Prevalencia de infección tuberculosa latente e incidencia de viraje tuberculínico en contactos escolares mayores de 5 años en la Ciudad Autónoma de Buenos Aires / Prevalence of latent tuberculosis infection and incidence of tuberculin conversion among school contacts older than 5 years in the City of Buenos Aires

Introducción. La tuberculosis continúa siendo un problema frecuente en contextos de vulnerabilidad socioeconómica. El objetivo principal fue establecer la prevalencia de infección latente y viraje tuberculínico en contactos escolares de casos de tuberculosis. Población y métodos. En un área programática del sur de la ciudad, se evaluó la prevalencia de infección y viraje tuberculínico de 691 niñas, niños y adolescentes utilizando la prueba cutánea de tuberculina. Se investigó la asociación entre pérdida de seguimiento por parte del equipo de salud y características demográficas, escolares y asistencia inicial, y se describió el grado de adherencia cuando la quimioprofilaxis con isoniacida fue indicada. Resultados. Según las definiciones consideradas, la prevalencia de infección latente fue entre el 3,4 % (IC95 %: 2,3-5,2) y el 11,6 % (IC95 %: 9,3-14,4) de los 610 contactos con al menos una prueba cutánea aplicada. La incidencia de viraje tuberculínico se encontró entre el 0,3 % y el 6,8 % de los 294 evaluados. La edad mayor de 18 años, la mayor prevalencia de necesidades básicas insatisfechas en la comuna escolar, la pertenencia al turno escolar vespertino, la negatividad en la baciloscopia del caso índice y la ausencia de aplicación de la prueba cutánea inicial se asociaron con pérdida de seguimiento del contacto. Conclusiones. La incidencia de viraje tuberculínico en contactos escolares fue baja. La adherencia a isoniacida continúa siendo limitada. Se identificaron factores asociados con la pérdida de seguimiento de contactos que podrían orientar estrategias necesarias para mejorar este proceso.

Introduction. Tuberculosis continues to be a common problem in settings of socioeconomic vulnerability. Our primary objective was to establish the prevalence of latent infection and tuberculin conversion among school contacts of tuberculosis cases. Population and methods. In a programmatic area in the south of the City of Buenos Aires, the prevalence of latent infection and tuberculin conversion was assessed in 691 children and adolescents using the tuberculin skin test. The association between loss to follow-up by the health care team and the demographic, school, and baseline care characteristics was studied, and the level of adherence when isoniazid chemoprophylaxis was indicated was described. Results. According to established definitions, the prevalence of latent infection was between 3.4% (95% confidence interval [CI]: 2.3­5.2) and 11.6% (95% CI: 9.3­14.4) in the 610 contacts with at least one skin test. The incidence of tuberculin conversion was between 0.3% and 6.8% in the 294 assessed participants. Age older than 18 years, a higher prevalence of unmet basic needs in the school district, attending the afternoon school shift, negative sputum smear results in the index case, and absence of baseline skin test were associated with contact lost to follow-up. Conclusions. The incidence of tuberculin conversion among school contacts was low. Adherence to isoniazid treatment remains limited. Factors associated with loss of contact tracing were identified, which may guide strategies necessary to improve this process.

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.

Tuberculosis pulmonar y laríngea: una forma poco frecuente de presentación en la edad pediátrica / Pulmonary and laryngeal tuberculosis: a rare presentation in pediatrics / Tuberculose pulmonar e laríngica: uma apresentação pouco frequente na idade pediátrica

Introducción: la tuberculosis (TB) es una enfermedad infectocontagiosa granulomatosa crónica, producida por Mycobacterium tuberculosis. En Uruguay se ha notificado un aumento en el número de casos, con una incidencia reportada en 2017 de 28,6/100.000 habitantes, siendo de 6,67/100.000 en menores de 15 años. La tuberculosis laríngea es una forma poco frecuente y evolucionada de tuberculosis, que suele manifestarse con disfonía crónica. Su diagnóstico requiere un alto índice de sospecha. Objetivo: describir un caso clínico de presentación poco frecuente en la edad pediátrica. Caso clínico: adolescente de 13 años, sana, vacunas vigentes, con antecedentes de conductas sexuales activas y papilomatosis laríngea diagnosticada por laringoscopía directa como causa de disfonía crónica. Consulta en emergencia por dolor abdominal, constatándose al examen clínico adelgazamiento asociado a síntomas respiratorios y síndrome tóxico bacilar asociado a disfonía crónica de cuatro meses de evolución, por lo cual se plantea tuberculosis laríngea e ingresa para estudio. Niega contacto de tuberculosis. En la radiografía de tórax se constata lesión cavernosa en vértice pulmonar izquierdo. Las baciloscopías de esputo fueron positivas (directo y cultivo) confirmando el planteo de TB pulmonar y laríngea. Se realizó tratamiento antituberculoso supervisado con excelente evolución posterior. Conclusiones: la tuberculosis es una enfermedad reemergente en nuestro país, que requiere un alto índice de sospecha. Su diagnóstico sigue siendo un desafío para los pediatras ya que la confirmación diagnóstica no siempre es posible. En este caso clínico la sospecha clínica frente a una disfonía crónica asociada a síntomas respiratorios fue fundamental para establecer el diagnóstico, a pesar de no contar con nexo epidemiológico.

Introduction: tuberculosis (TB) is an infectious, chronic granulomatous disease caused by Mycobacterium tuberculosis. An increase in the number of cases has been reported in Uruguay, with an incidence reported in 2017 of 28.6/100,000 inhabitants, being 6.67/100,000 in children under 15 years of age. Laryngeal tuberculosis is a rare and evolved form of tuberculosis, which usually shows chronic dysphonia, which requires high levels of suspicion. Objective: to describe a clinical case with a rare presentation in pediatric age. Clinical case: 13-year-old female adolescent, healthy, fully vaccinated, with a history of active sexual behaviors and laryngeal papillomatosis diagnosed by direct laryngoscopy as a cause of chronic dysphonia. The emergency consultation was caused by abdominal pain, confirming the clinical examination weight loss associated with respiratory symptoms and bacillary toxic syndrome associated with chronic dysphonia of four months of evolution, for which laryngeal tuberculosis was considered and she was admitted for screening. She denies having been in contact with tuberculosis. The chest X-ray revealed a cavernous lesion in the left pulmonary apex and sputum smears were positive (direct and culture), confirming the suggestion of pulmonary and laryngeal TB. Supervised anti-tuberculosis treatment was performed with excellent subsequent evolution. Conclusions: tuberculosis is a re-emerging disease in our country, which requires a high level of suspicion. Its diagnosis remains a challenge for pediatricians since diagnostic confirmation is not always possible. In this clinical case, clinical suspicion of chronic dysphonia associated with respiratory symptoms were key factors to establish the diagnosis, despite not having a clear epidemiological link.

Introdução: a tuberculose (TB) é uma doença infecciosa granulomatosa crônica causada pelo Mycobacterium tuberculosis. No Uruguai, houve aumento do número de casos notificados, com uma incidência notificada em 2017 de 28,6/100.000 habitantes, sendo 6,67/100.000 casos de menores de 15 anos. A tuberculose laríngea é uma forma rara e evoluída de tuberculose, que geralmente se manifesta com disfonia crônica, exigindo alto índice de suspeita. Objetivo: descrever um caso clínico de apresentação pouco frequente em idade pediátrica. Caso clínico: menina adolescente de 13 anos, saudável, totalmente vacinada, com história de comportamentos sexuais ativos e papilomatose laríngea diagnosticada por laringoscopia direta como causa de disfonia crônica. Consulta de urgência por dor abdominal, comprovando emagrecimento associado a sintomas respiratórios e síndrome bacilar tóxica associada a disfonia crônica de quatro meses de evolução, para a qual foi considerada tuberculose laríngea e a paciente foi internada para estudo. Ele nega contato com tuberculose. A radiografia de tórax revelou lesão cavernosa em ápice pulmonar esquerdo e as baciloscopias de escarro foram positivas (direta e cultura) confirmando a sugestão de TB pulmonar e laríngea. O tratamento antituberculose supervisionado foi realizado com excelente evolução subsequente. Conclusões: a tuberculose é uma doença reemergente em Uruguai e requer alto índice de suspeita. Seu diagnóstico permanece um desafio para o pediatra, pois a confirmação diagnóstica nem sempre é possível. Neste caso clínico, a suspeita clínica de disfonia crônica associada a sintomas respiratórios foi fundamental para o estabelecimento do diagnóstico, apesar de não ter vínculo epidemiológico.

Caracterización de los pacientes con tuberculosis ingresados en Hospital Regional de Malabo / Characterization of the patients with tuberculosis admitted in the Regional Hospital of Malabo

RESUMEN Introducción: hace más de un siglo, Robert Koch identificó el microorganismo que causa la tuberculosis en el hombre, el Mycobacterium tuberculosis. Sin embargo, aún constituye un grave problema epidemiológico a nivel mundial. Se presentó un estudio realizado en los pacientes ingresados en el Servicio de Infeccioso del Hospital Regional de Malabo. Objetivo: caracterizar los pacientes con tuberculosis ingresados en la primera fase de tratamiento antituberculoso. Materiales y métodos: se realizó un estudio descriptivo, retrospectivo de los pacientes ingresados en el Servicio de Tratamiento de Infecciosos del Hospital Regional de Malabo. Periodo correspondiente a los meses de enero a julio del 2016. El universo fue 172 pacientes con diagnóstico de tuberculosis en todas sus formas clínicas. Los datos se obtuvieron en las historias clínicas. Resultados: predominó el sexo masculino en el 57,5 % de los pacientes y el grupo etáreo de 25 a 34 años con el 33,7 %. La baciloscopia negativa representó el 67,9 % de los casos y el estado nutricional más frecuente fue el bajo peso con 50,09 %. La tuberculosis en su forma pulmonar predominó en el 95,9 % de los pacientes. El 65,6 % de los pacientes fueron VIH negativos. La mejoría clínico radiológica al terminar el tratamiento fue de un 87,7 %. Conclusiones: el 57,5 % de los pacientes fueron masculinos entre 25 y 34 años de edad. Predominó la Baciloscopia negativa y la tuberculosis en su forma pulmonar. La mejoría clínica radiológica fue superior al terminar el tratamiento (AU).

ABSTRACT Introduction: More than a century ago, Robert Koch identified the microorganism causing tuberculosis in people: Mycobacterium tuberculosis. But it is still a serious epidemiologic problem around the world. The authors presented a study carried out in patients admitted in the Infectious Service of the Regional Hospital of Malabo. Objective: to characterize the patients with tuberculosis admitted in the first stage of the anti-tuberculosis treatment. Materials and methods: a descriptive, retrospective study was carried out on the patients who were admitted in the Infectious Service of the Regional Hospital of Malabo in the period from January to July 2016. The universe were 172 patients with diagnosis of tuberculosis in all its clinical forms. Data were gathered from the clinical records. Results: male sex predominated in 57.5 % of the patients as it also did the 25-34 years-old age group with 33.7 %. Negative sputum smear represented 67.9 % of the cases and the most frequent nutritional status was the low weight with 50.9 %. Tuberculosis in its pulmonary form predominated in 95.9 % of the patients. 65.6 % of the patients were HIV negative. The clinical radiological improvement at the end of the treatment was 87.7 %. Conclusions: 57.5 % of the patients were male aged 25-34 years old. Negative sputum smear and the pulmonary form of tuberculosis predominated. The clinical radiological improvement was higher at the end of the treatment (AU).

Amigdalitis prolongada con pobre respuesta al manejo, raro caso de tuberculosis extrapulmonar / Prolonged tonsilitis with poor response to therapy: a rare case of extrapulmonary tuberculosis

La tuberculosis es la primera causa de mortalidad infectocontagiosa a nivel mundial. La tuberculosis pulmonar corresponde a la presentación más frecuente, sin embargo, el 15 % de los casos cursan con infección extrapulmonar, siendo raro el compromiso amigdalino. Este reporte de caso describe a un paciente de 39 años con odinofagia recurrente secundaria a amigdalitis por Mycobacterium tuberculosis, un raro caso de tuberculosis extrapulmonar. La amigdalitis es una infección leve y frecuente de la vía aérea superior, que responde adecuadamente al manejo antibiótico; sin embargo, cuadros recurrentes y prolongados, manifestaciones atípicas o pobre respuesta a la antibioticoterapia son características que obligan a la búsqueda de diagnósticos diferenciales, lo que lleva a considerar la presencia de Mycobacterium tuberculosis como agente etiológico, especialmente en países con alto índice de tuberculosis como Colombia

Tuberculosis is the leading cause of infectious mortality worldwide. The pulmonary one corresponds to the most frequent presentation, however up to 15% of tuberculosis cases present extrapulmonary involvement, tonsillar tuberculosis being rare. The following is a case report of a 39-year-old patient with recurrent odynophagia secondary to Mycobacterium tuberculosis tonsillitis, a rare form of extrapulmonary tuberculosis. Tonsillitis is a benign and extremely common infection of the upper airway. Such patients benefit from systemic antibiotics, although, recurrent episodes, prolonged odynophagia, atypical manifestations, or poor response to antimicrobial therapy forces consideration of diagnostic possibilities other than the obvious, including Mycobacterium tuberculosis as the etiological agent, especially in countries with the highest rates of tuberculosis.

Perfil de resistencia del Mycobacterium tuberculosis a fármacos antituberculosos de primera línea y sus combinaciones / Resistance profile of Mycobacterium tuberculosis to first-line antituberculosis drugs and their combinations

Introducción: En Colombia el control de la tuberculosis se ha visto amenazado por la resistencia a los fármacos antituberculosos y especialmente la tuberculosis multidrogorresistente. Objetivo: Determinar la resistencia global y perfiles de resistencia del Mycobacterium tuberculosis a fármacos antituberculosos de primera línea y combinaciones. Métodos: Estudio descriptivo, transversal, en el que se evaluaron 2 701 pacientes con tuberculosis en el Departamento del Atlántico (Colombia), durante los años 2011 a 2016. Se valoraron aspectos sociodemográficos, clínicos y condiciones de riesgo. Se realizó análisis de frecuencias relativas y absolutas, diferencia de proporciones ((2) y razón de prevalencias. Resultados: El 66,5 por ciento de los pacientes eran hombres, el 53 por ciento tenían entre 15 y 44 años de edad. El 47,34 por ciento con pérdida en el seguimiento y el 11,62 por ciento monorresistentes a isoniacida. La resistencia en casos nuevos fue 7,30 por ciento (IC95 por ciento: 6,3-8,5), para este grupo la multidrogorresistencia fue de 1,1 por ciento; mientras que en los previamente tratados la resistencia fue de 18,27 por ciento (IC95 por ciento: 15,6- 22,4) y la multidrogorresistencia de 5,7 por ciento. Los factores asociados a resistencia fueron presencia de VIH/TB (RP= 2,6; p= 0,000), otros factores inmunosupresores (RP= 3,5; p= 0,009), contacto de paciente con tuberculosis multidrogorresistente (RP= 16; p= 0,000) y caso previamente tratado (RP= 2,24; p= 0,00). Conclusiones: Se evidencia un descenso en la resistencia global a rifampicina e isoniacida, así como en la prevalencia multidrogorresistente tanto en casos nuevos como en previamente tratados en la población estudiada; lo que genera una línea base para la toma de decisiones que permita continuar mejorando la vigilancia y control de la resistencia del M. tuberculosis a fármacos de primera línea, debido a los nuevos retos que este microorganismo representa para la salud pública(AU)

Introduction: Tuberculosis control in Colombia has been hampered by resistance to antituberculosis drugs and particularly by multi-drug resistant tuberculosis. Objective: Determine the overall resistance and resistance profiles of Mycobacterium tuberculosis to first-line antituberculosis drugs and their combinations. Methods: A descriptive cross-sectional study was conducted of 2 701 tuberculosis patients from Atlántico Department in Colombia in the period 2011-2016. The evaluation included sociodemographic aspects, clinical characteristics and risk conditions. Data analysis was based on relative and absolute frequencies, proportion difference (x2) and prevalence ratio. Results: Of the total sample, 66.5 percent were men and 53 percent were aged 15-44 years. 47.34 percent were lost to follow-up and 11.62 percent were monoresistant to isoniazid. In new cases resistance was 7.30 percent (CI 95 percent: 6.3-8.5) and multi-drug resistance was 1.1 percent, whereas in previously treated cases resistance was 18.27 percent (CI 95 percent: 15.6-22.4) and multi-drug resistance was 5.7 percent. The factors associated to resistance were the presence of HIV/TB (AR= 2.6; p= 0.000), other immunosuppressive factors (AR= 3.5; p= 0.009), contact with multi-drug resistant tuberculosis patient (AR= 16; p= 0.000) and previously treated case (AR= 2.24; p= 0.00). Conclusions: A reduction is observed in overall resistance to rifampicin and isoniazid, as well as in the prevalence of multi-drug resistance, both in new cases and in previously treated cases, which creates a baseline for the taking of decisions aimed at the continuing improvement of the surveillance and control of M. tuberculosis resistance to first-line drugs, due to the new challenges posed by this microorganism to public health(AU)

A vivência do tratamento de tuberculose em unidades de Saúde da Família / La experiencia del tratamiento de tuberculosis en unidades de Salud de la Familia / The experience of tuberculosis treatment in Family Health Units

RESUMO Objetivo Compreender a vivência dos portadores de tuberculose referente aos cuidados recebidos durante o tratamento e sua relação com os profissionais de saúde. Método Pesquisa fenomenológica realizada com 27 portadores de tuberculose em unidades de Estratégia de Saúde da Família do município do Rio de Janeiro. Os dados foram obtidos por meio de entrevistas analisadas pelo referencial Heideggeriano. Resultados A análise evidenciou que os usuários estão dispostos no modo de ser da inautenticidade característica dos serviços de saúde; o temor existencial da morte domina o cotidiano dos doentes e os mantêm seguindo o tratamento. Considerações finais e implicações para a prática Existe a possibilidade de se efetivar um cuidado que integre o conhecimento técnico capaz de dominar o modo de ser dos profissionais na dimensão subjetiva de quem precisa do tratamento, superando a tradição ôntica do cuidado inautêntico para o cuidado autêntico, que libera o outro para a cura.

RESUMEN Objetivos Comprender la vivencia de los portadores de tuberculosis referentes a los cuidados recibidos durante el tratamiento y su relación con los profesionales de salud. Método Investigación fenomenológica realizada con 27 portadores de tuberculosis en unidades de Salud de la Familia del municipio de Rio de Janeiro. Los datos fueron obtenidos por medio de entrevistas analizadas con referencial Heideggeriano. Resultados El análisis de los discursos evidenció que los usuarios están dispuestos en el modo-de-ser de la inautenticidad característico de los servicios de salud; el temor existencial de la muerte es lo que domina el cotidiano de los enfermos y los mantiene siguiendo el tratamiento. Consideraciones finales e implicaciones para la práctica Existe la posibilidad de realizar un cuidado que integre el conocimiento técnico que domina el modo-de-ser de los profesionales con la dimensión subjetiva de quien necesita el tratamiento, superando la tradición óntica de un cuidado inauténtico para el cuidado auténtico que libera al otro para la curación.

ABSTRACT Objectives To understand the experience of patients having tuberculosis regarding the care received during treatment and their relationship with health professionals. Method Phenomenological research carried out with 27 tuberculosis patients in Family Health Strategy Units in the city of Rio de Janeiro. The data were obtained through interviews analyzed by Heidegger's referential. Results The analysis of the discourses evidenced that the users are disposed in the mode of being of the inauthenticity characteristic of health services; the existential fear of death dominates the daily lives of the patients and it keeps them following the treatment. Final considerations and Implications for the practice There is the possibility of performing a care, which integrates the technical knowledge able to dominate the way of being of professionals with the subjective dimension of those who need treatment, overcoming the ontic tradition of inauthentic care for the authentic care, which frees the other for the healing.

Factors associated with tuberculosis and multidrug-resistant tuberculosis in patients treated at a tertiary referral hospital in the state of Minas Gerais, Brazil / Fatores associados à tuberculose e à tuberculose multirresistente em pacientes atendidos em um hospital de referência terciária em Minas Gerais, Brasil

ABSTRACT Objective: To evaluate the risk factors for the development of tuberculosis and multidrug-resistant tuberculosis (MDR-TB) in patients treated at a tertiary referral hospital. Methods: This was a cross-sectional study based on data obtained from patients treated at the Júlia Kubitschek Hospital, located in the city of Belo Horizonte, Brazil, between October of 2012 and October of 2014. We evaluated sociodemographic, behavioral, clinical, and radiological variables. The outcome considered to identify associations between tuberculosis and the explanatory variables was the treatment prescribed. To evaluate the associations between MDR-TB and the same explanatory variables, the change in MDR-TB treatment was considered. Results: The factors associated with tuberculosis were alcoholism, comorbidities, pulmonary cavitations, and a radiological pattern suggestive of tuberculosis. Cavitation and previous treatment for tuberculosis were associated with MDR-TB. Conclusions: Despite the significant progress made in the fight against tuberculosis, there is a need for coordinated actions that include social protection measures and patient support.

RESUMO Objetivo: Avaliar os fatores de risco de pacientes atendidos em um hospital de referência terciária para o desenvolvimento de tuberculose e tuberculose multirresistente (TBMR). Métodos: Estudo transversal baseado em dados obtidos de pacientes atendidos no Hospital Júlia Kubitschek, na cidade de Belo Horizonte (MG), entre outubro de 2012 e outubro de 2014. As variáveis utilizadas foram agrupadas em características sociodemográficas, comportamentais, clínicas e radiológicas. O desfecho considerado para verificar associações entre tuberculose e variáveis explicativas foi o tratamento prescrito para tuberculose. Para avaliar a associação entre a tuberculose resistente e as mesmas variáveis explicativas considerou-se a mudança de tratamento para TBMR. Resultados: Alcoolismo, padrão radiológico sugestivo de tuberculose, presença de comorbidades e presença de cavitações pulmonares foram fatores associados à tuberculose. A TBMR foi associada a tratamento prévio para tuberculose e presença de cavitações. Conclusões: Apesar dos importantes progressos na luta contra a tuberculose, é necessário um conjunto de ações articuladas que incluam medidas de proteção social e suporte aos pacientes.

Spirometry results after treatment for pulmonary tuberculosis: comparison between patients with and without previous lung disease: a multicenter study / Comparação entre os resultados de espirometria após tratamento para tuberculose pulmonar em pacientes com e sem doença pulmonar prévia: um estudo multicêntrico

ABSTRACT Objective: To compare patients with and without previous lung disease, in terms of the spirometry results after they had been treated for pulmonary tuberculosis (PTB) and cured, as well as to analyze risk factors related to functional severity. Methods: This was a cross-sectional, multicenter study conducted at four referral centers in Brazil. Patients were divided into two groups: those with a history of lung disease or smoking (LDS+ group); and those with no such history (LDS− group). Patients underwent spirometry (at least six months after being cured). Sociodemographic and clinical data were collected. Results: A total of 378 patients were included: 174 (46.1%) in the LDS+ group and 204 (53.9%) in the LDS− group. In the sample as a whole, 238 patients (62.7%) had spirometric changes. In the LDS+ group, there was a predominance of obstructive lung disease (in 33.3%), whereas restrictive lung disease predominated in the LDS− group (in 24.7%). Radiological changes were less common in the LDS− group than in the LDS+ group (p < 0.01), as were functional changes (p < 0.05). However, of the 140 (79.1%) LDS− group patients with a normal or minimally altered chest X-ray, 76 (54%) had functional changes (p < 0.01). The risk factors associated with functional severity in the LDS− group were degree of dyspnea (p = 0.03) and moderate or severe radiological changes (p = 0.01). Conclusions: Impaired pulmonary function is common after treatment for PTB, regardless of the history of lung disease or smoking. Spirometry should be suggested for patients who develop moderate/severe dyspnea or relevant radiological changes after treatment for PTB.

RESUMO Objetivo: Comparar os resultados da espirometria de pacientes tratados e curados para tuberculose pulmonar (TBP) com e sem doença pulmonar prévia e analisar os fatores de risco relacionados à gravidade funcional. Métodos: Estudo transversal, multicêntrico, em quatro centros de referência no Brasil. Os pacientes foram classificados em dois grupos: grupo com doença pulmonar prévia ou história de tabagismo (grupo DPT+) e grupo sem doença pulmonar prévia e sem tabagismo (grupo DPT−). Os pacientes realizaram espirometria (pelo menos seis meses após a cura), e foram coletados dados sociodemográficos e clínicos. Resultados: Foram incluídos 378 pacientes: 174 (46,1%) no grupo DPT+ e 204 (53,9%) no grupo DPT−. Na amostra total, 238 pacientes (62,7%) apresentaram alguma alteração espirométrica. No grupo DPT+ houve predominância de distúrbio ventilatório obstrutivo (em 33,3%), e distúrbio ventilatório restritivo predominou no grupo DPT− (em 24,7%). Quando comparados com o grupo DPT+, os pacientes do grupo DPT− apresentaram menos frequentemente alteração radiológica (p < 0,01) e funcional (p < 0,05). Porém, dos 140 (79,1%) do grupo DPT− com radiografia de tórax normal ou minimamente alterada, 76 (54%) apresentaram alguma alteração funcional (p < 0,01). Os fatores de risco relacionados com a gravidade funcional no grupo DPT− foram grau de dispneia (p = 0,03) e alterações radiológicas moderadas ou acentuadas. Conclusões: O comprometimento da função pulmonar é frequente após o tratamento da TBP independentemente do histórico de tabagismo ou doença pulmonar prévia. A espirometria deve ser sugerida para esses pacientes que evoluem com grau moderado/grave de dispneia e/ou alteração radiológica relevante após o tratamento da TBP.

Accuracy of Xpert® MTB/RIF for the detection of tuberculosis and rifampicin-resistance tuberculosis in China: A systematic review and meta-analysis / 北京大学学报(医学版)

OBJECTIVE@#To systematically review the diagnostic accuracy of Xpert® Mycobacterium tuberculosis/rifampicin (Xpert® MTB/RIF) for the detection of active tuberculosis (TB) and rifampicin-resistance TB in Chinese patients.@*METHODS@#Four Chinese databases (SinoMed, CNKI, WanFang database, and VIP) and three English databases (PubMed, Embase, and The Cochrane Library) were searched from January 1, 2000 to September 15, 2017, to identify diagnostic tests about the accuracy of Xpert® MTB/RIF in Chinese patients. Two investigators screened the articles and extracted the information independently, and then the quality of each included study was evaluated by Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2. Bivariate random-effects meta-analysis was conducted to pool the sensitivity and specificity. In addition, subgroup analyses were performed based on patient type (TB patient and TB suspected patient), sample type (sputum, bronchoalveolar lavage fluid and others). All statistical analyses were conducted with Stata version 13.0.@*RESULTS@#A total of 47 articles were included in this systematic review. Most of them (38 articles) were in Chinese and only 9 articles were in English. All the articles were published during 2014 to 2017, and the sample size ranged from 31 to 3 151. Forty articles including 42 comparisons about TB were finally included with the pooled sensitivity of 0.94 (95%CI: 0.92, 0.95) and the pooled specificity of 0.87 (95%CI: 0.84, 0.91). Subgroup analysis showed that different patient and specimen types had no significant differences on sensitivity, but the specificity of sputum group was higher than that of bronchoalveolar lavage fluid. As for the detection of rifampicin-resistant TB, 33 articles (38 comparisons) were analyzed, the pooled sensitivity and specificity were 0.92 (95%CI: 0.89, 0.94) and 0.98 (95%CI: 0.97, 0.99) respectively. There were no significant differences between the patient and specimen in the subgroup analyses. The Deeks funnel plot showed a possible publication bias for detecting active tuberculosis (P=0.08) and no publication bias for rifampicin-resistant TB (P=0.24). The likelihood ratio scatter gram showed that in clinical applications, Xpert® MTB/RIF had a good diagnostic ability for detecting active tuberculosis, and it had good clinical diagnostic value in detecting rifampicin-resistant TB.@*CONCLUSION@#Xpert® MTB/RIF has good sensitivity and specificity in detecting TB and rifampicin-resistant TB in Chinese people. In particular, it has good clinical value in diagnosing rifampicin-resistance TB.

Relationship between multimorbidity and the outcome of the treatment for pulmonary tuberculosis / Relación entre la multimorbilidad y el resultado del tratamiento de la tuberculosis pulmonar / Relação entre multimorbidade e o desfecho do tratamento da tuberculose pulmonar

ABSTRACT Objective: To analyze the influence of multimorbidity on the treatment outcome of new cases of pulmonary tuberculosis. Method: A population-based analytical study, using secondary data, collected from the database of the Notification Disease Information System, of new cases of pulmonary tuberculosis in the state of Rio Grande do Sul between 2013 and 2016. The relationship between multimorbidity and the outcome was analyzed with Multinomial Logistic Regression. Results: Multimorbidity was present in 37.0% of the cases. Of these, the Relative Risk (RR) was 1.7 for treatment abandonment and 2.9 for death. HIV had an RR of 2.1 for dropout and of 3.9 for death. The higher the number of comorbidities, the higher the RR for unfavorable outcomes. Conclusion: Multimorbidity influences on unfavorable outcomes of the treatment for tuberculosis.

RESUMEN Objetivo: Analizar la influencia de la multimorbilidad en el resultado del tratamiento de nuevos casos de tuberculosis pulmonar. Método: Estudio analítico de base poblacional, en el que utilizan datos secundarios, recopilados de la base de datos del Sistema de Información de Enfermedades de Notificación, de nuevos casos de tuberculosis pulmonar en el estado de Rio Grande do Sul entre 2013 y 2016. La relación entre la multimorbilidad y el resultado se analizó con regresión logística multinominal. Resultados: Se registró multimorbilidad en el 37,0% de los casos. De estos, el riesgo relativo (RR) fue de 1,7 para el abandono del tratamiento y de 2,9 para la muerte. El VIH tuvo un RR de 2.1 para el abandono y de 3.9 para la muerte. A mayor cantidad de comorbilidades, mayor será el RR correspondiente a resultados desfavorables. Conclusión: La multimorbilidad influye en los resultados desfavorables del tratamiento de la tuberculosis.

RESUMO Objetivo: Analisar a influência da multimorbidade no desfecho do tratamento de casos novos de tuberculose pulmonar. Métodos: Estudo analítico de base populacional, utilizando dados secundários, coletados no banco do Sistema de informação de Agravos de Notificação, de casos novos de tuberculose pulmonar ocorridos no estado do Rio Grande do Sul entre os anos de 2013 e 2016. A relação entre a multimorbidade e o desfecho foi analisada com Regressão Logística Multinominal. Resultados: A multimorbidade esteve presente em 37,0% dos casos. Destes, o risco relativo (RR) foi de 1,7 para abandono do tratamento e 2,9 para o óbito. O HIV apresentou o RR de 2,1 para o abandono e de 3,9 para óbito. Quanto maior o número de comorbidades eleva-se o RR para os desfechos desfavoráveis. Conclusões: A multimorbidade influencia nos desfechos desfavoráveis do tratamento da tuberculose.

How can new technologies help reduce absenteeism in pediatric consultation? / Como as novas tecnologias podem auxiliar na redução do absenteísmo em consulta pediátrica?

ABSTRACT Objective: To identify the most effective form of contact, as a possible intervention to reduce absenteeism in consultations of children with suspected or confirmed pulmonary tuberculosis. Methods: A randomized clinical trial was conducted with prospective data collection, between March 2017 and February 2018. Patients were randomized into three groups to be reminded about the appointment: telephone contact, SMS or WhatsApp, or no intervention. A convenience sample was obtained, with a significance level of 5%. Results: 78 children were included, with a median age of four years old (zero to 14); 59.0% of them were in treatment for a latent infection and 6.4% had active tuberculosis. Among the 78 children, 74.4% lived in Curitiba (Sourhern Brazil); 62.8% lived with both parents; 38.5% of the parents had formal employment and 47.4% of the mothers were housewives; 50.8% of the fathers and 55.7% of the mothers had more than nine years of schooling. In 78.2% of the families, per capita income was up to 0.5 minimum wages; 27.3% were enrolled in social programs; 28.2% lived in homes provided by the government. There was a total of 238 interventions made: 85 (35.7%) by telephone contact, 78 (32.8%) by text message (WhatsApp was 97.2% of these) and 75 (31.5%) had no further contact. There was no statistical difference among the sociodemographic and cultural characteristics studied. The absenteeism rate was 24.0% and the abandonment rate was 16.7%. Giving a reminder to the patient's guardian prior to the consultation, regardless of the intervention (p=0.021) and specifically by WhatsApp message (p=0.032) was associated with no absenteeism, though it was not associated with abandonment of the treatment. Conclusions: Using new tools, such as WhatsApp, to remind guardians of appointments reduces absenteeism. Consequently, it may lead to a reduction in abandoning treatment and it may improvetreatment outcome of children with a tuberculosis infection or disease.

RESUMO Objetivo: Identificar a forma mais efetiva de contato, como possibilidade de intervenção, para diminuir o absenteísmo em consultas de crianças com suspeita ou com tuberculose pulmonar. Métodos: Ensaio clínico randomizado com coleta de dados prospectiva, entre março de 2017 e fevereiro de 2018. Os pacientes foram aleatorizados em três grupos para relembrar a consulta: contato telefônico; mensagens curtas (SMS) ou WhatsApp; e nenhuma intervenção. Amostra de conveniência, com nível de significância de 5%. Resultados: Incluídas 78 crianças, mediana de idade quatro anos (zero a 14); 59,0% em tratamento para infecção latente e 6,4% com tuberculose ativa; 74,4% moravam em Curitiba, Paraná; 62,8% residiam com ambos os pais; 38,5% dos pais possuíam emprego formal e 47,4% das mães eram do lar; 50,8% dos pais e 55,7% das mães possuíam mais de nove anos de estudo; em 78,2% das famílias a renda per capita foi de até 0,5 salário mínimo; 27,3% estavam inscritas em programas sociais; e 28,2% residiam em casa cedida. Foram 238 intervenções: 85 (35,7%) por contato telefônico, 78 (32,8%) por mensagem de texto (WhatsApp 97,2%) e 75 (31,5%) sem nenhum contato adicional. Nas características sociodemográficas e culturais estudadas não houve diferença estatística. O absenteísmo foi de 24,0% e o abandono, de 16,7%. Lembrar o responsável previamente à consulta, independente da intervenção (p=0,021) e especificamente por mensagem por WhatsApp (p=0,032) foi associado ao não absenteísmo, porém não associado ao abandono. Conclusões: O uso de novas ferramentas, como o aplicativo WhatsApp, pode reduzir o absenteísmo, diminuir a possibilidade de abandono no seguimento e melhorar o desfecho do tratamento de crianças com tuberculose, seja a infecção ou a doença.

Relationship of anti-tuberculosis drug-induced liver injury and genetic polymorphisms in CYP2E1 and GST

ABSTRACT Setting: Treatment of tuberculosis (TB) can result in Drug-Induced Liver Injury (DILI) since hepatotoxic metabolites are formed during the biotransformation of isoniazid (INH).DILI can be related to the genetic profile of the patient. Single nucleotide polymorphisms in the CYP2E1 gene and GSTM1 and GSTT1 deletion polymorphisms have been associated with adverse events caused by INH. Objective: To characterize the genetic polymorphisms of CYP2E1, GSTT1 and GSTM1 in TB carriers. Design: This is an observational prospective cohort study of 45 patients undergoing treatment of TB. PCR-RFLP and multiplex-PCR were used. Results: The distribution of genotypic frequency in the promoter region (CYP2E1 gene) was: 98% wild genotype and 2% heterozygous. Intronic region: 78% wild genotype; 20% heterozygous and 2% homozygous variant. GST enzyme genes: 24% Null GSTM1 and 22% Null GSTT1. Patients with any variant allele of the CYP2E1 gene were grouped in the statistical analyses. Conclusion: Patients with the CYP2E1 variant genotype or Null GSTT1 showed higher risk of presenting DILI (p = 0.09; OR: 4.57; 95% CI: 0.75-27.6). Individuals with both genotypes had no increased risk compared to individuals with one genotype.

Bacteriemia por Campylobacter jejuni en un paciente con infección por VIH en etapa SIDA / Campylobacter jejuni bacteremia in a patient with HIV infection in AIDS stage

Resumen La bacteriemia es una presentación atípica de la infección por Campylobacter jejuni, y es más frecuente en pacientes con inmunodepresión avanzada debido al VIH u otras enfermedades sistémicas. Debido a la terapia anti-retroviral, en las últimas décadas el número de casos ha disminuido. Presentamos el caso de una mujer en situación de calle, con VIH en etapa C3, que cursó con una bacteriemia por C. jejuni durante su hospitalización por una tuberculosis pulmonar. Realizamos una breve revisión de bacteriemia por C. jejuni en pacientes con VIH.

Bacteremia is an atypical presentation of Campylobacter jejuni infection and it is more frequent in patients with advanced inmunodepression due to HIV or other sistemic diseases. Because of the highly active antiretroviral therapy, in the last decades the number of cases had declined. We report a case of a homeless woman with HIV in C3 stage who was diagnosed with the bacteremia during her hospitalization for pulmonary tuberculosis, and a brief review of C. jejuni bacteremia in HIV patients.

Vulvar tuberculosis-A rare manifestation of the disease / Tuberculose vulvar - Uma manifestação rara da doença

Abstract Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. According to data from the World Health Organization, this disease remains one of the leading causes of death worldwide. Although it most commonly affects the lungs, tuberculosis can compromise any organ. The present study reports a rare case of vulvar tuberculosis in a postmenopausal woman with a history of asymptomatic pulmonary and pleural tuberculosis, with no prior documented contact with the bacillus. Diagnosis was based on vulvar lesion biopsies, with histological findings suggestive of infection and isolation of M. tuberculosis by microbiological culture and polymerase chain reaction (PCR) essays. The lesions reverted to normal after tuberculostatic therapy.

Resumo A tuberculose é uma doença infeciosa causada pelo Mycobacterium tuberculosis. De acordo com dados da Organização Mundial de Saúde, esta doença mantém-se entre as principais causas demorte nomundo. Embora afetemais frequentemente os pulmões, a tuberculose pode comprometer qualquer órgão. O presente artigo relata um caso raro de tuberculose vulvar numa mulher na pós-menopausa, com antecedentes de tuberculose pleural e pulmonar assintomática, sem contato documentado com o bacilo. O diagnóstico foi feito com base na biópsia da lesão vulvar, com achados histológicos sugestivos da infeção e isolamento do M. tuberculosis pormeios de cultura e pela técnica da reação em cadeia da polimerase (PCR). Após terapêutica tuberculostática, as lesões reverteram.

Concentrations of rifampicin in pre-dose samples in patients with pulmonary tuberculosis

ABSTRACT Rifampicin is used in both phases of treatment for tuberculosis. In chronic use, the short half-life and the self-induction of metabolism can decrease the levels of the drug below the minimal inhibitory concentration. The aim of the study was to investigate whether plasma concentrations of rifampicin are sustained above 0.5 µg/mL in patients with tuberculosis using 600 mg/day. Rifampicin was measured in plasma by high-performance liquid chromatography and a sputum smear microscopy was performed in all days of the study. A total of 44 male patients completed the study. On days 31, 61 and 91, the mean plasma concentrations of rifampicin were 0.6 (0.5) µg/mL, 0.55 (0.5) µg/mL and 0.46 (0.4) µg/mL. There was a high variation of rifampicin levels leading to a high percentage of samples with concentrations below 0.5 µg/mL. There was no significant association between the frequency of samples with drug levels below 0.5 µg/mL with the conversion of the sputum microscopy. These data suggest that pre-doses samples offer limited information on the exposure of M. tuberculosis to rifampicin.

Fatores associados com o tabagismo em pacientes com tuberculose pulmonar / Factors associated with smoking in patients with pulmonary tuberculosis

Objetivo: identificar fatores associados ao tabagismo em pacientes com tuberculose (TB) pulmonar. Métodos: estudo transversal utilizando entrevista domiciliar com pacientes em tratamento para tuberculose pulmonar na Atenção Primária à Saúde em Campinas (SP), no período de 2013­2014. Foram incluídos pacientes não institucionalizados com 18 anos ou mais. As características de fumantes, ex-fumantes e não fumantes foram comparadas mediante Qui-quadrado de Pearson. Para comparar fumantes com não fumantes as variáveis com p < 0,20 foram incluídas em regressão logística múltipla. Resultados: dos 195 entrevistados 37,9% eram não fumantes; 24,6% ex-fumantes; e 37,4% fumantes. Em fumantes, observaram-se maiores frequências de pais e cônjuges fumantes em relação aos ex-fumantes. O perfil dos fumantes caracterizou-se por: escolaridade baixa, apresentar falta de ar e uso abusivo de bebidas alcoólicas. Não tentar parar de fumar nos últimos 12 meses associou-se a familiar/amigo que oferece cigarro. Conclusão: destacou-se a necessidade de incluir a família no tratamento do tabagismo e o uso abusivo de álcool em pacientes com TB pulmonar.

Objective: to identify factors associated with smoking in patients with pulmonary tuberculosis. Methods: Cross-sectional study using a home interview with patients undergoing treatment for pulmonary tuberculosis in Primary Health Care in Campinas/SP, Brazil, 2013-2014. Non-institutionalized patients 18 years of age or older were included. The characteristics of smokers, former smokers and nonsmokers were compared using Pearson's chi square. To compare smokers with nonsmokers variables with p <0.20 were included in multiple logistic regression. Results: Of the 195 interviewees, 37.9% were non-smokers, 24.6% were ex-smokers and 37.4% were smokers. In smokers, higher frequencies of smokers among parents and spouses were observed in comparison to ex-smokers. The profile of smokers was characterized by: low schooling, shortness of breath and abusive use of alcoholic beverages. Not trying to quit smoking in the last 12 months was associated with family / friend who offer cigarette. Conclusion: It was highlighted the need to include the family in the treatment of smoking and in the abuse of alcohol in patients with pulmonary TB.