Analysis of anti-tuberculosis drug resistance and sociodemographic and clinical aspects of patients admitted in a referral hospital / Análise da resistência a medicamentos antituberculose e aspectos sociodemográficos e clínicos de pacientes atendidos em hospital referência

ABSTRACT Objective To determine the occurrence of anti-tuberculosis drug resistance and its association with sociodemographic and clinical characteristics of patients in a referral hospital. Methods This was a cross-sectional study based on data from patients who had mycobacterial culture identified and defined antimicrobials sensitivity profile (June 2014 to February 2016). The descriptive statistical analysis and Fisher's exact test were used to compare proportions. Results The study included 104 patients who had positive results for Mycobacterium tuberculosis . Bacilloscopy had high positivity (93.3%). A total of 15 patients (14.4%) had resistant strains and six (5.6%) multidrug-resistant. The sociodemographic and clinical characteristics were not related with resistance. Conclusion This study contributed to further the understandings about the tuberculosis patients' profile, the study also served as a tool for development of specific public policies. Patients diagnosed with resistant tuberculosis must be under greater supervision.

RESUMO Objetivo Verificar a ocorrência de resistência a fármacos antituberculose e a associação com características sociodemográficas e clínicas de pacientes de um hospital referência. Métodos Estudo transversal, com dados de pacientes que tiveram a cultura de micobactérias identificada e o respectivo perfil de sensibilidade aos antimicrobianos definido (junho de 2014 a fevereiro de 2016). Foram realizados a análise estatística descritiva e o teste exato de Fisher, para comparação de proporções. Resultados O estudo envolveu 104 pacientes, e todos tiveram resultados para Mycobacterium tuberculosis . A baciloscopia atingiu alta positividade (93,3%), e 15 pacientes (14,4%) apresentaram linhagens resistentes, sendo 6 (5,6%) multirresistentes. As características sociodemográficas e clínicas não foram associadas à resistência. Conclusão A pesquisa permitiu conhecer melhor o perfil dos pacientes com tuberculose e constitui ferramenta para elaboração de políticas públicas específicas. Os pacientes diagnosticados com tuberculose resistente devem ser submetidos à maior supervisão.

Analysis of anti-tuberculosis drug resistance and sociodemographic and clinical aspects of patients admitted in a referral hospital.

OBJECTIVE: To determine the occurrence of anti-tuberculosis drug resistance and its association with sociodemographic and clinical characteristics of patients in a referral hospital. METHODS: This was a cross-sectional study based on data from patients who had mycobacterial culture identified and defined antimicrobials sensitivity profile (June 2014 to February 2016). The descriptive statistical analysis and Fisher's exact test were used to compare proportions. RESULTS: The study included 104 patients who had positive results for Mycobacterium tuberculosis . Bacilloscopy had high positivity (93.3%). A total of 15 patients (14.4%) had resistant strains and six (5.6%) multidrug-resistant. The sociodemographic and clinical characteristics were not related with resistance. CONCLUSION: This study contributed to further the understandings about the tuberculosis patients' profile, the study also served as a tool for development of specific public policies. Patients diagnosed with resistant tuberculosis must be under greater supervision.

Risk factors for human Mycobacterium bovis infections in an urban area of Brazil.

BACKGROUND: The World Health Organization (WHO) has classified human zoonotic tuberculosis (TB) due to Mycobacterium bovis as a neglected issue in the developing world. In a recent cross-sectional study in Brazil, three of 189 TB patients presented with a coinfection of M. bovis and M. tuberculosis and were selected as cases for this study. OBJECTIVE: The aim was to evaluate risk factors (RF) for zoonotic TB in an urban area of Brazil in order to guide preventive programmes. METHODS: A matched case-control study was carried out nested within a cross-sectional study. For each of the three cases, 14 age- and sex-matched controls (TB due to M. tuberculosis) were selected. FINDINGS: Zoonotic potential exposures (ZE) and extrapulmonary TB (EPTB) were independently associated with zoonotic TB in multivariate analyses. CONCLUSIONS: ZE by occupation and consumption of raw milk and derivative products that place individuals in direct and indirect contact with animals and their excretions/secretions increase the risk for zoonotic TB in Brazil, especially among those with EPTB. Therefore, measures such as efficient control of bovine TB, distribution of pasteurised milk and its derivative products, and the diagnosis and monitoring of zoonotic TB in humans are essential steps, especially in developing countries where bovine TB is enzootic, and further studies are necessary.

Comparison between Ogawa-Kudoh and modified Petroff techniques for mycobacteria cultivation in the diagnosis of pulmonary tuberculosis.

OBJECTIVE: To compare the performance of the Ogawa-Kudoh method with the modified Petroff technique in diagnosis of pulmonary tuberculosis. METHODS: A total of 205 sputum samples from 166 patients with clinical suspicion or under pulmonary tuberculosis follow-up, seen at a public tertiary care hospital, from July 2014 to July 2016 were used. All samples were simultaneously processed using the Ogawa-Kudoh and modified Petroff decontamination methods, according to the recommendations of the Ministry of Health. In the statistical analysis, the McNemar test and the Kappa index were used, respectively, to compare proportions and verify agreement between data. RESULTS: The Ogawa-Kudoh and modified Petroff methods were efficient in mycobacteria detection, with no significant differences in results (p=0.549) and contamination rate of the cultures (p=0.065). The agreement between techniques was considered excellent (Kappa index of 0.877) and Ogawa-Kudoh, as compared to the modified Petroff technique, showed sensitivity of 90.4%, specificity of 96.6%, positive predictive value of 94.3% and negative predictive value of 94.2%. CONCLUSION: The Ogawa-Kudoh technique proved to be sufficiently sensitive and specific for diagnosis of pulmonary tuberculosis, and, therefore, suitable for routine laboratory application. Since it is simple, low-cost and has less technical requirements for biosafety and professional training, Ogawa-Kudoh is an alternative for managers and healthcare professionals to promote the expansion of bacteriological diagnostic coverage of pulmonary tuberculosis.

Perfil epidemiológico da tuberculose em Juiz de Fora, município prioritário no estado de Minas Gerais / Epidemiological profile of tuberculosis in Juiz de Fora, priority municipality in Minas Gerais state

Introdução: A tuberculose (TB) é considerada um dos maiores problemas mundiais de saúde. Visando a eliminação dessa doença, a organização mundial de saúde (oms) elaborou um plano, chamado "The end TB strategy", cujas metas propostas foram adotadas pelo ministério da saúde. Juiz de Fora é a segunda cidade do estado de minas Gerais com os maiores números de casos dessa doença sendo considerada município prioritário para controle da TB. Objetivo: Realizar uma análise do perfil epidemiológico da TB na cidade de Juiz de Fora nos anos de 2008 a 2017, comparando os dados registrados a nível nacional, estadual e municipal, bem como avaliar o cenário municipal frente às metas propostas pelo plano de enfrentamento da TB. Material e métodos: Foi realizado um estudo transversal, descritivo, de série temporal utilizando dados secundários disponibilizados pelo Departamento de Informática do sistema Único de saúde (DATAsus). Resultados: O coeficiente de incidência e mortalidade da TB assim como a taxa de abandono de tratamento verificados em Juiz de Fora, de 2008-2017, superaram as médias nacionais e estaduais, além de extrapolarem as metas previstas no plano de enfrentamento da TB. Cabe ressaltar, no entanto, que a proporção de teste rápido de HIV e o número de cultura de escarro realizados entre os casos de retratamento de TB superaram as médias nacional e estadual. Conclusão: O perfil epidemiológico da TB em Juiz de Fora revelou uma situação em alguns aspectos piores em relação ao cenário nacional e estadual, mas também evidenciou que medidas já estão sendo realizadas pelo município para o enfrentamento da doença.

Introduction: Tuberculosis (TB) is considered one of the biggest global health problems. In order to eliminate this disease, the World Health organization (WHo) elaborated a plan, called The end TB strategy, whose goals were implemented by the Brazilian National ministry of Health. Juiz de Fora is the second city in minas Gerais with higher numbers of disease cases that is being considered a priority municipality for the TB control. Objectives: Analyze the epidemiological profile of TB in Juiz de Fora from 2008 to 2017, comparing data recorded at national, state and municipal level, as well as to access the municipal scenario against the targets proposed by the WHo plan. Material and methods: A cross-sectional, descriptive, time series study was performed using secondary data provided by the Brazilian Unified Health System's Department of Informatics (DATASUS). Results: The TB incidence and mortality coefficient as well as treatment drop-out rate observed in Juiz de Fora, from 2008-2017, exceeded national and state averages, in addition to extrapolating the targets set in the WHo plan. It should be noted, however, that the proportion of rapid HIV test and the number of sputum culture performed among retreatment TB cases exceeded national and state averages. Conclusion: In some aspects, the TB epidemiological profile in Juiz de Fora revealed a situation worse than national and state scenario, but also showed that arrangements are already being carried out by the municipality to confront the disease.

Comparison between Ogawa-Kudoh and modified Petroff techniques for mycobacteria cultivation in the diagnosis of pulmonary tuberculosis / Comparação entre os métodos de Ogawa-Kudoh e Petroff modificado para o cultivo de micobactérias no diagnóstico da tuberculose pulmonar

ABSTRACT Objective To compare the performance of the Ogawa-Kudoh method with the modified Petroff technique in diagnosis of pulmonary tuberculosis. Methods A total of 205 sputum samples from 166 patients with clinical suspicion or under pulmonary tuberculosis follow-up, seen at a public tertiary care hospital, from July 2014 to July 2016 were used. All samples were simultaneously processed using the Ogawa-Kudoh and modified Petroff decontamination methods, according to the recommendations of the Ministry of Health. In the statistical analysis, the McNemar test and the Kappa index were used, respectively, to compare proportions and verify agreement between data. Results The Ogawa-Kudoh and modified Petroff methods were efficient in mycobacteria detection, with no significant differences in results (p=0.549) and contamination rate of the cultures (p=0.065). The agreement between techniques was considered excellent (Kappa index of 0.877) and Ogawa-Kudoh, as compared to the modified Petroff technique, showed sensitivity of 90.4%, specificity of 96.6%, positive predictive value of 94.3% and negative predictive value of 94.2%. Conclusion The Ogawa-Kudoh technique proved to be sufficiently sensitive and specific for diagnosis of pulmonary tuberculosis, and, therefore, suitable for routine laboratory application. Since it is simple, low-cost and has less technical requirements for biosafety and professional training, Ogawa-Kudoh is an alternative for managers and healthcare professionals to promote the expansion of bacteriological diagnostic coverage of pulmonary tuberculosis.

RESUMO Objetivo Comparar o desempenho do método de Ogawa-Kudoh ao de Petroff modificado no diagnóstico da tuberculose pulmonar. Métodos Utilizaram-se 205 amostras de escarro de 166 pacientes com suspeita clínica ou controle de tuberculose pulmonar atendidos em um hospital público terciário, entre os meses de julho de 2014 a julho de 2016. Todas as amostras foram processadas simultaneamente pelos métodos de descontaminação Ogawa-Kudoh e Petroff modificado, seguindo as recomendações do Ministério da Saúde. Na análise estatística, foi empregado o teste de McNemar, para comparação de proporções, e o índice Kappa, para verificar o grau de concordância entre os dados. Resultados Os métodos Ogawa-Kudoh e Petroff modificado mostraram-se eficientes na detecção de micobactérias, não sendo verificadas discordâncias significativas tanto nas comparações de pares de resultados (p=0,549), como na taxa de contaminação das culturas (p=0,065). O grau de concordância das técnicas foi considerado excelente (índice Kappa de 0,877), e o Ogawa-Kudoh, em relação ao Petroff modificado, apresentou 90,4% de sensibilidade, 96,6% de especificidade, 94,3% de valor preditivo positivo e 94,2% de valor preditivo negativo. Conclusão O método de Ogawa-Kudoh revelou-se suficientemente sensível e específico para o diagnóstico da tuberculose pulmonar e, portanto, adequado para a aplicação na rotina laboratorial. Por ser mais simples, de baixo custo e com menores exigências técnicas de biossegurança e capacitação profissional, o Ogawa-Kudoh apresenta-se como alternativa para gestores e profissionais da área promoverem a ampliação da cobertura diagnóstica bacteriológica da tuberculose pulmonar.

Risk factors for human Mycobacterium bovis infections in an urban area of Brazil

BACKGROUND The World Health Organization (WHO) has classified human zoonotic tuberculosis (TB) due to Mycobacterium bovis as a neglected issue in the developing world. In a recent cross-sectional study in Brazil, three of 189 TB patients presented with a coinfection of M. bovis and M. tuberculosis and were selected as cases for this study. OBJECTIVE The aim was to evaluate risk factors (RF) for zoonotic TB in an urban area of Brazil in order to guide preventive programmes. METHODS A matched case-control study was carried out nested within a cross-sectional study. For each of the three cases, 14 age- and sex-matched controls (TB due to M. tuberculosis) were selected. FINDINGS Zoonotic potential exposures (ZE) and extrapulmonary TB (EPTB) were independently associated with zoonotic TB in multivariate analyses. CONCLUSIONS ZE by occupation and consumption of raw milk and derivative products that place individuals in direct and indirect contact with animals and their excretions/secretions increase the risk for zoonotic TB in Brazil, especially among those with EPTB. Therefore, measures such as efficient control of bovine TB, distribution of pasteurised milk and its derivative products, and the diagnosis and monitoring of zoonotic TB in humans are essential steps, especially in developing countries where bovine TB is enzootic, and further studies are necessary.

Comparação entre determinações de glicemia capilar e venosa com glicosímetros e dosagem laboratorial da glicose plasmática venosa / Comparison of capilar and venous blood glucose using glucometers with laboratory determinations of venous plasma glucose

INTRODUÇÃO: O diabetes mellitus é uma doença crônica, das mais frequentes causas de morbimortalidade na população geral, sendo extremamente importante que seja feito o controle dos níveis da glicemia e o automonitoramento como fatores fundamentais para acompanhar o seu tratamento e prevenir as suas complicações. OBJETIVOS: Este estudo comparou valores de glicose determinados por diferentes metodologias, em amostras de sangue venoso e capilar de 76 pacientes atendidos no Centro de Atenção à Saúde do Hospital Universitário da Universidade Federal de Juiz de Fora. MÉTODOS: As glicemias capilar e venosa foram dosadas utilizando os glicosímetros Accu-Chek Performa (Roche) e Optium Xceed (Abott) e comparadas entre si e com a glicemia plasmática venosa determinada por automação laboratorial, considerada o método padrão do estudo. RESULTADOS: A análise dos dados obtidos revelou que, embora houvesse alta correlação (r≥0,95) entre as dosagens realizadas nos glicosímetros e o método padrão (GPAD), somente as médias obtidas para glicemia venosa com Accu-Chek Performa (GVenAC) e glicemia capilar com Optium Xceed (GCapOX) eram semelhantes entre si (p>0,05) e ao GPAD, enquanto as médias para glicemia capilar com Accu-Chek Performa (GcapAC) e glicemia venosa com Optium Xceed (GVenOX) se mostraram diferentes das demais (p<0,0001). CONCLUSÕES: Com base nos resultados obtidos, foi possível observar que o glicosímetro Accu-Chek Performa obteve os melhores resultados ao usar amostra de sangue venoso, enquanto o Optium Xceed obteve melhor desempenho com amostras de sangue capilar, o que significa que o desempenho dos dispositivos demonstrou ser dependente da amostra. (AU)

Profile and follow-up of patients with tuberculosis in a priority city in Brazil.

OBJECTIVE To analyze the cases of tuberculosis and the impact of direct follow-up on the assessment of treatment outcomes. METHODS This open prospective cohort study evaluated 504 cases of tuberculosis reported in the Sistema de Informação de Agravos de Notificação (SINAN - Notifiable Diseases Information System) in Juiz de Fora, MG, Southeastern Brazil, between 2008 and 2009. The incidence of treatment outcomes was compared between a group of patients diagnosed with tuberculosis and directly followed up by monthly consultations during return visits (287) and a patient group for which the information was indirectly collected (217) through the city's surveillance system. The Chi-square test was used to compare the percentages, with a significance level of 0.05. The relative risk (RR) was used to evaluate the differences in the incidence rate of each type of treatment outcome between the two groups. RESULTS Of the outcomes directly and indirectly evaluated, 18.5% and 3.2% corresponded to treatment default and 3.8% and 0.5% corresponded to treatment failure, respectively. The incidence of treatment default and failure was higher in the group with direct follow-up (p < 0.05) (RR = 5.72, 95%CI 2.65;12.34, and RR = 8.31, 95%CI 1.08;63.92, respectively). CONCLUSIONS A higher incidence of treatment default and failure was observed in the directly followed up group, and most of these cases were neglected by the disease reporting system. Therefore, effective measures are needed to improve the control of tuberculosis and data quality.

Profile and follow-up of patients with tuberculosis in a priority city in Brazil / Perfil e seguimento dos pacientes com tuberculose em município prioritário no Brasil

OBJECTIVE To analyze the cases of tuberculosis and the impact of direct follow-up on the assessment of treatment outcomes. METHODS This open prospective cohort study evaluated 504 cases of tuberculosis reported in the Sistema de Informação de Agravos de Notificação (SINAN – Notifiable Diseases Information System) in Juiz de Fora, MG, Southeastern Brazil, between 2008 and 2009. The incidence of treatment outcomes was compared between a group of patients diagnosed with tuberculosis and directly followed up by monthly consultations during return visits (287) and a patient group for which the information was indirectly collected (217) through the city’s surveillance system. The Chi-square test was used to compare the percentages, with a significance level of 0.05. The relative risk (RR) was used to evaluate the differences in the incidence rate of each type of treatment outcome between the two groups. RESULTS Of the outcomes directly and indirectly evaluated, 18.5% and 3.2% corresponded to treatment default and 3.8% and 0.5% corresponded to treatment failure, respectively. The incidence of treatment default and failure was higher in the group with direct follow-up (p < 0.05) (RR = 5.72, 95%CI 2.65;12.34, and RR = 8.31, 95%CI 1.08;63.92, respectively). CONCLUSIONS A higher incidence of treatment default and failure was observed in the directly followed up group, and most of these cases were neglected by the disease reporting system. Therefore, effective measures are needed to improve the control of tuberculosis and data quality. .

OBJETIVO Analisar casos de tuberculose e o impacto do acompanhamento direto na detecção dos desfechos dos tratamentos. MÉTODOS Estudo de coorte aberto prospectivo com 504 casos notificados ao Sistema de Informação de Agravos de Notificação, em Juiz de Fora, MG, no período de 2008 a 2009. Foram comparadas as incidências de encerramentos dos tratamentos de um grupo de casos de tuberculose detectadas por acompanhamento direto (287) por meio de contatos mensais com os pacientes durante os seus retornos, com as coletadas indiretamente (217) por meio do sistema de registro do município. Para comparar as proporções foi utilizado o teste Qui-quadrado, com nível de significância de 0,05. O risco relativo foi utilizado para avaliar a razão de incidências de cada tipo de encerramento entre os dois grupos. RESULTADOS Dos encerramentos acompanhados, direta e indiretamente, 18,5% e 3,2% o abandonaram e 3,8% e 0,5% tiveram falência de tratamento, respectivamente. As incidências de abandono e falência dos tratamentos foram maiores no grupo com acompanhamento direto (p < 0,05) (RR = 5,72; IC95% 2,65;12,34 e RR = 8,31; IC95% 1,08;63,92), respectivamente. CONCLUSÕES Houve maior incidência de abandonos e de falências na população acompanhada diretamente que, em sua maioria, permaneceu negligenciada pelo Sistema de Informação de Agravos de Notificação. São necessárias medidas efetivas para melhoria do controle da tuberculose e da qualidade dos dados. .

Fatores associados ao consumo de leite fluido em comunidades limítrofes rural-urbanas / Consumption of liquid milk and factors associated with it in neighboring communities rural-urban

INTRODUÇÃO: O leite é fonte de vários nutrientes importantes para o ser humano, porém o consumo de lácteos no Brasil ainda é baixo. OBJETIVO: Assim, o objetivo deste estudo foi estimar as quantidades de consumo de leite fluido e avaliar os fatores a ele associados em cinco regiões limítrofes rural-urbanas da cidade de Juiz de Fora, MG. MATERIAL E MÉTODO: Foi construído um modelo multivariado para estimar as quantidades de consumo de leite fluido e avaliar os fatores a ele associados. Os dados foram obtidos por meio de entrevista. RESULTADOS: A variável local de residência apresentou associação significativa com o consumo de leite, sendo que os entrevistados que residiam nas localidades de Monte Verde (p=0,058), Humaitá (p=0,023) e Torreões (p=0,012), apresentaram maiores consumos de leite do que aqueles que residiam na localidade de Filgueiras. A idade foi negativamente associada (p<0,001) ao consumo de leite. A renda per capita teve uma associação direta (p<0,001), apresentando um aumento no consumo de 8,880 mL/dia para cada aumento de um salário mínimo na renda. O número de moradores por residência apresentou uma associação inversa, sendo que cada morador a mais na residência impactou numa redução de 0,370 mL/dia. O hábito de fumar também teve uma associação inversa, mostrando que os individuos que não fumavam consumiam, em média, 21,710 mL/dia a mais de leite fluido que os indivíduos que fumavam 10 ou mais cigarros por dia. CONCLUSÃO: o consumo de leite nesta população esteve aquém das recomendações apropriadas para garantir uma média suficiente de cálcio, em especial entre adolescentes e adultos.

INTRODUCTION: The milk is a source of several important nutrients for the human being, but the consumption of dairy products in Brazil is still low. OBJECTIVE: Therefore, the objective of this study was to estimate the quantity of consumption of liquid milk and evaluate the factors associated with it in five regions neighboring rural-urban city of Juiz de Fora, MG. MATERIAL AND METHOD: A multivariate model was constructed to estimate the quantities of consumption of liquid milk and to evaluate the factors associated with it. RESULTS: The data were obtained by means of interview. The variable local of residence showed significant association with the consumption of milk, being that the interviewees who lived in towns of Monte Verde (p=0.058), Humaitá (p=0.023) and Torreões (p=0.012), had higher consumption of milk than those who lived in the locality of Filgueiras. Age was negatively associated (p< 0.001) with the consumption of milk. Per capita income had a direct association (p< 0.001), showing an increase in consumption of 8,880 mL/day for each increase of one minimum wage income. Number of inhabitants per residence showed an inverse association, being that for each homeowner to more in residence impacted in a reduction of 0,370 mL/day. The habit of smoking also had a inverse association, showing that individuals who do not smoked, drank on average, 21,710 mL/day to over milk fluid that those who smoked 10 or more cigarettes per day. CONCLUSION: The consumption of milk in this population was far short of the recommendations, in particular among adolescents and adults.

Ocorrência da Hepatite C entre pacientes portadores de micobacterioses atendidos em centros de referências de Juiz de Fora / Occurrence of Hepatitis C among patients attended mycobacteriosis in reference centers of Juiz de Fora

OBJETIVO: O presente trabalho objetiva avaliar a ocorrência da Hepatite C em pacientes com micobacteriose atendidos em dois centros de Juiz de Fora e comparar algumas características sócio-demográfica, econômica e clínico-epidemiológica da população em estudo em relação à situação para a Hepatite C. MATERIAL E MÉTODO: Trata-se de um estudo descritivo realizado com dados secundários de um projeto maior. Para o presente estudo, foram incluídos os pacientes, com suspeita de tuberculose, no período de março de 2008 a fevereiro de 2010. RESULTADO: A amostra foi constituída de 224 pacientes com tuberculose, sendo que 7 deles apresentavam histórico de Hepatite C (3,1%), sendo 6 do sexo masculino. Dos 224, 150 eram do sexo masculino. Os 7 portadores de HCV apresentaram idade mediana de 38 anos, baixo grau de escolaridade e renda mensal de até um salário mínimo (95,8%) correspondendo a 42,9% dos portadores de Hepatite C. Algumas características clínico epidemiológicas analisadas mostraram uma associação positiva com p < 0,05, como uma associação HCV - usuários de drogas (p<0,0001) e HCV - HIV. (p<0,01). CONCLUSÃO: Conhecer a prevalência de indivíduos coinfectados pela tuberculose/HCV/HIV, suas características sócio-demográficas, comportamentais, imunológicas e clínicas são fundamentais para o planejamento de medidas de saúde pública, capazes de oferecer a esses indivíduos melhores tratamentos além de um desenvolvimento de políticas de prevenção, visando diminuir as taxas dessas coinfecções em todo o mundo.

This study evaluates the occurrence of hepatitis C in patients with mycobacteriosi treated at two centers of Juiz de Fora and compare some socio-demographic, economic, clinical and epidemiological characteristics of the study population in relation to the situation for Hepatitis C. Material and Methods: This is a descriptive study using secondary data from alarger project. For this study, patients were enrolled with suspected tuberculosis, from March 2008 to February 2010 Result: The sample consisted of 224 patients with tuberculosis, and seven of them had a history of hepatitis C (3.1%), 6 were male. Of the 224, 150 were male.7 HCV carriers had a mean age of 38 years, low education level and monthly income below the poverty level (95.8%) corresponding to 42.9% of patients with hepatitis C. Some clinical epidemiological characteristics analyzed showed an association positive with p <0.05, an expanding association HCV - drug users (p <0.0001) and HCV - HIV. (p <0.01) Conclusion: Knowing the prevalence of individuals coinfected with TB / HCV / HIV, their socio-demographic, behavioral, immunological and clinical characteristics are fundamental for planning public health measures, able to offer these individuals better treatments as well as a policy development prevention in order to reduce the rates of these co-infections worldwide.

Perfil de resistência a fármacos antituberculose em um hospital de referência do Estado de Minas Gerais / Profile of resistance to antituberculosis drugs in a reference hospital in the State of Minas

A tuberculose é uma patologia grave, infecciosa e transmissível de grande relevância para a saúde pública mundial. A capacidade de adquirir resistência aos antimicrobianos de escolha para a terapêutica tem dificultado o tratamento de pacientes tuberculosos. O objetivo do presente estudo foi verificar em um hospital de referência de Juiz de Fora, Minas Gerais, o perfil de resistência das micobactérias isoladas de pacientes com tuberculose a partir da modificação do esquema terapêutico de 2009. Foi realizada uma análise retrospectiva em 45 culturas positivas de pacientes com tuberculose pulmonar e com teste de sensibilidade no período de janeiro de 2012 a maio de 2014. Das 45 culturas identificadas como M. tuberculosis: 30 (67%) foram sensíveis a todos os fármacos testados (estreptomicina, isoniazida, rifampicina, etambutol e pirazinamida). As monorresistentes corresponderam a 3 (7%), com resistência a: estreptomicina (2,33%), isoniazida (2,33%) e rifampicina (2,33%). As que apresentaram multirresistência corresponderam a 10 casos (22%), com resistência a: isoniazida + rifampicina (13,2%), isoniazida + rifampicina + estreptomicina (2,2%), isoniazida + rifampicina + etambutol (4,4%), isoniazida + rifampicina + etambutol + estreptomicina (2,2%). Por fim, as polirresistências corresponderam a 2 (4%), com resistência a isoniazida + estreptomicina. Os resultados apresentados demonstraram que 33% das amostras apresentaram algum tipo de resistência ao tratamento, com predomínio de multirresistência. Nesses casos houve evidente prolongamento de tratamento gerando maiores custos e toxicidade. Verifica-se a importância do teste de sensibilidade aos antimicrobianos para definir melhor o esquema para cada caso e observar a adesão ao tratamento a fim de diminuir as resistências.

Tuberculosis is a serious, infectiousand transmissible disease of great relevance to global public health. The ability to acquire resistance to antimicrobials of choice for therapy has hampered the treatment of TB patients. The aim of this study was to verify in a referral hospital in Juiz de Fora, Minas Gerais, the resistance profile of mycobacteria isolated from patients with tuberculosis from the modification of the treatment regimen 2009. A retrospective analysis was performed on 45 positive cultures from patients with pulmonary tuberculosis and susceptibility testing from January 2012 to May 2014. Of the 45 positive cultures from were identified M. tuberculosis: 30 (67%) were sensitive to all drugs tested (streptomycin, isoniazid, rifampicin, ethambutol and pyrazinamide). The monorresistente 3 (7%), with resistance to: streptomycin (2.33%), isoniazid (2.33%) and rifampicin (2.33%). The that presented multidrug resistance accounted for 10 cases (22%), with resistance: isoniazid + rifampicin (13.2%), rifampicin + isoniazid + streptomycin (2.2%), rifampicin + isoniazid + ethambutol (4.4%), isoniazid + rifampicin + streptomycin + ethambutol (2.2%). Finally, the matched polirresistências 2 (4%) with resistance: espreptomicycin+ isoniazid. The results presented demonstrated that 33% of the samples showed any resistance to treatment, with a prevalence of multidrug resistance. In these cases there is clear prolongation of treatment leading to higher costs and toxicity. There is the importance of antimicrobial susceptibility test to better define the schema for each case and observe adherence to treatment in order to reduce the resistances.

Tuberculose: perfil epidemiológico em hospital referência no tratamento da doença / Tuberculosis: epidemiological profile in a reference hospital in the treatment of disease

OBJETIVO: Este estudo transversal objetivou determinar o perfil epidemiológico, clínico e diagnóstico de pacientes portadores de micobactérias entre março de 2008 e fevereiro de 2010. MÉTODO: A coleta de dados foi feita junto aos prontuários médicos e pacientes. RESULTADOS: De 175 casos, 170 com Mycobacterium tuberculosis, dois M. tuberculosis/complexo M. avium, dois complexo M. avium e um M. bovis/M. tuberculosis. 75,4% dos casos em pacientes do sexo masculino, com mediana etária de 40 anos, 14,3% em HIV positivos, 32% com renda familiar baixa e moradia precária. A doença pulmonar ocorreu em 94,9%. 45,1% se curaram, 24,0% abandonaram o tratamento e 9,7% vieram a óbito. A supervisão do tratamento ocorreu em 60% dos casos e em 56% com investigação para HIV. Das 9,6% amostras paucibacilares e 55,5% das extrapulmonares, o diagnóstico só foi possível pela cultura. CONCLUSÃO: Evidenciou-se predileção por indivíduos masculinos, com doença pulmonar, muitos sem positividade para HIV conhecida e com supervisão de tratamento parcial. A cultura foi uma importante ferramenta diagnóstica, complementar a baciloscopia.

This cross-sectional descriptive study aimed to determine the epidemiological, clinical and diagnosis of patients with mycobacteria between March 2008 and February 2010, in Juiz de Fora, Minas Gerais State. Methods: Data collection was performed at the medical records and patients. Results: In 175 cases, 170 with Mycobacterium tuberculosis, two M. tuberculosis/M. avium complex, two M. avium complex and oneM. bovis/M. tuberculosis. 75.4% of cases in male patients, meian age 40 years, 14.3% in HIV positive, 32% with low family income and poor housing. Pulmonary disease occurred in 94.9%. 45.1% were cured, 24.0% abandoned the treatment and 9.7% died. Supervision of treatment occurred in 60% of cases and 56% of cases was tested for HIV. 9.6% of paucibacillary specimens and 55.5% of extrapulmonary TB the diagnosis was possible only by culture. Conclusion: Was a clear predominance of the disease in male patients with pulmonary tuberculosis. The treatment was partially observed and several pacients with no known diagnosis of HIV. The use of mycobacterial culture was an important diagnostic tool, complementary to smear.

Tuberculosis patients co-infected with Mycobacterium bovis and Mycobacterium tuberculosis in an urban area of Brazil

In this cross-sectional study, mycobacteria specimens from 189 tuberculosis (TB) patients living in an urban area in Brazil were characterised from 2008-2010 using phenotypic and molecular speciation methods (pncA gene and oxyR pseudogene analysis). Of these samples, 174 isolates simultaneously grew on Löwenstein-Jensen (LJ) and Stonebrink (SB)-containing media and presented phenotypic and molecular profiles of Mycobacterium tuberculosis, whereas 12 had molecular profiles of M. tuberculosis based on the DNA analysis of formalin-fixed paraffin wax-embedded tissue samples (paraffin blocks). One patient produced two sputum isolates, the first of which simultaneously grew on LJ and SB media and presented phenotypic and molecular profiles of M. tuberculosis, and the second of which only grew on SB media and presented phenotypic profiles of Mycobacterium bovis. One patient provided a bronchial lavage isolate, which simultaneously grew on LJ and SB media and presented phenotypic and molecular profiles of M. tuberculosis, but had molecular profiles of M. bovis from paraffin block DNA analysis, and one sample had molecular profiles of M. tuberculosis and M. bovis identified from two distinct paraffin blocks. Moreover, we found a low prevalence (1.6%) of M. bovis among these isolates, which suggests that local health service procedures likely underestimate its real frequency and that it deserves more attention from public health officials.

Identification of Mycobacterium tuberculosis complex based on amplification and sequencing of the oxyR pseudogene from stored Ziehl-Neelsen-stained sputum smears in Brazil.

A cross-sectional analysis of stored Ziehl-Neelsen (ZN)-stained sputum smear slides (SSS) obtained from two public tuberculosis referral laboratories located in Juiz de Fora, Minas Gerais, was carried out to distinguish Mycobacterium bovis from other members of the Mycobacterium tuberculosis complex (MTC). A two-step approach was used to distinguish M. bovis from other members of MTC: (i) oxyR pseudogene amplification to detect MTC and, subsequently, (ii) allele-specific sequencing based on the polymorphism at position 285 of this gene. The oxyR pseudogene was successfully amplified in 100 of 177 (56.5%) SSS available from 99 individuals. No molecular profile of M. bovis was found. Multivariate analysis indicated that acid-fast bacilli (AFB) results and the source laboratory were associated (p < 0.05) with oxyR pseudogene amplification. SSS that were AFB++ SSS showed more oxyR pseudogene amplification than those with AFB0, possibly due to the amount of DNA. One of the two source laboratories presented a greater chance of oxyR pseudogene amplification, suggesting that differences in sputum conservation between laboratories could have influenced the preservation of DNA. This study provides evidence that stored ZN-SSS can be used for the molecular detection of MTC.

Identification of Mycobacterium tuberculosis complex based on amplification and sequencing of the oxyR pseudogene from stored Ziehl-Neelsen-stained sputum smears in Brazil

A cross-sectional analysis of stored Ziehl-Neelsen (ZN)-stained sputum smear slides (SSS) obtained from two public tuberculosis referral laboratories located in Juiz de Fora, Minas Gerais, was carried out to distinguish Mycobacterium bovis from other members of the Mycobacterium tuberculosis complex (MTC). A two-step approach was used to distinguish M. bovis from other members of MTC: (i) oxyR pseudogene amplification to detect MTC and, subsequently, (ii) allele-specific sequencing based on the polymorphism at position 285 of this gene. The oxyR pseudogene was successfully amplified in 100 of 177 (56.5 percent) SSS available from 99 individuals. No molecular profile of M. bovis was found. Multivariate analysis indicated that acid-fast bacilli (AFB) results and the source laboratory were associated (p < 0.05) with oxyR pseudogene amplification. SSS that were AFB++ SSS showed more oxyR pseudogene amplification than those with AFB0, possibly due to the amount of DNA. One of the two source laboratories presented a greater chance of oxyR pseudogene amplification, suggesting that differences in sputum conservation between laboratories could have influenced the preservation of DNA. This study provides evidence that stored ZN-SSS can be used for the molecular detection of MTC.