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ABSTRACT BACKGROUND: The diagnosis and treatment of latent tuberculosis infection (LTBI) are crucial for tuberculosis (TB) control. Household contacts (HHC) of patients with pulmonary TB are at a high risk of LTBI due to their close proximity to source cases. OBJECTIVE: To describe the diagnosis and treatment of LTBI among HHC. DESIGN AND SETTING: This cross-sectional follow-up study was conducted in the municipality of Paulo Afonso, northeastern Brazil, between 2013 and 2022. METHODS: We retrieved secondary data from the medical records of HHC who were followed up at a specialized referral center for TB. LTBI prevalence estimates were calculated and are presented with 95% confidence intervals (CIs). RESULTS: In total, 622 HHC were screened for LTBI, with 620 evaluated using the tuberculin skin test (TST). Of these, 40 (6.5%) did not return for TST reading. The overall prevalence of LTBI was 53.1% (95% CI: 49–57.1%), with a high prevalence among females and individuals aged 25–34 years. The overall LTBI treatment initiation rate was 26.1% (95%CI: 21.5–31.3%), and 64.2% (95%CI: 53.3–73.8%) of HHC who initiated treatment completed their course. CONCLUSION: This study revealed a high prevalence of LTBI among HHC, particularly among women and individuals aged 25–34 years, underscoring the ongoing TB transmission within the community. Only 26.1% of the diagnosed HHC initiated treatment, with approximately 64% completing their course. This highlights the challenges in managing LTBI and emphasizes the need for targeted screening and interventions for high-risk groups. BACKGROUND (LTBI (TB control (HHC cases OBJECTIVE SETTING crosssectional cross sectional followup follow Afonso Brazil 201 2022 METHODS 95 CIs. CIs . (CIs) RESULTS total 62 TST. (TST) these 4 6.5% 65 6 5 (6.5% reading 531 53 1 53.1 (95 CI 49–57.1%, 49571 49–57.1% , 49 57 49–57.1%) 2534 25 34 25–3 years 261 26 26.1 95%CI 95CI (95%CI 21.5–31.3%, 215313 21.5–31.3% 21 31 3 21.5–31.3%) 642 64 2 64.2 53.3–73.8% 533738 73 8 course CONCLUSION community highrisk groups 20 202 9 (CIs (TST 6.5 (6.5 53. (9 4957 49–57.1 253 25– 26. 21531 21.5–31.3 64. 53.3–73.8 53373 7 6. (6. ( 495 49–57. 2153 21.5–31. 53.3–73. 5337 (6 49–57 215 21.5–31 53.3–73 533 49–5 21.5–3 53.3–7 49– 21.5– 53.3– 21.5 53.3 21.

https://doi.org/10.1590/1516-3180.2023.0339.r2.03072024

Advances in the development of new vaccines for tuberculosis and Brazil’s role in the effort forward the end TB strategy Brazils Brazil s
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Junqueira-Kipnis, Ana Paula

; Leite, Luciana Cesar de Cerqueira

; Croda, Júlio

; Chimara, Erica

; Carvalho, Anna Cristina C

; Arcêncio, Ricardo Alexandre

Memórias do Instituto Oswaldo Cruz

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2024, Volume 119 elocation e240093

Abstract: En | Text: En | PDF: En

Tuberculosis (TB) continues to be the world’s leading killer of infectious diseases. Despite global efforts to gradually reduce the number of annual deaths and the incidence of this disease, the coronavirus disease 19 (COVID-19) pandemic caused decreased in TB detection and affected the prompt treatment TB which led to a setback to the 2019 rates. However, the development and testing of new TB vaccines has not stopped and now presents the possibility of implanting in the next five years a new vaccine that is affordable and might be used in the various key vulnerable populations affected by TB. Then, this assay aimed to discuss the main vaccines developed against TB that shortly could be selected and used worldwide, and additionally, evidence the Brazilian potential candidates’ vaccines in developing in Brazil that could be considered among those in level advanced to TB end. (TB worlds world s diseases 1 COVID19 COVID (COVID-19 201 rates However Then worldwide additionally candidates end COVID1 (COVID-1 20 (COVID- 2 (COVID

https://doi.org/10.1590/0074-02760240093

PPE59 antibodies in tuberculous patients and potential use for diagnosis when assayed with other rapid biomarkers PPE PPE5
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Mulinari, Ana Carla de Paulo

; Sardella, Isabela Gama

; da Silva, Vania Maria C

; Matteelli, Alberto

; Carvalho, Anna Cristina C

; Saad, Maria Helena Féres

Memórias do Instituto Oswaldo Cruz

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2024, Volume 119 elocation e230183

Abstract: En | Text: En | PDF: En

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

https://doi.org/10.1590/0074-02760230183

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

Implantação do protocolo de vigilância do óbito com menção de tuberculose e seus efeitos na vigilância de um município brasileiro de grande porte
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Cordeiro, Dinah Carvalho

; Gonçalves, Maria Jacirema Ferreira

Cadernos de Saúde Pública

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2022, Volume 38 N. 2 elocation e00356120

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

O objetivo deste estudo foi avaliar o grau de implantação e de impacto do protocolo de vigilância do óbito por tuberculose (TB) em um município de grande porte e com elevada carga de TB. Para esta pesquisa avaliativa, elaborou-se um modelo lógico e matriz de julgamento. Os dados primários foram coletados a partir de um questionário aplicado aos profissionais e os dados secundários foram obtidos na Secretaria Municipal de Saúde de Manaus, Amazonas, Brasil. O impacto da adoção do protocolo foi analisado pelos indicadores de resultados e a evolução das taxas de incidência e mortalidade por TB, a partir da regressão linear simples e variação percentual. O grau de implantação da vigilância do óbito com menção de TB identificado foi parcial (51%). Quanto à evolução dos indicadores de incidência e mortalidade por TB, observou-se tendência significativa de aumento da taxa da incidência de TB no período de 2006 a 2019. A mortalidade por TB e a proporção dos óbitos com confirmação laboratorial para TB apresentaram incremento após a implantação do protocolo, indicando aumento da vigilância. A implantação parcial da vigilância do óbito de TB indica necessidades de mudanças no processo de trabalho da equipe que gerencia o Sistema de Informações sobre Mortalidade e o Programa de Controle da TB municipal. As mudanças observadas demonstram mais qualificação das informações do óbito por TB, assim como a vigilância no diagnóstico da TB contribuiu para a definição de casos com confirmação laboratorial para TB.

The study aimed to assess the degree of implementation and impact of the protocol for surveillance of deaths from tuberculosis (TB) in a large city with a high TB burden. For this evaluative study, a log frame model with a assessment matrix was elaborated. Primary data were collected with a questionnaire applied to healthcare workers, and secondary data were obtained from the Manaus Municipal Health Department, Amazonas State, Brazil. The impact of the protocol’s adoption was analyzed according to the indicators of results and evolution of TB incidence and mortality rates based on simple linear regression and percent change. The degree of implementation of surveillance of deaths with mention of TB was partial (51%). Evolution of TB incidence and mortality showed a significant upward trend in TB incidence from 2006 to 2019. TB mortality and the proportion of deaths with laboratory confirmation of TB showed an increase in the protocol’s implementation, indicating an increase in surveillance. Partial implementation of TB mortality surveillance suggests the need for changes in the work processes of the team managing the Brazilian Mortality Information System and the Municipal TB Control Program. The changes demonstrate improvement of information on TB deaths and the contribution of surveillance of TB diagnosis to definition of cases with TB laboratory confirmation.

El objetivo de este estudio fue evaluar el grado de implantación y de impacto del Protocolo de vigilancia de óbitos por tuberculosis (TB) en un municipio de gran tamaño y con elevada carga de TB. Para esta investigación evaluativa se elaboró un modelo lógico, así como una matriz de juicio. Los datos primarios se recogieron a partir de un cuestionario aplicado a profesionales y los datos secundarios se obtuvieron de la Secretaría Municipal de Salud de Manaos, Amazonas, Brasil. El impacto de la adopción del protocolo se analizó mediante indicadores de resultados, así como la evolución de las tasas de incidencia y mortalidad por TB, a partir de una regresión lineal simple y variación porcentual. El grado de implantación de la vigilancia del óbito con mención de TB identificado fue parcial (51%). En cuanto a la evolución de los indicadores de incidencia y mortalidad por TB, se observó una tendencia significativa de aumento de la tasa de la incidencia de TB en el período de 2006 a 2019. La mortalidad por TB, así como la proporción de los óbitos con confirmación de laboratorio para TB presentaron un incremento tras la implantación del protocolo, indicando un aumento de la vigilancia. La implantación parcial de la vigilancia de óbitos por TB indica que son necesarios cambios en el proceso de trabajo del equipo que gestiona el Sistema de Informaciones sobre Mortalidad y el Programa de Control de la TB municipal. Los cambios observados demuestran más cualificación respecto a la información del óbito por TB, así como la conclusión de que vigilancia en el diagnóstico de la TB contribuyó a la definición de casos con confirmación de TB por parte de laboratorios.

https://doi.org/10.1590/0102-311x00356120

Implantação do protocolo de vigilância do óbito com menção de tuberculose e seus efeitos na vigilância de um município brasileiro de grande porte
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Cordeiro, Dinah Carvalho

; Gonçalves, Maria Jacirema Ferreira

Cadernos de Saúde Pública

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2022, Volume 38 N. 2 elocation e00356120

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

https://doi.org/10.1590/0102-311x00356120

Tuberculosis: knowledge among nursing undergraduate students
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Carvalho, Cleina de Fátima

; Ponce, Maria Amélia Zanon

; Silva-Sobrinho, Reinaldo Antonio da

; Mendez, Roberto Della Rosa

; Santos, Mariana Alvina dos

; Santos, Edirlei Machado dos

; Wysocki, Anneliese Domingues

Revista Brasileira de Enfermagem

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oct 2019, Volume 72 N. 5 Pages 1279 - 1287

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

RESUMO Objetivo: Analisar o conhecimento sobre a tuberculose entre alunos de graduação de Enfermagem de uma Universidade Federal de Ensino Superior. Método: Estudo descritivo realizado de maneira transversal, com abordagem quantitativa. Os dados foram coletados por meio de questionário elaborado com base no guia da OMS para desenvolvimento de instrumentos de avaliação de conhecimento, atitudes e práticas relacionados à tuberculose. Os alunos foram categorizados em grupos de “conhecimento” e “pouco conhecimento” com base no percentual médio de respostas para as variáveis analisadas. Utilizaram-se técnicas de estatística descritiva. Resultados: Entrevistaram-se 60 alunos de enfermagem. Observou-se “pouco conhecimento” entre alunos com menor tempo de estudo na universidade e sem contato prévio com o tema e “conhecimento” entre aqueles cujo conhecimento sobre a tuberculose foi adquirido nos serviços de saúde. Conclusão: Identificaram-se falhas no conhecimento entre alunos de graduação em enfermagem, sugerindo necessidade de repensar estratégias de ensino-aprendizagem sobre o tema.

ABSTRACT Objective: To analyze the knowledge about tuberculosis among nursing undergraduate students of a Federal Higher Education Institution. Method: Descriptive cross-sectional study, with quantitative approach. Data were collected through a questionnaire based on the WHO’s guide to developing evaluation instruments on knowledge, attitudes and practices related to TB. Students were classified as “with knowledge” and “with little knowledge” based on the mean percentage of correct responses to the variables analyzed. Descriptive statistics techniques were used. Results: 60 nursing students were interviewed. “with little knowledge” was observed among students who were studying at the university for less time and who had no previous contact with the subject, and “with knowledge” was observed among those whose knowledge about tuberculosis was acquired in the health services. Conclusion: Knowledge gaps among undergraduate nursing students were identified, suggesting the need to rethink teaching-learning strategies on the subject.

RESUMEN Objetivo: analizar el conocimiento acerca de la tuberculosis entre alumnos de graduación de Enfermería de una Universidad Federal de Enseñanza Superior. Método: se trata de un estudio descriptivo, de abordaje cuantitativo, realizado de manera transversal. Los datos se recogieron con un cuestionario basado en la guía de la OMS para el desarrollo de instrumentos de evaluación sobre conocimientos, actitudes y prácticas relacionadas con la tuberculosis. Los alumnos se categorizaron en grupos de “conocimiento” y “poco conocimiento”, según el promedio de respuestas para las variables analizadas. Se utilizaron técnicas de estadística descriptiva. Resultados: de los 60 alumnos entrevistados, se advirtió “poco conocimiento” entre los que tenían menos tiempo de estudio en la universidad y prácticamente ningún contacto anterior con el tema, y “conocimiento”, entre aquellos que habían aprendido sobre la tuberculosis en los servicios de salud. Conclusión: el conocimiento sobre la tuberculosis entre alumnos de graduación de enfermería es exiguo, lo que demuestra la necesidad de repensar estrategias de enseñanza-aprendizaje sobre el tema.

https://doi.org/10.1590/0034-7167-2018-0384 2419 downloads

Tuberculosis: knowledge among nursing undergraduate students
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Carvalho, Cleina de Fátima

; Ponce, Maria Amélia Zanon

; Silva-Sobrinho, Reinaldo Antonio da

; Mendez, Roberto Della Rosa

; Santos, Mariana Alvina dos

; Santos, Edirlei Machado dos

; Wysocki, Anneliese Domingues

Revista Brasileira de Enfermagem

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oct 2019, Volume 72 N. 5 Pages 1279 - 1287

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

https://doi.org/10.1590/0034-7167-2018-0384 51 downloads

Latent tuberculosis infection in patients with rheumatic diseases
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Anton, Camila

; Machado, Felipe Dominguez

; Ramirez, Jorge Mario Ahumada

; Bernardi, Rafaela Manzoni

; Palominos, Penélope Esther

; Brenol, Claiton Viegas

; Mello, Fernanda Carvalho de Queiroz

; Silva, Denise Rossato

Jornal Brasileiro de Pneumologia

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2019, Volume 45 N. 2 elocation e20190023

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

RESUMO A maioria das pessoas infectadas por Mycobacterium tuberculosis (Mtb) não possui sinais ou sintomas da doença, quadro conhecido como infecção latente por tuberculose (ILTB). A introdução de agentes biológicos, sobretudo inibidores do fator de necrose tumoral (iTNF), para o tratamento de doenças imunomediadas, como artrite reumatoide (AR) e outras doenças reumatológicas, aumentou o risco de reativação de ILTB, levando ao desenvolvimento de tuberculose (TB) ativa. Assim, esta revisão abordará os aspectos relacionados à ILTB em pacientes com doenças reumatológicas, especialmente naqueles em uso de medicamentos iTNF. Para tanto, serão considerados a definição e a prevalência de ILTB, os mecanismos associados às doenças e às medicações em uso, bem como os critérios para rastreamento, diagnóstico e tratamento da ILTB. Como a reativação da ILTB é responsável pela grande proporção de casos de TB ativa, o diagnóstico e o tratamento adequados são cruciais, principalmente em grupos de alto risco, como os pacientes com doenças reumatológicas.

ABSTRACT Most people infected by Mycobacterium tuberculosis (Mtb) do not have any signs or disease symptoms, a condition known as latent tuberculosis infection (LTBI). The introduction of biological agents, mainly tumor necrosis factor (TNF) inhibitors, for the treatment of immune-mediated diseases such as Rheumatoid Arthritis (RA) and other rheumatic diseases, increased the risk of reactivation of LTBI, leading to development of active TB. Thus, this review will approach the aspects related to LTBI in patients with rheumatologic diseases, especially those using iTNF drugs. For this purpose it will be considered the definition and prevalence of LTBI, mechanisms associated with diseases and medications in use, criteria for screening, diagnosis and treatment. Considering that reactivation of LTBI accounts for a large proportion of the incidence of active TB, adequate diagnosis and treatment are crucial, especially in high-risk groups such as patients with rheumatologic diseases.

https://doi.org/10.1590/1806-3713/e20190023 3912 downloads

10.

Epidemiological aspects, clinical manifestations, and prevention of pediatric tuberculosis from the perspective of the End TB Strategy
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Carvalho, Anna Cristina Calçada

; Cardoso, Claudete Aparecida Araújo

; Martire, Terezinha Miceli

; Migliori, Giovanni Battista

; Sant’Anna, Clemax Couto

Jornal Brasileiro de Pneumologia

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apr 2018, Volume 44 N. 2 Pages 134 - 144

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

RESUMO A tuberculose continua sendo uma prioridade de saúde pública em muitos países. Em 2015, a tuberculose matou 1,4 milhão de pessoas, incluindo 210.000 crianças. Apesar dos recentes progressos no controle da tuberculose no nosso país, o Brasil ainda é um dos países com maior carga de tuberculose. Em 2015, houve 69.000 casos de tuberculose notificados no Brasil e a tuberculose foi a causa de 4.500 mortes no país. Em 2014, a Organização Mundial da Saúde aprovou a Estratégia End TB, que estabeleceu 2035 como data-alvo para atingir suas metas de redução da incidência de tuberculose em 90% e do número de mortes por tuberculose em 95%. No entanto, para alcançar essas metas no Brasil, há a necessidade de colaboração entre os diversos setores envolvidos no controle da tuberculose e de priorização de atividades, incluindo medidas de controle voltadas às populações mais vulneráveis. As crianças são altamente vulneráveis à tuberculose, e há particularidades específicas dos pacientes pediátricos quanto ao desenvolvimento da tuberculose (rápida progressão da infecção para a doença ativa), prevenção (baixa eficácia da vacinação contra as formas pulmonares e disponibilidade limitada de tratamento preventivo da infecção tuberculosa latente), diagnóstico (baixa taxa de diagnóstico confirmado bacteriologicamente); e tratamento (pouca disponibilidade de fármacos antituberculose próprios para crianças). Nesta revisão, discutimos a epidemiologia, as manifestações clínicas e a prevenção da tuberculose na infância e adolescência, destacando as peculiaridades da tuberculose ativa e latente nessas faixas etárias, a fim de promover a reflexão sobre novas abordagens para o manejo da tuberculose pediátrica no àmbito da Estratégia End TB.

ABSTRACT Tuberculosis continues to be a public health priority in many countries. In 2015, tuberculosis killed 1.4 million people, including 210,000 children. Despite the recent progress made in the control of tuberculosis in Brazil, it is still one of the countries with the highest tuberculosis burdens. In 2015, there were 69,000 reported cases of tuberculosis in Brazil and tuberculosis was the cause of 4,500 deaths in the country. In 2014, the World Health Organization approved the End TB Strategy, which set a target date of 2035 for meeting its goals of reducing the tuberculosis incidence by 90% and reducing the number of tuberculosis deaths by 95%. However, to achieve those goals in Brazil, there is a need for collaboration among the various sectors involved in tuberculosis control and for the prioritization of activities, including control measures targeting the most vulnerable populations. Children are highly vulnerable to tuberculosis, and there are particularities specific to pediatric patients regarding tuberculosis development (rapid progression from infection to active disease), prevention (low effectiveness of vaccination against the pulmonary forms and limited availability of preventive treatment of latent tuberculosis infection), diagnosis (a low rate of bacteriologically confirmed diagnosis), and treatment (poor availability of child-friendly anti-tuberculosis drugs). In this review, we discuss the epidemiology, clinical manifestations, and prevention of tuberculosis in childhood and adolescence, highlighting the peculiarities of active and latent tuberculosis in those age groups, in order to prompt reflection on new approaches to the management of pediatric tuberculosis within the framework of the End TB Strategy.

https://doi.org/10.1590/s1806-37562017000000461 21718 downloads

11.

Correlation between the BACTEC MGIT 960 culture system with Genotype MTBDRplus and TB-SPRINT in multidrug resistant Mycobacterium tuberculosis clinical isolates from Brazil
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Dantas, Nayanne Gama Teixeira

; Suffys, Phillip Noel

; Carvalho, Wânia da Silva

; Gomes, Harrison Magdinier

; Almeida, Isabela Neves de

; Figueiredo, Lida Jouca de Assis

; Gonçalves, Alan Douglas

; Gomgnimbou, Michel Kireopori

; Refregier, Guislaine

; Sola, Christophe

; Miranda, Silvana Spíndola de

Memórias do Instituto Oswaldo Cruz

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nov 2017, Volume 112 N. 11 Pages 769 - 774

Abstract: En | Text: En | PDF: En

BACKGROUND The accurate detection of multidrug-resistant tuberculosis (MDR-TB) is critical for the application of appropriate patient treatment and prevention of transmission of drug-resistant Mycobacterium tuberculosis isolates. The goal of this study was to evaluate the correlation between phenotypic and molecular techniques for drug-resistant tuberculosis diagnostics. Molecular techniques used were the line probe assay genotype MTBDRplus and the recently described tuberculosis-spoligo-rifampin-isoniazid typing (TB-SPRINT) bead-based assay. Conventional drug susceptibility testing (DST) was done on a BACTECTM MGIT 960 TB. METHOD We studied 80 M. tuberculosis complex (MTC) clinical isolates from Minas Gerais state, of which conventional DST had classified 60 isolates as MDR and 20 as drug susceptible. FINDINGS Among the 60 MDR-TB isolates with MGIT as a reference, sensitivity, specificity, accuracy, and kappa for rifampicin (RIF) resistance using TB-SPRINT and MTBDRplus, were 96.7% versus 93.3%, 100.0% versus 100.0%, 97.5% versus 95.0% and 0.94 versus 0.88, respectively. Similarly, the sensitivity, specificity, accuracy, and kappa for isoniazid (INH) resistance were 85.0% and 83.3%, 100.0% and 100.0%, 88.8% and 87.5% and 0.74 and 0.71 for both tests, respectively. Finally, the sensitivity, specificity, accuracy, and kappa for MDR-TB were 85.0% and 83.3%, 100.0% and 100.0%, 88.8% and 87.5% and 0.74 and 0.71 for both tests, respectively. MAIN CONCLUSIONS Both methods exhibited a good correlation with the conventional DST. We suggest estimating the cost-effectiveness of MTBDRplus and TB-SPRINT in Brazil.

https://doi.org/10.1590/0074-02760170062 1460 downloads

12.

Incidence of tuberculosis among patients with rheumatoid arthritis using TNF blockers in Brazil: data from the Brazilian Registry of Biological Therapies in Rheumatic Diseases (Registro Brasileiro de Monitoração de Terapias Biológicas - BiobadaBrasil)
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Yonekura, Claudia Leiko

; Oliveira, Rene Donizeti Ribeiro

; Titton, David C.

; Ranza, Roberto

; Ranzolin, Aline

; Hayata, André L.

; Duarte, Ângela

; Silveira, Inês G.

; Carvalho, Hellen M. da S. de

; Moraes, Júlio C. Bertacini de

; Abreu, Mirhelen Mendes de

; Valim, Valéria

; Bianchi, Washington

; Brenol, Claiton Viegas

; Pereira, Ivanio A.

; Costa, Izaias

; Macieira, José C.

; Miranda, José R.S.

; Guedes-Barbosa, Luiz S.

; Bertolo, Manoel B.

; Sauma, Maria Fátima Lobato da C.

; Silva, Marília B.G.

; Freire, Marlene

; Scheinberg, Morton A.

; Toledo, Roberto A.

; Oliveira, Sheila K.F.

; Fernandes, Vander

; Pinheiro, Marcelo M.

; Castro, Glaucio

; Vieira, Walber Pinto

; Baaklini, Cesar Emile

; Ruffino-Netto, Antonio

; Pinheiro, Geraldo da Rocha Castelar

; Laurindo, Ieda Maria Magalhães

; Louzada-Junior, Paulo

Revista Brasileira de Reumatologia

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2017, Volume 57 Suppl. 2 Pages s477 - s483

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

Resumo Objetivos Avaliar incidência de tuberculose e triagem para tuberculose latente em brasileiros com artrite reumatoide em uso de agentes biológicos na prática clinica. Pacientes e métodos Estudo de coorte com dados do Registro Brasileiro de Monitoração de Terapias Biológicas (BiobadaBrasil), de 01/2009 a 05/2013, abrangeu 1.552 tratamentos, 415 somente com drogas modificadoras do curso da doença (MMCDs) sintéticas, 942 MMCDs sintéticas em associação com anti-TNF (etanercepte, infliximabe, adalimumabe) e 195 MMCDs sintéticas em associação com outros biológicos (abatacepte, rituximabe e tocilizumabe). Avaliaram-se ocorrência de tuberculose, tempo de exposição às drogas e triagem para TB. Análise estatística: teste t não pareado e teste de Fisher bicaudal; p < 0,05. Resultados O tempo de exposição dos controles foi de 981 pacientes-ano, do grupo de anti-TNF foi de 1.744 pacientes-ano (adalimumabe = 676, infliximabe = 547 e etanercepte = 521 pacientes-ano) e o de outros biológicos de 336 pacientes-ano. A incidência de TB foi de 1,01/1.000 pacientes-ano nos controles e de 2,87 pacientes-ano nos usuários de anti-TNF (adalimumabe = 4,43/1.000 pacientes-ano; etanercepte = 1,92/1.000 pacientes-ano e infliximabe = 1,82/1.000 pacientes-ano). Não houve casos de tuberculose no grupo de outros biológicos. O tempo médio de exposição até a ocorrência de tuberculose foi de 27(11) meses para o grupo anti-TNF. Conclusões A incidência de tuberculose foi maior nos usuários de MMCDs sintéticas e anti-TNF do que nos usuários de MMCDs sintéticas e de MMCDs sintéticas e biológicos não anti-TNF, e também mais tardia, sugerindo infecção durante o tratamento, e não falha na triagem.

Abstract Objectives To assess the incidence of tuberculosis and to screen for latent tuberculosis infection among Brazilians with rheumatoid arthritis using biologics in clinical practice. Patients and methods This cohort study used data from the Brazilian Registry of Biological Therapies in Rheumatic Diseases (Registro Brasileiro de Monitoração de Terapias Biológicas - BiobadaBrasil), from 01/2009 to 05/2013, encompassing 1552 treatments, including 415 with only synthetic disease-modifying anti-rheumatic drugs, 942 synthetic DMARDs combined with anti-tumor necrosis factor (etanercept, infliximab, adalimumab) and 195 synthetic DMARDs combined with other biologics (abatacept, rituximab and tocilizumab). The occurrence of tuberculosis and the drug exposure time were assessed, and screening for tuberculosis was performed. Statistical analysis: Unpaired t-test and Fisher's two-tailed test; p < 0.05. Results The exposure times were 981 patient-years in the controls, 1744 patient-years in the anti-TNF group (adalimumab = 676, infliximab = 547 and etanercept = 521 patient-years) and 336 patient-years in the other biologics group. The incidence rates of tuberculosis were 1.01/1000 patient-years in the controls and 2.87 patient-years among anti-TNF users (adalimumab = 4.43/1000 patient-years; etanercept = 1.92/1000 patient-years and infliximab = 1.82/1000 patient-years). No cases of tuberculosis occurred in the other biologics group. The mean drug exposure time until the occurrence of tuberculosis was 27(11) months for the anti-TNF group. Conclusions The incidence of tuberculosis was higher among users of synthetic DMARDs and anti-TNF than among users of synthetic DMARDs and synthetic DMARDs and non-anti-TNF biologics and also occurred later, suggesting infection during treatment and no screening failure.

https://doi.org/10.1016/j.rbre.2017.05.005 3602 downloads

13.

The distribution of tuberculosis in Porto Alegre: analysis of the magnitude and tuberculosis-HIV coinfection
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Peruhype, Rarianne Carvalho

; Acosta, Lisiane Morelia Weide

; Ruffino Netto, Antônio

; Oliveira, Mônica Maria Celestina de

; Palha, Pedro Fredemir

Revista da Escola de Enfermagem da USP

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dec 2014, Volume 48 N. 6 Pages 1035 - 1043

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

Objective Analyzing the geographical distribution of the tuberculosis (TB), its incidence and prevalence and TB-HIV coinfection in the districts of Porto Alegre from 2007 to 2011. Method An ecological, descriptive study of time series that used descriptive and geoprocessing techniques. Results In total, were recorded 3,369 incident cases and 3,998 prevalent cases of pulmonary TB. In both contexts, there was predominance of cases in males and in Caucasians. Seventeen districts showed prevalence rates above 79.2 cases/100,000 inhabitants, considering that 15 of them had incidence rates above 73.7 cases/100,000 inhabitants. The TB-HIV coinfection rates reached 67% in some districts, which is above the city average value (30%). Conclusion The distribution analysis showed that the reformulation and restructuring of policies and health services in Porto Alegre are essential. 

Objetivo Analizar la distribución geográfica de la enfermedad, su incidencia, prevalencia y la coinfección TB - VIH en los barrios de este municipio en los años de 2007 a 2011. Método Estudio ecológico de serie histórica, descriptivo, que utilizó técnicas descriptivas y de geoprocesamiento. Resultados Fueron registrados 3.369 casos nuevos y 3.998 casos prevalentes de tuberculosis pulmonar bacilífera. En ambos contextos hubo predominancia de casos en el sexo masculino y la etnia blanca. Diecisiete barrios presentaron índices de prevalencia superiores a 79,2 casos/100.000 habitantes, siendo que 15 de esos tuvieron incidencia arriba de 73,7 casos/100.000 habitantes. El índice de coinfección TB-VIH alcanzó el 67% en algunos barrios, valor superior al promedio de la ciudad (30%). Conclusión El análisis de distribución señaló que son fundamentales las reformulaciones y reestructuraciones de políticas y servicios de salud en Porto Alegre.

Objetivo Analisar a distribuição geográfica da doença, sua incidência, prevalência e a coinfecção TB - HIV nos bairros deste município nos anos de 2007 a 2011. Método Estudo ecológico de série histórica, descritivo, que utilizou técnicas descritivas e de geoprocessamento. Resultados Foram registrados 3.369 casos novos e 3.998 casos prevalentes de tuberculose pulmonar bacilífera. Em ambos os contextos houve predominância de casos no sexo masculino e na etnia branca. Dezessete bairros apresentaram taxas de prevalência acima de 79,2 casos/100.000 habitantes, sendo que 15 deles tiveram incidência acima de 73,7 casos/100.000 habitantes. A taxa de coinfecção TB-HIV chegou a 67% em alguns bairros, valor superior à média da cidade (30%). Conclusão A análise de distribuição apontou que são fundamentais reformulações e reestruturações de políticas e serviços de saúde em Porto Alegre.

https://doi.org/10.1590/S0080-623420140000700011 2 downloads

14.

The distribution of tuberculosis in Porto Alegre: analysis of the magnitude and tuberculosis-HIV coinfection
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Peruhype, Rarianne Carvalho

; Acosta, Lisiane Morelia Weide

; Ruffino Netto, Antônio

; Oliveira, Mônica Maria Celestina de

; Palha, Pedro Fredemir

Revista da Escola de Enfermagem da USP

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dec 2014, Volume 48 N. 6 Pages 1035 - 1043

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

https://doi.org/10.1590/S0080-623420140000700011 9402 downloads

15.

Estigma social e as famílias de doentes com tuberculose: um estudo a partir das análises de agrupamento e de correspondência múltipla
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Touso, Michelle Mosna

; Popolin, Marcela Paschoal

; Crispim, Juliane de Almeida

; Freitas, Isabela Moreira de

; Rodrigues, Ludmila Barbosa Bandeira

; Yamamura, Mellina

; Pinto, Ione Carvalho

; Monroe, Aline Aparecida

; Palha, Pedro Fredemir

; Ferraudo, Antônio Sérgio

; Villa, Tereza Cristina Scatena

; Arcêncio, Ricardo Alexandre

Ciência & Saúde Coletiva

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nov 2014, Volume 19 N. 11 Pages 4577 - 4586

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

O estigma social da tuberculose é um desafio que se coloca à gestão do cuidado na área da saúde pública. O objetivo deste estudo foi investigar o estigma social em famílias de doentes com TB e identificar o perfil daquelas que são acometidas pelo evento em relação às condições socioeconômicas e demográficas. Trata-se de um estudo transversal realizado no município de Ribeirão Preto, São Paulo, Brasil, em 2011, com uma amostra de 110 sujeitos. Os dados foram analisados mediante técnica descritiva univariada e análises de agrupamento e de correspondência múltipla. Os grupos com estigma apresentaram baixa escolaridade, acesso incipiente aos meios de informação e pouca mobilização referente à compreensão sobre a doença, diferenciando-se dos demais grupos que apresentam comportamentos e atitudes positivas, com níveis de escolaridade mais elevados, acesso contínuo aos meios de informação e se dizem conhecedores da TB. A identificação de diferentes perfis aponta para necessidade de serem desenvolvidas ações em saúde sensíveis às singularidades das famílias no que se refere ao estigma social da doença.

The social stigma associated with TB is a challenge facing management of the area of public health care. The aim of this study was to investigate the social stigma in families of patients with TB and identify the profile of those who are affected by the event in relation to socioeconomic and demographic conditions. It is a cross-sectional study that was conducted in 2011 in the city of Ribeirão Preto, state of São Paulo, Brazil, with a sample of 110 individuals. The data were analyzed using the univariate descriptive technique and cluster and multiple correspondence assessment. The stigmatized groups tend to have lower scholarity, incipient access to the media and little understanding about TB, as opposed to those that have higher educational levels, continuous access to the media, consider themselves well informed and show proactive attitudes to deal with the disease. The identification of varied profiles highlights the need to develop health interventions to cater to the singularities of families with respect to the social stigma of the disease.

https://doi.org/10.1590/1413-812320141911.46062013 4661 downloads Cited 4 times in SciELO

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