Análise espacial e temporal da tuberculose entre pessoas em uso crônico de álcool, tabaco e ou drogas ilícitas no Estado do Paraná / Spatial and temporal analysis of tuberculosis among people with chronic use of alcohol, tobacco and/or illicit drugs in the state of Paraná

Introdução: A tuberculose é uma doença infectocontagiosa causada pelo Mycobacterium tuberculosis, que tem estreita relação com as desigualdades sociais, atingindo principalmente pessoas em exclusão social, e por vezes, em uso abusivo de álcool, tabaco e drogas ilícitas. Objetivo: Analisar a distribuição espacial e tendência temporal dos casos diagnosticados por tuberculose entre alcoolistas, tabagistas e usuários de drogas ilícitas no Estado do Paraná, Sul do Brasil. Métodos: Tratou-se de um estudo ecológico, desenvolvido nos 399 munícipios do Estado do Paraná. A população do estudo consistiu de casos diagnosticados de tuberculose no Sistema de Informação de Agravos de Notificação, entre o período de 2008 a 2018 com declaração de alcoolismo, tabagismo e uso de drogas ilícitas. Recorreu-se à análise exploratória dos dados por meio da estatística descritiva com o cálculo de medidas de frequências absolutas e relativas. Para a identificação de clusters, recorreu-se à técnica denominada Getis-Ord Gi*. Para a detecção dos aglomerados de risco espacial aplicou-se a Estatística de Varredura Puramente Espacial e o Spatial Variation in Temporal Trends. E nas séries temporais utilizou o método de autorregressão Prais-Winsten e a decomposição de séries temporais denominado Seasonal-Trend by Loess. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo. Resultados: Foram diagnosticados 29.499 casos de TB desses, 32,41% (n=9.529) faziam uso de algum tipo de substância psicoativa, sendo o alcoolismo o mais prevalente 20,4% (n=6.013), seguido do tabagismo 14,2% (n=4.185) e drogas ilícitas 9,8% (n=2.893). Quanto à detecção dos aglomerados de risco espacial, entre os que faziam uso do álcool, observou-se incidência de 5,4 casos/100 mil habitantes e um crescimento anual de 0,58%. Quanto ao tabagismo, verificou-se incidência de 3,8 casos por 100.000 habitantes, e um crescimento anual de 37,08% já as outras drogas, uma incidência de 2,6 casos/100.000 habitantes. Observou-se que 1.099 casos eram populações privadas de liberdade, sendo que a maioria era tabagista (n=460;41,8%), seguido por usuários de drogas ilícitas (n=451;41,0%) e alcoolistas (n=179;16,3%). Dentre esses casos, observou-se uma tendência temporal decrescente e hotspost para alcoolismo, tabagismo e drogas ilícitas nas quatro macrorregionais do Estado. Entre os casos de TB levantados, 560 eram de pessoas em situação de rua, tendo-se que a situação de alcoolismo foi a mais prevalente (n=420; 36,30%), seguido pelo tabagismo (n=382; 33,02%) e outras drogas ilícitas (n=355; 30,68%). Ao aplicar a tendência temporal também apresentou um cenário crescente no estado para todas as categorias analisadas. E ao identificar os hotspost entre a população nota-se que, houve associação espacial local apenas na macrorregional Leste na região metropolitana de Curitiba para alcoolismo, tabagismo e outras drogas ilícitas. Conclusão: O estudo avança no conhecimento ao evidenciar a problemática do uso de drogas entre pessoas com diagnóstico de TB, evidenciando uma tendência de crescimento desses eventos. Além disso, o estudo também evidenciou a problemática dessa situação em populações privadas de liberdade e em situação de rua. Apesar do Sul ser considerado região de grande riqueza, o estudo evidencia o contraste, da situação de desigualdade que aflige essa população, exprimindo a situação da TB, uso nocivo de drogas e da exclusão social. Os resultados advindos com o estudo evidenciam os desafios do país em se avançar no fim da TB, e serve de base de evidência para nutrir políticas publicas e desenvolvimento de ações estratégicas em territórios e grupos vulneráveis.

Introduction: Tuberculosis is an infectious and contagious disease caused by Mycobacterium tuberculosis, which is closely related to social inequalities, affecting mainly people in social exclusion, and sometimes in the abuse of alcohol, tobacco and illicit drugs. Objective: To analyze the spatial distribution and temporal trend of cases diagnosed with tuberculosis among alcoholics, smokers and illicit drug users in the state of Paraná, southern Brazil. Methods: This was an ecological study, developed in 399 municipalities in the state of Paraná. The study population consisted of diagnosed cases of tuberculosis in the Notifiable Diseases Information System, between 2008 and 2018, with declarations of alcoholism, smoking and use of illicit drugs. Exploratory data analysis was used through descriptive statistics with the calculation of absolute and relative frequency measures. For the identification of clusters, the technique called Getis-Ord Gi* was used. For the detection of spatial risk clusters, the Purely Spatial Scan Statistics and the Spatial Variation in Temporal Trends were applied. And in the time series used the Prais-Winsten autoregression method and the decomposition of time series called Seasonal-Trend by Loess. The study was approved by the Research Ethics Committee of the University of São Paulo at Ribeirão Preto College of Nursing. Results: Of these, 29,499 cases of TB were diagnosed, 32.41% (n=9,529) were using some type of psychoactive substance, with alcoholism being the most prevalent 20.4% (n=6,013), followed by smoking 14.2 % (n=4,185) and illegal drugs 9.8% (n=2,893). As for the detection of clusters of spatial risk, among those who used alcohol, there was an incidence of 5.4 cases/100 thousand inhabitants and an annual growth of 0.58%; As for smoking, there was an incidence of 3.8 cases per 100,000 inhabitants, and an annual growth of 37.08%, as for other drugs, an incidence of 2.6 cases/100,000 inhabitants. It was observed that 1,099 cases were populations deprived of liberty, with the majority being smokers (n=460;41.8%), followed by illicit drug users (n=451;41.0%) and alcoholics (n= 179;16.3%). Among these cases, there was a decreasing temporal trend and hotspot for alcoholism, smoking and illicit drugs in the four macro-regions of the state. Among the TB cases surveyed, 560 were homeless, with the situation of alcoholism being the most prevalent (n=420; 36.30%), followed by smoking (n=382; 33.02 %) and other illegal drugs (n=355; 30.68%). When applying the temporal trend, it also presented a growing scenario in the state for all categories analyzed. And when identifying the hotsposts among the population, it is noted that there was a local spatial association only in the East macro-region in the metropolitan region of Curitiba for alcoholism, smoking and other illicit drugs. Conclusion: The study advances in knowledge by highlighting the problem of drug use among people diagnosed with TB, showing a growing trend of these events. In addition, the study also highlighted the problem of this situation in populations deprived of liberty and on the streets. Although the South is considered a region of great wealth, the study highlights the contrast, the inequality that afflicts this population, expressing the situation of TB, harmful use of drugs and social exclusion. The results arising from the study highlight the country's challenges in moving towards the end of TB, and serve as an evidence base to nurture public policies and the development of strategic actions in territories and vulnerable groups.

Las posibles causas del aumento de la incidencia de la tuberculosis en Chile / Possible causes of the increase in tuberculosis incidence in Chile

La tuberculosis continúa siendo una de las principales causas de morbimortalidad a nivel mundial. En Chile, luego de un período de estancamiento, se ha observado un aumento de casos en los últimos dos años, llegando a una tasa de incidencia de 15,7 casos por 100.000 habitantes en 2018. El estudio busca dilucidar si este aumento es generalizado o si se produce en grupos específicos de la población, y en qué medida corresponde a cambios epidemiológicos u operacionales del programa. Se realizó un estudio descriptivo utilizando datos de fuentes secundarias oficiales para analizar los cambios en el número de casos de tuberculosis en los últimos dos años según áreas geográficas y grupos vulnerables. Además, se analizó el comportamiento de las actividades de pesquisa y diagnóstico de la enfermedad. Se observó aumento de casos en 6 regiones del país, siendo los extranjeros los que aumentan en mayor medida respecto a los otros grupos vulnerables, aunque la incidencia de tuberculosis en este grupo no afecta la incidencia entre los chilenos. La importancia de los extranjeros en el aumento de los casos se produce fundamentalmente en la Región Metropolitana, en cambio en las otras regiones son otros los grupos vulnerables prioritarios. En cuanto a la pesquisa y los métodos diagnósticos, éste puede ser un factor que colabora al aumento de casos en algunas regiones, pero en general no tiene un peso relevante. En conclusión, el aumento de casos de tuberculosis está focalizado a algunas áreas específicas lo que refuerza la importancia de los análisis locales y la definición de estrategias diferenciadas.

Tuberculosis (TB) continues to be one of the leading causes of morbidity and mortality worldwide. In Chile, after a period of stagnation, an increase in cases has been observed in the last two years, reaching an incidence rate of 15.7 per 100,000 inhabitants in 2018. The study seeks to elucidate whether this increase is widespread or if it occurs in specific groups, also if it corresponds to epidemiological or operational changes. A descriptive study was carry on using data from official secondary sources to analyze changes in the number of cases in the last two years according to geographic areas and risk groups. In addition, case finding and diagnosis activities of TB program was analyzed. Increase in cases was observed in 6 regions of the country and foreigner people had the largest increase compared to other risk groups, although the incidence among Chilean is not affected for this fact. The importance of foreigners in the increase of cases occurs mainly in metropolitan region, while in the other regions there are other priority risk groups. Case finding and diagnosis activities may be contribute to increase of cases in some regions, but it does not have a relevant weight in general. In conclusion, the increase of tuberculosis cases is focused on some specific areas, which reinforces the importance of local analysis and the definition of differentiated strategies.

Multiple cavitary lung lesions on CT: imaging findings to differentiate between malignant and benign etiologies / Lesões escavadas pulmonares múltiplas em TC: achados de imagem para diferenciação entre etiologia maligna e benigna

ABSTRACT Objective: To determine the CT findings of multiple cavitary lung lesions that allow the differentiation between benign and malignant etiologies. Methods: We reviewed CT scans, including patients with two or more cavitary lung lesions. We evaluated the number of cavitary lesions, their location, cavity wall thickness, and additional findings, correlating the variables with the diagnosis of a benign or malignant lesion. Results: We reviewed the chest CT scans of 102 patients, 58 (56.9%) of whom were male. The average age was 50.5 ± 18.0 years. Benign and malignant lesions were diagnosed in 74 (72.6%) and 28 (27.4%) of the patients, respectively. On the CT scans, the mean number of cavities was 3, the mean wall thickness of the largest lesions was 6.0 mm, and the mean diameter of the largest lesions was 27.0 mm. The lesions were predominantly in the upper lobes, especially on the right (in 43.1%). In our comparison of the variables studied, a diagnosis of malignancy was not found to correlate significantly with the wall thickness of the largest cavity, lymph node enlargement, emphysema, consolidation, bronchiectasis, or bronchial obstruction. The presence of centrilobular nodules correlated significantly with the absence of malignant disease (p < 0.05). In contrast, a greater number of cavities correlated significantly with malignancy (p < 0.026). Conclusions: A larger number of cavitary lung lesions and the absence of centrilobular nodules may be characteristic of a malignant etiology. However, on the basis of our evaluation of the lesions in our sample, we cannot state that wall thickness is a good indicator of a benign or malignant etiology.

RESUMO Objetivo: Determinar os achados tomográficos de lesões escavadas pulmonares múltiplas que contribuem para a diferenciação entre etiologia benigna e maligna. Métodos: Foram revisados exames de TC, sendo incluídos pacientes com duas ou mais lesões pulmonares escavadas. Avaliaram-se a quantidade de lesões escavadas, sua localização, espessura parietal das lesões e achados adicionais, correlacionando as variáveis com a presença de diagnóstico de benignidade ou de malignidade. Resultados: Foram revisadas TCs de tórax de 102 pacientes, sendo 58 (56,9%) desses do sexo masculino. A média de idade foi de 50,5 ± 18,0 anos. Lesões benignas e malignas foram diagnosticadas em 74 pacientes (72,6%) e em 28 (27,4%), respectivamente. Quanto aos achados tomográficos, a média do número de cavidades foi 3, a da espessura média da parede da maior lesão foi de 6,0 mm, e a do diâmetro da maior lesão foi de 27,0 mm. Houve predomínio das lesões em lobos superiores, especialmente no direito (43,1%). Após a comparação das variáveis estudadas, a espessura parietal da maior escavação, assim como a presença de linfonodomegalia, enfisema, consolidação, bronquiectasias e obstrução brônquica, não apresentaram diferenças estatisticamente significativas para o diagnóstico de malignidade. A presença de nódulos centrolobulares correlacionou-se significativamente com a ausência de doença maligna (p < 0,05). Observou-se também que um número maior de cavidades se correlacionou significativamente com malignidade (p < 0,026). Conclusões: Um maior número de lesões pulmonares escavadas e a ausência de nódulos centrolobulares podem ser características relacionadas à etiologia maligna. Por outro lado, a espessura parietal não permitiu a diferenciação entre etiologia benigna e maligna das lesões em nossa amostra.

Fatores predisponentes de tuberculose em indivíduos privados de liberdade: revisão integrativa / Predisposing factors of tuberculosis in liberty-deprived: an integrative review

Introdução: O ambiente prisional proporciona predisposição de diversas doenças, como é o caso da tuberculose, cujo risco de adoecimento aumenta em 28 vezes no interior das prisões. Objetivo: Integrar os fatores causadores de tuberculose em indivíduos privados de liberdade, mencionados na literatura nacional e internacional. Materiais e Métodos: Trata-se de uma revisão integrativa realizada nas bases de dados LILACS, MEDLINE e PUBMED nos meses de abril a junho de 2017. Resultados: A amostra foi constituída por 12 estudos. Os resultados permitiram constatar que o uso de drogas ilícitas injetáveis, o tempo de encarceramento, o compartilhamento de cela com outros detentos e a coinfecção HIV/TB foram os principais fatores relacionados ao adoecimento por tuberculose na população penitenciária. Ademais, a tuberculose pulmonar foi o principal achado dentro do ambiente prisional, seguida pela infecção latente por tuberculose. Conclusão: O controle da tuberculose é uma necessidade urgente na sociedade. O desenvolvimento de programas de controle desta, bem como a instalação de serviços de saúde efetivos, que promovam um cuidado integral e a prevenção e promoção, assim como a reabilitação da saúde das pessoas privadas de liberdade constitui-se em uma necessidade imperiosa no contexto prisional.

Introduction: The prison environment provides a predisposition for several diseases, such as tuberculosis. The risk of getting infected is increased by 28 times within prisons. Objective: To integrate the causative factors of tuberculosis in liberty-deprived individuals reported in both national and international literature. Materials and Methods: A literature review was performed to identify published studies from April to June 2017. Published studies were identified using an initial search of the LILACS, MEDLINE, and PUBMED database. Results: The literature search resulted in the identification of 12 studies. The results showed that injecting drug use, incarceration time, cell sharing with other inmates, and HIV/TB coinfection were the main factors related to tuberculosis in prison population. In addition, pulmonary tuberculosis was the main finding within the prison environment, followed by latent tuberculosis infection. Conclusion: Tuberculosis control is an urgent need in society. The development of programs to control it, as well as the establishment of effective health services that deliver integral health care, prevention and promotion of health care. Furthermore, the rehabilitation of prisoners' health constitutes a compelling need in the prisoner context.

El deterioro de la tuberculosis en Chile / Worsening situation of tuberculosis in Chile

Background: Recent data suggest an increase in tuberculosis (TB) incidence in Chile. Aim: To evaluate recent epidemiological trends, geographic extension and potential factors associated with TB reemergence in Chile. Material and Methods: Data analysis from official sources and trend analysis. Results: TB incidence rate increased from 12.3 (2014) to 14.7 (2017) per 100,000 inhabitants. Morbidity rates also increased in nine out of 15 regions. The proportion of TB cases in specific groups has also increased in the last six years: HIV/AIDS (68%), immigrants (118%), drug users/alcoholics (267%) and homeless people (370%). Several indicators of the national TB program performance have deteriorated including TB case detection, HIV co-infection study and contact tracing activities. Overall results indicate a higher than expected case-fatality ratio (> 3%), high rates of loss from follow-up (> 5%), and low percentage of cohort healing rate (< 90%). This decline is associated with a Control Program with scarce human resources whose central budget decreased by 90% from 2008 to 2014. New molecular diagnostic tools and liquid media culture were only recently implemented. Conclusions: TB trends and overall program performance indicators have deteriorated in recent years in Chile and several factors appear to be involved. Multiple strategies will be required to rectify this situation.

The effect of the lactic acid bacteria culturing conditions on their antagonistic activity to pathogens of tuberculosis

It has been found that the antagonistic activity of lactic acid bacteria depends on the composition of the nutrient medium and the temperature of culturing. It has been shown that the best antimicrobial effect to mycobacteria is achieved by the cultivation of lactic acid bacteria on the MRS nutrient media and a combined nutrient medium with the use of lactulose or glucose as a source of carbon. The optimum temperature for culturing an association of lactic acid bacteria for achieving high antagonistic activity to mycobacteria is 300C, and the duration of cultivation is 24 hours.

Infección diseminada por Bacilo Calmette-Guérin en un lactante con inmunodeficiencia: reporte de caso / Disseminated infection by Bacillus Calmette-Guérin in an immunodeficient infant: case report

RESUMEN La vacuna Bacillus Calmette-Guerin (BCG) que se administra a los recién nacidos de países con alta incidencia de tuberculosis puede ocasionar reacciones locales hasta infección diseminada en pacientes inmunocomprometidos. Reportamos el caso de un lactante varón de seis meses con antecedente de haber recibido vacuna BCG al nacer, y presentar cuadros infecciosos a repetición, nódulos violáceos blandos en tronco y extremidades con presencia de bacilos ácido alcohol resistentes (BARR) en la histopatología y en cultivo de piel; el estudio molecular reportó la presencia de Micobacterium bovis BCG. En la tomografía se observó opacidades intersticiales en pulmones y en el lavado gástrico se identificó BAAR. El estudio genético del paciente y de la madre reveló la presencia de mutación en el gen IL2RG confirmando el diagnóstico de inmunodeficiencia combinada severa, recibe tratamiento con inmunoglubolina humana y esquema antituberculosis con isoniacida, rifampicina y etambutol. Presentamos el caso por la implicancia en el pronóstico de vida de estos pacientes y por la necesidad de un diagnóstico preciso y oportuno.

ABSTRACT The Bacillus Calmette-Guerin (BCG) vaccine given to newborns in countries with a high incidence of tuberculosis may cause local reactions up to disseminated infection in immunocompromised patients. We report the case of a six-monthold male infant with a history of having received the BCG vaccine at birth, and presenting repeated infectious, soft violet nodules in the trunk and extremities with the presence of acid-alcohol-resistant bacilli (BAAR) in histopathology and skin culture; the molecular study reported the presence of Mycobacterium bovis BCG. In the tomography, interstitial opacities were observed in the lungs and in the gastric lavage BAAR was identified. The genetic study of the patient and the mother revealed the presence of a mutation in the IL2RG gene confirming the diagnosis of severe combined immunodeficiency. Received treatment with human immunoglobulin and anti-tuberculosis scheme with isoniazid, rifampicin, and ethambutol. We present the case because of the implication in the life prognosis of these patients and because of the need for an accurate and timely diagnosis

Risk factors for tuberculosis: diabetes, smoking, alcohol use, and the use of other drugs / Fatores de risco para tuberculose: diabetes, tabagismo, álcool e uso de outras drogas

ABSTRACT Tuberculosis continues to be a major public health problem. Although efforts to control the epidemic have reduced mortality and incidence, there are several predisposing factors that should be modified in order to reduce the burden of the disease. This review article will address some of the risk factors associated with tuberculosis infection and active tuberculosis, including diabetes, smoking, alcohol use, and the use of other drugs, all of which can also contribute to poor tuberculosis treatment results. Tuberculosis can also lead to complications in the course and management of other diseases, such as diabetes. It is therefore important to identify these comorbidities in tuberculosis patients in order to ensure adequate management of both conditions.

RESUMO A tuberculose continua a ser um importante problema de saúde para a humanidade. Embora os esforços para controlar a epidemia tenham reduzido sua mortalidade e incidência, há vários fatores predisponentes a ser controlados a fim de reduzir a carga da doença. Este artigo de revisão aborda alguns dos fatores de risco associados à infecção por tuberculose, como diabetes, tabagismo, uso de álcool e uso de outras drogas, que podem também contribuir para maus resultados do tratamento da tuberculose. A tuberculose pode levar a complicações no curso e no manejo de outras doenças, como o diabetes. Portanto, é importante identificar essas comorbidades em pacientes com tuberculose a fim de assegurar um manejo adequado de ambas as condições.

Factores asociados a la ocurrencia de tuberculosis y su distribución espacial en una ciudad brasileña, 1991-2010 / Factors associated with the occurrence of tuberculosis and its spatial distribution in a Brazilian city, 1991-2010

RESUMEN Se buscó identificar los factores asociados a la incidencia de tuberculosis y a la distribución espacial de la enfermedad en Olinda, Pernambuco, entre 1991 y 2010. Para el estudio de los factores asociados a la enfermedad se aplicó la regresión de Poisson y se utilizó la razón de morbilidad estandarizada para el análisis exploratorio espacial. Si bien se observó una reducción en la incidencia media de tuberculosis en Olinda, la tasa se mantiene alta comparada con la media nacional. El mapeo por quinquenios sugiere aumentos hasta 2005, con una caída entre 2006 y 2010, además de la persistencia de alta incidencia en áreas con mayores necesidades socioeconómicas. Las mayores incidencias de tuberculosis estuvieron asociadas a la proporción de analfabetos, de jefes de familia sin ingresos, de domicilios sin abastecimiento de agua, de adultos mayores, a la presencia de más de un caso de retratamiento en el sector censal, y a los domicilios con más de un caso nuevo de tuberculosis. Se concluye que es necesario incorporar el componente espacial a la organización de los servicios de salud y la planificación de la vigilancia epidemiológica de la tuberculosis.

ABSTRACT This article seeks to identify factors associated with the incidence of tuberculosis and the spatial distribution of the disease in Olinda, Pernambuco, from 1991 to 2010. In order to study the factors associated with the disease, Poisson regression was applied and standardized morbidity ratios were utilized for the spatial exploratory analysis. Although a reduction in the average incidence of tuberculosis in Olinda was observed, the rate remains high in comparison with the national average. Mapping according to five-year periods suggests rate increases until 2005, with a decline between 2006 and 2010 and the persistence of high incidence in areas of greater socioeconomic need. The highest tuberculosis incidence rates were associated in each area with the proportions of illiteracy, of heads of household without income, of households lacking water supply and of older adults, as well as with the presence of cases of retreatment and of households with two or more new cases of tuberculosis. Incorporating a spatial component is key for the organization of health services and the planning of epidemiological surveillance for tuberculosis.

Spatial risk of tuberculosis mortality and social vulnerability in Northeast Brazil

Abstract INTRODUCTION: Tuberculosis (TB) is the most common infectious disease in the world. We aimed to analyze the spatial risk of tuberculosis mortality and to verify associations in high-risk areas with social vulnerability. METHODS: This was an ecological study. The scan statistic was used to detect areas at risk, and the Bivariate Moran Index was used to verify relationships between variables. RESULTS: High-risk areas of tuberculosis mortality were statistically significantly associated with domain 2 of the Social Vulnerability Index (I=0.010; p=0.001). CONCLUSIONS: This study provides evidence regarding areas with high risk and that vulnerability is a determinant of TB mortality.

Tuberculosis among prison staff in Rio Grande do Sul / Tuberculosis entre los profesionales de las prisiones en Rio Grande do Sul / Tuberculose entre profissionais de penitenciárias do Rio Grande do Sul

ABSTRACT Objective: to evaluate the risk of infection and illness caused by Mycobacterium tuberculosis among health care and security staff in prisons in two regions of Rio Grande do Sul (RS). Method: cross-sectional study involving prison staff. An interview and sputum smear microscopy and culture were performed. Latent infection was evaluated according to the result of the tuberculin test (TT), self-referred. Results: among staff who had a TT, 10 (83.3%) in the central region and 2 (16.7%) in the southern region were considered reactors. Length of employment among prison officers who reacted to TT was 15.3 years, and among health care workers, 4.1 years (p = 0.01). No cases of active tuberculosis (TB) were identified. Conclusion: prevalence of latent TB was 27.9%. Length of employment between different professional categories and their working regions was considered a risk factor for latent TB.

RESUMEN Objetivo: evaluar el riesgo de infección y de la enfermedad por Mycobacterium tuberculosis entre los profesionales de la salud y seguridad en los centros penitenciarios en dos regiones del estado de Rio Grande do Sul (RS). Método: estudio transversal con la participación de profesionales de la prisión. Se llevó a cabo una entrevista, la baciloscopia y cultivo de esputo. La infección latente se evaluó de acuerdo con el resultado de la prueba de la tuberculina (TST) mediante auto-reporte. Resultados: entre los trabajadores que realizaron la TST en la región central, 10 (83,3%) fueron considerados reactores; y 2 (16,7%) en la región Sur. El tiempo de trabajo entre los agentes de la prisión con reacción a la TST fue de 15,3 años, y entre los trabajadores de la salud fue de 4,1 años (p = 0,01). No hubo casos identificados de la tuberculosis (TB) activa. Conclusión: la prevalencia de la TB latente fue del 27,9%. El tiempo de trabajo entre las diferentes categorías profesionales y la región en la que trabajan fueron considerados factores de riesgo para la TB latente.

RESUMO Objetivo: avaliar o risco de infecção e adoecimento por Mycobacterium tuberculosis entre profissionais de saúde e de segurança em casas penitenciárias de duas regiões do Rio Grande do Sul (RS). Método: estudo transversal, envolvendo profissionais de penitenciárias. Foi realizada uma entrevista, baciloscopia e cultura de escarro. A infecção latente foi avaliada de acordo com o resultado do teste tuberculínico (TT), auto-referido. Resultados: entre os trabalhadores que realizaram o TT na região central, 10 (83,3%) foram considerados reatores; e na região sul, 2 (16,7%). O tempo de trabalho entre os agentes penitenciários reatores ao TT foi 15,3 anos e entre os trabalhadores da saúde 4,1 anos (p = 0,01). Não foram identificados casos de Tuberculose (TB) ativa. Conclusão: a prevalência de TB latente foi 27,9%. O tempo de trabalho entre as diferentes categorias profissionais e a região em que trabalham foram considerados fator de risco para TB latente.

Factores que intervienen en la tuberculosis infantil en los centros de salud de la jurisdicción del Hospital Nacional Dos de Mayo en el año 2012 / Factors involved in childhood tuberculosis in the health centers of the jurisdiction of the National Hospital Dos de Mayo 2012

Perú, está atravesando una endemia de Tuberculosis en estos últimos tiempos agravando seriamente la Salud Pública. El objetivo fue determinar los factores que intervienen en la tuberculosis infantil según dimensiones en los centros de salud de la jurisdicción del Hospital Nacional Dos de Mayo 2012. Material y Método: El estudio es de nivel aplicativo, tipo cuantitativo, método descriptivo de corte transversal. La población estuvo conformada por 30 pacientes menores de 15 años. La técnica fue la entrevista y el instrumento un formulario tipo cuestionario aplicando previo consentimiento informado. Resultados: Del 100 por ciento (30); 50 por ciento (15) refieren que está presente y 50 por ciento (15) ausente. Acerca de los factores demográficos 93 por ciento (28) está presente y 7 por ciento (2) ausente, en el ambiental 73 por ciento (22) presente y 27 por ciento (8) ausente, en lo cultural 67 por ciento (20) presente y 33 por ciento (10) ausente; en el nutricional 10 por ciento (3) presente y 90 por ciento (27) ausente; en lo socioeconómico 3 por ciento (1) presente y 97 por ciento (29) ausente; y en los factores patológico y biológico en el 100 por ciento están ausentes. Conclusiones: El mayor porcentaje de las personas afectadas por tuberculosis refieren que está presente en el factor demográfico, ambiental y cultural referido a la instrucción del paciente, madre, padre y tiempo de residencia en el hogar actual, el hacinamiento, tipo de material de la ventana, número de habitantes destinados a dormir, cantidad de personas que duermen en la misma habitación, el desconocimiento de las medidas de prevención, como no cubrirse la boca al toser, concepto de la tuberculosis; mientras que en un menor porcentaje en el factor nutricional y socioeconómico que esta dado por la lactancia materna, consumo de carbohidratos, proteínas, frutas verduras, no tienen casa propia, la condición laboral del padre o tutor es inestable, presencia de animales en el hogar...

Peru, it crossing an epidemic of Tuberculosis in these latter times aggravating seriously the Public Health. The aim was to determine the factors that intervene in the infantile tuberculosis according to dimensions in the centers of health of the jurisdiction of the National Hospital Dos de Mayo, 2012. Material and Method: The study is of applicative level, quantitative type, and descriptive method of transverse court. The population was shaped by 30 15-year-old minor patients. The technology was the interview and the instrument a form type questionnaire applying previous informed assent. Results: Of 100 per cent (30); 50 per cent (15) these are present and 50 per cent (15) absent. About demographic factors 93 per cent (28) is present and 7 per cent (2) absent, in the environmental 73 per cent (22) is present and 27 per cent (8) absent, in the culture 67 per cent (20) is present and 33 per cent (10) absent; in nutrition factor 10 per cent (3) is present and 90 per cent (27) absent; in the socioeconomic 3 per cent (1) present and 97 per cent (29) absent; and the pathological and biological factors are 100 per cent absents. Conclusions: The highest percentage of people affected by tuberculosis is present in demographic, environmental and cultural factors referred instruction of the patient, of the mother, and the father and residence time in the current home, crowding, type of window material, number of rooms for to sleep, number of people sleeping in the same room, lack of preventive measures, such as it not covering at coughing, concept tuberculosis; while a smaller percentage are the nutritional and socio-economic factor that is given by breastfeeding, consumption of carbohydrates, protein, fruits and vegetables, do not have their own home, the employment status of the parent or guardian is unstable, there are presence of animals home, smoking in the home, while the pathological and biological factor is absent in the taking medication, suffer from other...

A clinicopathologic analysis of 88 lung resections of suspected metastatic carcinomas with proven primaries.

Background: The lung is the most common site for metastatic carcinomas. Very few studies have comprehensively analyzed all pulmonary resections for metastatic carcinomas. Aims and Objectives: To analyze all lung resections for suspected metastatic carcinomas accrued over 10 years to evaluate: The most frequent primary site, The interval between primary tumor diagnosis and lung metastases, and The proportion of inadvertently resected benign lesions, clinicoradiologically mistakenfor metastatic deposits. Materials and Methods: Between 2002 and 2011, 88 pulmonary metastasectomies were done for suspected metastatic carcinomas, which form the basis of this study. Results: In 81 of 88 cases (92%) the diagnosis of metastatic carcinoma was histologically confirmed, whereas 7 cases (8%) were non-neoplastic. The mean interval between primary tumor and metastases was 2.5 years. The primary sites were colorectum (30; 37%), kidney and breast (14; 17.3% each), cervix (9; 10%), salivary gland carcinoma (3), thyroid carcinoma (2), squamous carcinoma (2, one each of mandible and larynx), papillary urothelial carcinoma (2), hepatocellular carcinoma (1), endometrioid adenocarcinoma (1), carcinosarcoma of endometrium (1), adrenocortical carcinoma (1), and neuroendocrine carcinoma (1). The 7 non-neoplastic lesions (8%) histologically revealed tuberculosis (4), bronchopneumonia (2), and aspergillosis (1). Conclusions: Almost three fourths (71.6%) of the metastatic pulmonary resections comprised primaries from colorectum, breast and kidney. The interval between primary tumor and metastases ranged from zero months to 10 years (mean 2.5 years). Tuberculosis was the most common histologic diagnosis among the 8% of the non-neoplastic lesions, which were mistaken for metastatic carcinoma on clinical evaluation.

Prevalência de tuberculose em transplantados renais: revisão sistemática e meta-análise / Tuberculosis prevalence in renal transplant recipients: systematic review and meta-analysis

INTRODUÇÃO: A prevalência de tuberculose entre transplantados renais (TB-TXR) é maior do que na população geral. Assim, objetivamos realizar uma revisão sistemática e meta-análise da prevalência de TB-TXR. MÉTODOS: Após buscas eletrônicas e revisão de referências, estimou-se a prevalência agrupada de TB-TXR e realizou-se meta-regressão. Como referência para comparações, utilizou-se a prevalência de TB na população geral (0,18%; 95% IC = 0,16-0,20). RESULTADOS: Foram triados 253 estudos e 41 incluídos. A prevalência agrupada de TB-TXR foi 2,51% (95% IC = 2,17-2,85). Na meta-regressão, amostra > 2501 e alta prevalência de TB na população geral (p < 0,05) permaneceram associadas com a prevalência de TB-TXR. CONCLUSÃO: A prevalência agrupada de TB-TXR encontrada foi 14 vezes maior do que a prevalência de TB na população geral e, dessa forma, destacamos a necessidade de que o planejamento de medidas de prevenção e controle da TB específicas para este grupo de indivíduos seja pauta nas discussões do setor saúde.

INTRUDUCTION: Tuberculosis (TB) prevalence in subjects with kidney transplantation (KTX) is greater than in general population. We aimed to realize a systematic review and meta-analysis of prevalence of TB in KTX (TB-KTX). METHODS: We searched by the texts in electronic databases and references were reviewed. We estimated the pooled prevalence of TB-KTX subjects and we also conducted analysis by meta-regression. TB prevalence in general population (0.18%; 95% IC = 0.16-0.20) was reference to comparison. RESULTS: We screened 253 papers, which 41 studies entered in analysis. The pooled prevalence of TB-KTX was 2.51% (95% CI = 2.17-2.85). In the meta-regression sample size > 2.501 subjects and high prevalence of TB in general population remained associated with TB-KTX. CONCLUSION: TB prevalence in KTX was 14 times greater than in general population. Thus, we highlighted the necessity that planning of measures for prevention and control of TB for this population should be agenda in discussions of health sector.

Diabetes mellitus como factor predictor de tuberculosis en el Servicio de Salud Metropolitano Sur en Santiago, Chile / Diabetes mellitus as a predictor factor of tuberculosis in the Servicio de Salud Metropolitano Sur (SSMS-South Metropolitan Health Service) in Santiago, Chile

Background: Diabetes mellitus (DM) could be an important factor in identifying people with a high risk of tuberculosis (TB) in Chile, thus, we aim at studying the force of the relationship of these two pathologies. Methods: A case-control study was undertaken using secondary data from the SSMS population group. The cases (n = 473) were defined as first episodes of confirmed TB patients 15 years and older, registered between 2006 and 2009. The controls (n = 507) were non TB cases, residents in the same Health Service area, randomly selected from the population registered under the public health care system. Risk factors were taken from SIGGES (system for health information and management) files. Logistic regression adjusting for age and social vulnerability was used to estimate the OR (+/- CI 95 percent). Results: The higher frequency of DM among cases OR = 3.3 (95 percent CI 2.2-5.0) was confirmed. The inclusion of confounders -age, health insurance and residence in poorer counties- in the model yields produced an adjusted OR = 2.3 (95 percent CI 1.5-3.6). Conclusions: DM is strongly associated with TB in Chilean settings, therefore it may be anticipated that adding this diabetes criteria in screening of TB would help to increase earlier and inclusive diagnosis.

Introducción: La diabetes mellitus (DM) puede ser un importante factor para la identificación de personas con alto riesgo de tuberculosis (TBC) en Chile, por lo que se pretende estudiar la asociación entre estas dos patologías. Métodos: Se efectuó un estudio de caso-control con datos secundarios, obtenidos ambos de la población asignada al Servicio de Salud Metropolitano Sur. Los casos (n = 473) son pacientes de 15 o más años con un primer episodio de tuberculosis confirmada, entre los años 2006y 2009. Los controles (n = 507) son residentes del mismo Servicio, pero sin diagnóstico de TBC, seleccionados aleatoriamente de la población de inscritos en el Sistema Público de atención. Los factores de riesgo considerados son los consignados en el sistema de información para la gestión de garantías en salud (SIGGES). La estimación de asociación entre TBC y DM se efectuó mediante regresión logística, ajustando por edad y vulnerabilidad social para la estimación del OR (+/- IC95 por ciento). Resultados: Se confirma la mayor frecuencia de diabetes mellitus entre los casos, OR = 3,3 (IC95 por ciento 2,2-5,0). La inclusión en el modelo de las variables de confusión: edad, riesgo previsionaly residencia en una comuna más pobre que la Región Metropolitana, identifica un estimador (OR) ajustado de 2,3 (IC95 por ciento 1,5-3,6). Conclusiones: La DM se asocia con un mayor riesgo de enfermar de TBC. Orientando intervenciones diagnósticas, con pesquisa dirigida a los diabéticos aumentaría el diagnóstico precoz de la tuberculosis.

Ocorrência e caracterização da tuberculose em caprinos leiteiros criados no estado de Pernambuco / Occurrence and characterization of tuberculosis in dairy goats bred in the state of Pernambuco, Brazil

Acreditou-se durante muito tempo que a espécie caprina era resistente à infecção por Mycobacterium bovis, porém tal hipótese foi desconsiderada quando relatos da enfermidade surgiram em vários países. No entanto, ainda permanecem desconhecidas certas características da tuberculose em caprinos e suas implicações na saúde pública e caprinocultura nacional. Objetivou-se com este trabalho descrever os aspectos nosológicos, radiológicos, anátomo-histopatológicos, baciloscópicos e biomoleculares da tuberculose em caprinos leiteiros com doença respiratória, naturalmente infectados e procedentes do estado de Pernambuco. Para isso foram tuberculinizadas 442 cabras com sintomas respiratórios e, destas, 3,4% (15/442) foram consideradas positivas ao teste. Dos animais positivos, sete foram monitorados clinicamente durante 12 meses, descrevendo-se os achados obtidos. O agente etiológico foi identificado através da reação em cadeia da polimerase, por amplificação de sequências genômicas do Complexo Mycobacterium tuberculosis e posteriormente de Mycobacterium bovis. Este é o primeiro diagnóstico molecular com caracterização do envolvimento do Mycobacterium bovis na tuberculose caprina no Brasil.

For a long time, it was believed that the goat species is resistant to infection by Mycobacterium bovis; however, this hypothesis changed when reports of the disease became apparent in various countries. Nevertheless, certain characteristics of tuberculosis in goats and its impact on public health are still unknown. The objective of this study was to describe nosologic, radiologic, anatomo-histopathological, bacilloscopic and biomolecular aspects of tuberculosis in dairy goats with respiratory disease naturally infected, from the state of Pernambuco, Brazil. When we tuberculinized 442 goats with respiratory symptoms, 3.4% (15/442) of these were considered positive in the test. From the positive goats, seven were monitored clinically for 12 months. The etiological agent was identified through the polymerase chain reaction, by amplification of genomic sequences of the Mycobacterium tuberculosis complex and later Mycobacterium bovis. This is the first molecular diagnosis which characterizes the involvement of Mycobacterium bovis in goat tuberculosis in Brazil.

Prevalence and risk factors of mycrobacterium tuberculosis infection among prisoners in Kabul central prison [Puli Charkhi], Afghanistan

Afghanistan has the second highest tuberculosis [TB] burden in the Eastern Mediterranean Region with 76,000 new cases and 20,000 deaths each year. Among the highest risk settings for TB acquisition and transmission are prisons. There is a paucity of data to inform evidence-based design of health policies to control TB in prisons. This study aimed to determine the prevalence and relevant risk factors of TB in Kabul Puli Charkhi Prison. A cross-sectional study was conducted in Kabul Central Prison from January to September 2006. Using a structured questionnaire and tuberculin skin test [PPD], a total of 250 prisoners were selected using a stratified random sampling technique. Those who were sentenced to death, had less than 3 months remaining of their sentence, had a previously confirmed case of TB, or were pregnant, were excluded. The prevalence of TB infection was 55.7% [132/237] among the prison population. Using comparison analysis of two outcome groups [positive and negative PPD], we found that age [odds ratio [OR] = 4.14], income [OR = 7.62], duration of incarceration [OR = 2.62], accommodation area [OR = 3.51], personal hygiene [OR = 15.13], content of food [OR = 5.58] and low-grade fever [OR = 3.25] were positively associated with TB infection. To control TB in this environment, attention should be given to high risk groups such as those in low socio-economic classes, the elderly, and low-weight individuals. Rebuilding of damaged prison facilities and better distribution of prisoners will prevent overcrowding and decrease the likelihood of TB transmission. Improving the quality of food and hygiene would also reduce the level of infection. Based on preliminary findings of this study, the National TB program has strengthened its existing activities in prisons and has made a commitment to establish a comprehensive TB centre

Novos aspectos da patogenia da tuberculose / The Pathogenesis of Tuberculosis: Novel Aspects

A tuberculose continua a assombrar a humanidade como uma das doenças infecciosas que mais incapacita e mata. Nosso objetivo foi rever a patogenia da tuberculose, um processo complexo, que envolve tanto o agente etiológico Mycobacterium tuberculosis como os mecanismos de defesa do hospedeiro. Os novos instrumentos de biologia molecular permitiram grandes avanços na compreensão da epidemiologia da doença, assim como na identificação de possíveis alvos farmacológicos e de moléculas que podem ser usadas no diagnóstico das diversas fases da infecção. Estudos da patogenia da tuberculose nos sítios ativos dos pulmões mostraram níveis significativamente mais elevados demediadores que prejudicam a imunidade do tipo Th1 e inata, incluindo mediadores intracelulares e extracelulares. Esses e outros achados têm permitido aplicações no manejo da tuberculose. A proteína early secretory antigenic target-6, presente em micobactérias patogênicas e ausente no BCG, permitiu o desenvolvimento de testes diagnósticos úteis na identificação de infecção tuberculosa latente mesmo em vacinados com BCG. Há uma correlação entre altos níveis de IL-10 ao final de tratamento antituberculose e recidiva da doença ao longo de avaliação, apontando um possível nexo entre essa citocina anti-inflamatória e o risco de recaída por tuberculose

Tuberculosis (TB) still looms as one of the most incapacitating and lethal infectious diseases worldwide. The objective of this article was to review the pathogenesis of tuberculosis, a complex process that involves the interaction between the etiologic agent Mycobacterium tuberculosis and host defense mechanisms. New molecular biology methods have allowed great advances in the understanding of tuberculosis epidemiology, as well as in the identiication of possible pharmacologic targets and molecules that can be used in the diagnosis during the various stages of the infection. Studies of the pathogenesis of tuberculosis at active disease sites in the lungs have demonstrated increased levels of mediators that impair Th1-mediated and innate immunity, including intracellular and extracellular mediators. Such indings have facilitated the application of new techniques in tuberculosis management. The discovery of early secretory antigenic target-6, which is present in pathogenic mycobacteria and absent from BCG, allowed the development of useful diagnostic tests for the identiication of latent tuberculosis infection even in BCG-vaccinated individuals. There is a correlation between high IL-10 levels at the end of anti-tuberculosis treatment and tuberculosis recurrence, showing a possible link between this anti-inlammatory cytokine and the risk of tuberculosis recurrence