Diagnosis of pulmonary tuberculosis in children and adolescents: comparison of two versions of the Brazilian Ministry of Health scoring system.

The aim of this study was to evaluate the concordance between two versions of the scoring system (2011 and 2019), recommended by the Brazilian Ministry of Health, for the diagnosis of pulmonary tuberculosis (PTB) in children and adolescents. A retrospective descriptive study was performed to assess the medical records of children and adolescents with PTB, in TB units from Brazilian cities located in Rio de Janeiro, Minas Gerais, and Parana States, from January 1 st , 2004, to December 1 st , 2018. Patients aged 0 to 18 years old with a diagnosis of PTB were included. The comparison between the two scoring systems showed a moderate concordance according to the κ coefficient value = 0.625. Fourteen patients showed a reduction in the TB score, going from 30 points in the 2011, to 25 points or less in the 2019 one. Seventy one percent of these 14 patients had radiological changes suggestive of PTB and 86% had tuberculin skin tests greater than 10 mm. The study concluded that a moderate agreement was observed between the 2011 and 2019 scoring systems, with an increase in the number of patients scoring 25 points or less in 2019, which can eventually hinder the diagnosis of PTB.

Pediatric tuberculosis in the metropolitan area of Rio de Janeiro.

AIM: To evaluate the clinical characteristics, diagnostic approach, and treatment outcomes of tuberculosis (TB) in children living in a high-burden metropolitan area. METHODS: This was a retrospective study, based on a medical chart review, involving children under 15 years old treated for TB between 2007 and 2016, in four primary health units (PHU) and three reference centers (RC) in five cities of Rio de Janeiro metropolitan area. Factors associated with TB treatment setting, microbiological diagnosis, and treatment outcomes were evaluated. RESULTS: A total of 544 children were enrolled; 71% were treated in PHU, 36% were under 5 years old, and 72% had pulmonary TB (PTB). The HIV prevalence was 10% (31/322). Fifty-three percent had at least one microbiological test for TB, 68% of them (196/287) had TB confirmed. Among 222 children with previous TB contact, information on LTBI was available for 78 (35%), and only 17% (13/78) were treated. Extrapulmonary TB (56% vs 32%), microbiologically confirmed TB (77% vs 60%), and HIV positivity (18.5% vs 4.0%) were significantly more frequent in RC. Treatment in RC (odds ratio (OR) 3.08, 95% confidence interval (CI) 1.74-5.44) and PTB (OR 2.47, 95% CI 1.34-4.56) were independently associated with a microbiological diagnosis of TB. The treatment success rate was 85%. In the logistic regression analysis, HIV-infected children had a 2.5-fold higher risk of an unfavorable outcome (OR 2.53, 95% CI 1.0-6.38; p = 0.05). CONCLUSIONS: Opportunities for TB prevention and early TB treatment are missed due to suboptimal close contact screening. Microbiological diagnosis of TB and drug susceptibility testing in children should be made available through more sensitive and accessible tests.

Epidemiological aspects, clinical manifestations, and prevention of pediatric tuberculosis from the perspective of the End TB Strategy.

Tuberculosis continues to be a public health priority in many countries. In 2015, tuberculosis killed 1.4 million people, including 210,000 children. Despite the recent progress made in the control of tuberculosis in Brazil, it is still one of the countries with the highest tuberculosis burdens. In 2015, there were 69,000 reported cases of tuberculosis in Brazil and tuberculosis was the cause of 4,500 deaths in the country. In 2014, the World Health Organization approved the End TB Strategy, which set a target date of 2035 for meeting its goals of reducing the tuberculosis incidence by 90% and reducing the number of tuberculosis deaths by 95%. However, to achieve those goals in Brazil, there is a need for collaboration among the various sectors involved in tuberculosis control and for the prioritization of activities, including control measures targeting the most vulnerable populations. Children are highly vulnerable to tuberculosis, and there are particularities specific to pediatric patients regarding tuberculosis development (rapid progression from infection to active disease), prevention (low effectiveness of vaccination against the pulmonary forms and limited availability of preventive treatment of latent tuberculosis infection), diagnosis (a low rate of bacteriologically confirmed diagnosis), and treatment (poor availability of child-friendly anti-tuberculosis drugs). In this review, we discuss the epidemiology, clinical manifestations, and prevention of tuberculosis in childhood and adolescence, highlighting the peculiarities of active and latent tuberculosis in those age groups, in order to prompt reflection on new approaches to the management of pediatric tuberculosis within the framework of the End TB Strategy.

Epidemiological aspects, clinical manifestations, and prevention of pediatric tuberculosis from the perspective of the End TB Strategy / Aspectos epidemiológicos, manifestações clínicas e prevenção da tuberculose pediátrica sob a perspectiva da Estratégia End TB

ABSTRACT Tuberculosis continues to be a public health priority in many countries. In 2015, tuberculosis killed 1.4 million people, including 210,000 children. Despite the recent progress made in the control of tuberculosis in Brazil, it is still one of the countries with the highest tuberculosis burdens. In 2015, there were 69,000 reported cases of tuberculosis in Brazil and tuberculosis was the cause of 4,500 deaths in the country. In 2014, the World Health Organization approved the End TB Strategy, which set a target date of 2035 for meeting its goals of reducing the tuberculosis incidence by 90% and reducing the number of tuberculosis deaths by 95%. However, to achieve those goals in Brazil, there is a need for collaboration among the various sectors involved in tuberculosis control and for the prioritization of activities, including control measures targeting the most vulnerable populations. Children are highly vulnerable to tuberculosis, and there are particularities specific to pediatric patients regarding tuberculosis development (rapid progression from infection to active disease), prevention (low effectiveness of vaccination against the pulmonary forms and limited availability of preventive treatment of latent tuberculosis infection), diagnosis (a low rate of bacteriologically confirmed diagnosis), and treatment (poor availability of child-friendly anti-tuberculosis drugs). In this review, we discuss the epidemiology, clinical manifestations, and prevention of tuberculosis in childhood and adolescence, highlighting the peculiarities of active and latent tuberculosis in those age groups, in order to prompt reflection on new approaches to the management of pediatric tuberculosis within the framework of the End TB Strategy.

RESUMO A tuberculose continua sendo uma prioridade de saúde pública em muitos países. Em 2015, a tuberculose matou 1,4 milhão de pessoas, incluindo 210.000 crianças. Apesar dos recentes progressos no controle da tuberculose no nosso país, o Brasil ainda é um dos países com maior carga de tuberculose. Em 2015, houve 69.000 casos de tuberculose notificados no Brasil e a tuberculose foi a causa de 4.500 mortes no país. Em 2014, a Organização Mundial da Saúde aprovou a Estratégia End TB, que estabeleceu 2035 como data-alvo para atingir suas metas de redução da incidência de tuberculose em 90% e do número de mortes por tuberculose em 95%. No entanto, para alcançar essas metas no Brasil, há a necessidade de colaboração entre os diversos setores envolvidos no controle da tuberculose e de priorização de atividades, incluindo medidas de controle voltadas às populações mais vulneráveis. As crianças são altamente vulneráveis à tuberculose, e há particularidades específicas dos pacientes pediátricos quanto ao desenvolvimento da tuberculose (rápida progressão da infecção para a doença ativa), prevenção (baixa eficácia da vacinação contra as formas pulmonares e disponibilidade limitada de tratamento preventivo da infecção tuberculosa latente), diagnóstico (baixa taxa de diagnóstico confirmado bacteriologicamente); e tratamento (pouca disponibilidade de fármacos antituberculose próprios para crianças). Nesta revisão, discutimos a epidemiologia, as manifestações clínicas e a prevenção da tuberculose na infância e adolescência, destacando as peculiaridades da tuberculose ativa e latente nessas faixas etárias, a fim de promover a reflexão sobre novas abordagens para o manejo da tuberculose pediátrica no àmbito da Estratégia End TB.

III Brazilian Thoracic Association Guidelines on tuberculosis.

New scientific articles about tuberculosis (TB) are published daily worldwide. However, it is difficult for health care workers, overloaded with work, to stay abreast of the latest research findings and to discern which information can and should be used in their daily practice on assisting TB patients. The purpose of the III Brazilian Thoracic Association (BTA) Guidelines on TB is to critically review the most recent national and international scientific information on TB, presenting an updated text with the most current and useful tools against TB to health care workers in our country. The III BTA Guidelines on TB have been developed by the BTA Committee on TB and the TB Work Group, based on the text of the II BTA Guidelines on TB (2004). We reviewed the following databases: LILACS (SciELO) and PubMed (Medline). The level of evidence of the cited articles was determined, and 24 recommendations on TB have been evaluated, discussed by all of the members of the BTA Committee on TB and of the TB Work Group, and highlighted. The first version of the present Guidelines was posted on the BTA website and was available for public consultation for three weeks. Comments and critiques were evaluated. The level of scientific evidence of each reference was evaluated before its acceptance for use in the final text.

III Diretrizes para Tuberculose da Sociedade Brasileira de Pneumologia e Tisiologia / III Brazilian Thoracic Association Guidelines on Tuberculosis

Diariamente novos artigos científicos sobre tuberculose (TB) são publicados em todo mundo. No entanto, é difícil para o profissional sobrecarregado na rotina de trabalho acompanhar a literatura e discernir o que pode e deve ser aplicado na prática diária juntos aos pacientes com TB. A proposta das "III Diretrizes para TB da Sociedade Brasileira de Pneumologia e Tisiologia (SBPT)" é revisar de forma crítica o que existe de mais recente na literatura científica nacional e internacional sobre TB e apresentar aos profissionais da área de saúde as ferramentas mais atuais e úteis para o enfrentamento da TB no nosso país. As atuais "III Diretrizes para TB da SBPT" foram desenvolvidas pela Comissão de TB da SBPT e pelo Grupo de Trabalho para TB a partir do texto das "II Diretrizes para TB da SBPT" (2004). As bases de dados consultadas foram LILACS (SciELO) e PubMed (Medline). Os artigos citados foram avaliados para determinação do ...

New scientific articles about tuberculosis (TB) are published daily worldwide. However, it is difficult for health care workers, overloaded with work, to stay abreast of the latest research findings and to discern which information can and should be used in their daily practice on assisting TB patients. The purpose of the III Brazilian Thoracic Association (BTA) Guidelines on TB is to critically review the most recent national and international scientific information on TB, presenting an updated text with the most current and useful tools against TB to health care workers in our country. The III BTA Guidelines on TB have been developed by the BTA Committee on TB and the TB Work Group, based on the text of the II BTA Guidelines on TB (2004). We reviewed the following databases: LILACS (SciELO) and PubMed (Medline). The level of evidence of the cited articles was determined, and 24 recommendations ...

Immune function in young children with previous pulmonary or miliary/meningeal tuberculosis and impact of BCG vaccination.

OBJECTIVE: Children <5 years old are at increased risk of miliary/meningeal tuberculosis, but the immunologic factors that place them at risk are unknown. BCG vaccine protects against miliary/meningeal tuberculosis, but the mechanism of protection is unknown. We assessed for abnormalities in immune response associated with miliary/meningeal or pulmonary tuberculosis in young children. PATIENTS AND METHODS: We conducted a case-control study among HIV-seronegative Brazilian children who were <5 years old. Case subjects had previous culture-confirmed or clinical miliary/meningeal tuberculosis. There were 2 sets of control subjects: those with culture-confirmed pulmonary tuberculosis and purified protein derivative-positive household contacts. All of the children had completed treatment. Peripheral blood mononuclear cells were stimulated (phytohemagglutinin, phytohemagglutinin + interleukin 12, lipopolysaccharide, lipopolysaccharide + interferon-gamma, and purified protein derivative), and cytokine responses (interleukin 1beta, interleukin-4, interleukin-6, interleukin-8, interleukin 10, interleukin 12, interferon-gamma, tumor necrosis factor-alpha, and monocyte chemoattractant protein 1) were quantified by bead-based assay. Median cytokine responses were compared by the Kruskal-Wallis test. Multivariate analysis of variance accounted for multiple comparisons. RESULTS: There were 18 case subjects with miliary/meningeal tuberculosis, 28 pulmonary control subjects, and 29 purified protein derivative-positive control subjects. The median age was 4.2 years. There was no difference in case and control subjects by age, gender, race, BMI, or median CD4 count. Twelve (67%) of 18 case subjects, 26 (93%) of 28 pulmonary control subjects, and 28 (97%) of 29 purified protein derivative-positive subjects had received BCG vaccine. No cytokine defects were identified in case subjects with miliary/meningeal tuberculosis compared with either set of control subjects. Pulmonary control subjects had uniformly higher monocyte chemoattractant protein 1 levels than case subjects with miliary/meningeal tuberculosis and purified protein derivative-positive control subjects, both at rest and with lipopolysaccharide, lipopolysaccharide + interferon-gamma, and purified protein derivative stimulation. Pulmonary control subjects did not have a higher frequency of allele G in the -2518 monocyte chemoattractant protein 1 promoter polymorphism. Case subjects with miliary/meningeal tuberculosis who had received BCG vaccine (n = 12) had lower stimulated interleukin 8 production than children who did not receive BCG vaccine (n = 6). CONCLUSIONS: Children with previous miliary/meningeal tuberculosis did not have a major defect in the cytokine pathways studied. Increased monocyte chemoattractant protein 1 levels were associated with pulmonary disease, occurred despite BCG vaccination, and were not associated with a polymorphism in the monocyte chemoattractant protein 1 promoter.

Prova de função pulmonar na criança com asma / Respiratory function test of child with asthma

Os testes de função pulmonar confirmam a obstrução das vias aéreas, quando se avalia de forma objetiva o dianóstico de asma na criança. O VEF1 (volume expiratório forçado no 1 segundo) é o parâmetro de função pulmonar fornecido pela espirometria, que melhor documenta a severidade da doença, através da quantificação do grau de obstrução. A resposta broncodilatadora positiva (após beta 2 agonista de curta duração), com melhora de 12% nos valores do VeF1, confirma o diagnóstico de asma. Por sua vez, o teste de broncoprovocação mede o grau de broncoconstricção de um indivíduo a diversos estímulos inespecíficos, capaz de desencadear uma crise de asma. O teste com metacolina é seguro, requer uma ténica mais elaborada realizada a partir da linha de base da espirometria. O exame é útil principalmente para crianças com sintomatologia respiratória e espirometria normal. Os exames são realizados em crianças a partir dos 6 anos de idade.

When the effectiveness of ashtma diagnosis and interventions are evaluated the variable airways obstruction is always objectively measured by pulmonary function tests. The FEV denved from spirometry, is the most reproductible pulmonary function parameter and is related to the seventy of airways obstruction. In addition a positive acute response to bronchodilator confirm the diagnosis of ashtma. Airways responsiveness measures the degree to whic an individual withstands nonspecific stimuli that trigger asthamtic attacks. The methacoline challenge test is safe hit, requires more technical skill than baseline spirometry and is clinically useful when spirometry is normal. These tools are being use in clinical pratice in children over 6 years old, suspected of ashtma.

Síndrome do bebê chiador / Syndrome of a wheezing baby

Um grande grupo de crianças sibilam, em decorrência de infecções agudas virais. A síndrome do bebê chiador caracteriza-se por 3 ou mais episódios recorrentes de sibilância, refletindo diminuição do tamanho das vias aéreas. "Bronquiolite" é uma das maiores causas de hospitalização de crianças com menos de 12 meses de idade. A maioria dos bebês que sibilam, o que fazem de forma transitória, associada com diminuição da função pulmonar ao nascimento, sem atopia e/ou risco de asma. Entretanto, uma minoria de lactentes, apresentam sibilância recorrente e continuarão a chiar após 3 anos de idade apresentando fatores predisponentes e de risco de asma.

Many young children wheeze during viral respiratory infections and the wheeze baby syndrome is characterized by a wheezing clinically reflecting a diminishing of the size of the baby's airway. "Bronchiolitis" is one of the major causes of hospital adimission for young babies under 12 months old. The majority of infants with wheezing have transient condition associated with diminished airway function at birth and do not have increased risks of asthma or allergies later in life. In a substantial minority of infants, however, wheezing episodes are probably related to a predisposition to asthma.

Escorbuto: aspectos clínicos e radiológicos do escorbuto, Hospital Municipal Jesus (Rio de Janeiro) 1973 - 1983 análise de 13 casos / Scurvy: clinical and radiological aspects; Hospital Municipal Jesus (Rio de Janeiro) 1973-83; analysis of 13 cases

Os autores apresentam uma análise dos casos de escorbuto diagnosticados no Hospital Municipal Jesus, num período de 10 anos. Foram observados 13 casos de doença em pacientes cujas idades variaram de oito meses a três anos. Näo houve prevalência em relaçäo ao sexo. Irritaçäo ao manuseio foi o quadro clínico dominante encontrado nas crianças. O exame radiológico confirmou o diagnóstico de todos os casos e todos tiveram evoluçäo satisfatória