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RESUMO Historicamente, todos os esforços contra a tuberculose concentraram-se no diagnóstico rápido e no tratamento efetivo para quebrar a cadeia de transmissão do Mycobacterium tuberculosis. No entanto, nos últimos anos, têm sido encontradas mais e mais evidências sobre as dramáticas consequências da condição definida como doença pulmonar pós-tuberculose (DPPT). Aproximadamente um terço dos pacientes que sobrevivem à tuberculose pulmonar enfrenta morbidades consideráveis e persistentes, incluindo comprometimento respiratório, desafios psicossociais e redução da qualidade de vida relacionada à saúde após o término do tratamento. Diante da importante carga global e local da tuberculose, bem como da carga estimada da DPPT, considerou-se urgente o desenvolvimento de um documento de consenso por uma sociedade científica brasileira - a Sociedade Brasileira de Pneumologia e Tisiologia (SBPT) - para a prevenção e manejo dessa condição, a fim de alocar recursos de forma adequada para e nos serviços de tuberculose e servir de guia para os profissionais de saúde. Uma equipe de onze pneumologistas e um metodologista foi criada pela SBPT para revisar as evidências atuais sobre a DPPT e desenvolver recomendações adaptadas ao contexto brasileiro. O painel de especialistas selecionou os temas com base nas evidências atuais e diretrizes internacionais. Durante a primeira fase, três membros do painel redigiram as recomendações, que foram divididas em três seções: definição e prevalência de DPPT, avaliação da DPPT e manejo da DPPT. Na segunda fase, todos os membros do painel analisaram, discutiram e revisaram as recomendações até chegar a um consenso. O documento foi aprovado formalmente pela SBPT em sessão especial organizada durante o Congresso Anual da SBPT de 2023. Historicamente concentraramse concentraram se tuberculosis entanto anos póstuberculose pós . (DPPT) persistentes respiratório considerouse considerou (SBPT brasileiro internacionais fase seções analisaram 2023 (DPPT 202 20 2

ABSTRACT Historically, all efforts against tuberculosis were focused on rapid diagnosis and effective treatment to break the chain of transmission of Mycobacterium tuberculosis. However, in the last few years, more and more evidence has been found on the dramatic consequences of the condition defined as post-tuberculosis lung disease (PTLD). Approximately one third of patients surviving pulmonary tuberculosis face considerable ongoing morbidities, including respiratory impairment, psychosocial challenges, and reduced health-related quality of life after treatment completion. Given the important global and local burden of tuberculosis, as well as the estimated burden of PTLD, the development of a consensus document by a Brazilian scientific society-Sociedade Brasileira de Pneumologia e Tisiologia (SBPT)-was considered urgent for the prevention and management of this condition in order to allocate resources to and within tuberculosis services appropriately and serve as a guide for health care professionals. A team of eleven pulmonologists and one methodologist was created by the SBPT to review the current evidence on PTLD and develop recommendations adapted to the Brazilian context. The expert panel selected the topics on the basis of current evidence and international guidelines. During the first phase, three panel members drafted the recommendations, which were divided into three sections: definition and prevalence of PTLD, assessment of PTLD, and management of PTLD. In the second phase, all panel members reviewed, discussed, and revised the recommendations until a consensus was reached. The document was formally approved by the SBPT in a special session organized during the 2023 SBPT Annual Conference. Historically However years posttuberculosis post . (PTLD) morbidities impairment challenges healthrelated related completion societySociedade society Sociedade SBPTwas professionals context guidelines phase sections reviewed discussed reached 202 Conference (PTLD 20 2

https://doi.org/10.36416/1806-3756/e20230269

Migration and medical screening for tuberculosis
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Silva, Denise Rossato

; Mello, Fernanda Carvalho de Queiroz

; Johansen, Fernanda Dockhorn Costa

; Centis, Rosella

; D’Ambrosio, Lia

; Migliori, Giovanni Battista

Jornal Brasileiro de Pneumologia

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2023, Volume 49 N. 2 elocation e20230051

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Populações vulneráveis, como imigrantes e refugiados, apresentam maior risco de tuberculose doença, especialmente nos primeiros anos após a chegada ao país de acolhimento. A presença de imigrantes e refugiados no Brasil cresceu exponencialmente no período entre 2011 e 2020, sendo estimado que aproximadamente 1,3 milhão de imigrantes do Sul Global residiam no Brasil, a maioria proveniente da Venezuela e do Haiti. Os programas de controle da tuberculose para imigrantes podem ser divididos em estratégias de triagem pré- e pós-migração. A triagem pré-migração visa identificar casos de tuberculose infecção (TBI) e pode ser realizada no país de origem (pré-entrada) ou no país de destino (no momento da entrada). A triagem pré-migração também pode detectar imigrantes com maior risco de desenvolver tuberculose no futuro. Os imigrantes de alto risco são então acompanhados na triagem pós-migração. No Brasil, os imigrantes são considerados um grupo prioritário para a busca ativa de casos de tuberculose. No entanto, não há recomendação ou plano sobre triagem para TBI em imigrantes e refugiados. Garantir a prevenção, o diagnóstico e o tratamento da TBI e da tuberculose doença em populações imigrantes é um aspecto importante do controle e eliminação da tuberculose. Neste artigo de revisão, abordamos aspectos epidemiológicos e acesso à saúde para imigrantes no Brasil. Além disso, revisou-se a triagem médica de imigrantes para tuberculose. vulneráveis acolhimento 201 2020 13 1 3 1, Haiti pré pósmigração. pósmigração pós migração. migração pós-migração prémigração (TBI préentrada entrada (pré-entrada entrada. . entrada) futuro entanto prevenção revisão disso revisouse revisou se 20 202 2

ABSTRACT Vulnerable populations, such as migrants and refugees, have an increased risk of tuberculosis disease, especially in the first years after arrival in the host country. The presence of migrants and refugees in Brazil exponentially grew over the period between 2011 and 2020, and approximately 1.3 million migrants from the Global South were estimated to be residing in Brazil, most of whom from Venezuela and Haiti. Tuberculosis control programs for migrants can be divided into pre- and post-migration screening strategies. Pre-migration screening aims to identify cases of tuberculosis infection (TBI) and can be carried out in the country of origin (pre-entry) or in the destination country (at entry). Pre-migration screening can also detect migrants at an increased risk of developing tuberculosis in the future. High-risk migrants are then followed up in post-migration screening. In Brazil, migrants are considered a priority group for the active search for tuberculosis cases. However, there is no recommendation or plan regarding screening for TBI in migrants and refugees. Ensuring prevention, diagnosis, and treatment for TBI and tuberculosis disease in migrant populations is an important aspect of tuberculosis control and elimination. In this review article, we address epidemiological aspects and access to health care for migrants in Brazil. In addition, the migration medical screening for tuberculosis was reviewed. 201 2020 13 1 3 1. Haiti pre postmigration post strategies Premigration Pre (TBI preentry entry (pre-entry entry. . entry) future Highrisk High However prevention diagnosis elimination article addition reviewed 20 202 2

https://doi.org/10.36416/1806-3756/e20230051

Diagnosis and management of post-tuberculosis lung disease posttuberculosis post tuberculosis
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Silva, Denise Rossato

; Mello, Fernanda Carvalho de Queiroz

; Migliori, Giovanni Battista

Jornal Brasileiro de Pneumologia

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2023, Volume 49 N. 2 elocation e20230055

Abstract: En | Text: En | PDF: En

https://doi.org/10.36416/1806-3756/e20230055

Analysis of catastrophic costs incurred by patients with multidrug-resistant tuberculosis in an outpatient clinic in the state of Rio de Janeiro multidrugresistant multidrug resistant
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Medeiros, Regielle Luiza de

; Moreira, Adriana da Silva Rezende

; Neves, Ana Carolina de Oliveira Jeronymo

; Leite, Viviane de Jesus

; Almeida, Isabela Neves de

; Mello, Fernanda Carvalho de Queiroz

; Kritski, Afrânio

Revista da Sociedade Brasileira de Medicina Tropical

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2023, Volume 56 elocation e0148-2023

Abstract: En | Text: En | PDF: En

ABSTRACT Background: Multidrug-resistant tuberculosis (MDR-TB) is a serious global public health concern associated with social vulnerability. In Brazil, the Unified Health System (SUS, Portuguese) provides free diagnosis and treatment for MDR-TB; however, other expenses may still be incurred for patients and their families which, according to the World Health Organization (WHO), can be catastrophic when these costs surpass 20.0% of the annual household income. This study aimed to assess the extent of catastrophic costs related to the diagnostic and therapeutic aspects of MDR-TB among patients receiving care at an outpatient clinic in Rio de Janeiro. Methods: This prospective study used convenience sampling from July 2019 to June 2021. Data regarding direct and indirect costs were collected using a standardized questionnaire endorsed by the WHO. To analyze any impoverishment occurred from MDR-TB, a threshold established by the Brazilian Institute of Geography and Statistics for 2019 and 2020 of US$ 79,562 and US$ 94,5273, respectively, was applied. Descriptive statistics were used for data analysis, including mean; standard deviation; variation coefficient; median; and maximum, minimum, and interquartile ranges. Results: A total of 65 patients were interviewed. Among the participants, 73.8% experienced catastrophic costs, with indirect costs exerting the most significant impact (median: US$ 3,825.9), in contrast to direct costs (median: US$ 542.7). When comparing the periods before and after diagnosis, the prevalence of poverty increased from 12.0% to 28.0%. Conclusions: Despite the support from the SUS in Brazil, diagnostic and therapeutic cascades incur additional costs, exacerbating social vulnerability among patients with MDR-TB. Background Multidrugresistant Multidrug resistant MDRTB MDR TB (MDR-TB Brazil SUS, (SUS Portuguese however which WHO, WHO , (WHO) 200 20 0 20.0 income Janeiro Methods 201 2021 MDRTB, TB, 202 US 79562 79 562 79,56 945273 94 5273 94,5273 respectively applied analysis mean deviation coefficient median maximum minimum ranges Results 6 interviewed participants 738 73 8 73.8 (median 3,825.9, 38259 3,825.9 3 825 9 3,825.9) 542.7. 5427 542.7 . 542 7 542.7) 120 12 12.0 280 28 28.0% Conclusions MDRTB. TB. (WHO 2 20. 7956 56 79,5 94527 527 94,527 73. 3825 3,825. 82 542. 54 1 12. 28.0 795 5 79, 9452 52 94,52 382 3,825 28. 945 94,5 38 3,82 94, 3,8 3,

https://doi.org/10.1590/0037-8682-0148-2023

“Post-tuberculosis financial disease”-we need to face it to eliminate tuberculosis Posttuberculosis Post diseasewe disease we
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Santos, Ana Paula

; Mello, Fernanda Carvalho de Queiroz

Jornal Brasileiro de Pneumologia

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2023, Volume 49 N. 4 elocation e20230253

Abstract: En | Text: En | PDF: En

https://doi.org/10.36416/1806-3756/e20230253

Country-specific lockdown measures in response to the COVID-19 pandemic and its impact on tuberculosis control: a global study
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Migliori, Giovanni Battista

; Thong, Pei Min

; Alffenaar, Jan-Willem

; Denholm, Justin

; Tadolini, Marina

; Alyaquobi, Fatma

; Al-Abri, Seif

; Blanc, François-Xavier

; Buonsenso, Danilo

; Chakaya, Jeremiah

; Cho, Jin-Gun

; Codecasa, Luigi Ruffo

; Danila, Edvardas

; Duarte, Raquel

; Dukpa, Rada

; García-García, José-María

; Gualano, Gina

; Kurhasani, Xhevat

; Manika, Katerina

; Mello, Fernanda Carvalho de Queiroz

; Pahl, Kristin

; Rendon, Adrian

; Sotgiu, Giovanni

; Souleymane, Mahamadou Bassirou

; Thomas, Tania A.

; Tiberi, Simon

; Kunst, Heinke

; Udwadia, Zarir F.

; Goletti, Delia

; Centis, Rosella

; D’Ambrosio, Lia

; Silva, Denise Rossato

Jornal Brasileiro de Pneumologia

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2022, Volume 48 N. 2 elocation e20220087

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO O objetivo deste estudo foi descrever as medidas de confinamento específicas de cada país e os indicadores de tuberculose coletados durante o primeiro ano da pandemia de COVID-19. Dados referentes a confinamento/restrições sociais (uso obrigatório de máscaras faciais e higiene obrigatória das mãos; restrições a viagens internacionais e locais; restrições a visitas familiares e fechamento das escolas) foram coletados de 24 países em cinco continentes. A maioria dos países implantou múltiplos confinamentos, com reabertura parcial ou total. Houve uma redução geral dos casos de tuberculose ativa, tuberculose resistente e tuberculose latente. Embora os confinamentos nacionais tenham sido eficazes na contenção dos casos de COVID-19, vários indicadores de tuberculose foram afetados durante a pandemia.

ABSTRACT The objective of this study was to describe country-specific lockdown measures and tuberculosis indicators collected during the first year of the COVID-19 pandemic. Data on lockdown/social restrictions (compulsory face masks and hand hygiene; international and local travel restrictions; restrictions to family visits, and school closures) were collected from 24 countries spanning five continents. The majority of the countries implemented multiple lockdowns with partial or full reopening. There was an overall decrease in active tuberculosis, drug-resistant tuberculosis, and latent tuberculosis cases. Although national lockdowns were effective in containing COVID-19 cases, several indicators of tuberculosis were affected during the pandemic.

https://doi.org/10.36416/1806-3756/e20220087

Effects of COVID-19 on tuberculosis control: past, present, and future
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Silva, Denise Rossato

; Mello, Fernanda Carvalho de Queiroz

; Migliori, Giovanni Battista

Jornal Brasileiro de Pneumologia

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2022, Volume 48 N. 2 elocation e20220102

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36416/1806-3756/e20220102

10.

Applicability of the chronic obstructive pulmonary disease assessment test as a measure of health status in patients with sequelae of pulmonary tuberculosis
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Torres, Diego de Faria Magalhães

; Nascimento, Aléxia Carolina Soares do

; Destro, Sara Ferreira

; Cardoso, Alexandre Pinto

; Mello, Fernanda Carvalho de Queiroz

Jornal Brasileiro de Pneumologia

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2021, Volume 47 N. 4 elocation e20210170

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36416/1806-3756/e20210170

11.

Diagnosis of tuberculosis: a consensus statement from the Brazilian Thoracic Association
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Silva, Denise Rossato

; Rabahi, Marcelo Fouad

; Sant’Anna, Clemax Couto

; Silva-Junior, José Laerte Rodrigues da

; Capone, Domenico

; Bombarda, Sidney

; Miranda, Silvana Spíndola de

; Rocha, Jorge Luiz da

; Dalcolmo, Margareth Maria Pretti

; Rick, Mônica Flores

; Santos, Ana Paula

; Dalcin, Paulo de Tarso Roth

; Galvão, Tatiana Senna

; Mello, Fernanda Carvalho de Queiroz

Jornal Brasileiro de Pneumologia

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2021, Volume 47 N. 2 elocation e20210054

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO O diagnóstico precoce e adequado da tuberculose é um dos pilares mais importantes no controle da doença. A proposta deste consenso brasileiro é apresentar aos profissionais da área de saúde um documento com as evidências mais atuais e úteis para o diagnóstico da tuberculose. Para tanto, a Comissão de Tuberculose da Sociedade Brasileira de Pneumologia e Tisiologia reuniu 14 membros da Sociedade com reconhecida experiência em tuberculose no Brasil. Foi realizada uma revisão não sistemática dos seguintes tópicos: diagnóstico clínico, diagnóstico bacteriológico, diagnóstico radiológico, diagnóstico histopatológico, diagnóstico da tuberculose na criança e diagnóstico da tuberculose latente.

ABSTRACT Early, accurate diagnosis of tuberculosis is one of the major pillars of the control of the disease. The purpose of this consensus statement is to provide health professionals with the most current, useful evidence for the diagnosis of tuberculosis in Brazil. To that end, the Tuberculosis Committee of the Brazilian Thoracic Association brought together 14 members of the Association with recognized expertise in tuberculosis in Brazil to compose the statement. A nonsystematic review of the following topics was carried out: clinical diagnosis, bacteriological diagnosis, radiological diagnosis, histopathological diagnosis, diagnosis of tuberculosis in children, and diagnosis of latent tuberculosis infection.

https://doi.org/10.36416/1806-3756/e20210054 348 downloads

12.

Tuberculosis Series 2021
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Silva, Denise Rossato

; Mello, Fernanda Carvalho de Queiroz

; Migliori, Giovanni Battista

Jornal Brasileiro de Pneumologia

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2021, Volume 47 N. 2 elocation e20210109

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36416/1806-3756/e20210109 531 downloads

13.

Tuberculosis and COVID-19, the new cursed duet: what differs between Brazil and Europe?
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Silva, Denise Rossato

; Mello, Fernanda Carvalho de Queiroz

; D’Ambrosio, Lia

; Centis, Rosella

; Dalcolmo, Margareth Pretti

; Migliori, Giovanni Battista

Jornal Brasileiro de Pneumologia

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2021, Volume 47 N. 2 elocation e20210044

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Em 1º de abril de 2020, a COVID-19 ultrapassou a tuberculose em número de óbitos por dia no mundo. A associação da tuberculose com a COVID-19 apresenta grande potencial de morbidade e mortalidade. Além disso, a pandemia de COVID-19 tem tido um impacto significativo no diagnóstico e tratamento da tuberculose. Neste artigo de revisão, abordamos tuberculose e COVID-19 concomitantes, com particular atenção às diferenças entre Brasil e Europa. Além disso, discutimos as prioridades em atendimento clínico, saúde pública e pesquisa.

ABSTRACT On April 1st, 2020, COVID-19 surpassed tuberculosis regarding the number of deaths per day worldwide. The combination of tuberculosis and COVID-19 has great potential for morbidity and mortality. In addition, the COVID-19 pandemic has had a significant impact on the diagnosis and treatment of tuberculosis. In this review article, we address concurrent tuberculosis and COVID-19, with particular regard to the differences between Brazil and Europe. In addition, we discuss priorities in clinical care, public health, and research.

https://doi.org/10.36416/1806-3756/e20210044 956 downloads

14.

Shortened tuberculosis treatment regimens: what is new?
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Silva, Denise Rossato

; Mello, Fernanda Carvalho de Queiroz

; Migliori, Giovanni Battista

Jornal Brasileiro de Pneumologia

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2020, Volume 46 N. 2 elocation e20200009

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Em virtude da carga global da tuberculose, esquemas mais curtos de tratamento com medicamentos já existentes ou reaproveitados são necessários para contribuir para o controle da doença. A longa duração do tratamento da tuberculose sensível (TBS) está relacionada com não adesão e perda de seguimento, e a taxa de sucesso do tratamento da tuberculose multirresistente (TBMR) é baixa (de aproximadamente 50%) com esquemas mais longos. Neste artigo de revisão, relatamos avanços recentes e ensaios clínicos em andamento cujo objetivo é encurtar os esquemas de tratamento de TBS e TBMR. Discutimos o papel da rifampicina em altas doses, assim como o da clofazimina e linezolida em esquemas de tratamento de TBS. Relatamos também os resultados de estudos observacionais e ensaios clínicos de avaliação de um esquema padronizado de nove meses à base de moxifloxacina para o tratamento de TBMR. Mais estudos, especialmente ensaios clínicos randomizados, são necessários para avaliar esquemas que incluam medicamentos mais novos, medicamentos comprovadamente ou provavelmente eficazes e medicamentos exclusivamente orais na tentativa de dispensar o uso de medicamentos injetáveis.

ABSTRACT Given the global burden of tuberculosis, shortened treatment regimens with existing or repurposed drugs are needed to contribute to tuberculosis control. The long duration of treatment of drug-susceptible tuberculosis (DS-TB) is associated with nonadherence and loss to follow up, and the treatment success rate of multidrug-resistant tuberculosis (MDR-TB) is low (approximately 50%) with longer regimens. In this review article, we report recent advances and ongoing clinical trials aimed at shortening regimens for DS-TB and MDR-TB. We discuss the role of high-dose rifampin, as well as that of clofazimine and linezolid in regimens for DS-TB. There are at least 5 ongoing clinical trials and 17 observational studies and clinical trials evaluating shorter regimens for DS-TB and MDR-TB, respectively. We also report the results of observational studies and clinical trials evaluating a standardized nine-month moxifloxacin-based regimen for MDR-TB. Further studies, especially randomized clinical trials, are needed to evaluate regimens including newer drugs, drugs proven to be or highly likely to be efficacious, and all-oral drugs in an effort to eliminate the need for injectable drugs.

https://doi.org/10.36416/1806-3756/e20200009 8565 downloads

15.

A summary of the proceedings of a meeting on the treatment of latent tuberculosis infection in target populations in Brazil
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Rolla, Valeria

; Trajman, Anete

; Kawamura, Masae

; Cavalcante, Solange

; Soares, Elizabeth

; Perini, Filipe de Barros

; Carvalho, Anna Cristina Calçada

; Croda, Julio

; Silva, Jose Roberto Lapa e

; Schmaltz, Carolina Arana Stanis

; Sant’Anna, Flavia Marinho

; Bastos, Mayara

; Gomes, Adriano

; Durovni, Betina

; Saraceni, Valeria

; Silva, Elisangela

; Mello, Fernanda Carvalho de Queiroz

; Santos, Marcelo Cordeiro dos

; Pinto, Marcia

; Santos, Marisa

; Sanches, Fernando Augusto Dias e

; Oliveira, Sandra Maria do Valle Leone de

Jornal Brasileiro de Pneumologia

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2020, Volume 46 N. 4 elocation e20200023

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36416/1806-3756/e20200023 296 downloads

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