Alternativas de procesos para la búsqueda de casos de tuberculosis bajo condiciones económicas limitadas. Cuba 2022-2025 / Process Alternatives for the Tuberculosis Case Finding under Limited Economic Conditions. Cuba 2022-2025

Ejecutar procesos efectivos de búsqueda de casos de tuberculosis es crucial para acele-rar el paso hacia su eliminación. El empeoramiento de las condiciones económicas mun-diales y nacionales no nos permite aplicar extensivamente las tecnologías rápidas mo-leculares idóneas de diagnóstico. Consideramos sensato entonces aplicar algoritmos alternativos que satisfagan las necesidades nacionales presentes hasta que las condi-ciones permitan la cobertura completa de las tecnologías moleculares recomendadas. Sugerimos introducir la radiografía digital para todos los algoritmos, utilizar mejor la microscopía de fluorescencia LED y la óptica convencional ya probadas. En conclusión, es preciso que este enfoque de trabajo, que procura optimizar la efectividad y eficiencia del programa, se introduzca en la práctica cotidiana hasta que lo idóneo sea permisible

Executing effective tuberculosis case-finding processes is crucial to accelerate the path towards elimination of the disease. The worsening of global and national economic conditions do not allow us to extensively apply rapid molecular diagnostic technolo-gies. We consider it sensible and necessary to apply alternative algorithms that meet the current national needs, until conditions allow full coverage of the recommended molecular technologies. We suggest introducing digital X-rays for all algorithms, bet-ter use of LED fluorescence microscopy and conventional optics already appropriate-ly tested. In conclusion, it is necessary that this approach that seeks to optimize the effectiveness and efficiency of the Cuban program be introduced into daily practice until the ideal is permissible

Aplicación de PCR a partir de cultivo en la identificación de subespecies del complejo Mycobacterium Tuberculosis / The use of culture-based PCR for the identification of subspecies of the mycobacterium tuberculosis complex

Los métodos diagnósticos clásicos de tuberculosis (TB) se basan en la utilización de baciloscopía y cultivo. La identificación del agente etiológico desde la positivización del cultivo requiere entre 10 y 15 días, mientras que el empleo de la reacción en cadena de la polimerasa (PCR) disminuye el tiempo a 24 h, lo que permite no solo identificar las subespecies del complejo Mycobacterium tuberculosis (CMTB) sino también diferenciarlas de otras especies ambientales clínicamente importantes (MOTT) facilitando el diagnóstico y tratamiento. El objetivo del presente trabajo fue determinar la utilidad de la PCR en la identificación temprana de las micobacterias pertenecientes al CMTB, a partir de cultivos positivos, de pacientes con sospecha de TB, atendidos en un hospital pediátrico de alta complejidad, durante un período de cuatro años. A cada muestra, se le realizó baciloscopía y cultivo en medio líquido. A los cultivos positivos, una inmunocromatografía lateral (TBIDR) y luego PCR. El 4,6% del total de muestras (510/11.162) pertenecientes a 198 pacientes presentó cultivos positivos. Cuatrocientos veintiseis (84%) correspondieron a muestras respiratorias. El rendimiento de la baciloscopía directa fue del 41% (194/470). Cuatrocientos treinta y ocho (86%) resultaron M. tuberculosis, 21 (4%) Mycobacterium bovis, 7 (1%), M. bovis-BCG y 44 (9%) MOTT. La utilización de medios de cultivos líquidos junto con el empleo de PCR favorecen una rápida orientación microbiológica y constituye una estrategia útil para optimizar el manejo clínico de estas infecciones, desde el punto de vista terapéutico y epidemiológico, especialmente en pediatría (AU)

Classical diagnostic methods for tuberculosis (TB) are based on the use of smear microscopy and culture. The identification of the etiological agent from positive culture requires 10 to 15 days, while the use of the polymerase chain reaction (PCR) reduces the time to 24 h, which allows not only to identify the subspecies of the Mycobacterium tuberculosis complex (MTC) but also to differentiate them from clinically important environmental mycobacteria other than tuberculosis (MOTT), facilitating diagnosis and treatment. The aim of this study was to determine the usefulness of PCR in the early identification of mycobacteria belonging to the MTC, from positive cultures of patients with suspected TB seen in a pediatric tertiary hospital over a 4-year period. For each sample, smear microscopy and culture in liquid medium was performed. Positive cultures were subjected to lateral immunochromatography (TBIDR) and then PCR. Of the total number of samples (510/11,162) belonging to 198 patients, 4.6% showed positive cultures; 426 (84%) were respiratory samples. The direct smear microscopy yield was 41% (194/470). Overall, 438 (86%) were found to be M. tuberculosis, 21 (4%) Mycobacterium bovis, 7 (1%), M. bovis-BCG, and 44 (9%) MOTT. The use of liquid culture media together with the use of PCR favors a rapid microbiological orientation and is a useful strategy to optimize the clinical management of these infections, from a therapeutic and epidemiological point of view, especially in children (AU)

Access to tuberculosis diagnosis in a municipality of the Western Amazon: health professionals' perspective / Acesso ao diagnóstico da tuberculose em um município da Amazônia Ocidental: ótica dos profissionais de saúde / Acceso al diagnóstico de tuberculosis en un municipio de la Amazonia occidental: perspectiva de los profesionales de la salud

Background and Objective: identifying the factors that weaken access to tuberculosis diagnosis allows assessing the actions and surveillance strategies of Primary Health Care (PHC), in addition to ensuring follow-up and monitoring of cases. This study aimed to analyze the dimension of access to diagnosis in PHC from health professionals' perspective in a municipality in the Western Amazon. Methods: this is a descriptive survey-type study, carried out in a cross-sectional way and with a quantitative approach in Porto Velho with professionals who work in PHC in the urban area through interviews with the Primary Care Assessment Tool questionnaire, validated for Brazil and adapted for tuberculosis care. Only the access to diagnosis dimension of the version for health professionals was considered, which has twelve variables and presents categories of responses according to the Likert scale. Data were analyzed using descriptive statistics, after complying with ethical precepts. Results: a total of 266 professionals were interviewed, and the mean score was classified as regular as well as they almost always have difficulty obtaining information over the phone; sometimes they use motorized transport; have costs with public transport to travel to the health unit; and sometimes they miss a work shift or appointment for the appointment. Conclusion: it is essential to reflect on the role with PHC insertion and resolvability as well as adequate clinical conduct, considering the epidemiological data that remain challenging in the municipality.(AU)

Justificativa e Objetivo: identificar os fatores que fragilizam o acesso ao diagnóstico da tuberculose permite avaliar as ações e estratégias de vigilância da Atenção Primária à Saúde (APS), além de garantir acompanhamento e monitoramento dos casos. Este estudo teve como objetivo analisar a dimensão do acesso ao diagnóstico na APS, sob a ótica dos profissionais de saúde em um município da Amazônia Ocidental. Métodos: estudo descritivo, do tipo inquérito, realizado de forma transversal e abordagem quantitativa em Porto Velho, com os profissionais que atuam na APS da zona urbana por meio de entrevistas com o questionário Primary Care Assessment Tool, validado para o Brasil e adaptado para a atenção à TB. Considerou-se apenas a dimensão acesso ao diagnóstico da versão para profissionais de saúde, que possui doze variáveis, apresentando como categorias de respostas segundo a escala tipo Likert. Os dados foram analisados a partir da estatística descritiva, após atender aos preceitos éticos. Resultados: foram entrevistados 266 profissionais, sendo que o escore médio foi classificado como regular, bem como quase sempre têm dificuldade para obter informação por telefone; às vezes utilizam transporte motorizado, possuem custos com transporte público no deslocamento à unidade de saúde; e às vezes perdem turno de trabalho ou compromisso para a consulta. Conclusão: é essencial a reflexão do protagonismo com inserção e resolubilidade da APS, bem como conduta clínica adequada, considerando os dados epidemiológicos que permanecem desafiadores no município.(AU)

Justificación y Objetivos: identificar los factores que debilitan el acceso al diagnóstico de tuberculosis permite evaluar las acciones y estrategias de vigilancia de la Atención Primaria de Salud (APS), además de garantizar el seguimiento y seguimiento de los casos. Este estudio tuvo como objetivo analizar la dimensión del acceso al diagnóstico en la APS, desde la perspectiva de los profesionales de salud en un municipio de la Amazonia occidental. Métodos: estudio descriptivo, del tipo encuesta, realizado en abordaje transversal y cuantitativa en Porto Velho con profesionales que actúan en APS en el área urbana a través de entrevistas con el cuestionario Primary Care Assessment Tool, validado para Brasil y adaptada para la atención de la TB. Se consideró solamente la dimensión acceso al diagnóstico de la versión para profesionales de la salud que tiene doce variables y se presenta como categorías de respuestas según la escala Likert. Los datos fueron analizados con base en estadística descriptiva, después de cumplir con los preceptos éticos. Resultados: se entrevistó a un total de 266 profesionales, y el puntaje promedio fue clasificado como regular, además de tener casi siempre dificultades para obtener información por teléfono; a veces utilizando transporte motorizado y teniendo costos de transporte público al desplazarse a la unidad de salud; a veces perdiendo turno de trabajo o cita para la consulta. Conclusiones: es esencial reflejar el papel del papel con la inserción y resolución de la APS, así como la conducta clínica adecuada, considerando los datos epidemiológicos que siguen siendo desafiantes en el municipio.(AU)

Perguntas e respostas sobre tuberculose para educadores comunitários - Elaboração participativa de material educativo / Questions and answers about tuberculosis for community educators - Participatory development of educational material

Esta cartilha é resultado de um processo de construção participativa de material educativo entre educadores e lideranças comunitárias do Fórum TB/RJ e profissionais de saúde.

Avances en tuberculosis en el 54º congreso chileno de enfermedades respiratorias. 2ª parte: nuevas normas técnicas chilenas para el control y eliminación de la tuberculosis / New Chilean technical standards for the control and elimination of tuberculosis

La incidencia de la tuberculosis (TBC) en Chile se ha ido incrementando en el último quinquenio, excepto al inicio de la pandemia de Covid-19, donde la pesquisa de TBC se redujo en forma importante. El escenario epidemiológico actual dista del objetivo propuesto en la Estrategia Nacional de Salud (ENS) de la década 2011-2020 (un plan nacional de gobierno para enfermedades relevantes en la población) que consistía en alcanzar una tasa de incidencia de todas las formas de TBC menor a 5 / 100.000 habitantes. La nueva ENS para la década 2021-2030 propone reducir la incidencia de la enfermedad mediante el diagnóstico oportuno y precoz focalizando las intervenciones en las poblaciones de riesgo de la enfermedad (grupos vulnerables), a modo de pesquisa activa y no solo como pesquisa por consultas espontáneas de sintomáticos respiratorios, o tamizajes masivos que pueden no seleccionar a la población de riesgo. También propone intervenir en la prevención priorizando el estudio y tratamiento de la población con Infección Tuberculosa Latente (ITL) de mayor riesgo de progresión hacia la enfermedad. Por último, se pretende mejorar la eficiencia del proceso de tratamiento de la TBC, optimizando el acceso y adherencia a las terapias de los casos activos de TBC como medida de incrementar la proporción de curación. Una nueva norma ministerial para el manejo y control de la TBC puede ayudar enormemente a esta propuesta. Esta norma entrada plenamente en vigencia el año 2022 entrega las herramientas operacionales para cumplir el objetivo señalado para la nueva ENS. La norma incorpora actividades tendientes a lograr una mayor cobertura de estudio y tratamiento de la ITL en grupos específicos, donde se incluyen, además de los contactos infantiles, a los contactos adultos y a otros grupos vulnerables. La terapia para esta condición se realizará utilizando la asociación de Isoniazida con Rifapentina de preferencia. Esta terapia se aplica bajo supervisión en una dosis semanal durante 3 meses (12 dosis) y ha demostrado mejor adherencia y menor toxicidad hepática. Para el diagnóstico oportuno de TBC la pesquisa se ha focalizado en los sintomáticos respiratorios (tos con expectoración) de más de 2 semanas en personas que pertenecen a alguno de los grupos vulnerables, o que tienen rasgos clínicos muy sugerentes de la enfermedad (fiebre, sudoración vespertina, hemoptisis, compromiso del estado general). Como herramienta diagnóstica deja de utilizarse la baciloscopía por su baja sensibilidad y es sustituida por pruebas moleculares, siendo la plataforma automatizada de amplificación de ADN del complejo M. tuberculosis más utilizada y disponible en los servicios de salud públicos el GeneXpert MTB/RIF Ultra, que además entrega información de la susceptibilidad a la rifampicina a través de la identificación de una mutación específica del genoma (gen rpoB). Con esta tecnología se agiliza el proceso diagnóstico (puede obtener resultados durante el día de ejecución, habitualmente no demoraría más de 2 horas) y es de alta sensibilidad (sensibilidad muy similar al cultivo). El tratamiento de la TBC sensible a los fármacos del esquema primario (rifampicina = R, isoniazida = H, etambutol = E y pirazinamida = Z) consiste en la administración diaria en la fase inicial (con los 4 fármacos) durante 2 meses y en la fase de continuación (con isoniazida y rifampicina) durante 4 meses, totalmente supervisado. La TBC con resistencia a rifampicina tiene tratamiento con un esquema acortado oral de 9 meses con nuevos fármacos: bedaquilina, linezolid, clofazimina y levofloxacino (6 meses con los 4 fármacos, seguido de 3 meses con clofazimina y levofloxacino). Estas terapias de alta calidad son seguras y prometen mejores resultados de curación. La nueva norma significa una mayor cobertura para la erradicación de los reservorios de la enfermedad y una mayor precisión en el diagnóstico de las fuentes de trasmisión comunitaria de la enfermedad, siendo un aporte significativo hacia la eliminación de la TBC en el país.

The incidence of tuberculosis (TB) in Chile has been increasing in the last five years except at the beginning of the Covid-19 pandemic where TB screening has clearly decreased. The current epidemiological scenario is far from the goal proposed in the National Health Strategy (NHS) of the decade 2011-2020 (a national government plan for relevant diseases in the population) which was to achieve an incidence rate of all forms of TB less than 5/100,000 inhabitants. The new NHS for the decade 2021-2030 proposes to reduce the incidence of the disease through timely and early diagnosis by focusing interventions on populations at risk of the disease (vulnerable groups), as an active screening and not only as screening for spontaneous consultations of respiratory symptomatic or mass screenings that may not select the population at risk. It also proposed to intervene in prevention prioritizing the study and treatment of the population with Latent Tuberculosis Infection (LTI) at higher risk of progression to the disease. Finally, it intends to improve the efficiency of the TB treatment process, optimizing access and adherence to therapies of active TB cases as a measure to increase the cure rate. A new ministerial standard for the management and control of TB can greatly help this proposal. This standard, fully effective in 2022, provides the operational tools to meet the objective set for the new NHS. The standard incorporates activities aimed at achieving greater coverage of study and treatment of LTI in specific groups, which include, in addition to child contacts, adult contacts and other vulnerable groups. Therapy for this condition will be performed using the combination of isoniazid with rifapentine preferably. Therapy is administered under supervision and patients receive therapy once a week for 12 doses for 3 months. This therapy has shown better adherence and lower liver toxicity. For the timely diagnosis of TB, case finding has focused on respiratory symptoms (cough and expectoration) for more than 2 weeks, in individuals that belong to one of the vulnerable groups, or that have additional clinical features very suggestive of the disease (fever, afternoon sweats, hemoptysis, compromise of the general condition). Smear sputum as a diagnostic tool is no longer used due to low sensitivity and it was replaced by molecular tests in automated platform for DNA amplification of the mycobacterium TB complex. The more used and available in public health services is GeneXpert MTB / RIF Ultra, which also provides information on susceptibility to rifampicin through the identification of a specific genome mutation (rpoB gene). With this technology, the diagnostic process is streamlined (you can obtain results during the day of execution, usually it would not take more than 2 hours) and sensitivity is high (sensitivity very similar to culture). Treatment of TB sensitive to first line drugs (rifampicin, isoniazid, ethambutol and pyrazinamide) consists of daily administration in the initial phase (with four drugs) for 2 months and in the continuation phase (with isoniazid and rifampicin) for 4 months, fully supervised. In rifampicin resistant TB, the treatment is a shortened oral regimen of 9 months with new drugs: bedaquiline, linezolid, clofazimine and levofloxacin (six months with four drugs, followed by three months with clofazimine and levofloxacin). These high-quality therapies are safe and promise better healing results. The new national standards mean a greater coverage for the eradication of the reservoirs of the disease and a greater precision in the diagnosis of the sources of community transmission of tuberculosis, being a significant contribution towards the path of control and elimination of TB in the country.

Comparison of different diagnostic modalities for isolation of Mycobacterium Tuberculosis among suspected tuberculous lymphadenitis patients / Comparação de diferentes modalidades de diagnóstico para isolamento de Mycobacterium tuberculosis entre pacientes com suspeita de linfadenite tuberculosa

Tuberculosis is a communicable disease with high morbidity and mortality rates in developing countries. The study's primary objective is to compare conventional methods such as acid-fast bacillus (AFB) culture and microscopy with rapid diagnostic methods. The secondary objective is to compare histopathological and microbiological findings in suspected patients with tubercular lymphadenitis. A total of 111 samples (August 2018 to September 2019) of lymph nodes were processed for AFB microscopy, AFB cultures, drug-susceptibility testing (DST), histopathology, and Xpert Mycobacterium Tuberculosis (MTB)/resistance to Rifampin (RIF) assays. Out of 111 lymph node samples, 6 (5.4%) were positive for AFB smear microscopy, 84 (75.6%) were positive for AFB culture, 80 (70.7%) were positive on Gene Xpert, and 102 (91.8%) were indicative of tuberculosis for histopathology studies. Mycobacteria growth indicator tube (MGIT) culture positivity was 84 (75.6%) higher than solid Lowenstein-Jensen (LJ) culture 74 (66.6%). Positive cultures underwent phenotypic DST. Two cases were Multidrug-resistant (MDR) on DST, while three cases were Rifampicin resistant on Gene Xpert. The sensitivity of Genexpert was (62%) against the conventional AFB culture method. The poor performance of conventional lymphadenitis diagnostic methods requires early and accurate diagnostic methodology. Xpert MTB/RIF test can help in the treatment of multidrug-resistant TB cases. Nonetheless, rapid and conventional methods should be used for complete isolation of Mycobacterium tuberculosis.

A tuberculose é uma doença transmissível com altas taxas de morbimortalidade nos países em desenvolvimento. O objetivo principal do estudo é comparar métodos convencionais, como cultura de bacilo álcool-ácido resistente (BAAR) e microscopia, com métodos de diagnóstico rápido. O objetivo secundário é comparar os achados histopatológicos e microbiológicos em pacientes com suspeita de linfadenite tubercular. Um total de 111 amostras (agosto de 2018 a setembro de 2019) de gânglios linfáticos foi processado para microscopia de AFB, culturas de AFB, teste de susceptibilidade a drogas (DST), histopatologia e Xpert Mycobacterium tuberculosis (MTB)/ensaios de resistência à rifampicina (RIF). Das 111 amostras de linfonodos, 6 (5,4%) foram positivas para baciloscopia de AFB, 84 (75,6%) foram positivas para cultura de AFB, 80 (70,7%) foram positivas para o GeneXpert e 102 (91,8%) foram indicativas de tuberculose para estudos histopatológicos. A positividade da cultura do tubo indicador de crescimento de micobactérias (MGIT) foi 84 (75,6%), maior que a cultura sólida de Lowenstein-Jensen (LJ), 74 (66,6%). As culturas positivas foram submetidas a DST fenotípico. Dois casos eram multirresistentes (MDR) ao DST, enquanto três casos eram resistentes à rifampicina no GeneXpert. A sensibilidade do GeneXpert foi 62% contra o método convencional de cultura AFB. O fraco desempenho dos métodos convencionais de diagnóstico de linfadenite requer metodologia de diagnóstico precoce e precisa. O teste Xpert MTB/RIF pode ajudar no tratamento de casos de tuberculose multirresistente. No entanto, métodos rápidos e convencionais devem ser usados para o isolamento completo do Mycobacterium tuberculosis.

Clinical and bronchoscopy features of tracheobronchial tuberculosis in children / 中国当代儿科杂志

OBJECTIVES@#To study the clinical and bronchoscopic characteristics of tracheobronchial tuberculosis (TBTB) in children and to identify factors influencing residual airway obstruction or stenosis.@*METHODS@#The clinical data of children with TBTB were retrospectively collected. The children were divided into two groups based on the last bronchoscopic result within one year of follow-up: a group with residual airway obstruction or stenosis (n=34) and a group without residual airway obstruction or stenosis (n=58). A multivariate logistic regression analysis was used to identify the factors influencing residual airway obstruction or stenosis in children with TBTB. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of the factors influencing residual airway obstruction or stenosis in children with TBTB.@*RESULTS@#A total of 92 children with TBTB were included, and the main symptoms were cough (90%) and fever (68%). In children under 1 year old, the incidence rates of dyspnea and wheezing were significantly higher than in other age groups (P<0.008). Chest CT findings included mediastinal or hilar lymph node enlargement (90%) and tracheobronchial stenosis or obstruction (61%). The lymphatic fistula type was the main type of TBTB observed bronchoscopically (77%). All children received interventional treatment, and the effective rate was 84%. During one year of follow-up, 34 children had residual airway obstruction or stenosis. The TBTB diagnostic time and the initiation of interventional treatment were significantly delayed in the group with residual airway obstruction or stenosis compared with the group without residual airway obstruction or stenosis (P<0.05). The multivariate logistic regression analysis showed that the TBTB diagnostic time was closely related to residual airway obstruction or stenosis in children (P<0.05). ROC curve analysis showed that at the cut-off value of 92 days of TBTB diagnostic time, the area under the curve for predicting residual airway obstruction or stenosis in children with TBTB was 0.707, with a sensitivity of 58.8% and a specificity of 75.9%.@*CONCLUSIONS@#The clinical manifestations of TBTB are nonspecific, and symptoms are more severe in children under 1 year old. TBTB should be suspected in children with tuberculosis and chest imaging indicating airway involvement. Delayed diagnosis of TBTB is associated with the development of residual airway obstruction or stenosis.

Research progress in transcriptional and immunological biomarkers associated with tuberculosis infection / 中华预防医学杂志

Tuberculosis (TB) is an infectious disease that poses a serious threat to human health. About a quarter of the world's population were infected with Mycobacterium tuberculosis in 2020, and the majority of them were latently infected. Approximately 5%-10% of the population with latent tuberculosis infection may progress to active TB disease. Identifying latent TB infection from active TB by biomarkers and screening people with latent TB infection at high risk of progression for preventive treatment by biomarkers that can reliably predict the progression is one of the most effective strategies to control TB. This article reviews the progress of research on transcriptional and immunological biomarkers for identifying TB infection and predicting the progression from latent infection to active TB, with the aim of providing new ideas for tuberculosis control.

Paciente con quistes pulmonares y diagnóstico de coinfección con tuberculosis e hidatidosis: reporte de un caso pediátrico / Patient with pulmonary cysts and diagnosis of co-infection with tuberculosis and hydatidosis. Pediatric cases report

Existen numerosas entidades en la población pediátrica que pueden presentarse en forma de quistes o como lesiones de similares características. De estas patologías, las infecciosas son las más frecuentes. Se presenta el caso de una paciente oriunda de Bolivia con migración reciente a la Argentina que presentó una coinfección con tuberculosis e hidatidosis pulmonar. Ambas infecciones se pueden presentar con signos y síntomas similares y, aunque la asociación citada es poco frecuente en la bibliografía, ciertos mecanismos inmunitarios podrían intervenir en la coinfección de parásitos helmintos y micobacterias. Ambas patologías son infecciones prevalentes en nuestra región y deben ser tenidas en cuenta entre los diagnósticos diferenciales ante pacientes con imágenes quísticas o cavitarias pulmonares.

Numerous entities in the pediatric population can present in the form of cysts or as lesions with similar characteristics. Of the pathologies that can cause these images in children, infectious diseases are the most frequent. We present the case of a native of Bolivia with recent immigration to Argentina who presented a pulmonary co-infection with tuberculosis and hydatidosis. Both infections can present with similar signs and symptoms and although this association is rarely reported in the literature, certain immunological mechanisms could intervene in the causal association of co-infection between helminth parasites and mycobacteria. Both pathologies are very prevalent infections in our region and should be taken into account among the differential diagnoses in patients with cystic or cavitary pulmonary diseases.

El dilema en los laboratorios de Koch, ¿Cultivar o no Cultivar? / The Dilemma in Koch's Laboratories, To Cultivate or Not to Cultivate?

La nueva norma técnica para el control y la eliminación de la tuberculosis es un gran avance para el diagnóstico de este microorganismo en Chile. Actualmente la principal técnica microbiológica para el diagnóstico de laboratorio es la biología molecular, que reduce el tiempo del resultado a tan solo un par de horas. La normativa actual indica que en el paciente caso presuntivo de tuberculosis (CPT) la técnica exclusiva a realizar es Biología molecular. La literatura indica que la detección a través de amplificación de material genético de la micobacteria tiene un límite de detección de 15,6 UFC/ ml, por tanto, todas las muestras bajo ese límite umbral potencialmente podrían no ser diagnosticadas bajo esta estructura emanada por el ministerio de Salud en Chile. Nuestra recomendación es continuar con el estudio de cultivo en medios líquidos o sólidos para todas las muestras hasta obtener literatura que avale lo contrario

The new technical standard for the control and elimination of tuberculosis in Chile is a great advance for the diagnosis of this microorganism. Currently the main microbiological technique for laboratory diagnosis is PCR, which reduces the time to result to just a couple of hours. The current regulations indicate that in the patient with a presumptive case of tuberculosis (CPT) t he exclusive technique to be performed is PCR. The literature indicates that the detection through amplification of genetic material of the mycobacterium has a detection limit of 15.6 CFU/ml, therefore, all samples under this threshold limit could potentially not be diagnosed under this structure emanated by the Ministry of Health in Chile. Our recommendation is to continue with the study of culture in liquid or solid media for all samples until literature confirms otherwise

Estudo do perfil epidemiológico da tuberculose na população idosa no estado de São Paulo entre os anos de 2018-2020 / Study of the epidemiological profile of tuberculosis in the elderly population in the state of São Paulo between the years 2018-2020 / Estudio del perfil epidemiológico de la tuberculosis en la población anciana del estado de São Paulo entre los años 2018- 2020

A tuberculose e um doença que causa preocupação para as autoridades de saúde pública. Quando analisamos o envelhecimento da população, os idosos são mais susceptíveis a várias doenças, entre elas a tuberculose. Um dos motivos dessa fragilidade na saúde e devido a sua imunossenescência, além das comorbinadas frequentes nesse grupo etário. Desta forma, objetivou realizar uma pesquisa quantitativa, descritiva, realizada por bases secundárias de dados online, no qual foram utilizados o Serviço de Informação do Sistema Único de Saúde (DATASUS). Na pessquisa, foram inclusas pessoas de ambos os sexos com idade igual ou superior a 60 anos e com diagnóstico de Tuberculose no Estado de São Paulo entre os anos de 2018 a 2020. Nesta pesquisa pode se observar uma elevada ocorrência de tuberculose na população idosa principalmente no sexo masculino. Em relação a faixa etária com maior contaminados pela tuberculose foi entre 60-64 anos já a faixa etária com grande número de óbitos ocorreu 70-79 anos, por causa dessa doença.

Tuberculosis is a disease of concern to public health authorities. When we analyze the aging of the population, the elderly are more susceptible to several diseases, including tuberculosis. One of the reasons for this fragility in health is due to its immunosenescence, in addition to the frequent co-morbidities in this age group. In this way, it aimed to carry out a quantitative, descriptive research, carried out by secondary online databases, in which the Information Service of the Unified Health System (DATASUS) was used. In the research, people of both sexes aged 60 years or older and diagnosed with tuberculosis in the State of São Paulo between the years 2018 to 2020 were included. in male. Regarding the age group with the highest number of tuberculosis infections, it was between 60-64 years old, while the age group with a large number of deaths occurred between 70-79 years old, because of this disease.

La tuberculosis es una enfermedad que preocupa a las autoridades de salud pública. Cuando analizamos el envejecimiento de la población, los ancianos son más susceptibles de padecer diversas enfermedades, entre ellas la tuberculosis. Una de las razones de esta fragilidad en la salud se debe a su inmunosenescencia, además de las frecuentes comorbilidades en este grupo de edad. De esta forma, se pretendía realizar una investigación cuantitativa, descriptiva, realizada por bases secundarias de datos online, en las que se utilizó el Servicio de Información del Sistema Único de Salud (DATASUS). En la investigación se incluyeron personas de ambos sexos con 60 años o más y diagnosticadas de Tuberculosis en el Estado de São Paulo entre los años 2018 y 2020. En esta investigación se puede observar una alta ocurrencia de tuberculosis en la población de edad avanzada, especialmente en los varones. En relación con el grupo de edad con mayor contaminación por tuberculosis fue entre 60-64 años ya el grupo de edad con un gran número de muertes se produjo 70- 79 años, a causa de esta enfermedad.

Coloración de Ziehl-Neelsen en el laboratorio de patología: rendimiento y contribución al diagnóstico de micobacterias en el lavado broncoalveolar / Ziehl-Neelsen stain in the pathology laboaratory: Performance and diagnostic aid for mycobacteria in bronchoalveolar lavage

Introducción. La coloración de Ziehl-Neelsen, con más de 100 años de uso, continúa vigente mundialmente. Objetivo. Comparar el rendimiento de las pruebas diagnósticas utilizadas para la determinación de micobacterias en el laboratorio clínico de patología en muestras de lavado broncoalveolar. Materiales y métodos. Se revisaron retrospectivamente 737 muestras de lavado broncoalveolar procesadas en el 2019 y el 2020 en el Hospital San Vicente Fundación (Medellín, Colombia) y se compararon las características de tres pruebas diagnósticas realizadas en paralelo: la reacción en cadena de la polimerasa (PCR) para micobacterias con detección de resistencia, el cultivo, y la coloración de Ziehl-Neelsen. Resultados. Se catalogaron como enfermos a 93 de los 737 pacientes a partir de los resultados positivos en alguna de las tres pruebas. El cultivo tuvo una sensibilidad de 0,80, la PCR una de 0,76 y la coloración de Ziehl-Neelsen una de 0,51. Sin embargo, solo 5 de 75 (6,5 %) cultivos fueron positivos a las cuatro semanas y el resto lo fue a las ocho semanas. La PCR combinada con la coloración de Ziehl-Neelsen mejoró la sensibilidad de la PCR por sí sola, de 0,76 a 0,88, diferencia que fue estadísticamente signifcativa (p=0,022). Conclusión. En las muestras de lavado broncoalveolar, el cultivo sigue siendo la prueba con mejor sensibilidad. El uso conjunto de la prueba de PCR y la coloración de ZiehlNeelsen mejora signifcativamente la sensibilidad de la primera, lo que compensa la demora relativa en la entrega de los resultados debida al tiempo requerido para la tinción de Ziehl-Neelsen.

Introduction: With more than 100 years of use, the Ziehl-Neelsen stain is still currently used worldwide. Objective: To compare the performance of diagnostic tests used to determine mycobacteria in the clinic and pathology laboratory in bronchoalveolar lavage samples. Materials and methods: We retrospectively reviewed 737 bronchoalveolar lavage samples from 2019 to 2020 in the San Vicente Fundación hospital (Medellín, Colombia) comparing the performance of three tests done in parallel: mycobacteria and resistance PCR, culture, and Ziehl-Neelsen stain. Results: In total, 93/737 patients were classifed as sick due to a positive result in any of the three tests. The culture, PCR, and Ziehl-Neelsen stain had a sensibility of 0.80, 0.76 y 0.51, respectively. However, only 5/75 (6.5%) of the positive cultures had results within the frst four weeks and the rest in eight weeks. The PCR test combined with the Ziehl-Neelsen stain improved the sensibility of the PCR test alone from 0.76 a 0.88, a change that was statistically signifcant (p = 0.022). Conclusion: At least in bronchoalveolar lavage samples, culture is still the test with better sensibility. The use in parallel of the PCR test and the Ziehl-Neelsen stain improved in a statistically signifcant manner the performance of the PCR test alone, regardless of the higher turnaround time of the Ziehl-Neelsen stain.

Impact of the COVID-19 pandemic on laboratory diagnosis of tuberculosis in southern Brazil / Impacto da pandemia de COVID-19 no diagnóstico laboratorial de tuberculose no sul do Brasil / Impacto de la pandemia COVID-19 en el diagnóstico de laboratorio de la tuberculosis en el sur de Brasil

Background and objectives: to understand the impact of the COVID-19 pandemic on tuberculosis (TB) diagnosis in different settings is essential to guide the establishment of appropriate TB control strategies. This study aimed to assess the influence of COVID-19 pandemic in laboratory diagnosis of TB in patients tested and diagnosed for TB. Methods: a data survey was carried out in the database of laboratories that perform TB diagnosis for the public health system in Rio Grande city (Rio Grande do Sul, Brazil). Results: there was a decrease of 1,368 to 735 (reduction of 46.3%) in the number of patients tested for TB in public diagnostic services in 2019 and 2020, respectively, and a decrease of 197 to 119 (reduction of 39.6%) in the number of new TB cases diagnosed. In contrast, the positivity rate was 14.4% in 2019 and 16.2% in 2020. Moreover, it was observed that the laboratory that performs the diagnostic service for Primary Health Care was the most affected, when compared to Tertiary Health Care. Conclusion: as a consequence of measures to control the spread of SARS-CoV-2, there was a reduction in TB testing and in the detection of new cases, especially in Primary Health Care, where patients with less need for hospitalization are received.(AU)

Justificativa e objetivos: compreender o impacto da pandemia COVID-19 no diagnóstico da tuberculose (TB) em diferentes locais é essencial para orientar o estabelecimento de estratégias adequadas de controle da TB. O objetivo deste estudo foi avaliar a influência da pandemia de COVID-19 no diagnóstico laboratorial de TB, em pacientes testados e diagnosticados com TB. Métodos: foi realizado um levantamento de dados no banco de dados de laboratórios que realizam diagnóstico de TB para o sistema público de saúde na cidade de Rio Grande (Rio Grande do Sul, Brasil). Resultados: houve redução de 1.368 para 735 (redução de 46,3%) no número de pacientes testados para TB nos serviços públicos de diagnóstico em 2019 e 2020, respectivamente, e redução de 197 para 119 (redução de 39,6%) no número de novos casos de TB diagnosticados. Em contrapartida, a taxa de positividade foi de 14,4% em 2019 e 16,2% em 2020. Além disso, observou-se que o laboratório que realiza o serviço de diagnóstico para a Atenção Primária à Saúde foi o mais afetado, quando comparado com a Atenção Terciária à Saúde. Conclusão: como consequência das medidas de controle da disseminação do SARS-CoV-2, houve redução na testagem de TB e na detecção de novos casos, principalmente na atenção primária à saúde, onde são recebidos pacientes com menor necessidade de internação.(AU)

Justificación y objetivos: comprender el impacto de la pandemia Covid-19 en el diagnóstico de tuberculosis (TB) en diferentes lugares es fundamental para orientar el establecimiento de estrategias adecuadas de control de la TB. El objetivo de este estudio fue evaluar la influencia de la pandemia de COVID-19 en el diagnóstico de laboratorio de TB, en términos de pacientes examinados y diagnosticados de TB. Métodos: los datos fueron recolectados de la base de datos de los laboratorios que realizan el diagnóstico de TB para el sistema público de salud en la ciudad de Rio Grande (Rio Grande do Sul, Brasil). Resultados: hubo una reducción de 1.368 a 735 (reducción del 46,3%) en el número de pacientes sometidos a pruebas de TB en los servicios públicos de diagnóstico en 2019 y 2020, respectivamente, y una reducción de 197 a 119 (reducción del 39,6%) en el número de nuevos casos de TB diagnosticados. Por otro lado, la tasa de positividad fue de 14,4% en 2019 y 16,2% en 2020. Además, se observó que el laboratorio que realiza el servicio de diagnóstico para la Atención Primaria de Salud fue el más afectado, en comparación con la Atención Terciaria de Salud. Conclusiones: como consecuencia de las medidas para el control de la propagación del SARS-CoV-2, hubo una reducción en las pruebas de TB y en la detección de nuevos casos, especialmente en la Atención Primaria de Salud, donde se encuentran los pacientes con menor necesidad de hospitalización.(AU)

Impacto de la pandemia COVID-19 sobre el programa de tuberculosis infantil / Impact of the COVID-19 pandemic on the child tuberculosis program

Las pandemias siempre han perturbado los sistemas de atención de salud, incluida la prevención y el control de enfermedades endémicas. Esta alteración ha dado lugar a un aumento de la carga de enfermedad en los períodos posteriores a una pandemia. La crisis de salud y económica creada por la actual pandemia COVID-19, así como las medidas de salud pública para detener su propagación, pueden tener un impacto en la transmisión, diagnóstico, tratamiento, prevención y control de la tuberculosis (TBC). Los niños son un grupo vulnerable especialmente propenso a sufrir parte del daño. Es necesario recuperar cuanto antes las actividades de pesquisa, diagnóstico y tratamiento de la TBC de manera de disminuir el impacto que la pandemia por Covid19 tendrá en la morbimortalidad por TBC.

Pandemics have always disrupted health care systems, including the prevention and control of endemic diseases. This alteration has led to an increased burden of disease in the aftermath of a pandemic. The health and economic crisis created by the current COVID-19 pandemic, as well as public health measures to stop its spread, may have an impact on the transmission, diagnosis, treatment, prevention and control of tuberculosis. Children are a vulnerable group especially prone to suffering as part of the harm. It is necessary to recover as soon as possible the activities of investigation, diagnosis and treatment of tuberculosis in order to reduce the impact that the Covid19 pandemic will have on TB morbidity and mortality.

Impacto da implantação do teste rápido molecular para a tuberculose no Brasil / Impact of roll out of rapid molecular test for tuberculosis in Brazil

Introdução: A tuberculose (TB) ainda se apresenta como um grave problema de saúde pública no mundo, com mais de 10 milhões de casos e 1,3 milhão de mortes anualmente. Em 2020, no Brasil, foram notificados 66.819 casos novos de TB, e aproximadamente 913 casos de TB drogarresistente. Cerca de 4.500 pessoas vão a óbito, anualmente, por TB no país. Com as tecnologias atuais, a melhor estratégia para controlar a transmissão e reduzir a incidência da TB é o diagnóstico e tratamento dos casos pulmonares bacilíferos, associados ao diagnóstico e tratamento da infecção latente. O Brasil incorporou, em 2014, o teste rápido molecular (TRM), recomendando-o como estratégia inicial para diagnóstico da TB e detecção da resistência à rifampicina (TB-RR). A presente tese buscou descrever e analisar o impacto da implantação do teste rápido molecular para tuberculose sobre os indicadores programáticos para o controle da tuberculose no Brasil, e o efeito do teste rápido molecular no início do tratamento em casos de tuberculose resistentes à rifampicina e/ou multidrogarresistente. Métodos: foram realizados estudos observacionais, com dados secundários. O primeiro, trata-se de um estudo ecológico cujas unidades de análise foram os municípios que compõe a rede de teste rápido molecular para TB (RTR-TB), e foram analisados os indicadores da TB antes e depois do início de utilização do TRM. Foi utilizada a modelagem de séries temporais interrompidas pela Regressão de Prais-Winsten. O segundo estudo teve como desenho uma coorte retrospectiva, tomando o indivíduo como unidade de análise. Foi utilizado o método de análise de sobrevida para avaliar o efeito do TRM sobre o tempo entre o diagnóstico e o início do tratamento dos casos novos de TB-RR / TB-MDR. A Regressão de Cox foi utilizada para estimação dos riscos proporcionais. Resultados: no período estudado, a RTR-TB consumiu um total de 1.756.358 cartuchos de TRM, sendo 1.734.935 testes realizados. A notificação de casos novos de TB na série histórica trimestral de janeiro de 2010 a junho de 2014 apresentou tendência estacionária. Após a implantação do TRM-TB, verificou-se uma tendência de aumento médio da ordem de 0,5% (IC 95%: 0,13 - 0,87) de casos novos, por trimestre, e em todo o período pós-intervenção, houve um incremento de 8.241 casos novos de TB nos municípios da RTR-TB, um aumento de 15% (IC 95%: 10,71 - 19,46) no nível de confirmação laboratorial dos casos novos de TB, e uma queda de 8,42% (IC 95%: -15,61 - -0,62) na realização de baciloscopia. Entre 2014 e 2019, 2.071 casos de TB-RR / TB-MDR tiveram o diagnóstico da resistência por meio do TRM, e 1.592 por meio do TSA. Após a incorporação do TRM, houve uma redução no tempo médio de início do tratamento da resistência em 89 dias (p-valor < 0,0001), quando comparado ao TSA. Indivíduos diagnosticados pelo TRM apresentam maior probabilidade de iniciar o tratamento da TB-DR mais precocemente quando comparado aos indivíduos diagnosticados pelo TSA, e essa diferença é mais acentuada até os primeiros 60 dias após o diagnóstico. Indivíduos diagnosticados pelo TSA apresentaram probabilidade 78% menor de iniciar o tratamento nos primeiros 30 dias após o diagnóstico da resistência quanto comparado aos indivíduos diagnosticados pelo TRM (HRadj: 0,22; IC95%: 0,13 - 0,36), e 49% menor probabilidade de iniciar o tratamento nos primeiros seis meses após o diagnóstico quando comparado aos indivíduos diagnosticados pelo TRM (HRadj: 0,51; IC95%: 0,39 - 0,62). Conclusões: o TRM apresentou, de forma global, impacto positivo nas estratégias de controle da TB do Brasil, reestruturando a rede de diagnóstico da doença, aumentando a confirmação laboratorial, e diminuindo o tempo entre o diagnóstico e o início do tratamento da TB-RR / TB-MDR. A incorporação do TRM no SUS propiciou um diagnóstico da doença mais rápido e com maior sensibilidade, viabilizando um diagnóstico muito mais oportuno da TB-RR / TB-MDR, e encurtando o tempo para início do tratamento da TB resistente. A ampliação do diagnóstico rápido molecular por TRM para os municípios que ainda não compõe a RTR-TB podem contribuir para um melhor controle da TB no país.

Introduction: Tuberculosis (TB) still is as a serious public health problem in the world, with more than 10 million cases and 1.3 million deaths annually. In 2020, in Brazil, 66.819 new cases of TB and approximately 913 cases of drug-resistant TB were notified. About 4,500 persons die annually from TB in the country. With the current technologies available, the best strategies to control the transmission and to reduce the TB incidence is the diagnosis and treatment of the bacilliferous pulmonary cases, associated with the diagnosis and treatment of latent infection. In 2014, Brazil has incorporated the rapid molecular test (TRM), recommending it as an initial strategy for diagnosing TB and detecting rifampicin resistance (TB-RR). The present thesis describes and analyses the impact of the roll out of the TRM for TB on the programmatic indicators for TB control in Brazil, and the effect of the TRM in the beginning of the treatment in cases of tuberculosis resistant to rifampicin and/or multidrugresistent. Methods: observational studies were performed with routine data. The first study was an ecological study whose units of analysis were the municipalities that make up the rapid molecular testing network for TB (RTR-TB), and TB indicators were analyzed before and after the beginning of TRM use. The modeling of time series interrupted by the Prais-Winsten Regression was used. The second study was a retrospective cohort, whose the individual was the unit of analysis. The survival analysis method was used to assess the effect of TRM on the time between diagnosis and initiation of treatment of new cases of RR-TB / MDR-TB. Cox regression was used to estimate proportional hazards. Results: in the period studied, the RTR-TB consumed a total of 1,756,358 TRM cartridges, with 1,734,935 tests performed. The notification of new TB cases in the quarterly historical series from January 2010 to June 2014 showed a stationary trend. After the implementation of the TRM-TB, there was a trend towards an average increase of around 0.5% (95% CI: 0.13 - 0.87) of new cases, per quarter-year, and throughout the post-intervention period, there was an increase of 8,241 new TB cases in the municipalities of RTR-TB, a 15% increase (95% CI: 10.71 - 19.46) in the level of laboratory confirmation of new TB cases, and a decrease of 8.42% (95% CI: -15.61 - -0.62) in performing smear microscopy. Between 2014 and 2019, 2,071 RR-TB/MDR-TB cases were diagnosed with resistance through TRM, and 1,592 through TSA. After the incorporation of TRM, there was a reduction in the mean time of initiation of resistance treatment by 89 days (p-value < 0.0001), when compared to TSA. Individuals diagnosed by TRM are more likely to start DR-TB treatment earlier when compared to individuals diagnosed by TSA, and this difference is more accentuated up to the first 60 days after diagnosis. Persons diagnosed by TSA were 78% less likely to start the treatment in the first 30 days after the diagnosis of resistance when compared to those diagnosed by TRM (HRadj: 0.22; 95% CI: 0.13 - 0.36), and 49% lower probability of starting the treatment in the first six months after the diagnosis when compared to those diagnosed by TRM (HRadj: 0.51; 95%CI: 0.39 - 0.62). Conclusions: Overall, the TRM had a positive impact on TB control strategies in Brazil, restructuring the disease diagnosis network, increasing laboratory confirmation, and reducing the time between diagnosis and initiation of TB-RR / TB-MDR treatment. The incorporation of TRM into the Public Health System in Brazil provided a faster and more sensitive diagnosis of the disease, enabling a much more timely diagnosis of RR-TB / MDR-TB, and shortening the time to start treatment for resistant TB. The expansion of rapid molecular diagnosis by TRM to municipalities that are not yet part of the RTR-TB may contribute to better control of the disease in the country.

Tuberculosis congénita - el desafío parte con la madre / Congenital tuberculosis - the challenge starts with the mother

La tuberculosis es la enfermedad infecciosa por un solo agente que provoca más muertes en el mundo. A la fecha, no hay un registro de casos de embarazadas con tuberculosis en el mundo ni en Chile, y menos de los casos de tuberculosis congénita. El diagnóstico en ambas situaciones suele ser tardío y con malos resultados clínicos. Se presenta una revisión de la literatura con relación a tuberculosis perinatal y dos casos clínicos de los binomios madre e hijo afectados.

Tuberculosis is the single agent infectious disease that causes the most deaths in the world. To date, there is no record of pregnant women with tuberculosis in the world or in Chile, even less of congenital tuberculosis. Diagnosis in both situations is usually late and with poor clinical results. A literature review is presented in relation to perinatal tuberculosis and two clinical cases of affected mother and child binomials.

Terapias biológicas y tuberculosis en pediatría / Biological therapies and tuberculosis in pediatrics

En los últimos años, ha habido un aumento sostenido del uso de terapias inmunomoduladoras como las terapias biológicas y en un período más reciente, de las terapias con moléculas pequeñas. Estos tratamientos constituyen un factor de riesgo más para enfermar de tuberculosis en adultos y aunque en menor grado, también en niños, especialmente con el uso de anti TNF-α, por lo que antes de iniciar una terapia biológica, hay que descartar la tuberculosis activa y la latente. En el tratamiento de una tuberculosis activa producida por un biológico se debe prolongar la etapa de continuación a 9 meses. Es importante el seguimiento clínico prolongado en años de quienes usan o han completado el uso de estas terapias. Hay que posponer la vacunación BCG en los hijos de madres que usaron terapias biológicas durante la gestación hasta la edad 6 a 12 meses de los niños. El foco de esta revisión está centrado en la tuberculosis por progresión de una forma latente a una activa o por un contacto estrecho con una persona con tuberculosis pulmonar en pacientes que reciben terapias biológicas anti TNF alfa de uso inmunoreumatológico.

In recent years, there has been a sustained increase in the use of immunomodulatory therapies such as biologic therapies and, more recently, small molecule therapies. Those therapies have become another risk factor for tuberculosis in adults and, although to lesser degree, also in children, especially some of them, such as anti-TNF α. Before starting biological therapy, active tuberculosis and latent tuberculosis must be ruled out. In the treatment of active tuberculosis caused by a biologic, the continuation stage should be extended to 9 months. Long-term clinical follow-up in years of those who use them or have completed their use, is important. BCG vaccine should be postponed in children of mother who used biologic therapies during pregnancy until the children ́s age 6 to 12 months. The focus of this review is centered on tuberculosis due to progression from a latent to an active form or due to close contact with a person with pulmonary tuberculosis in patients receiving anti-TNF alpha biological therapies for immunorheumatology use.

Magnitude entre a acessibilidade, espaço de tempo e o diagnóstico da tuberculose / Magnitud entre la accesibilidad, el espacio de tiempo y el diagnóstico de la tuberculosis / Magnitude between accessibility, time period, and tuberculosis diagnosis

Resumo Objetivo Analisar, na perspectiva dos portadores de tuberculose, a relação entre a acessibilidade ao sistema de saúde, o espaço de tempo e a realização do diagnóstico. Métodos Estudo analítico, correlacional, com delineamento transversal, realizado com 105 portadores de tuberculose atendidos na Atenção Primária à Saúde e no Serviço de Referência Especializado de um município prioritário mineiro. A análise de correspondência múltipla foi utilizada para identificar a associação entre os componentes da acessibilidade ao sistema de saúde, o espaço de tempo e a realização do diagnóstico da tuberculose. Resultados Observou-se associação temporal com o retardo no diagnóstico da tuberculose, com relação direta do serviço de primeira escolha do paciente, sendo os hospitais os locais que realizavam o diagnóstico em tempo oportuno, revelando baixa resolutividade dos serviços de atenção primária para as ações de controle da doença, no que se refere, principalmente, à identificação dos sintomáticos respiratórios. Conclusão Os achados destacam a urgência na reorganização dos serviços de atenção à tuberculose, fortalecendo a descentralização das ações para a Atenção Primária à Saúde, com enfoque na identificação precoce dos sintomáticos respiratórios e garantia de acessibilidade aos serviços de saúde, a fim de minimizar os impactos da extensão temporal no diagnóstico precoce.

Resumen Objetivo Analizar, bajo la perspectiva de los portadores de tuberculosis, la relación entre la accesibilidad al sistema de salud, el espacio de tiempo y la realización del diagnóstico. Métodos Estudio analítico, correlacional, con diseño transversal, realizado con 105 portadores de tuberculosis atendidos en la Atención Primaria de Salud y en el Servicio de Referencia Especializado de un municipio prioritario del estado de Minas Gerais. El análisis de correspondencia múltiple fue utilizado para identificar la relación entre los componentes de la accesibilidad al sistema de salud, el espacio de tiempo y la realización del diagnóstico de tuberculosis. Resultados Se observó asociación temporal con el retraso del diagnóstico de la tuberculosis, con relación directa del servicio de primera opción del paciente, de los cuales los hospitales era el lugar que se realizaba el diagnóstico a su debido tiempo, lo que revela una baja resolución de problemas de los servicios de atención primaria para las acciones de control de la enfermedad, principalmente respecto a la identificación de los sintomáticos respiratorios. Conclusión Los resultados señalan la urgencia de reorganizar los servicios de atención de tuberculosis y fortalecer la descentralización de las acciones hacia la Atención Primaria de Salud, con enfoque en la identificación temprana de los sintomáticos respiratorios y garantía de accesibilidad a los servicios de salud a fin de minimizar los impactos de la extensión temporal del diagnóstico temprano.

Abstract Objective To analyze, from the perspective of tuberculosis patients, the relationship between accessibility to the health system, time period, and diagnosis. Methods This is an analytical, correlational study with a cross-sectional design was carried out with 105 tuberculosis patients treated in Primary Healthcare and in the Specialized Reference Service of a priority municipality in Minas Gerais. Multiple correspondence analysis was used to identify the association between the components of accessibility to the health system, time period, and tuberculosis diagnosis. Results A temporal association was observed with the delay in tuberculosis diagnosis, with a direct relationship between patients' first choice service, and hospitals were the places that gave diagnosis in a timely manner, revealing low resolution of primary care services for disease control actions, especially regarding the identification of respiratory symptoms. Conclusion The findings highlight the urgency in the reorganization of tuberculosis care services, strengthening the decentralization of actions for Primary Healthcare, focusing on the early identification of respiratory symptoms and ensuring accessibility to healthcare services, in order to minimize the impacts of temporal extension on early diagnosis.