Latent tuberculosis infection and the EndTB Strategy: ethical tensions and imperatives.

Latent tuberculosis infection (LTBI) is increasingly recognised as central to programmatic TB activity, and a critical element in global progress towards TB elimination. LTBI affects a much larger group of people than active disease, who by definition are asymptomatic. Furthermore, while LTBI represents a state of risk, there remains significant uncertainty regarding which individuals will progress to active disease. Therefore, the development and implementation of LTBI management policies within the End TB Strategy requires careful ethical consideration. This article reviews ethical issues related to developments in LTBI diagnosis and management, including new tools and emerging policies and practice. Implications of LTBI management practices in specific settings are discussed, including healthcare worker infection and management of likely multidrug-resistant (MDR) LTBI. Better prediction of progression to active disease and less burdensome treatments would allow ethically appropriate expansion of testing programmes in future. However, even with existing tools there is a strong ethical imperative to provide the most effective and least burdensome therapy possible to those with LTBI, particularly those at highest risk of progression and/or poor outcomes from active disease. Greater community engagement is required in designing optimal LTBI management programmes, and ensure harms and benefits are appropriately balanced in specific settings.

[Clinical features of cerebral toxoplasmosis in Cuban patients with AIDS]. / Manifestaciones clínicas de la toxoplasmosis cerebral en pacientes cubanos con sida.

INTRODUCTION: Neurotoxoplasmosis (NTX) is one of the commonest opportunist infections in patients infected by the human immunodeficiency virus. It presents with a variety of clinical features in the immunocompromised patient. PATIENTS AND METHODS: We made a horizontal retrospective descriptive study of 88 patients with a diagnosis of NTX treated in the Pedro Kour Institute during a three years period. Our aim was to find which were the most common forms of clinical presentation in our setting and to evaluate the use of paraclinical examinations in reaching the presumptive diagnosis. The patients had clinical examinations, CSF studies, detection of indirect immunofluorescence titres (IFI) for Toxoplasma, imaging studies (CAT) and lymphocyte counts. RESULTS: The commonest symptoms were: headache in 79%, fever in 55.68%, motor defect in 44.31% and disorders of consciousness in 29.54% of the patients. The IFI titres were negative in 31.54% of the patients, between 1/16 and 1/32 in 38.34% and between 1/64 and 1/1,024 in only 30.07% of cases. The T CD4+ lymphocyte count was less than 200 cells in 66.7% of the patients; 72% of imaging studies showed typical lesions, in association with other disorders in 38% of the cases (lymphomas, cryptococcosis, tuberculous meningoencephalitis and cytomegalovirus encephalitis). CONCLUSIONS: NTX in a patient with AIDS often presents in our setting with headache and fever, motor deficit and alterations of consciousness. The diagnosis should be confirmed by immunological or imaging studies since in this disease serology and CSF studies are less specific.

[Infections and other opportunistic processes in a group of Cuban stage-IV HIV patients]. / Infecciones y otros procesos oportunistas en un grupo de pacientes cubanos con VIH en estadio IV.

Forty Cuban patients affected by the human immunodeficiency virus (HIV), belonging to Group IV, assisted during a year at the Pedro Kourí Tropical Medicine Institute, are reported. Pneumocystis carinii, cryptosporidiosis, mucocutaneous herpes simplex, oral candidiasis and multidermatoma herpes zoster were the most commonly found infections. Other non-opportunistic diseases such as dermatitis seborrhoeica and onychomycosis were also present.

[Levamisole, mebendazole, thiabendazole. Their effectiveness as helminthicides in African patients recently arrived in Cuba. From 1987 to 1988]. / Levamisol, mebendazol, tiabendazol. Su efectividad como helminticidas en pacientes africanos recién arribados a Cuba. Período 1987-1988.

Ninety one passengers coming from Africa, carriers of geohelminthes, were selected and treated with helminthicides of large use in our country (levamisole, mebendazole, thiabendazole). An excellent effective response was obtained for Ascaris lumbricoides (96.5%), and a good effective response was obtained for the rest of the parasites: Trichuri trichiura (88.5%), Strongyloides stercoralis (87.5%), and Necator americanus (78.9), according to data of therapeutical response efficiency of the WHO.

[Cryptosporidium sp. infection in Cuban individuals infected by HIV]. / Infección por Cryptosporidium sp. en individuos cubanos infectados por el VIH.

A study was conducted on the presence of Cryptosporidium sp in 47 Cuban adult patients infected by HIV in different infective stages in order to assess for the first time its prevalence in this group. The parasite was found in 18 patients (38.3%), of whom 18 (44.7%) were asymptomatic. The most frequent symptoms were aqueous diarrhea, fever, abdominal colics, asthemia and weight loss. Emphasis is placed on the frequently asymptomatic nature of these infections, which could be an important reservoir for nosocomial transmission of this disease among individuals with immunological disregulations.

[Tuberculosis and HIV coinfection in Cuba]. / La coinfección de la tuberculosis y el VIH en Cuba.

The first 28 Cuban HIV-seropositive patients with bacteriologically confirmed tuberculosis in the period of 21 months between July, 1993, and March, 1995, were presented. The clinical characterization and the therapeutic response of the multidrug regimen considered by the National Program for Tuberculosis Control are stressed. The most frequent clinical form of presentation was the pulmonary one with 89.3% No lesions were found in the chest X-ray of 8 patients. The response to the multidrug treatment was satisfactory, which together with a group of procedures performed prevented the propagation of this disease among the HIV-seropositive patients and the population in general.