Pesquisa | SciELO

BACKGROUND Cutaneous tuberculosis (CTB) is a rare extrapulmonary form of tuberculosis (TB). Despite the increase in the number of cases of TB and HIV, few cases of CTB have been reported. OBJECTIVE To describe CTB cases among patients with HIV infection from a cohort with tuberculosis. METHODS We describe a series of 15 CTB and HIV cases, based on secondary data from 2000 to 2016. Diagnosis was based on isolation of Mycobacterium tuberculosis in culture or clinical response to anti-tuberculous treatment associated with positive smear or histopathologic findings from affected skin or an adjacent lymph node. FINDINGS Scrofuloderma was present in 12 (80%) patients and solitary gumma in three (20%) patients. One case of scrofuloderma was associated with papulonecrotic tuberculid. Seven (46.6%) patients had pulmonary TB. Diagnosis was based on culture in nine patients (60%). The median CD4 cell count was 262 cells/µL. All patients were cured at the end of treatment (median time 6 months). Three patients presented with immune reconstitution inflammatory syndrome. CONCLUSIONS In this study, CTB associated with HIV infection presented as localised forms or in association with pulmonary TB. In patients with HIV who have subacute and chronic skin lesions, CTB should be considered in differential diagnosis, which may represent a good opportunity for early diagnosis of active TB.

https://doi.org/10.1590/0074-02760180184 1088 downloads

Survival of HIV patients with tuberculosis started on simultaneous or deferred HAART in the THRio cohort, Rio de Janeiro, Brazil
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Saraceni, Valeria

; Durovni, Betina

; Cavalcante, Solange C.

; Cohn, Silvia

; Pacheco, Antonio Guilherme

; Moulton, Lawrence H.

; Chaisson, Richard E.

; Golub, Jonathan E.

Brazilian Journal of Infectious Diseases

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Out 2014, Volume 18 Nº 5 Páginas 491 - 495

Resumo: En | Texto: En | PDF: En

Background:The timing of highly active antiretroviral therapy (HAART) after a tuberculosis diagnosis in HIV-infected patients can affect clinical outcomes and survival. We compared survival after tuberculosis diagnosis in HIV-infected adults who initiated HAART and tuberculosis therapy simultaneously to those who delayed the start of HAART for at least two months.Methods:The THRio cohort includes 17,983 patients receiving HIV care in 29 public clinics in Rio de Janeiro, Brazil. HAART-naïve patients at the time of a new TB diagnosis between September 2003 and June 2008 were included. Survival was measured in days from diagnosis of TB. We compared survival among patients who initiated HAART within 60 days of TB treatment (simultaneous – ST) to those who started HAART >60 days of TB treatment or never started (deferred – DT). Kaplan–Meier plots and Cox proportional hazards regression analyses were conducted.Results:Of 947 patients diagnosed with TB, 572 (60%) were HAART naïve at the time of TB diagnosis; 135 were excluded because of missing CD4 count results. Among the remaining 437 TB patients, 56 (13%) died during follow-up: 25 (10%) among ST patients and 31 (16%) in DT group (p = 0.08). ST patients had lower median CD4 counts at TB diagnosis than DT patients (106 vs. 278, p < 0.001). Cox proportional hazards utilizing propensity score analysis showed that DT patients were more likely to die (adjusted HR = 1.89; 95% CI: 1.05–3.40; p = 0.03).Conclusion:HAART administered simultaneously with TB therapy was associated with improved survival after TB diagnosis. HAART should be given to patients with HIV-related TB as soon as clinically feasible.

https://doi.org/10.1016/j.bjid.2014.02.004 1677 downloads

Operational lessons drawn from pilot implementation of Xpert MTB/Rif in Brazil
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Durovni, Betina

; Saraceni, Valeria

; Cordeiro-Santos, Marcelo

; Cavalcante, Solange

; Soares, Elizabeth

; Lourenço, Cristina

; Menezes, Alexandre

; van den Hof, Susan

; Cobelens, Frank

; Trajman, Anete

Bulletin of the World Health Organization

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Ago 2014, Volume 92 Nº 8 Páginas 613 - 617

Resumo: En Es Fr | Texto: En Es Fr | PDF: En | PDF: Es | PDF: Fr

Problem The World Health Organization has endorsed the Xpert MTB/RIF (Xpert), an automated polymerase-chain-reaction-based assay, for the rapid diagnosis of tuberculosis. However, large-scale use of a new technology calls for preparation and adaptation. Approach A pilot implementation study was conducted in two Brazilian cities to explore the replacement of sputum smear microscopy with Xpert. The laboratories included covered 70% of the tuberculosis cases diagnosed, had no overlap in population catchment areas, handled different workloads and were randomly shifted to Xpert. Sputum samples were collected through the same routine procedures. Before the study the medical information system was prepared for the recording of Xpert results. Laboratory technicians were trained to operate Xpert machines and health workers were taught how to interpret the results. Local setting The average annual tuberculosis incidence in Brazil is around 90 cases per 100 000 population. However, co-infection with the human immunodeficiency virus and multidrug resistance are relatively infrequent (10% and < 2%, respectively). Relevant changes Of the tested sputum samples, 7.3% were too scanty for Xpert and had to be examined microscopically. Ten per cent of Xpert equipment needed replacement, but spare parts were not readily available in the country. Absence of patient identification numbers led to the introduction of errors in the medical information system. Lessons learnt For nationwide scale-up, a local service provider is needed to maintain the Xpert system. Ensuring cartridge availability is also essential. The capacity to perform smear microscopy should be retained. The medical information system needs updating to allow efficient use of Xpert.

Resumen Situación La Organización Mundial de la Salud ha aprobado Xpert MTB/RIF (Xpert), un ensayo automatizado basado en la reacción en cadena de la polimerasa para el diagnóstico rápido de la tuberculosis (TB). Sin embargo, el uso a gran escala de una tecnología nueva requiere una preparación y adaptación. Enfoque Con objeto de examinar la sustitución de la microscopia de frotis de esputo con Xpert, se llevó a cabo un estudio piloto de implementación en dos ciudades brasileñas. Los laboratorios participantes incluyeron el 70 % de los casos de tuberculosis diagnosticados, no se produjo ningún solapamiento en las zonas de captación de población, manejaron cargas de trabajo distintas y se asignaron a Xpert de forma aleatoria. Las muestras de esputo se recogieron a través de los mismos procedimientos rutinarios. Antes del estudio, se preparó el sistema de información médica con objeto de registrar los resultados de Xpert. Se capacitó a los técnicos de laboratorio para operar máquinas Xpert y se enseñó a los trabajadores sanitarios cómo interpretar los resultados. Marco regional La tasa de incidencia anual media de la tuberculosis en Brasil es de unos 90 casos por cada 100 000 habitantes. Sin embargo, la coinfección con el virus de la inmunodeficiencia humana y la multirresistencia son relativamente poco frecuentes (10 % y < 2 %, respectivamente). Cambios importantes De las muestras de esputo sometidas a prueba, el 7,3 % fueron demasiado escasas para Xpert y tuvieron que ser examinadas con microscopio. El diez por ciento de los equipos Xpert necesitó piezas de repuesto, pero estas no estaban disponibles en el país. La ausencia de números de identificación de pacientes dio lugar a la introducción de errores en el sistema de información médica. Lecciones aprendidas La expansión nacional del sistema Xpert necesita un proveedor de servicios local que se haga cargo del mantenimiento del sistema. También es fundamental garantizar la disponibilidad de los cartuchos, y debería conservarse la capacidad de realizar microscopias de frotis. El sistema de información médica debe mantenerse actualizado para permitir un uso eficiente de Xpert.

Résumé Problème L'Organisation mondiale de la Santé a approuvé Xpert MTB/RIF (Xpert), un test automatisé basé sur l'amplification en chaîne par polymérase, pour le diagnostic rapide de la tuberculose (TB). Cependant, l'utilisation à grande échelle d'une nouvelle technologie exige une préparation et une adaptation préalables. Approche Une étude de mise en œuvre pilote a été menée dans deux villes du Brésil pour étudier le remplacement de l'examen au microscope des frottis d'expectoration par Xpert. Les laboratoires inclus couvraient 70% des cas de TB diagnostiqués, ne présentaient pas de chevauchement dans les bassins de vie des populations, traitaient différentes charges de travail et basculaient aléatoirement vers l’utilisation de Xpert. Les échantillons d'expectoration étaient recueillis avec les mêmes procédures de routine. Avant l'étude, le système d'informations médicales a été préparé pour l'enregistrement des résultats Xpert. Les techniciens de laboratoire ont été formés à l'utilisation des machines Xpert, et le personnel de santé a appris à interpréter les résultats. Environnement local Le taux moyen annuel d'incidence de la TB au Brésil est d'environ 90 cas pour 100 000 habitants. Cependant, la co-infection avec le virus de l'immunodéficience humaine et la multirésistance aux médicaments sont relativement peu fréquentes (10% et > 2%, respectivement). Changements significatifs Parmi les échantillons d'expectoration testés, 7,3% étaient insuffisants pour Xpert et ont dû être examinés par microscope. Dix pour cent de l'équipement Xpert a dû être remplacé, mais les pièces de rechange n'étaient pas facilement disponibles dans le pays. L'absence de numéros d'identification des patients a conduit à l'apparition d'erreurs dans le système d'informations médicales. Leçons tirées Pour un déploiement à l'échelle du pays, un prestataire de service local est nécessaire pour la maintenance du système Xpert. Assurer la disponibilité des cartouches est également indispensable. La capacité à effectuer les examens des frottis par microscope doit être maintenue. Le système d'informations médicales doit être mis à jour pour permettre l'utilisation efficace de Xpert.

https://doi.org/10.2471/BLT.13.131409 1688 downloads Citado 1 vez em SciELO

Physician adherence to guidelines for tuberculosis and HIV care in Rio de Janeiro, Brazil
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Saraceni, Valeria

; Pacheco, Antonio Guilherme

; Golub, Jonathan E

; Vellozo, Vitoria

; King, Bonnie S

; Cavalcante, Solange C

; Eldred, Lois

; Chaisson, Richard E

; Durovni, Betina

Brazilian Journal of Infectious Diseases

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Jun 2011, Volume 15 Nº 3 Páginas 249 - 252

Resumo: En | Texto: En | PDF: En

BACKGROUND: Tuberculosis is the most common opportunistic infection among HIV-infected patients in Brazil. Brazil's national policy for HIV care recommends screening for latent tuberculosis (TB) and implementing isoniazid preventive therapy (IPT). OBJECTIVES: We compared physician adherence to TB screening and other prevention and care policies among HIV primary care clinics in Rio de Janeiro City. METHODS: Data on performance of CD4 counts, viral load testing, tuberculin skin testing (TST) and IPT were abstracted from patient charts at 29 HIV clinics in Rio de Janeiro as part of the TB/HIV in Rio (THRio) study. Data on use of pneumocystis jiroveci pneumonia (PCP) prophylaxis were also abstracted from a convenience sample of 150 patient charts at 10 HIV clinics. Comparisons were made between rates of adherence to TB guidelines and other HIV care guidelines. RESULTS: Among the subset of 150 patients with confirmed HIV infection in 2003, 96% had at least one reported CD4 counts result; 93% had at least one viral load result reported; and, PCP prophylaxis was prescribed for 97% of patients with CD4 counts < 200 cells/mm³ or when clinically indicated. In contrast, 67 patients (45%) had a TST performed (all eligible); and only 11% (17) of eligible patients started IPT. Among 12,027 THRio cohort participants between 2003 and 2005, the mean number of CD4 counts and viral load counts was 2.5 and 1.9, respectively, per patient per year. In contrast, 49% of 8,703 eligible patients in THRio had a TST ever performed and only 53% of eligible patients started IPT. CONCLUSION: Physicians are substantially more compliant with HIV monitoring and PCP prophylaxis than with TB prophylaxis guidelines. Efforts to improve TB control in HIV patients are badly needed.

2626 downloads Citado 5 vezes em SciELO

III Diretrizes para Tuberculose da Sociedade Brasileira de Pneumologia e Tisiologia
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Conde, Marcus Barreto

; Melo, Fernando Augusto Fiuza de

; Marques, Ana Maria Campos

; Cardoso, Ninarosa Calzavara

; Pinheiro, Valeria Goes Ferreira

; Dalcin, Paulo de Tarso Roth

; Machado Junior, Almério

; Lemos, Antonio Carlos Moreira

; Netto, Antônio Ruffino

; Durovni, Betina

; Sant'Anna, Clemax Couto

; Lima, Dinalva

; Capone, Domenico

; Barreira, Draurio

; Matos, Eliana Dias

; Mello, Fernanda Carvalho de Queiroz

; David, Fernando Cezar

; Marsico, Giovanni

; Afiune, Jorge Barros

; Silva, José Roberto Lapa e

; Jamal, Leda Fátima

; Telles, Maria Alice da Silva

; Hirata, Mário Hiroyuki

; Dalcolmo, Margareth Pretti

; Rabahi, Marcelo Fouad

; Cailleaux-Cesar, Michelle

; Palaci, Moises

; Morrone, Nelson

; Guerra, Renata Leborato

; Dietze, Reynaldo

; Miranda, Silvana Spíndola de

; Cavalcante, Solange Cesar

; Nogueira, Susie Andries

; Nonato, Tatiana Senna Galvão

; Martire, Terezinha

; Galesi, Vera Maria Nader

; Dettoni, Valdério do Valle

Jornal Brasileiro de Pneumologia

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Out 2009, Volume 35 Nº 10 Páginas 1018 - 1048

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

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 nível de evidência científica, e 24 recomendações sobre TB foram avaliadas, discutidas por todo grupo e colocadas em destaque. A primeira versão das "III Diretrizes para TB da SBPT" foi colocada no website da SBPT para consulta pública durante três semanas, e as sugestões, críticas e o nível de evidência da referência científica que as embasavam foram avaliados e discutidos antes de serem incorporadas ou não ao texto final.

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.

112639 downloads Citado 23 vezes em SciELO

Peculiaridades do controle da tuberculose em um cenário de violência urbana de uma comunidade carente do Rio de Janeiro
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Souza, Fabiana Barbosa Assumpção de

; Villa, Tereza Cristina Scatena

; Cavalcante, Solange Cesar

; Ruffino Netto, Antonio

; Lopes, Luciane Blanco

; Conde, Marcus Barreto

Jornal Brasileiro de Pneumologia

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Jun 2007, Volume 33 Nº 3 Páginas 318 - 322

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

OBJETIVO: Descrever as dificuldades e peculiaridades encontradas por profissionais de saúde durante o tratamento e a investigação de contatos de pacientes com tuberculose (TB) em comunidades carentes. MÉTODOS: Estudo de abordagem qualitativa realizado nas unidades de saúde localizadas na Área Programática 1.0, no município do Rio de Janeiro, Brasil, com taxa de incidência de TB de 240/100.000 habitantes. Foram selecionados para o estudo dois visitadores domiciliares e um auxiliar de enfermagem, responsáveis pela visita e atendimento dos casos de TB e contatos. Os dados foram transcritos e estruturados sob forma de citação, com destaque para as idéias mais predominantes. RESULTADOS: As idéias centrais têm como eixo a dimensão da violência que se expressa através das regras do tráfico de drogas, das barreiras ao deslocamento dos pacientes e profissionais de saúde para o tratamento da TB, e da segurança pública (policiais). CONCLUSÃO: Este estudo fornece dados para reflexão e análise aos formuladores de políticas de saúde e aos órgãos formadores de profissionais de saúde sobre a dificuldade que a violência urbana impõe ao controle da TB em uma comunidade carente.

OBJECTIVE: To describe the difficulties and peculiarities encountered by health professionals during the treatment and investigation of contacts of tuberculosis (TB) patients in disadvantaged communities. METHODS: A qualitative study carried out at health care facilities in Health Programming Area 1.0, located in the city of Rio de Janeiro, Brazil, which has a TB incidence rate of 240/100,000 inhabitants. From among the professionals responsible for visiting and treating TB cases and their contacts, two home visit agents and one clinical nurse were selected to be interviewed for the study. Data were transcribed and structured in the form of quotations, emphasizing the predominant ideas. RESULTS: The central ideas focus on the issue of violence, one significant facet of which is the set of rules imposed by narcotraffickers, and on the barriers to the movement of patients/health professionals for TB treatment, as well as on public safety (police). CONCLUSION: This study provides public health officials, as well as institutions that graduate health professionals, data for reflection and analysis of the difficulties that urban violence creates for the control of TB in a disadvantaged community.

5268 downloads Citado 1 vez em SciELO

Tuberculose como doença definidora de síndrome da imunodeficiência adquirida: dez anos de evolução na Cidade do Rio de Janeiro
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Soares, Elizabeth Cristina Coelho

; Saraceni, Valéria

; Lauria, Lilian de Mello

; Pacheco, Antonio Guilherme

; Durovni, Betina

; Cavalcante, Solange Cesar

Jornal Brasileiro de Pneumologia

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Out 2006, Volume 32 Nº 5 Páginas 444 - 448

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

OBJETIVO: Analisar a freqüência da tuberculose e das outras principais doenças oportunistas definidoras de síndrome da imunodeficiência adquirida, no momento em que estes casos são notificados, no Município do Rio de Janeiro. MÉTODOS: Análise do banco de dados do Sistema de Vigilância Epidemiológica do Programa de Doenças Sexualmente Transmissíveis e Síndrome da Imunodeficiência Adquirida da Cidade do Rio de Janeiro, no período de 1993 a 2002. RESULTADOS: A expansão da definição de casos de síndrome da imunodeficiência adquirida ocorrida em 1998 criou um aumento substancial no número de casos notificados de síndrome da imunodeficiência adquirida, principalmente por aqueles que passaram a ser definidos pelo critério imunológico. Dentre os casos de síndrome da imunodeficiência adquirida que foram definidos apenas por doença, a candidíase em suas diversas formas manteve-se como a doença oportunista de maior freqüência no momento da notificação. Embora a pneumonia por Pneumocystis carinii se apresentasse como a segunda doença mais freqüente na maioria dos anos observados, a partir de 2001, a tuberculose ultrapassou-a em freqüência, tornando-se a segunda doença mais freqüente no momento da notificação dos casos de síndrome da imunodeficiência adquirida. CONCLUSÃO: Apesar da diminuição do número de casos de síndrome da imunodeficiência adquirida definidos por doença, a tuberculose manteve-se como um importante evento definidor dessa síndrome, sendo atualmente de ocorrência mais freqüente do que a pneumonia por Pneumocystis carinii e a toxoplasmose, provavelmente por sua alta taxa de prevalência na cidade.

OBJECTIVE: To analyze the frequency of tuberculosis and of the other principal opportunistic infections defining acquired immunodeficiency syndrome at the time such cases were reported in the city of Rio de Janeiro, Brazil. METHODS: Analysis of the data compiled in the Rio de Janeiro Municipal Program for the Surveillance of Sexually Transmitted Diseases and Acquired Immunodeficiency Syndrome database from 1993 to 2002. RESULTS: The expanded definition of a case of acquired immunodeficiency syndrome, implemented in 1998, resulted in a substantial increase in the number of reported cases of acquired immunodeficiency syndrome, especially of those defined by immunologic criteria. Among the cases of acquired immunodeficiency syndrome defined only by disease, esophageal candidiasis, in its various forms, remained the most common opportunistic infection present at the time the cases of acquired immunodeficiency syndrome were reported. Although Pneumocystis carinii pneumonia was the second leading opportunistic infection in most of the years evaluated, it was surpassed by tuberculosis in 2001. CONCLUSION: Despite the decreased numbers of cases of acquired immunodeficiency syndrome defined by disease, tuberculosis remains a significant acquired immunodeficiency syndrome-defining event, currently more common than P. carinii pneumonia and toxoplasmosis. This is probably due to the high rate of tuberculosis prevalence in the city.

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Use of the 2,3-diacyl-trehalose and the purified protein derivative in the serodiagnosis of tuberculosis in AIDS
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Saad, Maria Helena F

; Kritski, Afranio L

; Werneck-Barroso, Eduardo

; Cavalcante, Solange

; Ferreira, Monica Antônia S

; Fonseca, Leila de Souza

Memórias do Instituto Oswaldo Cruz

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Fev 1996, Volume 91 Nº 1 Páginas 97 - 100

Resumo: En | Texto: En | PDF: En

The effect of the human immunodeficiency virus (HIV) infection on IgG production against purified protein derivative (PPD) and 2,3-diacil-trehalose (SL-IV) was investigated by an enzyme-linked immunosorbent assay (ELISA) test. Comparison between the antigens showed that immunocompetent patients produce preferentially antibodies to SL-IV than to PPD (73.3% versus 63.3%). Combination of these results showed an increase of the sensitivity to 80%, which decreased over the spectrum of immunodepression caused by HIV. In the tuberculous HIV seropositive group the sensitivities of SL-IV and PPD were 36.4% versus 40% and 0% versus 22.2% in the tuberculosis/acquired immunodeficiency syndrome (TB/AIDS) group. Combination of these results gave respectively 54.5% and 20%, showing that serological tests have limited value for diagnosis of tuberculosis in HIV infected patients. High antibody levels were observed in HIV seropositive asymptomatic group, but only two individuals were positive for both antigens. In the follow up, one of them developed tuberculous lymphadenitis, indicating that further work is needed to access the value of serological tests in predicting tuberculosis in HIV infected individuals.

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