Health Screening Strategies for Artisanal and Small-Scale Miners for Tuberculosis, Human Immunodeficiency Virus and Silicosis: A Case of the USAID-Supported Kunda Nqob'iTB Project in Zimbabwe.

Artisanal and small-scale mining is characterized by excessive exposure to physical, chemical, ergonomic, psychosocial and biological hazards. There is a high burden of tuberculosis (TB), human immunodeficiency virus (HIV) infections and silicosis among artisanal and small-scale miners (ASMs). The aim of this project report is to describe lessons learned from strategies implemented to reach ASMs with screening services for TB, HIV and silicosis in Zimbabwe through the Kunda-Nqob'i TB (KNTB) project supported by the United States Agency for International Development (USAID). The intervention package for screening ASMs for TB, HIV and silicosis included service provision through two occupational health clinics at two provincial hospitals and a mobile workplace-based screening (WBS) facility at the mining sites. From 1 October 2020 to 30 September 2023, 10,668 ASMs were screened, with a high number of cases of silicosis (21%) and TB (7.4%). There was a high burden of HIV (30%) in ASMs attending the occupational health clinics. The two occupational health clinics screened 3453 ASMs, while the mobile WBS activities screened 7215 ASMs during the period. A total of 370 healthcare workers (doctors/clinical officers, nurses, environmental health technicians and district tuberculosis and Leprosy control officers) were trained on TB and the fundamental diagnostic principles of silicosis. The KNTB project has been successful in reaching out to many ASMs operating in remote and hard-to-reach mining areas. The KNTB project has brought to light the positive health-seeking behavior of ASMs operating in remote areas. The project has brought to the fore the effectiveness of multi-stakeholder engagement and collaboration in reaching out to ASMs in remote areas with health screening services. There is a high burden of TB, HIV and silicosis in ASMs. Screening for TB, HIV and silicosis using workplace-based screening and occupational health clinics is an effective strategy and should be rolled out to all areas with high artisanal and small-scale mining activity.

A masquerade: An uncommon presentation of a dual infection of leprosy and human immunodeficiency virus.

Leprosy and human immunodeficiency virus (HIV) often mimic clinical features of connective tissue disease (CTD). They can present such as lupus, rheumatoid arthritis, scleroderma, or overlap syndromes and it sometimes creates confusion about the diagnosis. Serology may not be enough to differentiate the two and effective tissue biopsies are often the answer. We report the case of a 38-year-old female, who presented clinically with features of multisystem involvement suspected to be CTD, but was found to have dual infection: HIV and borderline tuberculoid leprosy.

Factors associated with tuberculosis treatment success among tuberculosis and human immunodeficiency virus co-infected patients in Kelantan.

INTRODUCTION: Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection is a global public health issue among people living with HIV. The objective was to assess the prevalence of TB treatment outcomes (successful and unsuccessful) and associated factors with TB treatment success among TB and HIV co-infected patients in Kelantan for 5 years (2014-2018). The successful TB treatment was defined as the sum of cured patients and those who completed the treatment. The unsuccessful treatment was defined as the sum of treatment failed, died, and default. MATERIALS AND METHODS: A cross-sectional study was conducted at the TB/Leprosy Unit of the State Health Department of Kelantan (JKNK) using secondary data from January 2014 to December 2018 assessed in the MyTB online system. The data were analyzed using SPSS 25.0 and STATA 14. Ethics approvals were obtained from Medical Research Ethics Committee (MREC) and UniSZA Human Research Ethics Committee (UHREC). RESULTS: Kelantan had 6,313 TB cases from January 2014 to December 2018. There were 703 (11.1%) cases of TB and HIV co-infection. The prevalence of successful treatment among TB and HIV co-infected patients was 57.1%. The duration of treatment and anatomy of TB location was significantly associated with TB treatment success. CONCLUSION: This study's findings showed that the prevalence of TB treatment success rate was 57.1%, and the unsuccessful rate was 42.9%. The treatment duration and the TB location's anatomy were significantly associated with the treatment success rate. Improving TB treatment outcomes should be started with anti-TB treatment immediately after TB diagnosis. Therefore, the government should strengthen the TB/HIV collaborative efforts to achieve good treatment outcomes among these vulnerable patients.

Nova lei garante sigilo a pessoas vivendo com HIV, hepatites crônicas, tuberculose e hanseníase

Foi sancionada, nesta terça-feira (4) a Lei nº 14.289, que obriga o sigilo sobre a condição de pessoas infectadas pelo vírus HIV e hepatites crônicas. A medida também abrange pessoas com hanseníase ou tuberculose. O sigilo é obrigatório no âmbito dos serviços de saúde, estabelecimentos de ensino, locais de trabalho, administração pública, segurança pública, processos judiciais e mídias escrita e audiovisual. O texto foi publicado no Diário Oficial da União.

Perfil clínico-epidemiológico das pessoas acometidas por hiv/aids, tuberculose e hanseníase no paraná, brasil, 2010-2019 / Perfil clínico-epidemiológico de las personas afectadas por vih/sida, tuberculosis y lepra en paraná, brasil, 2010-2019 / Clinical-epidemiological profile of people affected by hiv/aids, tuberculosis and leprosy in paraná, brazil, 2010-2019

RESUMO Objetivo: caracterizar o perfil cínico-epidemiológico das pessoas acometidas por HIV/AIDS, tuberculose e hanseníase no Paraná, entre 2010 e 2019. Método: estudo descritivo, de abordagem quantitativa, com dados provenientes do Sistema de Informação de Agravos de Notificação. A população foi definida como os casos novos de HIV/AIDS, tuberculose e hanseníase notificados entre 2010e 2019, no Paraná. Para a análise, foram utilizadas técnicas de estatística descritiva. Resultados: entre 2010 e 2019, foram registrados 14.149 casos de HIV/AIDS, 7.868 de hanseníase e 22.147 de tuberculose. Houve predomínio de casosentre homens, com raça/cor branca e ensino fundamental (in)completo para os três agravos. Evidenciou-se maior número de notificações do HIV/AIDS entre adolescentes e adultos com até 39 anos, da tuberculose entre adultos em fase economicamente ativa e da hanseníase entre adultos com mais de 50 anos. Ademais, observou-se aumento do HIV/AIDS entrehomossexuais e bissexuais, dos óbitos por tuberculose e de crianças/adolescentes com hanseníase. Conclusão: o perfil de homens adultos com baixa escolaridade evidenciado neste estudofoi semelhante à literatura, o que sugere possibilidades de atuação para profissionais da assistência, vigilância e gestão, com vistas à proposição de estratégias direcionadas ao controle do HIV/AIDS, da tuberculose e da hanseníasea nível estadual.

RESUMEN Objetivo: caracterizar el perfil clínico-epidemiológico de las personas afectadas por VIH/sida, tuberculosis y lepra en Paraná/Brasil, entre 2010 y 2019. Método: estudio descriptivo, de abordaje cuantitativo, con datos provenientes del Sistema de Información de Agravios de Notificación. La población fue definida como los casos nuevos de VIH/sida, tuberculosis y lepra notificados entre 2010 y 2019, en Paraná/Brasil. Para el análisis, se utilizaron técnicas de estadística descriptiva. Resultados: entre 2010 y 2019 se registraron 14.149 casos de VIH/sida, 7.868 de lepra y 22.147 de tuberculosis. Hubo predominio de casos entre hombres, con raza/color blanco y enseñanza primaria (in)completa para los tres agravios. Se evidenció mayor número de notificaciones del VIH/sida entre adolescentes y adultos de hasta 39 años, de la tuberculosis entre adultos en fase económicamente activa y de la lepra entre adultos de más de 50 años. Además, se observó aumento del VIH/sida entre homosexuales y bisexuales, de los óbitos por tuberculosis y de niños/adolescentes con lepra. Conclusión: el perfil de hombres adultos con baja escolaridad evidenciado en este estudio fue similar a la literatura, lo que sugiere posibilidades de actuación para profesionales de la asistencia, vigilancia y gestión, con vistas a proponer estrategias dirigidas al control del VIH/sida, la tuberculosis y la lepra a nivel estatal.

ABSTRACT Objective: to characterize the clinical-epidemiological profile of people affected by HIV/AIDS, tuberculosis and leprosy in Paraná, between 2010 and 2019. Method: descriptive study, quantitative approach, with data from the Information System of Notifiable Diseases. The population was defined as new cases of HIV/AIDS, tuberculosis and leprosy reported between 2010 and 2019 in Paraná. For the analysis, descriptive statistical techniques were used. Results: between 2010 and 2019, 14,149 cases of HIV/AIDS, 7,868 of leprosy and 22,147 of tuberculosis were registered. There was a predominance of cases among men, with white race/color and (in)complete elementary school for the three diseases. There was a higher number of HIV/AIDS notifications among adolescents and adults up to 39 years old, tuberculosis among adults in an economically active phase and leprosy among adults over 50 years old. In addition, there was an increase in HIV/AIDS among homosexuals and bisexuals, deaths from tuberculosis and children/adolescents with leprosy. Conclusion: the profile of adult men with low schooling evidenced in this study was similar to the literature, which suggests possibilities of management, with a view to proposing strategies aimed at controlling HIV/AIDS, tuberculosis and leprosy at the state level.

Potential of recombinant LiHyQ, a novel Leishmania infantum protein, for the diagnosis of canine visceral leishmaniasis and as a diagnostic and prognostic marker for human leishmaniasis and human immunodeficiency virus co-infection: A preliminary study.

Laboratory diagnosis of leishmaniasis shows variable efficacy in detecting infected mammalian hosts and there is a need to identify suitable antigens to improve the accuracy of diagnostic tests. In the present study, a L. infantum hypothetical protein called LiHyQ was evaluated for the diagnosis of tegumentary (TL) and visceral (VL) leishmaniasis using canine and human samples. A collection of dog sera (n=155) were tested and contained samples from asymptomatic (n=20) and symptomatic (n=25) VL animals, from healthy dogs living in endemic (n=25) or non-endemic (n=25) areas of disease, from Leish-Tec® vaccinated dogs (n=20) or from dogs infected with Ehrlichia canis (n=15), Babesia canis (n=10) and Trypanosoma cruzi (n=15). Sensitivity (Se), Specificity (Sp), Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of 100% were observed for rLiHyQ with these samples, whereas the Se, Sp, PPV and NPV values with L. infantum Soluble Leishmania Antigen (SLA) preparation were 60.0%, 99.0%, 96.0% and 86.0%, respectively. A collection of human sera (n=305) were tested and contained samples from TL (n=50) and VL (n=40) patients, from VL/HIV co-infected patients (n=35), from patients infected with HIV alone (n=30), Chagas Disease (n=30), malaria (n=10), tuberculosis (n=10), paracoccidioidomycosis (n=15), leprosy (n=30) or aspergillosis (n=15); and from healthy subjects (n=40). Se, Sp, PPV and NPV values of 100% were observed for rLiHyQ with these samples, whereas the Se, Sp, PPV and NPV values with SLA were 58.0%, 76.0%, 50.0% and 82.0%, respectively. The antibody reactivity against the protein was compared with commercial kits, and the kappa index varied from 0.95 to 1.00 for rLiHyQ, and of 0.55 to 0.82 for the kits. In addition, the serological follow-up of treated patients showed a significant reduction in rLiHyQ-specific IgG antibody levels. All canine and human samples were tested at the same time using the same reagents, in order to reduce experimental variation and interference in data interpretation. In conclusion, our preliminary data suggest a diagnostic and prognostic role for rLiHyQ against leishmaniasis.

Identificación de especies micobacterianas ambientales u oportunistas en pacientes sintomáticos y con VIH/sida / Identification of environmental or opportunistic mycobacterial species in symptomatic symptomatic and HIV/AIDS patients

El aumento de las infecciones por micobacterias ambientales u oportunistas (MAO) coincide mundialmente con el declive de la infección tuberculosa e incremento de la infección por el virus de inmunodeficiencia humana (VIH). El presente trabajo es un estudio retrospectivo realizado en el Laboratorio Nacional de Referencia-Investigaciones de Tuberculosis/Micobacterias/Lepra (LNRI-TB/Lepra/Micobacterias), del Instituto de Medicina Tropical Pedro Kourí (IPK), La Habana, Cuba, durante el período enero 2014-diciembre 2018. El objetivo de nuestro estudio fue conocer la variabilidad de especies aisladas para establecer un referente actualizado sobre las infecciones causadas por estas. En este trabajo se clasificaron-identificaron 413 cepas procedentes de pacientes sintomáticos; 162 (39.22%) eran aislamientos de pacientes con VIH/sida atendidos en nuestro Hospital Nacional de Referencia a Atención al paciente VIH/sida (IPK), y el resto (n = 251 [60.77%]), procedentes de pacientes inmunocompetentes, incluyendo aislamientos recibidos de los Centros Provinciales de Higiene, Epidemiología, y Microbiología (CPHEM). Las muestras fueron analizadas con las técnicas convencionales establecidas: las pulmonares fueron descontaminadas por el método de Petroff modificado; las extrapulmonares, por el método del ácido sulfúrico al 4%; el cultivo se realizó en medio de Löwenstein-Jensen modificado. Posteriormente se realizó la clasificación-identificación de especies según el esquema fenotípico-bioquímico establecido. Las especies con mayor porcentaje de aislamiento pertenecieron a los Grupos III y IV, complejo Mycobacterium avium-intracellulare (34.14%) y complejo M. fortuitum (20.82%), respectivamente. Estos resultados permitirán conocer la prevalencia de estas especies en nuestro país, reafirmando la importancia diagnóstica de estos microorganismos para aplicar tratamiento específico, sobre todo en pacientes con factores de riesgo, en quienes es más probable la diseminación de la infección.

The increase in infections by environmental or opportunistic mycobacteria (MAO) coincides worldwide with the decline in tuberculosis infection and an increase in infection by the human immunodeficiency virus (HIV). The present work is a retrospective study carried out at the National Reference Laboratory-Tuberculosis/Mycobacterial/Leprosy Research (LNRI-TB / Leprosy / Mycobacteria), of the Pedro Kourí Institute of Tropical Medicine (IPK), La Habana, Cuba, during the period January 2014-December 2018. The objective of our study was to know the variability of isolated species to establish an updated reference on the infections caused by MAO. In this study, 413 strains from symptomatic patients were classified and identified; 162 (39.22%) were isolates from patients with HIV/AIDS treated at our National Hospital of Reference for Attention to HIV/AIDS patients (IPK), and the remaining (n=251 [60.77%]), from immunocompetent patients, including isolates received from the Provincial Centers of Hygiene, Epidemiology, and Microbiology (CPHEM). The samples were analyzed with the established conventional techniques: the lung samples were decontaminated by the modified Petroff method; the extrapulmonary, by the 4% sulfuric acid method; the culture was carried out in modified Löwenstein-Jensen medium. Subsequently, the classification-identification of species was carried out according to the established phenotypic-biochemical scheme. The species with the highest percentage of isolation belonged to Groups III and IV, Mycobacterium avium-intracellulare complex (34.14%), and M. fortuitum complex (20.82%), respectively. These results will allow us to know the prevalence of these species in our country, emphasizing the diagnostic importance of these microorganisms and thus apply a specific treatment, especially in patients with risk factors, in whom the spread of the infection is more likely

Informe epidemiológico doenças transmissíveis e não transmissíveis 1º quadrimestre de 2020 / Epidemiological report of communicable and non-communicable diseases 1st quarter of 2020

Apresenta o informe epidemiológico do Tocantins dando alusão aos Número de Casos de Beribéri, Doenças Crônicas, Taxa de óbitos por acidente de transporte terrestre, Acidentes de Trânsito, Coberturas das Vacinas, casos confirmados de meningites por etiologia, Hanseníase, tuberculose, doenças diarreica aguda, Toxoplasmose Gestacional e Congênita, HIV/AIDS, hepatites virais no ano de 2020.

It presents the epidemiological report of Tocantins alluding to the Number of Beriberi Cases, Chronic Diseases, Death rate due to land transport accidents, Traffic Accidents, Vaccine Coverage, confirmed cases of meningitis by etiology, Hansen's disease, tuberculosis, acute diarrheal diseases, Gestational and Congenital Toxoplasmosis, HIV / AIDS, viral hepatitis in 2020.

Presenta el informe epidemiológico de Tocantins referido al Número de Casos de Beriberi, Enfermedades Crónicas, Tasa de mortalidad por accidentes de transporte terrestre, Accidentes de tráfico, Cobertura de vacunas, Casos confirmados de meningitis por etiología, Enfermedad de Hansen, Tuberculosis, Enfermedades diarreicas agudas Toxoplasmosis gestacional y congénita, VIH / SIDA, hepatitis viral en 2020.

Il présente le rapport épidémiologique de Tocantins faisant allusion au nombre de cas de béribéri, aux maladies chroniques, au taux de mortalité dû aux accidents de transport terrestre, aux accidents de la circulation, à la couverture vaccinale, aux cas confirmés de méningite par étiologie, à la maladie de Hansen, à la tuberculose, aux maladies diarrhéiques aiguës, Toxoplasmose gestationnelle et congénitale, VIH / SIDA, hépatite virale en 2020.

Coinfección VIH- lepra. A propósito de dos casos / No disponible

La lepra, enfermedad milenaria y estigmatizante, sigue estando vigente en nuestros días. Aunque en nuestro país no constituye un problema de salud, a nivel de país ni de provincia, se notifican casos todos los años. La población masculina se ve afectada en mayor cuantía que la población femenina a pesar de que la misma no distingue su aparición por sexo. Es una enfermedad infecciosa, crónica que afecta a la piel y los nervios periféricos, a la mucosa de las vías respiratorias superiores y también a los ojos, además de algunas otras estructuras. Ocurre en personas de cualquier edad, y es causada por el Mycobacterium leprae. A pesar de ser producida por una micobacteria como la Tuberculosis, no contamos con la evidencia de que la misma se comporte de forma oportunista en los casos VIH. Pensar en ella ante la presencia de lesiones de piel con pérdida de sensibilidad, permite el diagnostico precoz, esto reviste gran importancia ya que cura al enfermo, interrumpe la cadena de transmisión y evita las discapacidades. Presentamos los dos únicos casos diagnosticados en nuestra provincia de coinfección VIH/Lepra en los últimos 20 años. Ambos del sexo masculino, los cuales presentaron lesiones en piel después de sus diagnósticos de VIH y al ser estudiados se les diagnóstico lepra y se impuso tratamiento. Logrando la curación del primer caso y encontrándose en estos momentos en observación el segundo caso con evolución satisfactoria de sus lesiones en piel. Los pacientes con diagnóstico de VIH no escapan a la posibilidad de contraer lepra, ante lesiones en piel tanto los pacientes como los médicos deben pensar en ella. Con tratamiento se cura, un enfermo en tratamiento no contagia y las incapacidades se pueden prevenir

Leprosy, a millennial and stigmatizing disease continues is still active in our days. Although it no longer constitutes a problem of health at country or department level, are cases are notified every year. The male population is more affected that the female population. It is an infectious and chronic illness that affects skin and outlying nerves, the mucous of the upper respiratory tract and also the eyes, besides some other structures. It can appear in people of any age and is caused by Mycobacterium leprae. In spite of being caused by mycobacteria like Tuberculosis, we don’t have evidence that leprosy behaves in an opportunist manner in the HIV affected individuals. In the presence of skin lesions with loss of sensibility one should think of leprosy and this can lead to an early diagnosis and treatment, interrupting the transmission chain and avoiding disabilities. We present the only two cases diagnosed in our department of co infection HIV/Leprosy in the last 20 years. Both are males, presenting lesions in skin after their diagnoses of HIV and finally being diagnosed leprosy and treatment was implemented. The first case is cured and in observation and the second case presents a satisfactory evolution of his skin lesions. The patients diagnosed of HIV can contract leprosy, therefore in a case with skin lesions and HIV clinicians should consider leprosy. With treatment the patient can be cured, rendered non-infectious and kept free of disabilities

Lepromatous leprosy and human immunodeficiency virus co-infection associated with phenomenon of Lucio versus immune reconstitution inflammatory syndrome / Lepra lepromatosa y coinfección con el virus de la inmunodeficiencia humana asociada a fenómeno de Lucio versus síndrome inflamatorio de reconstitución inmune

Diffuse lepromatous leprosy (DLL) is a severe clinical outcome of lepromatous leprosy (LL). The aetiologic cause is believed to be different from Mycobacterium leprae. A new species, Mycobacterium lepromatosis, was identified from a group of Mexican patients with DLL, and severe leprosy reactional state type 3 (Lucio's phenomenon). However, a total sequencing of its genome is necessary to prove the existence of this new species. This is a report on a non-typical Colombian case of leprosy - HIV coinfection, associated with an immune reconstitution inflammatory syndrome clinically compatible with a leprosy reaction type 3 or Lucio's phenomenon.

La lepra difusa (LLD) es una variedad de la lepra lepromatosa (LL), frecuente enMéxico. El agente etiológico se cree que es diferente a Mycobacterium leprae y se considerauna especie nueva denominada Mycobacterium lepromatosis, hecho que no se ha comprobado.El reporte de este caso se realiza para dar a conocer el cuadro clínico atípico que presentóuna paciente colombiana con coinfección VIH---LL variedad difusa (LLD), asociado a síndromede reconstitución inmunológica, compatible clínicamente con una leprorreacción tipo 3 o fenó-meno de Lucio.

Observatório de Saúde subsidiando identificação precoce de potenciais riscos de interações medicamentosas no tratamento da tuberculose e HIV / Health observatory subsidizing the early identification of potencial drug interaction risks in the treatment of tuberculosis and HIV

Objetivo: Buscou-se identificar, mediante uso do Observatório de Saúde.... Método: Foram selecionados pacientes internados no Instituto de Infectologia Emílio Ribas (IIER), notificados pela vigilância epidemiológica no Sistema de Informação de Agravos de Notificação (SINAN). Realizou-se estudo transversal descritivo exploratório, de janeiro a dezembro de 2008, utilizando-se dados secundários do prontuário médico, associados à reinternação, óbito e alteração de CD4, considerando antecedentes de abuso de álcool e/ou drogas, hepatopatias, uso de antiprotease ou outros medicamentos metabolizados no fígado, hepatite, quantidade de medicamentos e os medicamentos metabolizados no fígado. Resultados: A casuística foi composta por 82 pacientes,... Conclusões: Identificou-se fatores como antecedentes de abuso de álcool e drogas associados a reinternações, alteração do CD4 e aos óbitos, os antecedentes de hepatopatias e uso de antiproteases ou outros medicamentos metabolizados no fígado associados a reinternações e a alteração do CD4. O escore proposto é de fácil aplicação, podendo contribuir na identificação de pacientes com maior risco utilizando-se de variáveis clínico-epidemiológicas e laboratoriais e adoção de uma rotina de monitoramento dos registros hospitalares para identificar a incidência de reinternações e suas causas, estabelecendo um protocolo de alta hospitalar com agendamento prévio em unidade especializada próxima à residência.

Background and objective: Through the use of Health Observatory, we sought.... An exploratory descriptive cross-sectional study was conducted from January to December 2008 using secondary data from medical records associated with re-hospitalization, death and CD4 change, considering history of alcohol and/or drug abuse, liver disease, use of anti-proteinase or other drugs metabolized in the liver, hepatitis, quantity of drugs and drugs metabolized in the liver. Results: The sample was composed of 82 patients... Conclusions: We identified factors such as alcohol and drug abuse background associated to re-hospitalizations, CD4 changes and deaths, history of liver disease and use of protease inhibitor or other drugs metabolized in the liver. The proposed score is easy to apply and may help identify patients at higher risk using epidemiological and laboratory and clinical variables and also the adoption of a monitoring routine of hospital records to identify the incidence of re-hospitalizations and their causes establishing a protocol for hospital discharge with prior appointment at the health facility closest to the patient’s home.

Caracterización de pacientes hospitalizados con infecciones causadas por micobacterias no tuberculosas, en un hospital de alta complejidad en Colombia / Characteristics of inpatients with nontuberculous mycobacterial infections in a highly complex hospital in Colombia

Antecedentes: Las infecciones por micobacterias no tuberculosas (MNT) se describen en los últimos años con mayor frecuencia, especialmente en pacientes con inmunosupresión y en pacientes tratados por procedimientos estéticos. Las MNT incluyen especies del género Mycobacterium , diferentes del complejo Mycobacterium tuberculosis y Mycobacterium leprae . Objetivo: Describir las características demográficas y clínicas de pacientes hospitalizados con infecciones por MNT. Metodología: Estudio descriptivo retrospectivo. Resultados: De 187 pacientes con infección por micobacterias documentadas por cultivo, 17 (9,1%) tuvieron infección por MNT. Edad promedio de 38,4 ± 19,2 años. El 58,82% fueron hombres. Las principales comorbilidades fueron VIH/sida (41,17%), diabetes mellitus (23,53%), enfermedad renal crónica (17,64%), terapia inmunosupresora (17,64%) y neoplasias (17,64%). En los coinfectados con VIH el recuento de CD4 fue <50 en 85,71%. Las especies más frecuentes fueron complejo M. avium (CMA) 35,29%, M. abscessus (17,65%) y M. chelonae (11,76%). Las formas de infección fueron: diseminada (35,29%), pulmonar (23,53%), piel y tejidos blandos (17,64%) y gastrointestinal (11,76%). Estancia promedio de 22,1 días; un 23,53% requirió atención en UCI. La mortalidad general fue 23,53%. Conclusión: Las infecciones por MNT causan una serie de condiciones patológicas, los pacientes inmunocomprometidos son la población de mayor riesgo y las formas diseminada y pulmonar,las más frecuentes. La sospecha temprana así como la toma de muestras adecuadas y el uso de métodos diagnósticos apropiados son indispensables para su diagnóstico oportuno y tratamiento adecuado.

Background: Nontuberculous mycobacteria (NTM) infections has been described more frequently in recent years, especially in immunosuppression conditions and after cosmetic surgical procedures. The NTM include species of the genus Mycobacterium , other than Mycobacterium tuberculosis complex and Mycobacterium leprae. Objective: To describe the demographic and clinical characteristics of Colombian in-patientswith NTM infections. Methodology: A retrospective descriptive study. Results: In 187 patients with culture- confirmed mycobacterial infection, 17 (9,1%) had NTM.The mean age was 38,4 ± 19,2 and 58,82% were men. Major comorbidities were: HIV/AIDS(41,1%), diabetes mellitus (23,5%), chronic renal disease (17,6%), immunosuppressive therapy(17,6%) and neoplasms (17,6%). In patients co-infected with HIV, CD4 count was <50 in 85,7%.The most frequent species were M. avium complex (MAC) in 35,2%, M. abscessus in 17,6% and M. chelonae in 11,7%. Infections were disseminated (35,2%), pulmonary (23,5%), skin and soft tissue (17,6%) and in gastrointestinal system (11,7%). The average hospital stay was 22,1 day sand 23,5% required intensive care unit. Overall mortality was 23,5%. Conclusion: MNT infections cause a number of pathological conditions, being more frequent in immunocompromised patients. The disseminated and pulmonary forms were the most common. Early clinical suspicion and appropriate samples and diagnostic assays, are crucial for early diagnosis and treatment.

Aspectos clínicos y aislamientos de micobacterias ambientales en muestras pulmonares y extrapulmonares / Clinical aspects and the isolation of environmental mycobacteria in pulmonary and extrapulmonary samples

Las infecciones provocadas por micobacterias atípicas, micobacterias no tuberculosas y más recientemente denominadas micobacterias ambientales u oportunistas, en los últimos tiempos desempeñan un papel preponderante en el diagnóstico clínico. Estas especies se relacionan generalmente con estados de inmuno depresión del paciente. En este trabajo se estudiaron 136 cepas aisladas de pacientes con sintomatología específica tanto pulmonar como extrapulmonar, incluidos aquellos infectados por el virus de la inmunodeficiencia humana (VIH), éstas fueron estudiadas e identificadas en el Laboratorio Nacional de Referencia e Investigaciones de Tuberculosis, Lepra y Micobacterias, durante el período de enero de 2011 a diciembre de 2012. Es importante destacar que el 72.79% de los aislamientos eran procedentes de pacientes VIH positivos. El total de las cepas aisladas fue analizado según la clasificación establecida por Runyon; los grupos encontrados con mayor frecuencia fueron el III y el IV; por especie, las de mayor porcentaje de aislamiento fueron las del complejo Mycobacterium avium-intracellulare, Mycobacterium malmoense, Mycobacterium fortuitum y Mycobacterium chelonae, respectivamente. Estos estudios son de gran importancia diagnóstica en los laboratorios de micobacteriología, pues de esta forma se puede llegar a conocer cuáles son las especies micobacterianas predominantes en la población,y lograr establecer una vigilancia sobre este tipo de infecciones, particularmente en pacientes inmunodeficientes, los que pueden ser origen de una peligrosa diseminación de la enfermedad...

The magnitude and risk factors of intestinal parasitic infection in relation to Human Immunodeficiency Virus infection and immune status, at ALERT Hospital, Addis Ababa, Ethiopia.

Human Immunodeficiency Virus (HIV) and intestinal parasitic infections are among the main health problems in developing countries like Ethiopia. Particularly, co-infections of these diseases would worsen the progression of HIV to Acquired Immunodeficiency Syndrome (AIDS). The purpose of this study was to determine the magnitude and risk factors for intestinal parasites in relation to HIV infection and immune status. The study was conducted in (1) HIV positive on antiretroviral therapy (ART) and (2) ART naïve HIV positive patients, and (3) HIV-negative individuals, at All African Leprosy and Tuberculosis (TB) Eradication and Rehabilitation Training Center (ALERT) hospital in Addis Ababa, Ethiopia. Study participants were interviewed using structured questionnaires to obtain socio-demographic characteristics and assess risk factors associated with intestinal parasitic infection. Intestinal parasites were identified from fecal samples by direct wet mount, formol ether concentration, and modified Ziehl-Neelsen staining techniques. The immune status was assessed by measuring whole blood CD4 T-cell count. The overall magnitude of intestinal parasite was 35.08%. This proportion was different among study groups with 39.2% (69/176), 38.83% (40/103) and 27.14% (38/140) in ART naïve HIV positives patients, in HIV negatives, and in HIV positive on ART patients respectively. HIV positive patients on ART had significantly lower magnitude of intestinal parasitic infection compared to HIV negative individuals. Intestinal helminths were significantly lower in HIV positive on ART and ART naïve patients than HIV negatives. Low monthly income, and being married, divorced or widowed were among the socio-demographic characteristics associated with intestinal parasitic infection. No association was observed between the magnitude of intestinal parasites and CD4 T-cell count. However, Cryptosporidium parvum, and Isospora belli were exclusively identified in individuals with CD4 T-cell count of ≤ 350 cells/mm(3). Regular provision of mass preventive chemotherapy and extended health education will curb the burden of intestinal parasitic infection in the community. Emphasis should also be given to laboratory diagnosis and identification of opportunistic intestinal parasites in patients with lower CD4-Tcell count.

Projeto Start - Estratégias para o início do tratamento antirretroviral / Project Start - Strategies for early treatment antirretroviral

Nesta edição do programa do Insight - Gerando Novas Ideias do dia 03 de dezembro recebeu a psicóloga e membro relator do CEP - SMS, Cristina Abbate e o médico infectologista Luiz Carlos Pereira Júnior, diretor do Instituto Emílio Ribas e coordenador do estudo internacional START - Estratégias para Início do Tratamento Antirretroviral. Este resultado levantou uma nova questão, usada como base no projeto: o tratamento da Aids com antirretrovirais era iniciado tardiamente.

"Human Immunodeficiency Virus serostatus disclosure-Rate, reactions, and discrimination": a cross-sectional study at a rural tertiary care hospital.

BACKGROUND: From the moment scientists identified Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS), social responses of fear, denial, stigma, and discrimination have accompanied the epidemic. AIMS: To assess the rate of disclosure of HIV serostatus, reactions by the HIV/AIDS patients and their spouse, and discrimination faced by the patients. METHODS: The present cross-sectional study was conducted at Antiretroviral Therapy (ART) center of a rural tertiary care hospital, situated in Marathawada region of Maharashtra state from November 2008 to October 2010. Totally, 801 HIV-positive patients coming to ART center for treatment were included after ensuring confidentiality and taking informed consent. A preformed questionnaire was used to enquire about reaction after diagnosis, disclosure, and discrimination faced by the patients. The data analyzed using descriptive statistics and Chi-square test. RESULTS: The most common immediate reaction by the HIV patients after getting diagnosed as seropositive was fear (593, 74.03%) followed by depression (385, 48.06%) and suicidal thoughts (98, 12.25%). Out of 801 patients, 769 (96%) had spouse and of these maximum number of patients (653, 84.92%) had disclosed HIV status to their spouses. Most common immediate reaction by spouse after disclosure was crime (324, 42.13%) followed by horror (294, 38.23%) and anger (237, 36.29%). Maximum number of patients were discriminated by friends (120, 71.01%) followed by discrimination at workplace (49, 67.12%), by neighbors (32, 56.14%), and by relatives (53, 43.80%). CONCLUSION: Male positives were granted greater acceptance, care, and support by their spouses. More percentage of females discriminated by neighbors, relatives, and friends and at workplace which might be due to factors like customs, morals, and taboos.

Avaliação dos aspectos epidemiológicos, clínicos e imunopatológicos da reação tipo 1 em pacientes coinfectados pelo vírus da imunodeficiência humana e o Mycobacterium leprae / The epidemiological, clinical and immunopathological reaction of type 1 evaluation in patients co-infected with human immunodeficiency virus and Mycobacterium leprae

Introdução: Na última década, diversas publicações sobre a associação entre o início de terapia antirretroviral e o desenvolvimento de reação reversa foram publicadas. [...] Objetivo: Avaliar a influência da infecção pelo HIV na epidemiologia, apresentação clínica e mecanismos imunopatológicos envolvidos na reação tipo 1. Material e método: Estudo I: Estudo de série de casos, onde foi realizada uma descrição das características clínicas e epidemiológicas de todos os pacientes coinfectados pelo HIV/ M. leprae no momento do diagnóstico de hanseníase no ASA entre 1989 e 2011. Uma análise multivariada dos fatores associados à presença de reação reversa foi realizada. Os dados foram coletados pelo banco de registros dos pacientes no ASA e complementados por revisão de prontuários. Mapas temáticos sobre a distribuição geográfica dos pacientes foram construídos através do programa ArcMap. Estudo II: estudo de coorte retrospectiva, onde foram incluídos todos os pacientes borderline tuberculoide , maiores de 15 anos de idade e atendidos no ASA entre 1997 a 2008. Os pacientes foram comparados de acordo com a sorologia para infecção pelo HIV. Os dados foram coletados através de revisão de prontuários. A densidade de incidência de reação reversa foi calculada para cada grupo. Os fatores de risco para reação reversa foram avaliados através de análise multivariada por regressão de Poisson. Comparou- se as características clínicas da reação. Em soro de pacientes com reação reversa, foi avaliada a expressão de citocinas por Luminex e de proteína C reativa por ELISA. A detecção de IgM anti-PGL1 no diagnóstico de hanseníase foi avaliada através de ELISA.

Resultados: Estudo I: Houve um aumento no número de pacientes diagnosticados com hanseníase e HIV nos últimos anos, em um centro de referência. A maioria dos pacientes apresentava a forma paucibacilar da hanseníase e o uso de TARV foi único fator associado ao desenvolvimento de reação. A maioria dos pacientes eram moradores da região metropolitana e da região norte da cidade do Rio de Janeiro. Estudo II: A incidência de reação reversa foi significantemente maior entre pacientes coinfectados pelo HIV. A presença de BAAR nas lesões cutâneas, a infecção pelo HIV e o teste de Mitsuda negativo foram fatores de risco para a reação reversa. Uma maior proporção de pacientes coinfectados apresentou lesões cutâneas ulceradas, porém todos os pacientes responderam bem ao tratamento para reação com prednisona. Houve uma maior frequência de citocinas de perfil Th1 em pacientes sem HIV e de perfil Th2 em pacientes coinfectados na reação reversa. Nenhum paciente coinfectado apresentou positividade no exame de ELISA anti- PGL1. Conclusões: A maioria dos pacientes coinfectados foi proveniente de regiões com grande densidade populacional. A reação reversa é mais frequente em pacientes coinfectados. A infecção pelo HIV, o teste de Mitsuda negativo e a presença de BAAR em lesões cutâneas são fatores de risco para reação reversa. A reação reversa não parece ser mais grave em indivíduos coinfectados pelo HIV.

Introduction: In the last decade, Leprosy and HIV coinfection gained the attention of thescientific community due to the relation of type 1 reaction and the initiation of antiretroviraltherapy. [...] Objective: To evaluate the interaction of the HIV infection with the epidemiological, clinicaland immune pathological features of type 1 reaction.Subjects and Methods: Study I: A case series description of the geographical distributionand demographic characteristics of HIV/ M. leprae co-infected patients at the moment ofleprosy diagnosis in a Brazilian Leprosy referral center from 1989 - 2011. A multivariateanalysis was performed in order to establish clinical factors associated with type 1 reaction.Study II: We have conducted a retrospective longitudinal study of all BT leprosy patients older than 15 years of age attended at the FIOCRUZ Clinic from 1st January 1997 to 31th December 2008. Data retrieved from patients chart were compared according to the status of HIVinfection. The incidence rate of type 1 reaction and recurrent reaction was calculated. Riskfactors for type 1 reaction were evaluated by multivariate Poison regression model. In serumsamples from patients under type 1 reaction before prednisone treatment, cytokine levels wereanalyzed by Luminex and reactive C protein levels by ELISA. The presence of IgM antiPGL1was determinate by ELISA at leprosy diagnosis.

Results: Study I: There were an increasing number of patients diagnosed with leprosy andHIV over the last years at a referral center. Most patients presented paucibacillary leprosyclinical form and the use of ART was the only independent factor associated with type 1reaction. The majority of the patients were living in the metropolitan region and in the northsubarea of Rio de Janeiro city. Study II: The incidence per 100 person-years of type 1reaction was significantly greater in the HIV positive group. The presence of AFB in the skinlesion, a negative lepromin test and HIV infection were independent risk factors for type 1reaction. A greater proportion of coinfected patients presented ulcerated skin lesion, howeverall patients had a favorable evolution after treatment with corticosteroid. There was a greaterfrequency of type 1 cytokines among HIV negative patients and type 2 cytokines among HIVpositive patients. No coinfected patients responded for the detection of anti- PGL1.Conclusions: Patients living with both HIV and leprosy are likely to live in regionscharacterized by a high density impoverished population. The incidence rate of type 1 isgreater in HIV coinfected individuals under TARV. The HIV infection, a lepromin negativetest and the presence of AFB in the skin lesion are risk factor for type 1 reaction. Type 1reaction did not seem to be more severe in this group of individuals.