The impact of sputum quality on Xpert positivity in active case-finding for TB.

BACKGROUND: Studies evaluating sputum quality and Xpert® MTB/RIF positivity in the context of active case finding are scarce. We aimed to determine whether sputum quality is associated with Xpert positivity and whether the association differed according to demographic and clinical characteristics.METHODS: A cross-sectional analysis using data from a mass screening programme in Brazilian prisons was conducted from 2017 to 2021. We administered a standardised questionnaire, obtained a chest X-ray and collected a spot sputum sample for Xpert testing. Sputum quality was classified as 'salivary', 'mucoid/mucopurulent' or 'blood-stained'. We used log binomial regressions to estimate the relationship between sputum quality and Xpert positivity, assessing interactions with participant characteristics.RESULTS: Among 4,368 participants for whom sputum quality was assessed, 957 (21.9%) produced salivary specimens, 3,379 (77.4%) had mucoid/mucopurulent sputum and 32 (0.7%) had blood-stained sputum. Xpert positivity was higher among those with mucoid/mucopurulent sputum than among those with salivary samples (12.0% vs. 3.7%). Mucopurulent sputum independently predicted Xpert positivity among individuals with and without symptoms, current smoking and abnormal chest radiographs on CAD4TB.CONCLUSIONS: In our study, sputum appearance independently predicted Xpert positivity, and could be used together with chest X-ray and symptom screening to inform use of Xpert in individual or pooled testing.

[Nosocomial urinary tract infections by Candida species]. / Infecção urinária hospitalar por leveduras do gênero Candida.

BACKGROUND: Isolation of a yeast in urine does not necessarily indicate infection, but Candida urinary tract infection is an increasing nosocomial problem. In this study the clinical significance of candiduria was investigated in a Brazilian university hospital. METHODS: Between January and December 1998 species of Candida were isolated in the urine of 166 patients admitted to a tertiary-care general hospital at Ribeirão Preto, SP, Brazil. The data of 100 of these patients were retrospectivelly reviewed concerning microbiological, epidemiological, and clinical aspects of candiduria. RESULTS: C. tropicalis was found in 53% of the patients and C. albicans in 36%. Urine cultures yielded more than 20.000 yeast colonies/ml in 76% of cases. Neurological, cardiac and other chronic diseases, cancer, and trauma were frequent underlying illnesses. Diabetes mellitus was present in 25% of patients. The major predisposing factors associated with candiduria were previous antibiotic therapy (93%) indwelling urinary catheter (83%), surgery in the last 60 days (48%), renal failure (32%), concomitant bacterial infections (28%), use of corticosteroids (20%), and use of other immunosuppressive drugs (10%). Therapy for candiduria, fluconazole or amphotericin B with one exception, was given only to 43/100 patients. The overall mortality in the 60 days after the candiduria episode was 40%. CONCLUSIONS: The non-albicans species of Candida were the major agents of candiduria and are emergent pathogens of the urinary tract in critically ill patients. The underlying illnesses, risk factors and high mortality commonly associated with Candida urinary tract infection were also observed in a Brazilian university hospital.

Characterization of the fishes and of subsistence fishing in the Pantanal of Mato Grosso, Brazil.

Fishing is one of the oldest human activities in the Pantanal of Mato Grosso in Central Brazil. In the of Bento Gomes River Basin (Pantanal of Poconé) the presence of fishermen is very common. The objective of this study is to describe the fishing activity in the basin in view of the elaboration of proposals for the sustainable use of this natural resource. Of the 256 fishermen that were registered most are fishing for their subsistence (92%) and the rest (8%) are occasional fishermen (locally called "de lufada" fishermen). "Traíra" (Hoplias malabaricus) and "piranhas" (Serrasalmus marginatus, Serrasalmus spilopleura and Pygocentrus nattereri) were the species most frequently captured for human consumption. The fishing is more intensive during the ebb season and at the beginning of the drought season, when the waters begin to recede for the river channel, as the catch is facilitated by the concentration of fishes at the river margin. The fishermen and their families consume fish three to four times a week, twice a day. Fish meat is one of the only means of obtaining animal protein for dozens of poor families in the area. The number of fishermen, as well as the actual number of catches do not appear to compromise the natural fish stocks, although no specific capture criteria is obeyed by the fishing activity.