RESUMO Objetivo: Fazer um levantamento bibliográfico referente à tuberculose (TB) em crianças e adolescentes com doenças reumáticas, em uso de imunobiológicos. Fonte de dados: Revisão integrativa com busca na base United States National Library of Medicine (PubMed) utilizando os descritores e operadores booleanos: ([“tuberculosis”] AND ([“children”] OR [“adolescent”]) AND [“rheumatic diseases”] AND ([“tumor necrosis fator-alpha”] OR [“etanercept”] OR [“adalimumab”] OR [“infliximab”] OR [“biological drugs”] OR [“rituximab”] OR [“belimumab”] OR [“tocilizumab”] OR [“canakinumab”] OR [“golimumab”] OR [“secukinumab”] OR [“ustekinumab”] OR [“tofacitinib”] OR [“baricitinib”] OR [“anakinra”] OR [“rilonacept”] OR [“abatacept”]), entre janeiro de 2010 e outubro de 2021. Síntese de dados: Trinta e sete artigos foram incluídos, com o total de 36.198 pacientes. Houve 81 casos de tuberculose latente (ILTB), 80 casos de tuberculose pulmonar (TBP) e quatro casos de tuberculose extrapulmonar (TBEP). A principal doença reumática foi a artrite idiopática juvenil. Entre os casos de ILTB, a maioria foi diagnosticada no rastreio e nenhum evoluiu para a TB. Dos casos de TB em uso de imunobiológicos, a maioria utilizava fármacos antiTNFα. Houve somente um caso de óbito. Conclusões: O estudo demonstrou baixa taxa de TB nos pacientes pediátricos em uso de imunobiológicos. O rastreio para ILTB antes do início da terapia com agentes biológicos deve ser realizado em todos os pacientes, e o tratamento, nos casos de rastreio positivo, é importante para evitar a progressão para TB doença. Objetivo (TB reumáticas imunobiológicos dados PubMed (PubMed booleanos tuberculosis ([“tuberculosis” children ([“children” adolescent [“adolescent”] rheumatic diseases diseases” tumor fatoralpha fator alpha fator-alpha” etanercept [“etanercept” adalimumab [“adalimumab” infliximab [“infliximab” biological drugs drugs” rituximab [“rituximab” belimumab [“belimumab” tocilizumab [“tocilizumab” canakinumab [“canakinumab” golimumab [“golimumab” secukinumab [“secukinumab” ustekinumab [“ustekinumab” tofacitinib [“tofacitinib” baricitinib [“baricitinib” anakinra [“anakinra” rilonacept [“rilonacept” abatacept, abatacept , [“abatacept”]) 201 2021 incluídos 36198 36 198 36.19 8 (ILTB) TBP (TBP TBEP. TBEP . (TBEP) juvenil antiTNFα óbito Conclusões tratamento positivo ([“tuberculosis ([“children [“adolescent” fator-alpha [“etanercept [“adalimumab [“infliximab [“rituximab [“belimumab [“tocilizumab [“canakinumab [“golimumab [“secukinumab [“ustekinumab [“tofacitinib [“baricitinib [“anakinra [“rilonacept [“abatacept”] 20 202 3619 3 19 36.1 (ILTB (TBEP [“adolescent [“abatacept” 2 361 1 36. [“abatacept

ABSTRACT Objective: To conduct a bibliographic review on tuberculosis (TB) disease in children and adolescents with rheumatic diseases, being managed with biologic therapy. Data source: An integrative review with a search in the U.S. National Library of Medicine and the National Institutes of Health (PubMed) using the following descriptors and Boolean operators: ([“tuberculosis”] AND ([“children”] OR [“adolescent”]) AND [“rheumatic diseases”] AND ([“tumor necrosis factor-alpha”] OR [“etanercept”] OR [“adalimumab”] OR [“infliximab”] OR [“biological drugs”] OR [“rituximab”] OR [“belimumab”] OR [“tocilizumab”] OR [“canakinumab”] OR [“golimumab”] OR [“secukinumab”] OR [“ustekinumab”] OR [“tofacitinib”] OR [“baricitinib”] OR [“anakinra”] OR [“rilonacept”] OR [“abatacept”]), between January 2010 and October 2021. Data synthesis: Thirty-seven articles were included, with the total number of 36,198 patients. There were 81 cases of latent tuberculosis infection (LTBI), 80 cases of pulmonary tuberculosis (PTB), and four of extrapulmonary tuberculosis (EPTB). The main rheumatic disease was juvenile idiopathic arthritis. Among LTBI cases, most were diagnosed at screening and none progressed to TB disease during follow-up. Of the TB cases using biologics, most used tumor necrosis factor-alpha inhibitors (anti-TNFα) drugs. There was only one death. Conclusions: The study revealed a low rate of active TB in pediatric patients using biologic therapy. Screening for LTBI before initiating biologics should be done in all patients, and treatment, in cases of positive screening, plays a critical role in preventing progression to TB disease. Objective (TB diseases therapy source US U S U.S PubMed (PubMed operators ([“tuberculosis” ([“children” adolescent [“adolescent”] diseases” factoralpha factor alpha factor-alpha” etanercept [“etanercept” adalimumab [“adalimumab” infliximab [“infliximab” biological drugs drugs” rituximab [“rituximab” belimumab [“belimumab” tocilizumab [“tocilizumab” canakinumab [“canakinumab” golimumab [“golimumab” secukinumab [“secukinumab” ustekinumab [“ustekinumab” tofacitinib [“tofacitinib” baricitinib [“baricitinib” anakinra [“anakinra” rilonacept [“rilonacept” abatacept, abatacept , [“abatacept”]) 201 2021 synthesis Thirtyseven Thirty seven included 36198 36 198 36,19 8 LTBI, (LTBI) PTB, PTB (PTB) EPTB. EPTB . (EPTB) arthritis followup. followup follow up. up follow-up antiTNFα anti TNFα (anti-TNFα death Conclusions treatment ([“tuberculosis ([“children [“adolescent” [“etanercept [“adalimumab [“infliximab [“rituximab [“belimumab [“tocilizumab [“canakinumab [“golimumab [“secukinumab [“ustekinumab [“tofacitinib [“baricitinib [“anakinra [“rilonacept [“abatacept”] 20 202 3619 3 19 36,1 (LTBI (PTB (EPTB [“adolescent [“abatacept” 2 361 1 36, [“abatacept

ABSTRACT Background: The treatment strategy for latent tuberculosis infection is to reduce the number of tuberculosis cases and consequently reduce the transmission of pathogenic bacteria. This study aimed to determine the safety, effectiveness, and adherence of isoniazid use for latent tuberculosis infection treatment. Methods: To identify studies on isoniazid use for latent tuberculosis infection, five electronic databases were searched. The methods and results are presented in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Most studies (53) used isoniazid for 9 months. The prevalence of use and adherence to treatment varied considerably (18% to 100%), and were evaluated by participant completion of isoniazid treatment for latent tuberculosis infection. The adverse events most frequently reported were hepatotoxicity, gastric intolerance, and neuropathy; the rates of occurrence ranged from < 1% to 48%. In the studies that evaluated the effectiveness of isoniazid for latent tuberculosis infection, the rate varied from 0 to 19.7% for patients who did not have active tuberculosis after the follow-up period. Conclusions: The importance of maintaining follow up for patients using isoniazid should be emphasized due to the risk of developing adverse events. Despite the treatment challenges, the rates of patients who used isoniazid and developed active tuberculosis during the follow-up period were low. We believe that isoniazid continues to contribute to tuberculosis control worldwide, and better care strategies are required. Background bacteria safety Methods searched MetaAnalyses Meta Analyses guidelines Results 53 (53 months 18% 18 (18 100%, 100 100% , 100%) hepatotoxicity intolerance neuropathy 1 48 48% 197 19 7 19.7 followup Conclusions challenges low worldwide required 5 (5 (1 10 4 19. (

RESUMO Objetivo: O objetivo deste estudo foi sintetizar as evidências sobre a prevalência de infecção de Mycobacterium tuberculosis (ILTB) entre estudantes de graduação da área da saúde. Método: Foi realizada uma revisão sistemática de prevalência com metanálise. Coortes prospectivas e retrospectivas e estudos transversais envolvendo provável exposição a M. tuberculosis durante a graduação, juntamente com o teste tuberculínico (TT) ou ensaio de liberação de interferon-γ (IGRA) para investigação de tuberculose latente foram pesquisados. As buscas foram realizadas nas bases de dados MEDLINE, CINAHL, EMBASE, LILACS, Scopus e Web of Science. Revisores independentes foram responsáveis pela seleção e inclusão dos estudos. Os dados foram extraídos, avaliados criticamente e sintetizados utilizando a abordagem JBI. PRISMA foi usado para relatar o estudo. Resultados: Vinte e dois estudos foram analisados. A prevalência geral em estudantes de graduação da área da saúde foi de 12,53%. Conclusão: A prevalência de ILTB em estudantes de graduação em saúde foi alta para uma população com alto nível de escolaridade. Triagem com TT e/ou IGRA e quimioprofilaxia, quando necessária, deve ser fornecida aos estudantes de graduação da área da saúde quando em contato com pacientes sintomáticos respiratórios. Objetivo (ILTB Método metanálise M (TT interferonγ interferon γ (IGRA pesquisados MEDLINE CINAHL EMBASE LILACS Science extraídos JBI Resultados analisados 1253 12 53 12,53% Conclusão escolaridade eou quimioprofilaxia necessária respiratórios 125 1 5 12,53 12,5 12,

ABSTRACT Objective: The aim of this study was to synthesize the evidence on the prevalence of latent Mycobacterium tuberculosis infection (LTBI) among undergraduate health care students. Methods: A systematic review of prevalence with meta-analysis was conducted. Prospective and retrospective cohorts and cross-sectional studies involving probable exposure to M. tuberculosis during undergraduate education, along with the tuberculin skin test (TST) or interferon-γ release assay (IGRA) for investigation of latent tuberculosis were searched. Searches were conducted in MEDLINE, CINAHL, EMBASE, LILACS, Scopus, and Web of Science databases. Independent reviewers were responsible for the selection and inclusion of studies. Data were extracted, critically appraised, and synthesized using the JBI approach. PRISMA was used to report the study. Results: Twenty-two studies were analyzed. The overall prevalence in healthcare undergraduate students was 12.53%. Conclusion: The prevalence of LTBI in undergraduate health students was high for such a highly educated population. Screening with TST and/or IGRA and chemoprophylaxis, when necessary, should be provided to undergraduate health students when in contact with respiratory symptomatic patients. Objective (LTBI Methods metaanalysis meta analysis crosssectional cross sectional M education (TST interferonγ interferon γ (IGRA searched MEDLINE CINAHL EMBASE LILACS Scopus databases extracted appraised approach Results Twentytwo Twenty two analyzed 1253 12 53 12.53% Conclusion population andor chemoprophylaxis necessary patients 125 1 5 12.53 12.5 12.

RESUMEN Objetivo: El objetivo de este estudio fue sintetizar la evidencia sobre la prevalencia de infección latente por Mycobacterium tuberculosis (ILTB) entre estudiantes universitarios de la salud. Métodos: Se realizó una revisión sistemática de la prevalencia con metanálisis. Cohortes prospectivas y retrospectivas y estudios transversales que involucran exposición probable a M tuberculosis durante la educación universitaria, junto con la prueba cutánea de tuberculina (TST) o el ensayo de liberación de interferón-γ (IGRA) para la investigación de tuberculosis latente. Las búsquedas se realizaron en las bases de datos MEDLINE, CINAHL, EMBASE, LILACS, Scopus y Web of Science. Revisores independientes fueron responsables de la selección e inclusión de los estudios. Los datos se extrajeron, se evaluaron críticamente y se sintetizaron utilizando el enfoque JBI. Se utilizó PRISMA para informar el estudio. Resultados: Se analizaron veintidós estudios. La prevalencia global en estudiantes universitarios en salud fue del 12,53%. Conclusión: La prevalencia de LTBI en estudiantes universitarios de salud fue alta para una población con un nivel educativo tan alto. Se debe proporcionar tamizaje con TST y/o IGRA y quimioprofilaxis, cuando sea necesario, a los estudiantes universitarios en salud cuando estén en contacto con pacientes sintomáticos respiratorios. Objetivo ILTB (ILTB Métodos metanálisis universitaria (TST interferónγ interferón γ (IGRA MEDLINE CINAHL EMBASE LILACS Science extrajeron JBI Resultados 1253 12 53 12,53% Conclusión alto yo quimioprofilaxis necesario respiratorios 125 1 5 12,53 12,5 12,

RESUMO Contexto: A tuberculose latente (TBL) é uma condição em que o paciente está infectado com Mycobacterium tuberculosis, mas não desenvolve tuberculose (TB) ativa. Existe a possibilidade de ativação da TB após a introdução de anti-TNFs. Objetivo: Avaliar o risco da terapia biológica induzindo TBL durante o tratamento de doenças inflamatórias intestinais (DII) ao longo de 15 anos em uma área de alto risco no Brasil. Métodos: Foi realizado um estudo retrospectivo de um banco de dados de pacientes com DII em uma clínica privada de referência no Brasil. Todos os pacientes foram submetidos a teste de TST e radiografia de tórax antes do tratamento e uma vez por ano após seu início. Os pacientes foram classificados de acordo com a estratificação de Montreal e foram considerados fatores de risco para o desenvolvimento de TB. Resultados: Entre os fatores analisados, a idade e o sexo foram fatores de risco para TBL. Os pacientes com doença de Crohn’ (B2 e P) e colite ulcerativa (E2) apresentaram maior número de casos de TBL com significância estatística, o que também foi observado para usuários de adalimumab e infliximab, em comparação com outros medicamentos, e o tempo de exposição a eles favoreceu significativamente. Outros fatores, como ambiente de trabalho fechado, foram relatados como riscos. Conclusão: O risco da terapia biológica causar TBL é real, por isso os pacientes com DII devem ser monitorados continuamente. Este estudo revela que quanto maior a exposição aos anti-TNFs, maior o risco. Contexto (TBL tuberculosis (TB ativa antiTNFs. antiTNFs anti TNFs. TNFs anti-TNFs Objetivo (DII 1 Brasil Métodos início Resultados analisados Crohn B2 B (B P E2 E (E2 estatística infliximab medicamentos significativamente fechado riscos Conclusão real continuamente antiTNFs, TNFs, (E

ABSTRACT Background: Latent tuberculosis (LTB) is a condition where the patient is infected with Mycobacterium tuberculosis but does not develop active TB. There’s a possibility of tuberculosis (TB) activation following the introduction of anti-TNFs. Objective: To assess the risk of biological therapy inducing LTB during inflammatory bowel diseases (IBD) treatment over 15 years in a high-risk area in Brazil. Methods: A retrospective study of an IBD patients’ database was carried out in a private reference clinic in Brazil. All patients underwent TST testing and chest X-ray prior to treatment, and once a year after starting it. Patients were classified according to the Montreal stratification and risk factors were considered for developing TB. Results: Among the analyzed factors, age and gender were risk factors for LTB. DC (B2 and P) and UC (E2) patients showed a higher number of LTB cases with statistical significance, what was also observed for adalimumab and infliximab users, compared to other medications, and time of exposure to them favored it significantly. Other factors such as enclosed working environment have been reported as risk. Conclusion: The risk of biological therapy causing LTB is real, so patients with IBD should be continually monitored. This study reveals that the longer the exposure to anti-TNFs, the greater the risk. Background (LTB TB Theres There s (TB antiTNFs. antiTNFs anti TNFs. TNFs anti-TNFs Objective (IBD 1 highrisk high Brazil Methods Xray X ray Results B2 B (B P E2 E (E2 significance users medications significantly Conclusion real monitored antiTNFs, TNFs, (E

Tuberculosis (TB), caused by Mycobacterium tuberculosis, remains the leading cause of mortality by a single infectious agent in the world. M. tuberculosis infection could also result in clinical chronic infection, known as latent TB infection (LTBI). Compared to the current limited treatment, several subunit vaccines showed immunotherapeutic effects and were included in clinical trials. In this study, a subunit vaccine of Ag85B with a novel mucosal adjuvant c-di-AMP (Ag85B:c-di-AMP) was delivered intranasally to a persistent M. tuberculosis H37Ra infection mouse model, which also presented the asymptomatic characteristics of LTBI. Compared with Ag85B immunization, Ag85B:c-di-AMP vaccination induced stronger humoral immune responses, significantly higher CD4+ T cells recruitment, enhanced Th1/Th2/Th17 profile response in the lung, decreased pathological lesions of the lung, and reduced M. tuberculosis load in mice. Taken together, Ag85B:c-di-AMP mucosal route immunization provided an immunotherapeutic effect on persistent M. tuberculosis H37Ra infection, and c-di-AMP, as a promising potential mucosal adjuvant, could be further used in therapeutic or prophylactic vaccine strategies for persistent M. tuberculosis infection as well as LTBI. TB, , (TB) world M LTBI . (LTBI) treatment trials study AgB Ag B cdiAMP c di AMP Ag85BcdiAMP AgBcdiAMP (Ag85B:c-di-AMP HRa H Ra model responses CD4 CD recruitment Th1Th2Th17 ThThTh Th1 Th2 Th17 Th Th1/Th2/Th1 lung mice together cdiAMP, AMP, (TB (LTBI BcdiAMP Th1Th2Th1 Th1/Th2/Th Th1Th2Th

RESUMO Objetivo: Investigar a infecção latente por tuberculose (ILTB) em pacientes com doença de Crohn no período de janeiro de 2005 a dezembro de 2019. Métodos: Estudo retrospectivo, descritivo transversal realizado nos casos diagnosticados de doença de Crohn do hospital universitário em uma cidade do nordeste brasileiro. Foram incluídos todos os casos de pacientes com doença de Crohn em terapia com isoniazida ou rifampicina para tuberculose latente que fazem acompanhamento no HU-UFPI. Os dados sobre doença de Crohn e tuberculose latente foram obtidos do banco de dados que foi solicitado ao HU-UFPI após aprovação da proposta de pesquisa no Comitê de Ética e Pesquisa da UFPI. Foram identificados todos os casos de pacientes com doença de Crohn com ILTB diagnosticados no HU-UFPI. Os dados foram analisados estatisticamente no programa Statistical Package for the Social Sciences-SPSS. Resultados: Foram analisados 235 prontuários, observou-se que 56% eram do sexo masculino, com a média de idade 42,7. 54% se declaravam pardos, 31% tinham o ensino médio completo e 47% residentes na cidade de Teresina. As características clínico-epidemiológicas dos pacientes estudados classificados como portadores de ILTB. 34% dos prontuários tinham diagnóstico pela prova tuberculínica, 48,51% foram investigados através do exame de raio x. Houve dados semelhantes em relação ao comportamento inicial e recente da doença de Cronh sendo 62% e 47% com a doença não estenosante/não penetrante, respectivamente, ao que se refere a localização inicial 31% acometido no colón e íleo terminal/colón, e a localização recente acometido no colón com 27%. Conclusão: Em síntese observou se que, o perfil de saúde dos participantes do presente estudo assemelha-se com os resultados previamente estabelecidos pela literatura, como estudos realizados em outros estados brasileiros e outros países em desenvolvimento. Esse trabalho contribuiu para ampliar o conhecimento sobre a doença de Crohn, bem como propor estratégias na melhoria da investigação do diagnóstico de tuberculose latente e ou doença, porém sugere novos estudos nesta temática em questão. Objetivo (ILTB 200 2019 Métodos retrospectivo brasileiro HUUFPI. HUUFPI HU UFPI SciencesSPSS. SciencesSPSS Sciences SPSS. SPSS Sciences-SPSS Resultados 23 observouse 56 masculino 427 42 7 42,7 54 pardos 31 47 Teresina clínicoepidemiológicas clínico epidemiológicas 34 tuberculínica 4851 48 51 48,51 x 62 estenosantenão estenosante penetrante respectivamente terminalcolón terminal terminal/colón 27 27% Conclusão assemelhase assemelha literatura desenvolvimento questão 20 201 2 5 4 42, 3 485 48,5 6 48,

ABSTRACT Background: Among chronic condition problems, tuberculosis still represents a serious public health problem globally. Objective: To investigate latent tuberculosis infection in patients with Crohn’s disease. Retrospective, descriptive cross-sectional study of quantitative analysis. Methods: The research was conducted on diagnosed cases of Crohn’s disease at the University Hospital located in a city in Northeastern Brazil. All cases of patients with Crohn’s disease undergoing isoniazid or rifampicin therapy for latent tuberculosis (LTBI) were included in the study. The data obtained were subsequently subjected to statistical analysis using the Statistical Package for the Social Sciences (SPSS) program. Results: We analyzed 235 medical records, and it was observed that 56% were male, with a mean age of 42.7. Among these, 54% declared themselves as brown, 31% had completed high school, and 47% were residents of the city of Teresina. Regarding the clinical and epidemiological characteristics of the studied patients classified as having ILTB, 34% of the medical records were diagnosed by tuberculin test, 48.51% were investigated by x-ray examination, and the recent location affected the colon with 27%. Conclusion: Overall, the health profile of the participants in this study aligns with findings previously established in the literature, particularly studies conducted in other Brazilian states, as well as in other developing countries. Background problems globally Objective Crohns Crohn s Retrospective crosssectional cross sectional Methods Brazil LTBI (LTBI SPSS (SPSS program Results 23 56 male 427 42 7 42.7 these 54 brown 31 school 47 Teresina ILTB 34 test 4851 48 51 48.51 xray x ray examination 27 27% Conclusion Overall literature states countries 2 5 4 42. 3 485 48.5 48.

ABSTRACT Objective: Many biologic agents cause some degree of immunosuppression, which can increase the risk of reactivation of tuberculosis infection (TBI). This risk is variable between individual biologics. We aimed to assess current (and recommended) clinical practice of TBI screening and treatment among patients initiating treatment with biologic agents. Methods: An online questionnaire was distributed via email to members of the Global Tuberculosis Network and associated professional organisations to seek insights into the screening for and treatment of TBI in patients treated with biologics. Results: A total of 163 respondents in 27 countries answered at least one question. For all biologics described in the questionnaire, respondents advised increasing screening relative to current practice. Observed and supported TBI screening rates in patients treated with TNF-a inhibitors were high, especially for older TNF-a inhibitors. Most participants supported TBI screening in patients treated with B- or T-cell inhibitors but not in those treated with interleukin inhibitors. Guideline awareness was higher for TNF-a inhibitors than for other biologic classes (79% vs. 34%). Conclusions: Although respondents stated that TBI screening rates are lower than what they consider ideal, there was a tendency to recommend TBI screening in patients treated with biologics not known to be associated with an increased risk of TBI. As a result, there is a potential risk of over-screening and over-treatment of TBI, potentially causing harm, in patients treated with biologics other than TNF-a inhibitors. There is a need to research the risk of TBI associated with biologics and for guidelines to address the spectrum of TBI risk across all types of biologics. Objective immunosuppression . (TBI) recommended Methods Results 16 2 question TNFa TNF high B Tcell T cell 79% 79 (79 vs 34%. 34 34% 34%) Conclusions ideal result overscreening over overtreatment harm (TBI 1 7 (7 3 (

Resumo Objetivo Avaliar a tuberculose latente entre pessoas vivendo com HIV e contatos de pessoas com tuberculose. Métodos Estudo transversal, quantitativo, realizado no estado do Pará, a partir dos casos de infecção tuberculosa latente notificados entre os anos 2019 e 2020. Os dados foram extraídos do Sistema de Informação de Infecção Latente por Tuberculose, na Secretaria de Estado de Saúde Pública, no período de novembro a dezembro de 2021. Para análise, utilizaram-se a estatística descritiva, o teste qui-quadrado e o teste G, além da razão de prevalência, no Bioestat 5.3, com nível de significância de 5%. Resultados Foram estudados 1.116 casos de tuberculose latente, sendo 653 em 2019 e 463 em 2020. O desfecho indicou baixa proporção de tratamentos completos (n=734). Entre os registros, 371 eram de pessoas vivendo com HIV e 416 contatos de casos de tuberculose. Observou-se associação da infecção latente em pessoas vivendo com HIV e contatos com as variáveis sexo, idade, procedência e situação de encerramento (p<0,0001). Conclusão A tuberculose latente em pessoas vivendo com HIV e contatos apresenta diferentes padrões quando associada ao perfil sociodemográfico, sendo necessário priorizar a identificação desses grupos para a adoção de ações estratégicas que impactem no controle da doença. transversal quantitativo Pará 201 2020 Tuberculose Pública 2021 análise utilizaramse utilizaram se descritiva quiquadrado qui quadrado G prevalência 53 5 3 5.3 5% 1116 1 116 1.11 65 46 n=734. n734 n n=734 . 734 (n=734) registros 37 41 Observouse Observou sexo idade p<0,0001. p00001 p p<0,0001 0 0001 (p<0,0001) sociodemográfico doença 20 202 5. 111 11 1.1 6 4 n73 n=73 73 (n=734 p0000 p<0,000 000 (p<0,0001 2 1. n7 n=7 7 (n=73 p000 p<0,00 00 (p<0,000 n= (n=7 p00 p<0,0 (p<0,00 (n= p0 p<0, (p<0,0 (n p<0 (p<0, p< (p<0 (p< (p

Abstract Objective To assess latent tuberculosis among people living with HIV and contacts of people with tuberculosis. Methods This is a cross-sectional, quantitative study, carried out in the state of Pará, based on cases of latent tuberculosis infection reported between 2019 and 2020. Data were extracted from the Latent Tuberculosis Infection Information System, at the State Department of Public Health, from November to December 2021. For analysis, descriptive statistics, chi-square test and G test were used, in addition to prevalence ratio, in Bioestat 5.3, with a significance level of 5%. Results A total of 1,116 cases of latent tuberculosis were studied: 653 in 2019 and 463 in 2020. The outcome indicated a low proportion of complete treatments (n=734). Among the records, 371 were of people living with HIV and 416 were of contacts of tuberculosis cases. An association was observed between latent infection in people living with HIV and contacts with the variables sex, age, origin and termination situation (p<0.0001). Conclusion Latent tuberculosis in people living with HIV and contacts presents different patterns when associated with the sociodemographic profile, making it necessary to prioritize the identification of these groups in order to adopt strategic actions that impact disease management. crosssectional, crosssectional cross sectional, sectional cross-sectional study Pará 201 2020 System Health 2021 analysis statistics chisquare chi square used ratio 53 5 3 5.3 5% 1116 1 116 1,11 studied 65 46 n=734. n734 n n=734 . 734 (n=734) records 37 41 sex age p<0.0001. p00001 p p<0.0001 0 0001 (p<0.0001) profile management 20 202 5. 111 11 1,1 6 4 n73 n=73 73 (n=734 p0000 p<0.000 000 (p<0.0001 2 1, n7 n=7 7 (n=73 p000 p<0.00 00 (p<0.000 n= (n=7 p00 p<0.0 (p<0.00 (n= p0 p<0. (p<0.0 (n p<0 (p<0. p< (p<0 (p< (p

Resumen Objetivo Evaluar la tuberculosis latente entre personas que viven con el VIH y los contactos de personas con tuberculosis. Métodos Estudio transversal, cuantitativo, realizado en el estado de Pará, a partir de casos de infección por tuberculosis latente notificados entre los años 2019 y 2020. Los datos se extrajeron del Sistema de Información de Infección por Tuberculosis Latente, de la Secretaría de Salud Pública del Estado de Pará, en noviembre y diciembre de 2021. Para el análisis se utilizó la estadística descriptiva, la prueba ji cuadrado y la prueba G, además de la razón de prevalencia, en Bioestat 5.3, con nivel de significación de 5 %. Resultados Se estudiaron 1.116 casos de tuberculosis latente, de los cuales 653 fueron en 2019 y 463 en 2020. El resultado indicó baja proporción de tratamiento completo (n=734). Entre los registros, 371 eran de personas que viven con el VIH y 416 contactos de casos de tuberculosis. Se observó relación entre la infección latente en personas que viven con el VIH y los contactos, con las variables sexo, edad, procedencia y situación de cierre (p<0,0001). Conclusión La tuberculosis latente en personas que viven con el VIH y contactos presenta diferentes patrones al relacionarla con el perfil sociodemográfico, por lo que es necesario priorizar la identificación de estos grupos para adoptar acciones estratégicas que impacten en el control de la enfermedad. transversal cuantitativo Pará 201 2020 Latente 2021 descriptiva G prevalencia 53 3 5.3 % 1116 1 116 1.11 65 46 n=734. n734 n n=734 . 734 (n=734) registros 37 41 sexo edad p<0,0001. p00001 p p<0,0001 0 0001 (p<0,0001) sociodemográfico enfermedad 20 202 5. 111 11 1.1 6 4 n73 n=73 73 (n=734 p0000 p<0,000 000 (p<0,0001 2 1. n7 n=7 7 (n=73 p000 p<0,00 00 (p<0,000 n= (n=7 p00 p<0,0 (p<0,00 (n= p0 p<0, (p<0,0 (n p<0 (p<0, p< (p<0 (p< (p

Resumo Objetivo Analisar o monitoramento de contatos de pacientes com tuberculose (TB) na perspectiva de Agentes Comunitários de Saúde (ACS). Métodos Estudo descritivo, transversal e qualitativo, com ACS de oito Unidades Básicas de Saúde da Supervisão Técnica de Saúde Casa Verde/Cachoerinha/Limão do Município de São Paulo, SP. Foram realizadas entrevistas semiestruturadas de junho a julho de 2021. A Vigilância à Saúde constituiu o referencial conceitual e os depoimentos foram submetidos a análise de conteúdo. Resultados Os ACS (51) tinham um tempo médio de atuação de 7,4 anos e 169 famílias sob sua responsabilidade; referiram já ter tido casos de TB na microárea de atuação (68,7%) e algum treinamento em relação à doença (70,6%). Em geral, o monitoramento de contatos não era conhecido pelos participantes, que também não reconheciam essa atividade como uma tarefa de sua responsabilidade. Várias dificuldades foram identificadas na rotina de trabalho, incluindo: resistência dos contatos em ser avaliados em consulta e realizar os exames solicitados, aceitar a possibilidade de ter TB, não conseguir acessar os contatos, dentre outras. Conclusão O desconhecimento da necessidade de monitorar os contatos pode fragilizar a detecção precoce de casos novos de Tuberculose e a Infecção Latente por Tuberculose, e contribuir para a manutenção da transmissão da doença. Dada a importância dos ACS para essa prática, e considerando que são um importante elo entre a comunidade e a equipe de saúde, recomenda-se sua devida instrumentalização para a identificação precoce de novos casos de TB e para o monitoramento adequado dos contatos. (TB ACS. . (ACS) descritivo qualitativo VerdeCachoerinhaLimão Verde Cachoerinha Limão Paulo SP 2021 conteúdo 51 (51 74 7 4 7, 16 responsabilidade 68,7% 687 68 (68,7% 70,6%. 706 70,6% 70 6 (70,6%) geral participantes trabalho incluindo solicitados outras prática saúde recomendase recomenda se (ACS 202 5 (5 1 68,7 (68,7 70,6 (70,6% 20 ( 68, (68, 70, (70,6 2 (68 (70, (6 (70 (7

Abstract Objective To analyze the monitoring of contacts of tuberculosis (TB) patients from the perspective of Community Health Workers (CHWs). Methods This was a descriptive, cross-sectional, qualitative study with CHWs from eight Primary Care Center in the Casa Verde/Cachoerinha/Limão Technical Health Supervision in the city of São Paulo, SP. Semi-structured interviews were conducted from June to July 2021. Health Surveillance was the conceptual framework and the statements were subjected to content analysis. Results The CHWs (51) had an average working time of 7.4 years and 169 families under their responsibility; they reported having already had cases of TB in the micro-area they worked in (68.7%) and had some training in the disease (70.6%). In general, the monitoring of contacts was not known by the participants, who also did not recognize this activity as a task for which they were responsible. Several difficulties were identified in the work routine, including: contacts’ resistance to being assessed at appointments and carrying out the tests requested, accepting the possibility of having TB, not being able to access contacts, among others. Conclusion Ignorance of the need to monitor contacts can weaken the early detection of new cases of tuberculosis and latent tuberculosis infection, and contribute to maintaining the transmission of the disease. Given the importance of CHWs for this practice, and considering that they are an important link between the community and the health team, it is recommended that they be properly trained for the early identification of new TB cases and for the proper monitoring of contacts. (TB CHWs. . (CHWs) descriptive crosssectional, crosssectional cross sectional, sectional cross-sectional VerdeCachoerinhaLimão Verde Cachoerinha Limão Paulo SP Semistructured Semi structured 2021 analysis 51 (51 74 7 4 7. 16 responsibility microarea micro area 68.7% 687 68 (68.7% 70.6%. 706 70.6% 70 6 (70.6%) general participants responsible routine including requested others infection practice team (CHWs 202 5 (5 1 68.7 (68.7 70.6 (70.6% 20 ( 68. (68. 70. (70.6 2 (68 (70. (6 (70 (7

Resumen Objetivo Analizar el monitoreo de contactos de pacientes con tuberculosis (TB) bajo la perspectiva de agentes comunitarios de salud (ACS). Métodos Estudio descriptivo, transversal y cualitativo, con ACS de ocho Unidades Básicas de Salud de la Supervisión Técnica de Salud Casa Verde/Cachoerinha/Limão del municipio de São Paulo, estado de São Paulo. Se realizaron entrevistas semiestructuradas de junio a julio de 2021. La Vigilancia de la Salud constituyó el marco conceptual y los testimonios fueron sometidos al análisis de contenido. Resultados Los ACS (51) contaban con un tiempo promedio de actuación de 7,4 años y 169 familias bajo su responsabilidad. Declararon haber tenido casos de TB en su microárea de actuación (68,7 %) y alguna capacitación relacionada con la enfermedad (70,6 %). En general, los participantes no conocían el monitoreo de contactos y tampoco reconocían esa actividad como una tarea bajo su responsabilidad. Se identificaron varias dificultades en la rutina de trabajo: resistencia de los contactos a ser evaluados en consulta y realizar los exámenes solicitados, aceptar la posibilidad de tener TB, no poder acceder a los contactos, entre otras. Conclusión La falta de conocimiento de la necesidad de monitorear los contactos puede debilitar la detección temprana de nuevos casos de tuberculosis y de infección por tuberculosis latente, lo que contribuye a mantener la transmisión de la enfermedad. Dada la importancia de los ACS para esta práctica y considerando que son un importante eslabón entre la comunidad y el equipo de salud, se recomienda que sean debidamente preparados para la identificación temprana de nuevos casos de TB y para el monitoreo adecuado de los contactos. (TB ACS. . (ACS) descriptivo cualitativo VerdeCachoerinhaLimão Verde Cachoerinha Limão Paulo 2021 contenido 51 (51 74 7 4 7, 16 responsabilidad 68,7 687 68 (68, % 70,6 706 70 6 (70, %. general trabajo solicitados otras latente (ACS 202 5 (5 1 68, (68 70, (70 20 ( (6 (7 2

Abstract Objectives To evaluate the tuberculin skin test (TST) conversion in chronic inflammatory arthropathies (CIA) patients on TNFα inhibitors (TNFi) and without previous latent tuberculosis infection (LTBI) treatment. Methods Patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) with negative LTBI were retrospectively evaluated for TST conversion and active tuberculosis (TB) after six months of exposition to TNFi. Two groups were compared: patients who repeated TST (TST-repetition) during the follow-up and patients who did not (non-TST-repetition). Results A total of 355 CIA patients on TNFi were screened and 138 (38.9%) did not fulfill the inclusion criteria. Of the remaining 217 CIA patients, 81 (37.3%) repeated TST during TNFi treatment. TST conversion rate was observed in 18 (22.2%) patients without significant differences among CIA (p = 0.578). The number of TB cases was low (n = 10; 4.6%) and was similar in TST-repetition and non-TST-repetition groups [2 (2.5%) vs. 8 (5.9%), p = 0.328]. Of note, 30% of active TB occurred early (6–12 months of TNFi exposure) and the median (full range) time to incident TB was 1.3 (0.6–10.6) years, whereas the median (full range) time to TST repetition was later [3.3 (0.5–13.4) years]. The incidence of active TB was lower among RA patients than AS patients [342 (95% CI 41 − 1446) vs. 1.454 (95% CI 594-2993)/100,000 patient-years, p = 0.049]. Conclusion These results indicate that TST repetition is associated with a high conversion rate, suggesting the need for recommended treatment. The delayed repetition of TST and low number of active TB cases hampered the evaluation of this strategy effectiveness to prevent active infection. Larger studies with systematic repetition patterns are necessary. In addition, the study highlights the need for a greater surveillance for TB in AS patients. Key messages TST repetition is associated with a high conversion rate for positive LTBI after long-term TNFi. Active tuberculosis diagnosis occurs early (1.3 years) during TNFi therapy. AS patients require greater surveillance for incident TB. (TST (CIA (TNFi (LTBI treatment RA, , (RA) (AS PsA (PsA (TB compared TSTrepetition (TST-repetition followup follow up nonTSTrepetition. nonTSTrepetition non . (non-TST-repetition) 35 13 38.9% 389 38 9 (38.9% criteria 21 37.3% 373 37 3 (37.3% 1 22.2% 222 22 2 (22.2% 0.578. 0578 0.578 0 578 0.578) n 10 4.6% 46 4 6 [ 2.5% 25 5 (2.5% vs 5.9%, 59 5.9% (5.9%) 0.328. 0328 0.328 328 0.328] note 30 6–12 612 12 (6–1 exposure full range 1. 0.6–10.6 06106 (0.6–10.6 years 3.3 33 [3. 0.5–13.4 05134 (0.5–13.4 years. years] 342 [34 95% 95 (95 1446 1454 454 1.45 5942993/100,000 5942993100000 594 2993 /100,000 100 000 594-2993)/100,00 patientyears, patientyears patient patient-years 0.049. 0049 0.049 049 0.049] necessary addition longterm long term (1. therapy (RA (non-TST-repetition 38.9 (38.9 37.3 (37.3 22.2 (22.2 057 0.57 57 4.6 2.5 (2.5 5.9 (5.9% 032 0.32 32 6–1 61 (6– 0.6–10. 0610 (0.6–10. 3. [3 0.5–13. 0513 (0.5–13. 34 (9 144 145 45 1.4 5942993 5942993/100,00 594299310000 299 100000 /100,00 00 594-2993)/100,0 004 0.04 04 (1 38. (38. 37. (37. 22. (22. 05 0.5 4. 2. (2. 5. (5.9 03 0.3 6– (6 0.6–10 061 (0.6–10 0.5–13 051 (0.5–13 ( 14 594299 5942993/100,0 59429931000 29 10000 /100,0 594-2993)/100, 0.0 (38 (37 (22 0. (2 (5. 0.6–1 06 (0.6–1 0.5–1 (0.5–1 59429 5942993/100, 5942993100 1000 /100, 594-2993)/100 (3 (5 0.6– (0.6– 0.5– (0.5– 5942 5942993/100 594299310 /100 594-2993)/10 0.6 (0.6 (0.5 5942993/10 59429931 /10 594-2993)/1 (0. 5942993/1 /1 594-2993)/ (0 5942993/ / 594-2993) 594-2993 594-299 594-29 594-2 594-

RESUMO Objetivo: Descrever os indicadores de resultado da implementação de uma cascata de cuidados da infecção latente por Mycobacterium tuberculosis em pessoas vivendo com o vírus da imunodeficiência humana. Método: Estudo transversal realizado com pessoas vivendo com HIV no período de 2022 a 2024 em serviço de referência de Campo Grande, Mato Grosso do Sul. Foi feito após a implementação do seguinte processo de trabalho: Identificação de pessoas em risco para investigação de Infecção Latente da Tuberculose (ILTB); Teste para ILTB; Exclusão de casos de TB ativa; Tratamento para ILTB; Adesão ao tratamento; e Conclusão do tratamento. Os dados foram analisados por estatística descritiva, teste Qui-quadrado e teste exato de Fisher. Resultados: Foram acompanhadas 735 pessoas. Desse total, 29,6% tinham indicação de iniciar o tratamento de infecção latente, das quais 32,5% iniciaram. A taxa de conclusão do tratamento foi maior no grupo que usou o esquema encurtado (90,2% versus 71,8%; p-value < 0,05, 7,8% com Isoniazida e 2% com Rifampicina). Houve uma (0,9%) reação adversa grave. Conclusão: A implementação da cascata de cuidados demonstrou que um terço dos pacientes tinha indicação de tratamento e ampliou o acesso ao tratamento preconizado. A taxa de conclusão do tratamento foi maior com o esquema encurtado. As reações adversas foram infrequentes. Objetivo humana Método 202 Grande Sul trabalho ILTB (ILTB) ativa descritiva Quiquadrado Qui quadrado Fisher Resultados 73 total 296 29 6 29,6 325 32 5 32,5 iniciaram 90,2% 902 90 2 (90,2 71,8% 718 71 8 pvalue p value 005 0 05 0,05 78 7 7,8 Rifampicina. Rifampicina . Rifampicina) 0,9% 09 9 (0,9% grave preconizado infrequentes 20 (ILTB 29, 3 32, 90,2 (90, 71,8 00 0,0 7, 0,9 (0,9 90, (90 71, 0, (0, (9 (0 (

ABSTRACT Objective: To describe the outcome indicators of implementing a cascade of care for latent Mycobacterium tuberculosis infection in people living with the human immunodeficiency virus. Method: Cross-sectional study, carried out with people living with HIV, from 2022 to 2024, in a reference service in Campo Grande, Mato Grosso do Sul. It occurred after the implementation of the following work process: Identification of people at risk for investigation of Latent Tuberculosis Infection (LTBI); Test for LTBI; Exclusion of active TB cases; Treatment for LTBI; Adherence to treatment; and Completion of treatment. Data were analyzed using descriptive statistics, Chi-square test and Fisher's exact test. Results: 735 people were monitored, of which 29.6% were indicated to start treatment for latent infection, and 32.5% started it. Treatment completion was higher in those who used the shortened regimen (90.2% versus 71.8%; p-value < 0.05, 7.8% with isoniazid and 2% with rifampin). There was one (0.9%) serious adverse reaction. Conclusion: The implementation of the cascade of care demonstrated that 1⁄3 of participants had an indication for treatment and expanded access to recommended treatment. The conclusion was greater with the shortened scheme. Adverse reactions were infrequent. Objective virus Method Crosssectional Cross sectional study HIV 202 2024 Grande Sul process LTBI (LTBI) cases statistics Chisquare Chi square Fishers Fisher s Results 73 monitored 296 29 6 29.6 325 32 5 32.5 it 90.2% 902 90 2 (90.2 71.8% 718 71 8 pvalue p value 005 0 05 0.05 78 7 7.8 rifampin. rifampin . rifampin) 0.9% 09 9 (0.9% reaction Conclusion 13 1 3 1⁄ scheme infrequent 20 (LTBI 29. 32. 90.2 (90. 71.8 00 0.0 7. 0.9 (0.9 90. (90 71. 0. (0. (9 (0 (

RESUMEN Objetivo: Describir los indicadores de resultados de la implementación de una cascada de atención para la infección latente por Mycobacterium tuberculosis en personas que viven con el virus de la inmunodeficiencia humana. Método: Estudio transversal, realizado con personas que viven con VIH, de 2022 a 2024, en un servicio de referencia en Campo Grande, Mato Grosso do Sul. Ocurrió después de la implementación del siguiente proceso de trabajo: Identificación de personas en riesgo de contraer VIH. investigación de la Infección Tuberculosis Latente (LTBI); Prueba de LTBI; Exclusión de casos de tuberculosis activa; Tratamiento para la LTBI; Adherencia al tratamiento; y Finalización del tratamiento. Los datos fueron analizados mediante estadística descriptiva, prueba de Chi-cuadrado y prueba exacta de Fisher. Resultados: Se monitorearon 735 personas, de las cuales al 29,6% se les indicó iniciar tratamiento por infección latente y al 32,5% lo iniciaron. La finalización del tratamiento fue mayor en aquellos que utilizaron el régimen acortado (90,2% versus 71,8%; valor de p <0,05, 7,8% con isoniazida y 2% con rifampicina). Hubo una reacción adversa grave (0,9%). Conclusión: La implementación de la cascada de atención demostró que 1⁄3 de los participantes tenía una indicación de tratamiento y un acceso ampliado al tratamiento recomendado. La conclusión fue mayor con el esquema acortado. Las reacciones adversas fueron poco frecuentes. Objetivo humana Método transversal VIH 202 2024 Grande Sul trabajo LTBI (LTBI) activa descriptiva Chicuadrado Chi cuadrado Fisher Resultados 73 296 29 6 29,6 325 32 5 32,5 iniciaron 90,2% 902 90 2 (90,2 71,8% 718 71 8 005 0 05 <0,05 78 7 7,8 rifampicina. rifampicina . rifampicina) 0,9%. 09 0,9% 9 (0,9%) Conclusión 13 1 3 1⁄ recomendado frecuentes 20 (LTBI 29, 32, 90,2 (90, 71,8 00 <0,0 7, 0,9 (0,9% 90, (90 71, <0, 0, (0,9 (9 <0 (0, ( < (0

Abstract Tuberculosis is one of the first diseases that affected humans, it is considered an infectious diseasecausing significant morbidity and mortality in the world. The fight against this disease began in our country at the beginning of the 20th century with a sanatorium approach and later with the implementation of different strategies proposed by the World Health Organization to move towards its elimination. The aim of this report is to provide information on the approach to tuberculosis in Costa Rica. Methods: A descriptive and qualitative study. It included reviews of articles in scientific journals such as Scielo, as well as systematic reviews in: LILACS, PubMed, Cochrane, and a review of the history of data collected in the Epidemiological Surveillance Subarea of the Costa Rican Social Security Fund. Results: The fight against tuberculosis began in our country in the 20th century, through the launch of the Durán Sanatorium. With the discovery of Koch’s bacillus and medications for its treatment, we moved from a sanatorium approach to the implementation of different strategies suggested by the World Health Organization aimed at strengthening timely diagnosis and treatment, as well as surveillance of tuberculosis /Human Immuno- deficiency Virus (HIV) coinfection, drug resistance, latent infection and intensified case finding in vulnerable populations. Conclusions: The Ministry of health and the Social Security System of Costa Rica have been supporting the fight against tuberculosis, however, to achieve the goals proposed by the World Health Organization, health authorities are required to continue prioritizing the fight against this disease, providing all the recommended resources and supplies required for timely diagnosis and treatment. Only in this way will we be able to move towards its elimination.

Resumen La tuberculosis ha sido una de las primeras enfermedades en afectar al ser humano, por ende, es considerada un mal infeccioso causante de una importante morbilidad y mortalidad en el mundo. La lucha contra esta enfermedad inició en nuestro país a principios del siglo XX con un abordaje sanatorial y, posteriormente, con la puesta en marcha de diferentes estrategias propuestas por la Organización Mundial de la Salud para avanzar hacia su eliminación. El objetivo del presente informe es brindar información sobre el enfoque de la tuberculosis en Costa Rica. Métodos: estudio descriptivo cualitativo. Incluyó la revisión de artículos en revistas científicas como Scielo, revisiones sistemáticas en: LILACS, PubMed, Cochrane y del historial de datos recopilados en la Subárea de Vigilancia Epidemiológica de la Caja Costarricense Seguro Social. Resultados: la lucha contra la tuberculosis inició en nuestro país en el siglo XX a través de la puesta en marcha del Sanatorio Durán. Con el descubrimiento del bacilo de Koch y de medicamentos para su tratamiento, se pasó de un abordaje sanatorial a la implementación de diferentes estrategias sugeridas por la Organización Mundial de la Salud dirigidas a fortalecer el diagnóstico y el tratamiento oportunos, así como la vigilancia de la coinfección tuberculosis /virus inmunodeficiencia humana, la resistencia a medicamentos, la infección latente y la búsqueda intensificada de casos en poblaciones vulnerables. Conclusiones: El Ministerio de Salud y la Caja Costarricense de Seguro Social han venido apoyando la lucha contra la tuberculosis, sin embargo, para el logro de las metas propuestas por la Organización Mundial de la Salud se requiere que las autoridades de salud continúen priorizando la lucha contra esta enfermedad, cuya finalidad es brindar todos los recursos e insumos de punta requeridos para su diagnóstico y oportunos tratamientos. Solo de esta forma lograremos avanzar hacia su eliminación.