectasia não fibrocística estável e determinar os fatores de risco relacionados com o isolamento de Pseudomonas aeruginosa (PA) nesses pacientes. Métodos: Pacientes consecutivos foram recrutados em um ambulatório de um hospital terciário em Fortaleza (CE). Os pacientes foram submetidos a espirometria, teste de caminhada de seis minutos, TCAR e coleta de escarro. Foram coletados dados referentes ao fibrinogênio sérico, gravidade da doença, cor do escarro e histórico de tratamento com azitromicina. Resultados: O estudo incluiu 112 pacientes, com predomínio do sexo feminino (68%). A média de idade foi de 51,6 ± 17,4 anos. A maioria dos pacientes apresentou doença leve a moderada (83%). A média da distância percorrida no teste de caminhada de seis minutos foi de 468,8 ± 87,9 m. A média do VEF1 em % do previsto foi de 60,4 ± 21,8%, e a da CVF em % do previsto foi de 69,9 ± 18,5%. A média do fibrinogênio sérico foi de 396,1 ± 76,3 mg/dL. PA foi isolada em 47 pacientes; outros microrganismos potencialmente patogênicos (MPP) foram isolados em 31; não MPP foram isolados em 34. Escarro purulento foi identificado em 77 pacientes (68%). Os pacientes com PA, em comparação com aqueles sem, apresentaram doença mais grave, fibrinogênio sérico mais elevado e menor CVF%. Além disso, escarro purulento e tratamento prolongado com azitromicina foram mais comuns naqueles com PA. A análise de regressão multivariada mostrou que os fatores independentes relacionados com PA foram fibrinogênio sérico > 400 mg/dL (OR = 3,0; IC95%: 1,1-7,7) e escarro purulento (OR = 4,3; IC95%: 1,6-11,3). Conclusões: Em nossa amostra, a prevalência de PA no escarro foi de 42%. A cor do escarro e os marcadores inflamatórios foram capazes de prever o isolamento de PA, o que enfatiza a importância do monitoramento rotineiro do escarro.

Effectiveness of GeneXpert® in the diagnosis of tuberculosis in people living with HIV/AIDS / Efetividade do GeneXpert® no diagnóstico da tuberculose em pessoas que vivem com HIV/aids

ABSTRACT OBJECTIVE To identify and synthesize the scientific knowledge produced regarding the effectiveness of the GeneXpert test in the diagnosis of pulmonary tuberculosis (TB) in people living with HIV/AIDS. METHODS Integrative literature review, which was searched on Embase, Scopus, PubMed, Cinahl, Academic Search Premier, Socindex, and LILACS platforms, in December 2019. The studies surveyed went through two stages of selection: reading of titles and abstracts by two reviewers independently; using the Rayyan platform and reading. Nineteen primary studies in English, Portuguese, and Spanish that answered the study's guiding question were included: How effective is the GeneXpert test in the diagnosis of pulmonary TB in people living with HIV/AIDS? RESULTS The use of GeneXpert substantially increased the detection of TB cases among the population co-infected with HIV/AIDS, with sensitivity ranging from 68% to 100%, superior to sputum smear microscopy. Specificity ranged from 91.7% to 100%; the positive predictive value from 79.2% to 96.1%; and the negative predictive value from 84.6% to 99.3%. These values were considered similar to sputum smear microscopy by most studies. We also compared these results with different ways of performing culture and other molecular tests, being considered inferior only to the Xpert Ultra. CONCLUSION It is possible to affirm that places with a high incidence of HIV/AIDS would benefit from the implementation of the GeneXpert test, entailing effectiveness in diagnosing pulmonary TB in this population when compared to sputum smear microscopy, a widely used test for detection of cases.

RESUMO OBJETIVO Identificar e sintetizar o conhecimento científico produzido a respeito da efetividade do teste GeneXpert no diagnóstico da tuberculose (TB) pulmonar em pessoas vivendo com HIV/aids. MÉTODOS Revisão integrativa da literatura, cuja busca foi feita nas plataformas Embase, Scopus, PubMed, Cinahl, Academic Search Premier, Socindex e Lilacs, em dezembro de 2019. Os estudos levantados passaram por duas etapas de seleção: leitura dos títulos e resumos por dois revisores de forma independente, utilizando a plataforma Rayyan e leitura integral dos mesmos. Foram incluídos 19 estudos primários em inglês, português e espanhol que respondiam à pergunta norteadora do estudo: Qual é a efetividade do teste GeneXpert no diagnóstico da TB pulmonar em pessoas que vivem com HIV/aids? RESULTADOS A utilização do GeneXpert aumentou substancialmente a detecção de casos de TB entre a população coinfectada com HIV, com sensibilidade que variou de 68% a 100%, sendo superior à baciloscopia. A especificidade variou de 91,7% a 100%; o valor preditivo positivo, de 79,2% a 96,1%; e o valor preditivo negativo, de 84,6% a 99,3%, valores considerados semelhantes à baciloscopia pela maioria dos estudos. O teste também foi comparado com as diferentes formas de realização da cultura e outros testes moleculares, sendo considerado inferior apenas ao Xpert Ultra. CONCLUSÃO É possível afirmar que locais com alta incidência de HIV se beneficiariam com a implantação do teste GeneXpert, uma vez que sua efetividade no diagnóstico da TB pulmonar nessa população é expressiva quando comparada à baciloscopia, teste que foi por muito tempo amplamente utilizado para a detecção dos casos.

Utilidad de los criterios de Murray para el procesamiento de esputo en pacientes con fibrosis quística. Laboratorio de Infectados de la Universidad de Antioquia (Medellín/Colombia) / Utility of the Murray criteria for sputum processing in patients with cystic fibrosis. Laboratory of Infected of the University of Antioquia (Medellín/Colombia)

Resumen Introducción: la fibrosis quística (FQ) es una enfermedad autosómica recesiva que aumenta la viscosidad de las secreciones, en especial las del árbol respiratorio; genera inflamación crónica y colonización/infección por microorganismos, conduciendo a deterioro de la función pulmonar y muerte. Nuestro estudio evaluó la calidad del esputo de pacientes con FQ que ingresaron al Laboratorio de Infectados de la UdeA con base a los criterios de Murray. Metodología: estudio descriptivo con información retrospectiva, incluyendo todos los esputos de pacientes con FQ, recolectados entre enero de 2015 a diciembre de 2018. Resultados: se analizaron 686 muestras de 85 pacientes, de las cuáles se obtuvo cultivo positivo en 501 (73 %) y el 21 % no cumplían los criterios de calidad según Murray. De 908 aislamientos identificados, 823 (90.6 %) corresponden a microorganismos considerados como patógenos en la vía aérea de los pacientes con FQ donde se incluyen S aureus, Pseudomonas spp, H influenzae, Burkhordelia spp, A. xylosoxidans, S maltophilia, A fumigatus, entre otras. Conclusiones: los criterios de Murray no se deben utilizar para definir el procesamiento o no del esputo en pacientes con FQ.

Abstract Introduction: Cystic fibrosis (CF) is an autosomal recessive disease that affects the production and viscosity of secretions, especially the origin of the respiratory airways; generating chronic inflammation and colonization / infection by microorganisms, leading to functional deterioration and death. Our study evaluated the quality of sputum samples from patients with CF who enter the Infected Laboratory of the UDEA based on the Murray criteria. Methodology: A descriptive study with retrospective information was carried out. All sputum from patients with CF were included, collected between January 2015 and December 2018 in the Infected Laboratory of the University of Antioquia. Results: We analyzed 686 samples from 85 patients with CF, positive culture was obtained in 501 (73 %), considering that 21 % of the respiratory samples did not meet the quality criteria according to Murray criteria. Of 908 isolates identified, 823 (90.6 %) correspond to microorganisms considered as pathogens in the airway of CF patients including S aureus, Pseudomonas spp, H influenzae, Burkhordelia spp, A. xylosoxidans, S maltophilia, A fumigatus, among others. Conclusions: The Murray criteria should not be used to define the processing or not of the sputum in patients with CF, all should be processed.

Improvement of Mycobacterium tuberculosis detection in sputum using DNA extracted by sonication

Abstract Tuberculosis (TB) is one of the infectious diseases with high mortality in the world. DNA amplification techniques have been used to overcome barriers to the diagnosis of this disease. However, the success of these methodologies is highly dependent on the DNA obtained from the sample. This study was carried out to verify whether the DNA extracted by sonication (in house method) could yield suitable DNA for amplification by real-time PCR (qPCR). Sixty sputum samples were submitted to DNA extraction using sonication compared to a commercial method (Detect-TB kit, Labtest/MG-Brazil). All DNA samples were amplified by qPCR for IS6110 region (IS6110-qPCR/SYBR Green assay). Out of 60 samples, 40 were positive for TB; of these, all had positive results when extracted by sonication (100%) and 80% when extracted by the commercial method. The limit of detection (LOD) of Mycobacterium tuberculosis (H37Rv strain) by qPCR was 14CFU/mL when the DNA was extracted by sonication, compared to countless colonies when extracted by commercial kit. In conclusion, the sonication protocol (without purification step) proved to be a simple, fast, and suitable method for obtaining DNA for use in qPCR from sputum samples.

Guia prático de abordagem da criança e do adolescente com asma grave: Documento conjunto da Associação Brasileira de Alergia e Imunologia e Sociedade Brasileira de Pediatria / Practical guide to approaching children and adolescents with severe asthma: a joint document of the Brazilian Association of Allergy and Immunology and the Brazilian Society of Pediatrics

Asma grave é a asma que requer tratamento com altas doses de corticosteroide inalado associado a um segundo medicamento de controle (e/ou corticosteroide sistêmico) para impedir que se torne "descontrolada" ou permaneça "descontrolada" apesar do tratamento. Asma grave é considerada um subtipo de asma de difícil tratamento. A prevalência em crianças evidenciada pelo International Study of Asthma and Allergies in Childhood variou entre 3,8% e 6,9%. Existem diversos instrumentos para avaliação subjetiva, como diários de sintomas e questionários, bem como para avaliação objetiva com função pulmonar e avaliação da inflamação por escarro induzido, ou óxido nítrico exalado. A abordagem terapêutica varia desde doses altas de corticosteroide inalado e/ou oral, broncodilatadores de longa duração, antaganonistas de receptores muscarínicos, até os mais recentes imunobiológicos que bloqueiam a IgE ou IL-5.

Severe asthma is asthma that requires treatment with high doses of inhaled corticosteroids in combination with a second control drug (and/or a systemic corticosteroid) to prevent it from becoming "uncontrolled" or remaining "uncontrolled" despite treatment. Severe asthma is considered a difficult-to-treat asthma subtype. The prevalence in children found by the International Study of Asthma and Allergies in Childhood ranged from 3.8% to 6.9%. There are several instruments for subjective assessment, such as symptom diaries and questionnaires, as well as for objective assessment, including pulmonary function testing and evaluation of inflammation by induced sputum or exhaled nitric oxide. The therapeutic approach includes high doses of inhaled and/or oral corticosteroids, long-acting bronchodilators, muscarinic receptor antagonists, and the latest biologics that block IgE or IL-5.

Normativa: técnica de esputo inducido en enfermedades inflamatorias broncopulmonares / Technical Guidelines for Induced Sputum in Bronchopulmonary Inflammatory Diseases

Las enfermedades broncopulmonares se asocian a diversos mecanismos inflamatorios de las vías aéreas. Evaluar y comprender el perfil inflamatorio de estos pacientes podría contribuir a conocer la etiología y así optimizar el tratamiento. El esputo inducido es una técnica mínimamente invasiva, por lo que su implementación resulta de interés en la práctica habitual. Aunque el estudio del esputo inducido ha demostrado utilidad y seguridad, los centros que desarrollan esta técnica en la Argentina son escasos. Con el objetivo de estandarizar el procedimiento de recolección y análisis de muestras de esputo inducido en pacientes con enfermedades inflamatorias broncopulmonares, se desarrolló esta guía consensuada por los centros con experiencia en esta técnica en nuestro país. Es nuestra intención difundir esta técnica, mínimamente invasiva, para su aplicación en servicios especializados. Esta guía de procedimientos detalla los materiales que son requeridos, los métodos y los estándares de calidad y seguridad tanto para los pacientes como para los operadores.

Bronchopulmonary diseases are associated with different inflammatory mechanisms of the airways. Assessing and understanding the inflammatory profile of these patients could contribute to the understanding of the etiology and thus optimize the treatment. Induced sputum is a minimally invasive technique, so its implementation is of interest in the usual practice. Although the studies of induced sputum have shown usefulness and safety, the centers that develop this technique in Argentina are scarce. With the aim of standardizing the procedure that includes the collection and analysis of induced sputum samples in patients with bronchopulmonary inflammatory diseases, some centers in our country with experience in this technique achieved a consensus on the development of this Guide. It is our intention to disseminate this minimally invasive technique for its application in specialized services. This procedure guide details the necessary materials and methods and quality and safety standards for both patients and operators.