ABSTRACT Paracoccidioidomycosis is a deep systemic mycosis, endemic in some Latin American countries, with an acute/subacute clinical presentation. In our country, it is the main differential diagnosis of pulmonary tuberculosis. We describe the clinical case of a 48-year-old man from a rural area, immunocompetent, who presented clinically with respiratory distress, progressive weight loss and lesions in the oral mucosa; as radiological findings, he presented bilateral reticular infiltrates. From a mycological point of view, the presence of the microorganism was evidenced in various biological samples: biopsies of oropharyngeal lesions and mycological study of sputum. Targeted treatment with intravenous antifungals was performed, presenting a good response to it with clinical improvement.

RESUMEN La paracoccidioidomicosis es una micosis profunda sistémica, endémica en algunos países de Latinoamérica, de presentación clínica es de evolución aguda/subaguda, en nuestro país es el principal diagnostico diferencial de la tuberculosis pulmonar. Se describe el caso clínico de un hombre de 48 años, procedente de zona rural, inmunocompetente, que se presentó clínicamente por dificultad respiratoria, pérdida de peso de forma progresiva y lesiones en mucosas oral; como hallazgos radiológicos presentó infiltrados reticulares bilaterales. Desde el punto de vista micológico se evidenció la presencia del microorganismo en diversas muestras biológicas: biopsias de lesiones orofaríngeas y estudio micológico del esputo. Se realizó tratamiento dirigido con antimicótico intravenoso presentando buena respuesta al mismo con mejoría clínica.

ABSTRACT Miliary Tuberculosis (TB) is a potentially fatal condition if not diagnosed and treated promptly, although it requires certain circumstances to develop. This article studies the case of a 48-year-old man with no significant pathological history, who developed the disease over a period of six months, initially presenting with diffuse gastrointestinal symptoms. One month prior to admission, he developed progressive respiratory symptoms and was admitted to the emergency department where bilateral diffuse miliary involvement was evident on the chest computed tomography. He was administered oxygen and support measures and passed an HIV test, which was negative. Nevertheless, his sputum smear microscopy showed positive results. His clinical evolution remained stationary until the administration of antituberculosis therapy, observing slight clinical improvement. Low doses of corticosteroids were also administered, leading to a favorable evolution, and he was subsequently discharged.

RESUMEN La tuberculosis (TB) miliar es una presentación con un desenlace fatal de no ser diagnosticada ni tratada a tiempo; para desarrollar esta presentación se requieren de ciertas condicionantes. En este artículo, se estudia el caso de un varón de 48 años sin antecedentes patológicos, quien inició la enfermedad por un periodo de seis meses, con un cuadro gastrointestinal difuso inicial; un mes antes del ingreso presentó un cuadro respiratorio progresivo, por lo que fue ingresado a Emergencias, en donde se evidenció, en la tomografía computarizada de tórax, compromiso miliar difuso bilateral; se le administró oxígeno y medidas de soporte, se obtuvo prueba VIH, cuyo resultado fue negativo. Se obtuvieron resultados positivos en la baciloscopia de esputo. Su evolución fue estacionaria hasta la administración de la terapia antituberculosa y se observó leve mejoría clínica; así mismo, se le administraron dosis bajas de corticoide, luego de los cuales se evidenció una evolución favorable, por lo que se le dio de alta.

ABSTRACT Neuroleptic malignant syndrome (NMS) is a neurologic emergency potentially fatal. This rare side effect is most commonly associated with first-generation antipsychotics and less frequently with atypical or second-generation antipsychotics. The diagnosis relies on both clinical and laboratory criteria, with other organic and psychiatric conditions being ruled out. CASE REPORT: A 39-year-old female patient, who is institutionalized and completely dependent, has a medical history of recurrent urinary infections and colonization by carbapenem-resistant Klebsiella pneumoniae. Her regular medication regimen included sertraline, valproic acid, quetiapine, risperidone, lorazepam, diazepam, haloperidol, baclofen, and fentanyl. The patient began experiencing dyspnea. Upon physical examination, she exhibited hypotension and a diminished vesicular murmur at the right base during pulmonary auscultation. Initially, after hospitalization, she developed high febrile peaks associated with hemodynamic instability, prompting the initiation of antibiotic treatment. Despite this, her fever persisted without an increase in blood inflammatory parameters, and she developed purulent sputum, necessitating antibiotherapy escalation. The seventh day of hospitalization showed no improvement in symptoms, suggesting NNMS as a differential diagnosis. All antipsychotic and sedative drugs, as well as antibiotherapy, were discontinued, after which the patient showed significant clinical improvement. CONCLUSION: Antipsychotic agents are commonly employed to manage behavioral changes linked to various disorders. However, their severe side effects necessitate a high degree of vigilance, the cessation of all medications, and the implementation of supportive care measures. A prompt and accurate diagnosis of NMS is crucial to alleviating the severe, prolonged morbidity and potential mortality associated with this syndrome. (NMS fatal firstgeneration first generation secondgeneration second criteria out REPORT 39yearold yearold 39 year old dependent carbapenemresistant carbapenem resistant pneumoniae sertraline acid quetiapine risperidone lorazepam diazepam haloperidol baclofen fentanyl dyspnea examination auscultation Initially instability treatment parameters sputum escalation symptoms drugs discontinued CONCLUSION disorders However vigilance medications measures 3

RESUMEN Objetivo: Analizar la asociación entre la oferta de acciones de tratamiento para tuberculosis con las características sociodemográficas y clínicas de los casos durante la pandemia de COVID-19. Método: Estudio transversal realizado con datos de fuente secundaria de 134 casos de tuberculosis que realizaron tratamiento en 2020 en Pelotas-RS. Los datos fueron analizados por estadística descriptiva, Chi-cuadrado y prueba exacta de Fisher. Resultados: Las acciones ofertadas en el periodo fueron: radiografía de tórax al sexto mes (48,5%), cultivo de esputo (49%), tres o más microscopía de frotis (12,7%) y microscopía al final del tratamiento (16,7%). El número de consultas médicas y de enfermería no alcanzó seis en 52,9% y 83,3% de los casos, respectivamente. La menor oferta de acciones de tratamiento se asoció a: retratamiento (p=0,001); comorbilidades (p=0,023); VIH (p<0,001); trastorno mental (p=0,013); uso de sustancias ilícitas (p=0,018); resultado normal de la radiografía de tórax (p=0,024); y régimen especial de tratamiento farmacológico (p=0,009). Conclusión: Después de la pandemia de COVID-19, es esencial invertir en el seguimiento de los casos, especialmente aquellos en retratamiento, con comorbilidades, radiografía normal y régimen de tratamiento especial. Objetivo COVID19. COVID19 COVID 19. 19 COVID-19 Método 13 202 PelotasRS. PelotasRS Pelotas RS. RS Pelotas-RS descriptiva Chicuadrado Chi cuadrado Fisher Resultados 48,5%, 485 48,5% , 48 5 (48,5%) 49%, 49 49% (49%) 12,7% 127 12 7 (12,7% 16,7%. 167 16,7% . 16 (16,7%) 529 52 9 52,9 833 83 3 83,3 respectivamente a p=0,001 p0001 p 0 001 (p=0,001) p=0,023 p0023 023 (p=0,023) p<0,001 (p<0,001) p=0,013 p0013 013 (p=0,013) p=0,018 p0018 018 (p=0,018) p=0,024 p0024 024 (p=0,024) p=0,009. p0009 p=0,009 009 (p=0,009) Conclusión COVID19, 19, COVID1 1 COVID-1 20 48,5 4 (48,5% (49% 12,7 (12,7 16,7 (16,7% 52, 8 83, p=0,00 p000 00 (p=0,001 p=0,02 p002 02 (p=0,023 p<0,00 (p<0,001 p=0,01 p001 01 (p=0,013 (p=0,018 (p=0,024 (p=0,009 COVID- 2 48, (48,5 (49 12, (12, 16, (16,7 p=0,0 p00 (p=0,00 (p=0,02 p<0,0 (p<0,00 (p=0,01 (48, (4 (12 (16, p=0, p0 (p=0,0 p<0, (p<0,0 (48 ( (1 (16 p=0 (p=0, p<0 (p<0, p= (p=0 p< (p<0 (p= (p< (p

ABSTRACT Objective: To analyze the association between the provision of tuberculosis treatment actions and the sociodemographic and clinical characteristics of cases during the COVID-19 pandemic. Method: Cross-sectional study conducted with data from secondary sources of 134 tuberculosis cases that underwent treatment in 2020 in the city of Pelotas, RS, Brazil. Data were analyzed using descriptive statistics, Chi-square test, and Fisher’s exact test. Results: The least frequently offered actions in the period were: three or more control smear microscopies (12.7%), smear microscopy at the end of treatment (16.7%), chest X-ray at sixth month (48.5%) and sputum culture (49%). The number of medical and nursing consultations did not reach six in 52.9% and 83.3% of cases, respectively. The lower offer of treatment actions was associated with: retreatment (p<0.001); comorbidities (p=0.023); HIV infection (p<0.001); mental disorder (p=0.013); illicit substance use (p=0.018); normal chest X-ray (p=0.024); and special treatment regimen (p=0.009). Conclusion: After the COVID-19 pandemic, it is essential to invest in cases follow-up, especially those undergoing retreatment, with comorbidities, drug use, normal chest X-ray results, and special treatment regimens. Objective COVID19 COVID 19 COVID-1 pandemic Method Crosssectional Cross sectional 13 202 Pelotas RS Brazil statistics Chisquare Chi square test Fishers Fisher s Results 12.7%, 127 12.7% , 12 7 (12.7%) 16.7%, 167 16.7% 16 (16.7%) Xray X ray 48.5% 485 48 5 (48.5% 49%. 49 49% . (49%) 529 52 9 52.9 833 83 3 83.3 respectively p<0.001 p0001 p 0 001 (p<0.001) p=0.023 p0023 023 (p=0.023) p=0.013 p0013 013 (p=0.013) p=0.018 p0018 018 (p=0.018) p=0.024 p0024 024 (p=0.024) p=0.009. p0009 p=0.009 009 (p=0.009) Conclusion followup, followup follow up, up follow-up results regimens COVID1 1 COVID- 20 12.7 (12.7% 16.7 (16.7% 48.5 4 (48.5 (49% 52. 8 83. p<0.00 p000 00 (p<0.001 p=0.02 p002 02 (p=0.023 p=0.01 p001 01 (p=0.013 (p=0.018 (p=0.024 p=0.00 (p=0.009 2 12. (12.7 16. (16.7 48. (48. (49 p<0.0 p00 (p<0.00 p=0.0 (p=0.02 (p=0.01 (p=0.00 (12. (16. (48 (4 p<0. p0 (p<0.0 p=0. (p=0.0 (12 (16 ( p<0 (p<0. p=0 (p=0. (1 p< (p<0 p= (p=0 (p< (p= (p

RESUMO Objetivo: Analisar a associação entre a oferta de ações de tratamento para tuberculose com as características sociodemográficas e clínicas dos casos durante a pandemia da COVID-19. Método: Estudo transversal, realizado com dados de fontes secundárias de 134 casos de tuberculose que realizaram tratamento em 2020 em Pelotas-RS. Os dados foram analisados por estatística descritiva, teste Qui-quadrado e exato de Fisher. Resultados: As ações menos ofertadas no período foram: três ou mais baciloscopia de controle (12,7%), baciloscopia ao final do tratamento (16,7%), radiografia de tórax no sexto mês (48,5%) e cultura de escarro (49%). O número de consultas médicas e de enfermagem não atingiram seis em 52,9% e 83,3% dos casos, respectivamente. A menor oferta de ações de tratamento esteve associada à: retratamento (p<0,001); comorbidades (p=0,023); infecção por HIV (p<0,001); transtorno mental (p=0,013); uso de substâncias ilícitas (p=0,018); imagem de tórax normal (p=0,024); e esquema especial de tratamento (p=0,009). Conclusão: Após a pandemia da COVID-19, é imprescindível investir no acompanhamento dos casos, principalmente daqueles em retratamento, com comorbidades, uso de drogas, radiografia normal e esquema especial de tratamento. Objetivo COVID19. COVID19 COVID 19. 19 COVID-19 Método transversal 13 202 PelotasRS. PelotasRS Pelotas RS. RS Pelotas-RS descritiva Quiquadrado Qui quadrado Fisher Resultados 12,7%, 127 12,7% , 12 7 (12,7%) 16,7%, 167 16,7% 16 (16,7%) 48,5% 485 48 5 (48,5% 49%. 49 49% . (49%) 529 52 9 52,9 833 83 3 83,3 respectivamente à p<0,001 p0001 p 0 001 (p<0,001) p=0,023 p0023 023 (p=0,023) p=0,013 p0013 013 (p=0,013) p=0,018 p0018 018 (p=0,018) p=0,024 p0024 024 (p=0,024) p=0,009. p0009 p=0,009 009 (p=0,009) Conclusão COVID19, 19, drogas COVID1 1 COVID-1 20 12,7 (12,7% 16,7 (16,7% 48,5 4 (48,5 (49% 52, 8 83, p<0,00 p000 00 (p<0,001 p=0,02 p002 02 (p=0,023 p=0,01 p001 01 (p=0,013 (p=0,018 (p=0,024 p=0,00 (p=0,009 COVID- 2 12, (12,7 16, (16,7 48, (48, (49 p<0,0 p00 (p<0,00 p=0,0 (p=0,02 (p=0,01 (p=0,00 (12, (16, (48 (4 p<0, p0 (p<0,0 p=0, (p=0,0 (12 (16 ( p<0 (p<0, p=0 (p=0, (1 p< (p<0 p= (p=0 (p< (p= (p

ABSTRACT Objective: To assess differences in the sputum microbiota of community-acquired pneumonia (CAP) patients with either COPD or asthma, specifically focusing on a patient population in Turkey. Methods: This retrospective study included hospitalized patients > 18 years of age with a diagnosis of pneumonia between January of 2021 and January of 2023. Participants were recruited from two hospitals, and three patient groups were considered: CAP patients with asthma, CAP patients with COPD, and CAP patients without COPD or asthma. Results: A total of 246 patients with CAP were included in the study, 184 (74.8%) and 62 (25.2%) being males and females, with a mean age of 66 ± 14 years. Among the participants, 52.9% had COPD, 14.2% had asthma, and 32.9% had CAP but no COPD or asthma. Upon analysis of sputum cultures, positive sputum culture growth was observed in 52.9% of patients. The most commonly isolated microorganisms were Pseudomonas aeruginosa (n = 40), Acinetobacter baumannii (n = 20), Klebsiella pneumoniae (n = 16), and Moraxella catarrhalis (n = 8). CAP patients with COPD were more likely to have a positive sputum culture (p = 0.038), a history of antibiotic use within the past three months (p = 0.03), utilization of long-term home oxygen therapy (p < 0.001), and use of noninvasive ventilation (p = 0.001) when compared with the other patient groups. Additionally, CAP patients with COPD had a higher CURB-65 score when compared with CAP patients with asthma (p = 0.004). Conclusions: This study demonstrates that CAP patients with COPD tend to have more severe presentations, while CAP patients with asthma show varied microbial profiles, underscoring the need for patient-specific management strategies in CAP. Objective communityacquired community acquired (CAP Turkey Methods 1 202 2023 hospitals considered Results 24 74.8% 748 74 8 (74.8% 6 25.2% 252 25 2 (25.2% females participants 529 52 9 52.9 142 14.2 329 32 32.9 cultures n 40, 40 , 40) 20, 20 20) 16, 16 16) 8. . 8) p 0.038, 0038 0.038 0 038 0.038) 0.03, 003 0.03 03 0.03) longterm long term 0.001, 0001 0.001 001 Additionally CURB65 CURB 65 CURB-6 0.004. 0004 0.004 004 0.004) Conclusions presentations profiles patientspecific specific 74.8 7 (74.8 25.2 (25.2 5 52. 14. 3 32. 4 00 0.0 000 0.00 CURB6 CURB- 74. (74. 25. (25. 0. (74 (25 (7 (2 (

Abstract Objective: To evaluate the correlation between multidetector computed tomography (MDCT) findings and laboratory test results in patients with pulmonary tuberculosis (PTB). Materials and Methods: A total of 57 patients were evaluated. Patients with suspected PTB were divided into groups according to the final diagnosis (confirmed or excluded), and the groups were compared in terms of sociodemographic variables, clinical symptoms, tomography findings, and laboratory test results. Results: Among the patients with a confirmed diagnosis of PTB, small pulmonary nodules with a peribronchovascular distribution were significantly more common in the patients with a positive sputum smear microscopy result (47.4% vs. 8.3%; p = 0.046), as were a miliary pattern (36.8% vs. 0.0%; p = 0.026), septal thickening (84.2% vs. 41.7%; p = 0.021), and lymph node enlargement (52.6% vs. 8.3%; p = 0.020). Small pulmonary nodules with a centrilobular distribution were significantly more common among the culture-positive patients (75.0% vs. 35.7%; p = 0.045), as was a tree-in-bud pattern (91.7% vs. 42.9%; p = 0.014). A tree-in-bud pattern, one of the main tomography findings characteristic of PTB, had a sensitivity, specificity, positive predictive value, and negative predictive value of 71.0%, 73.1%, 75.9%, and 67.9%, respectively. Conclusion: MDCT presented reliable predictive values for the main tomography findings in the diagnosis of PTB, being a safe tool for the diagnosis of PTB in patients with clinical suspicion of the disease. It also appears to be a suitable tool for the selection of patients who are candidates for more complex, invasive examinations from among those with high clinical suspicion of PTB and a negative sputum smear microscopy result. Objective (MDCT PTB. . (PTB) Methods 5 evaluated excluded, excluded , excluded) variables symptoms Results 47.4% 474 47 4 (47.4 vs 8.3% 83 8 3 0.046, 0046 0.046 0 046 0.046) 36.8% 368 36 (36.8 0.0% 00 0.026, 0026 0.026 026 0.026) 84.2% 842 84 2 (84.2 41.7% 417 41 7 0.021, 0021 0.021 021 0.021) 52.6% 526 52 6 (52.6 0.020. 0020 0.020 020 0.020) culturepositive culture 75.0% 750 75 (75.0 35.7% 357 35 0.045, 0045 0.045 045 0.045) treeinbud tree bud 91.7% 917 91 (91.7 42.9% 429 42 9 0.014. 0014 0.014 014 0.014) sensitivity specificity 710 71 71.0% 731 73 1 73.1% 759 75.9% 679 67 67.9% respectively Conclusion disease complex (PTB 47.4 (47. 8.3 004 0.04 04 36.8 (36. 0.0 002 0.02 02 84.2 (84. 41.7 52.6 (52. 75.0 (75. 35.7 91.7 (91. 42.9 001 0.01 01 71.0 73.1 75.9 67.9 47. (47 8. 36. (36 0. 84. (84 41. 52. (52 75. (75 35. 91. (91 42. 71. 73. 67. (4 (3 (8 (5 (7 (9 (

Resumo Objetivo: Avaliar a correlação entre os achados na tomografia computadorizada multidetectores (TCMD) comparativamente aos resultados laboratoriais em pacientes com tuberculose pulmonar (TBP). Materiais e Métodos: Amostra de 57 pacientes foi avaliada. Pacientes com suspeita clínica de TBP foram divididos de acordo com a positividade do diagnóstico, e as variáveis sociodemográficas, sintomas clínicos e achados tomográficos e laboratoriais foram comparados. Resultados: Nos pacientes com TBP e baciloscopia positiva, foram verificadas frequências significativas para pequenos nódulos pulmonares com distribuição peribroncovascular (47,4% vs. 8,3%; p = 0,046) e miliar (36,8% vs. 0,0%; p = 0,026), espessamento septal (84,2% vs. 41,7%; p = 0,021) e linfonodomegalias (52,6% vs. 8,3%; p = 0,020). Em relação à cultura, os pequenos nódulos pulmonares com distribuição centrolobular (75,0% vs. 35,7%; p = 0,045) e opacidades em árvore em brotamento (91,7% vs. 42,9%; p = 0,014) apresentaram frequências significativamente superiores. Medidas de sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo para árvore em brotamento, um dos principais achados tomográficos característicos da TBP, foram, respectivamente, 71.0%, 73,1%, 75,9% e 67,9%. Conclusão: A TCMD apresentou medidas preditivas confiáveis para os principais achados tomográficos no diagnóstico de TBP, sendo uma ferramenta segura para o diagnóstico da doença em pacientes com suspeita clínica. Também se mostrou adequada para selecionar os pacientes para exames mais complexos e invasivos entre os com alta suspeita clínica de TBP e baciloscopia negativa. Objetivo (TCMD TBP. . (TBP) Métodos 5 avaliada sociodemográficas comparados Resultados positiva 47,4% 474 47 4 (47,4 vs 8,3% 83 8 3 0,046 0046 0 046 36,8% 368 36 (36,8 0,0% 00 0,026, 0026 0,026 , 026 0,026) 84,2% 842 84 2 (84,2 41,7% 417 41 7 0,021 0021 021 52,6% 526 52 6 (52,6 0,020. 0020 0,020 020 0,020) cultura 75,0% 750 75 (75,0 35,7% 357 35 0,045 0045 045 91,7% 917 91 (91,7 42,9% 429 42 9 0,014 0014 014 superiores sensibilidade especificidade respectivamente 710 71 71.0% 731 73 1 73,1% 759 75,9 679 67 67,9% Conclusão negativa (TBP 47,4 (47, 8,3 0,04 004 04 36,8 (36, 0,0 002 0,02 02 84,2 (84, 41,7 52,6 (52, 75,0 (75, 35,7 91,7 (91, 42,9 0,01 001 01 71.0 73,1 75, 67,9 47, (47 8, 36, (36 0, 84, (84 41, 52, (52 (75 35, 91, (91 42, 71. 73, 67, (4 (3 (8 (5 (7 (9 (

RESUMEN Objetivo: mapear las repercusiones del uso de la prueba molecular rápida para el diagnóstico de tuberculosis en personas privadas de libertad en la literatura científica. Método: scoping review, siguiendo las recomendaciones del Joanna Briggs Institute y PRISMA for Scoping Reviews. La búsqueda se realizó utilizando vocabularios controlados y libres en las siguientes bases de datos: EMBASE, Scopus, MEDLINE, Cinahl, Academic Search Premier, LILACS y Web of Science, en la Biblioteca Digital Brasileña de Tesis y Disertaciones y en Google Scholar. Los materiales que respondieron a la pregunta de revisión fueron seleccionados por dos revisores independientes, basándose en la lectura de títulos, resúmenes y publicaciones. Se incluyeron todo tipo de estudios y publicaciones. Los datos extraídos fueron sometidos a síntesis narrativa y presentados gráficamente. Resultados: entre las 461 publicaciones encontradas, 13 fueron incluidas en la revisión. Los estudios señalaron las siguientes repercusiones del uso de la prueba molecular rápida en la población penitenciaria: aumento del diagnóstico de casos en comparación con la baciloscopia de esputo; reducción del tiempo de diagnóstico, inicio de tratamiento y aislamiento; identificación de cepas resistentes a la terapia con antibióticos; reducir la prevalencia y aparición de la tuberculosis; alta concordancia de los resultados de las pruebas con los resultados del cultivo; menor coste de la prueba cuando se realiza en grupos de muestras o cuando el cribado se realiza mediante radiografía. Conclusión: la literatura indicó que la prueba molecular rápida es relevante para el combate a la tuberculosis en las unidades penitenciarias, por lo que su uso debe ser considerado por autoridades y gestores como una herramienta estratégica para el control de la enfermedad. Objetivo científica Método review Reviews EMBASE Scopus MEDLINE Cinahl Premier Science Scholar independientes títulos gráficamente Resultados 46 encontradas 1 penitenciaria esputo aislamiento antibióticos cultivo radiografía Conclusión penitenciarias enfermedad 4

ABSTRACT Objective: to map the repercussions of using the rapid molecular test for diagnosing tuberculosis among people deprived of liberty in the scientific literature. Method: this is a scoping review following the recommendations of the Joanna Briggs Institute and PRISMA for Scoping Reviews. The search was conducted using controlled and free vocabulary in the following databases: EMBASE, Scopus, MEDLINE, Cinahl, Academic Search Premier, LILACS and Web of Science, in the Brazilian Digital Library of Theses and Dissertations and Google Scholar. The materials which answered the review question were selected by two independent reviewers based on reading the titles, abstracts and publications. All types of studies and publications were included. The extracted data was subjected to narrative synthesis and presented graphically. Results: a total of 13 among the 461 publications found were included in the review. The studies pointed out the following repercussions of using the rapid molecular test in the prison population: increase in the diagnosis of cases compared to sputum smear microscopy; reduction in diagnosis time, initiating treatment and isolation; identification of strains resistant to antibiotic therapy; reducing the prevalence and occurrence of tuberculosis; high agreement of test results with culture results; lower cost of the test when carried out in groups of samples or when screening is carried out by radiography. Conclusion: the literature indicated that the rapid molecular test is relevant for combating tuberculosis in prison units, so its use should be considered by authorities and managers as a strategic tool for controlling the disease. Objective Method Reviews databases EMBASE Scopus MEDLINE Cinahl Premier Science Scholar titles graphically Results 1 46 population microscopy time isolation therapy radiography Conclusion units disease 4

RESUMO Objetivo: mapear as repercussões da utilização do teste rápido molecular para o diagnóstico de tuberculose entre as pessoas privadas de liberdade junto à literatura científica. Método: revisão de escopo seguiram-se as recomendações do Joanna Briggs Institute e do PRISMA for Scoping Reviews. A busca foi realizada com vocabulários controlados e livres nas bases de dados: EMBASE, Scopus, MEDLINE, Cinahl, Academic Search Premier, LILACS e Web of Science, na Biblioteca Digital Brasileira de Teses e Dissertações e no Google Scholar. Foram selecionados por dois revisores independentes, os materiais que respondiam à pergunta da revisão, a partir da leitura dos títulos, resumos e publicações. Foram incluídos todos os tipos de estudo e publicações. Os dados extraídos foram submetidos à síntese narrativa e apresentados graficamente. Resultados: entre as 461 publicações encontradas, 13 foram incluídas na revisão. Os estudos apontaram as seguintes repercussões da utilização do teste rápido molecular na população prisional: aumento no diagnóstico de casos comparado à baciloscopia; redução no tempo de diagnóstico, início do tratamento e isolamento; identificação de cepas resistentes à antibioticoterapia; redução da prevalência e ocorrência da tuberculose; alta concordância dos resultados do teste com os da cultura; menor custo do teste quando realizado em grupos de amostras ou quando o rastreamento é realizado por radiografia. Conclusão: a literatura apontou que o teste rápido molecular é relevante para o enfrentamento da tuberculose nas unidades prisionais, de modo que a sua utilização deve ser considerada pelas autoridades e gestores como uma ferramenta estratégica para o controle da doença. Objetivo científica Método seguiramse seguiram se Reviews EMBASE Scopus MEDLINE Cinahl Premier Science Scholar independentes títulos graficamente Resultados 46 encontradas 1 prisional baciloscopia isolamento antibioticoterapia cultura radiografia Conclusão prisionais doença 4

ABSTRACT Tuberculosis (TB) is a global public health concern and a leading cause of death. Its persistence occurs mainly because barriers in the care cascade are not being fully addressed. Healthcare professionals and scientists have been addressing treatment challenges such as abandonment and irregular drug intake via strategies such as directly observing treatment and singular therapeutic projects to improve adherence. However, while protocols and guidelines advocate these strategies, their implementation requires a broader approach from healthcare teams. This article examines the importance of such strategies in clinical TB management and analyzes an unfavorable outcome in an immunocompetent patient treated for pulmonary tuberculosis (PTB) from 2017 to 2022. After recurrence and treatment, the patient continued to have persistent acid-fast bacilli in the sputum, positive cultures for Mycobacterium tuberculosis, and progressive lung lesions, despite receiving the recommended treatment. Although categorized as having an intermediate risk of treatment abandonment, the patient faced challenges, such as the COVID-19 pandemic, pregnancy, and being diagnosed with COVID-19. After therapeutic failure and the loss of beneficial prospects, palliative care was initiated. This case illustrates the complexities of managing TB in patients with recurrent disease despite apparent adherence to treatment. After reassessing the risk of abandonment score, the patient was categorized as high-risk. This underscores the importance of singular therapeutic projects, such as psychological support for high-risk or intermediate patients, to prevent negative outcomes. This case reinforces the critical need for comprehensive patient-centered approaches to successfully treat and manage TB. (TB death addressed However teams PTB (PTB 201 2022 acidfast acid fast sputum lesions COVID19 COVID 19 COVID-1 pandemic pregnancy COVID19. 19. prospects initiated score highrisk. highrisk high risk. outcomes patientcentered centered 20 202 COVID1 1 COVID- 2

Abstract As it is an infrequent etiology, the diagnosis of perianal tuberculosis is challenging, especially in the absence of a pulmonary focus. TB should be considered in the differential diagnosis of perianal ulcers, fistulas, abscesses, mainly in non-healing and recurrent anal lesions. Treatment with anti-TB agents can provide complete recovery. Furthermore, these lesions are often diagnosed later after complete histopathological and mycobacterial results, where the benefit of avoiding morbid multiple surgeries by effective anti-TB treatment is lost. We reported a rare case of an immuno-competent patient with perianal TB, which was the first manifestation of the disease. A fit-and-well man in his 20s presented a large perianal abscess. Unexpectedly, his chest X-ray showed a rounded hyper-transparency in the left lung. The abscess was drained. Posterior investigation with culture analysis from pus swabs and sputum revealed the presence of Mycobacterium tuberculosis complex infection. After completing the 6 months of oral administration of anti-TB drugs, the patient was asymptomatic. By highlighting this unusual manifestation, we aim to improve clinicians' awareness of perianal TB, facilitating early recognition and appropriate management. etiology challenging focus ulcers fistulas abscesses nonhealing non healing antiTB anti recovery Furthermore results lost immunocompetent immuno competent disease fitandwell fit well s Unexpectedly Xray X ray hypertransparency hyper transparency lung drained infection drugs asymptomatic clinicians management

BACKGROUND PPE 59, which is absent from bacillus Calmette Guérin (BCG) strains, seems to induce a humoral immune response in patients with tuberculosis (TB). Additional studies are needed to better evaluate this protein in immune response to tuberculosis. OBJECTIVES To evaluate the response of antibodies to PPE59 in TB individuals, its combination with IgG response to other, previously tested mycobacterial antigens (Ag) and with sputum smear microbiology (SM) results. METHODS We have cloned and expressed the rv3429 gene that encodes PPE59, then IgG, IgM, and IgA against PPE59 antigens measured by enzyme-linked immunosorbent assay (ELISA) in 212 sera samples obtained from the following subject cohorts: TB residents from Italy (79) and in Brazil (52); and an all-Brazilian cohort of 55 patients with other respiratory disorders; 10 patients infected with non-tuberculous mycobacteria, and 16 asymptomatic subjects. Drawing on results from a previous study(17) of serum samples from Brazilian subjects tested for IgG by ELISA against mycobacterial antigens ESAT-6, 16kDa, MT10.3, MPT-64 and 38kDa, the results were analysed in combination with those of the PPE59 and SM tests. FINDINGS Keeping the specificity rate at 97%, the overall PPE59 IgA sensitivity was 42.7%, while IgG and IgM showed lower performance (p < 0.0001). Combining PPE59 IgA/16kDa IgG results increased sensitivity to 71%, and even higher rates when the results were combined with SM results (86.5%, p = 0.001), at 88.9% specificity. Positive IgA was associated with pulmonary image alterations of high TB probability (p < 0.05). MAIN CONCLUSIONS Tests with TB patients found a moderate frequency of positivity for PPE59 IgA. However, the higher level of sensitivity attained in combination with PPE59 IgA/16kDa IgG/SM results unheard of before, although imperfect, suggests that this may be a potential additional tool for rapid detection of TB in low-resource areas. 59 BCG (BCG strains TB. . (TB) PPE5 individuals Ag (Ag (SM rv rv342 enzymelinked enzyme linked (ELISA 21 cohorts 79 (79 52 (52) allBrazilian all 5 disorders 1 nontuberculous non tuberculous mycobacteria study17 study 17 study(17 ESAT6, ESAT6 ESAT 6, 6 ESAT-6 16kDa kDa MT103 MT MT10 3 MT10.3 MPT64 MPT 64 MPT-6 38kDa tests 97 97% 427 42 7 42.7% 0.0001. 00001 0.0001 0 0001 0.0001) IgA16kDa IgAkDa 71 71% 86.5%, 865 86 (86.5% 0.001, 0.001 , 001 0.001) 889 88 9 88.9 0.05. 005 0.05 05 0.05) However IgGSM before imperfect lowresource low resource areas (TB rv34 2 (7 (52 study1 study(1 ESAT- MT1 MT10. MPT6 MPT- 4 42.7 0000 0.000 000 86.5% 8 (86.5 0.00 00 88. 0.0 rv3 ( (5 study( 42. 86.5 (86. 0. 86. (86 (8

Objectives: To characterize clinical aspects, evaluate the diagnostic opportunity, and identify factors associated with mortality in patients hospitalized for tuberculosis (TB). Methods: Retrospective study of patients admitted for TB to a Regional Hospital in Chile between 2011 and 2019. Results: 142 TB events required hospitalization in this period (38.2% of total cases). All risk groups were identified, with a significant increase in patients with diabetes mellitus. The pulmonary location was the most frequent (71.1%), followed by disseminated forms (16.2%). The sensitivity of microscopy smear in cases of pulmonary TB (isolated or combined) was 78.8% and lower in cases of bronchoalveolar lavage (58.3%). PCR was only occasionally applied (< 10%) with a sensitivity of 100% in sputum samples. Its use increased progressively and reached a positivity of 33% (6 out of 18 cases) in cases with negative sputum staining. The median time between symptom onset and diagnosis was prolonged (9 weeks), and 32.5% of all regional events were diagnosed at the hospital. Dose adjustments (22.1%), corticosteroid use (25%), and treatment interruptions were frequent (11%). Lethality reached 19%, and by multivariate analysis, only shock was associated with a fatal outcome. Conclusions: In this case series, the diagnosis of TB cases was delayed, scarcely diagnosed by molecular methods, highly concentrated at the hospital level, required admission in a large percentage of cases, and had a high case-fatality rate.

Objetivos: Caracterizar aspectos clínicos, evaluar la oportunidad diagnóstica e identificar factores asociados a mortalidad en pacientes ingresados por tuberculosis (TB). Métodos: Estudio retrospectivo de pacientes ingresados por TB a un Hospital Regional en Chile entre el 2011 y 2019. Resultados: Un total de 142 eventos de TB requirieron hospitalización en el período (38,2% del total). Todos los grupos de riesgo fueron identificados con un aumento significativo de los pacientes con diabetes mellitus. La localización pulmonar fue la más frecuente (71,1%), seguida de la forma diseminada (2 o más sitios; 16,2%). La sensibilidad de la tinción de expectoración en casos de TB pulmonar (aislada o combinada) fue de 78,8% y más baja en casos de lavado broncoalveolar (58,3%). La PCR fue sólo ocasionalmente aplicada (< 10%) con una sensibilidad del 100% en muestras de expectoración. Su uso aumentó progresivamente en el período y el incremento diagnóstico de TB en casos con tinción negativa de expectoración estudiados con PCR fue de 33% (6 de 18 casos). La mediana entre inicio de síntomas y el diagnóstico fue prolongada (9 semanas) y el 32,5% de los eventos regionales fueron diagnosticados en el hospital. Los ajustes de dosis (22,1%), uso de corticoides (25%) e interrupciones del tratamiento fueron hechos frecuentes (11%). La letalidad alcanzó 19% y en el análisis multivariado sólo la aparición de shock se asoció a un desenlace fatal. Conclusiones: En esta serie de casos, el diagnóstico de casos de TB fue tardío, infrecuentemente diagnosticado por métodos moleculares, concentrado en la atención terciaria, requirió hospitalización en un gran porcentaje de casos y tuvo una elevada letalidad.

Abstract: The case of a male patient who was admitted to the pulmonology department for a diagnostic protocol for left apical cavitation is presented. One of the risk factors he had was type 2 diabetes. His condition began with productive cough, whitish sputum, and dyspnea. During the diagnostic process, a bronchoscopy study was performed, revealing endobronchial invasion. Samples were taken, and in the initial assessment, tuberculosis was ruled out due to its high prevalence in our region. Ultimately, the diagnosis was established as pulmonary mucormycosis and an uncommon endobronchial mucormycosis, both of which have a high mortality rate.

Resumen: Se presenta el caso de un paciente masculino que ingresó al servicio de neumología para someterse a un protocolo diagnóstico de cavitación apical izquierda. Uno de los factores de riesgo que presentaba era la diabetes mellitus tipo 2. Inició su padecimiento con tos productiva, expectoración blanquecina y disnea. Durante el proceso de diagnóstico se realizó un estudio de broncoscopia en el que se observó invasión endobronquial. Se tomaron muestras y, en primera instancia, se descartó la tuberculosis debido a su alta prevalencia en nuestro medio. Finalmente, el diagnóstico se estableció como mucormicosis pulmonar y mucormicosis endobronquial poco común, ambas condiciones con una alta tasa de mortalidad.

Determining outcomes and predictors of mortality following discharge from tuberculosis (TB) hospitalization is crucial to establish health policies. The objective of this study was to analyze outcomes and, secondarily, predictors of mortality following discharge from TB hospitalization. This was a prospective cohort study of patients diagnosed with TB (all forms) discharged from the hospital who began treatment during hospitalization. Out of 169 subjects included, 38 died during the 13-months of follow-up, within a median of 3 months (95%CI: 1.49-4.51). In the multivariate analysis, the variables independently associated with death were age (HR=1.04, 95%CI: 1.01-1.06, P=0.001), presence of sputum production (HR=2.18, 95%CI: 1.09-4.34, P=0.027), and Charlson Comorbidity Index (HR=1.19, 95%CI: 1.04-1.36, P=0.015). In conclusion, post-discharge mortality in subjects hospitalized for TB was 22.5%, with mean survival of 4.6 months. The mortality was higher in older subjects, in those who reported sputum production, and in those with a high comorbidity index. (TB policies secondarily all forms 16 included 13months 13 followup, followup follow up, up follow-up 95%CI 95CI CI 95 (95%CI 1.494.51. 149451 1.49 4.51 . 1 49 4 51 1.49-4.51) analysis HR=1.04, HR104 HR 04 (HR=1.04 1.011.06, 101106 1.01 1.06, 01 06 1.01-1.06 P=0.001, P0001 P P=0.001 , 0 001 P=0.001) HR=2.18, HR218 2 18 (HR=2.18 1.094.34, 109434 1.09 4.34, 09 34 1.09-4.34 P=0.027, P0027 P=0.027 027 P=0.027) HR=1.19, HR119 19 (HR=1.19 1.041.36, 104136 1.04 1.36, 36 1.04-1.36 P=0.015. P0015 P=0.015 015 P=0.015) conclusion postdischarge post 225 22 5 22.5% 46 6 4. index 9 494 1.494.51 14945 149 1.4 451 4.5 1.49-4.51 HR=1.04 HR10 (HR=1.0 011 1.011.06 10110 101 1.0 106 1.06 1.01-1.0 P000 P=0.00 00 HR=2.18 HR21 (HR=2.1 094 1.094.34 10943 109 434 4.34 1.09-4.3 P002 P=0.02 02 HR=1.19 HR11 (HR=1.1 041 1.041.36 10413 104 136 1.36 1.04-1.3 P001 P=0.01 22.5 1.494.5 1494 14 1. 45 1.49-4.5 HR=1.0 HR1 (HR=1. 1.011.0 1011 10 1.01-1. P00 P=0.0 HR=2.1 HR2 (HR=2. 1.094.3 1094 43 4.3 1.09-4. HR=1.1 1.041.3 1041 1.3 1.04-1. 22. 1.494. 1.49-4. HR=1. (HR=1 1.011. 1.01-1 P0 P=0. HR=2. (HR=2 1.094. 1.09-4 1.041. 1.04-1 1.494 1.49-4 HR=1 (HR= 1.011 1.01- P=0 HR=2 1.094 1.09- 1.041 1.04- 1.49- HR= (HR P=

Healthcare-related infections caused by resistant microorganisms are a severe public health problem and are becoming increasingly prevalent in the hospital environment, especially Pseudomonas aeruginosa. This work aimed to evaluate the resistance profile of Pseudomonas aeruginosa to antimicrobials before the COVID-19 pandemic and during the pandemic period. Bacteria strains were obtained from tracheal aspiration, sputum, and bronchoalveolar lavage for diagnosis and phenotypic characterization. Matrix assisted laser-desorption ionization-time of flight mass spectrometry (MALD-TOF MS) was used to identify strains. Automated Phoenix and VITEK® 2 Compact system and the disc diffusion method were performed to determine the antimicrobial susceptibility profile. A total of 41,000 medical reports from adult patients with pneumonia were analyzed. Of these, 951 patients were positive for P. aeruginosa, of which 373 were related to the pre-pandemic period and 578 to the pandemic period. Older men (≥60 years) were more prevalent in both periods. P. aeruginosa strains were resistant to imipenem in both periods: 38.8 and 42.5%, respectively, followed by meropenem (34.2 and 39.2%), ciprofloxacin (33.6 and 36.7%), and levofloxacin (34.9 and 43.5%). Intensive care units had the highest percentage of affected patients (62 and 65%) compared with other sectors, with a prevalence of 71% in the public network before COVID-19 and 59% during the pandemic. Our data showed a prevalence of P. aeruginosa in elderly patients in both the pre-pandemic and pandemic periods. In addition, an increase in P. aeruginosa resistance to beta-lactams, quinolones, carbapenems, and cephalosporins was observed during the COVID-19 pandemic compared with the period before the pandemic, especially in ICUs. Healthcarerelated Healthcare environment COVID19 COVID 19 COVID-1 aspiration sputum characterization laserdesorption laser desorption ionizationtime ionization time MALDTOF MALD TOF MS VITEK 41000 41 000 41,00 analyzed these 95 P 37 prepandemic pre 57 ≥60 60 (≥6 years periods 388 38 8 38. 425 42 5 42.5% respectively 34.2 342 34 (34. 39.2%, 392 39.2% , 39 39.2%) 33.6 336 33 6 (33. 36.7%, 367 36.7% 36 7 36.7%) 34.9 349 9 43.5%. 435 43.5% . 43 43.5%) 62 (6 65% 65 sectors 71 59 addition betalactams, betalactams beta lactams, lactams beta-lactams quinolones carbapenems ICUs COVID1 1 COVID- 4100 4 00 41,0 3 ≥6 (≥ 42.5 34. (34 39.2 33. (33 36.7 43.5 ( 410 0 41, ≥ 42. (3 39. 36. 43.

Abstract Introduction Tuberculosis is a disease of diversified presentation. It affects almost all organs in the body, and otorhinolaryngological, head and neck involvement is not an exception. Objective To increase awareness about the different clinical presentations of otorhinolaryngological, head and neck tuberculosis, the techniques employed to diagnose it, and to assess the response to the treatment. Methods We conducted a prospective study of 114 patients who presented primarily with otorhinolaryngological, head and neck tuberculosis. Routine blood investigations, chest radiographs, the tuberculin test, and sputum examination for the presence of acid-fast bacilli were performed in all cases. Site-specific investigations were performed in relevant cases only. The patients were treated according to the antitubercular treatment (ATT) regimen recommended by the Indian Ministry of Health and Family Welfare’s National Tuberculosis Elimination Program (NTEP), and they were followed up clinically two and six months after starting the ATT. Results Tubercular cervical lymphadenopathy was the most common clinical presentation (85.96%), followed by deep neck abscess (5.27%). Fine-needle aspiration cytology proved to be a reliable tool for the diagnosis of tubercular lymphadenopathy. Improvement at the end of 2 and 6 months of the ATT was observed in 90.35% and 96.50% of the cases respectively. Conclusion The diagnosis of otorhinolaryngological, head and neck tuberculosis requires a high index of clinical suspicion, and the ATT proved to be very effective in reducing the severity of the disease. body otorhinolaryngological exception it 11 radiographs test acidfast acid fast Sitespecific Site specific only (ATT Welfares Welfare s NTEP, NTEP , (NTEP) 85.96%, 8596 85.96% 85 96 (85.96%) 5.27%. 527 5.27% . 5 27 (5.27%) Fineneedle Fine needle 9035 90 35 90.35 9650 50 96.50 respectively suspicion 1 (NTEP 859 85.96 8 9 (85.96% 52 5.27 (5.27% 903 3 90.3 965 96.5 85.9 (85.96 5.2 (5.27 90. 96. 85. (85.9 5. (5.2 (85. (5. (85 (5 (8 (