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Avaliação do desempenho dos serviços de atenção primária à saúde no controle da tuberculose em metrópole do Sudeste do Brasil
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Rabelo, Juliana Veiga Costa

; Navarro, Pedro Daibert de

; Carvalho, Wânia da Silva

; Almeida, Isabela Neves de

; Oliveira, Camila Stefânie Fonseca

; Haddad, João Paulo Amaral

; Miranda, Silvana Spindola de

Cadernos de Saúde Pública

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2021, Volume 37 N. 3 elocation e00112020

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

Resumo: A Organização Mundial da Saúde destaca a importância da organização e do desempenho dos serviços de saúde nas ações de controle da tuberculose. O objetivo deste estudo foi avaliar o desempenho dos serviços de atenção primaria à saúde em Belo Horizonte, Minas Gerais, Brasil, em relação às ações de controle da tuberculose nos eixos Estrutura e Processo, antes e após a utilização do instrumento validado denominado Estratificação por Grau de Risco Clínico e de Abandono do Tratamento da Tuberculose (ERTB). Estudo descritivo e prospectivo, no qual foram realizadas duas entrevistas (455 profissionais), tendo a segunda ocorrido após a ERTB. A classificação do desempenho seguiu os valores: ≤ 49,9%, críticos; entre 50% e 79,9%, insatisfatórios; e, ≥ 80%, satisfatórios. Na avaliação comparativa, foi utilizado o teste estatístico de McNemar, com p < 0,05. Após a estratificação de risco, a maior parte das variáveis de cada eixo melhorou significativamente. Nós concluímos que, por meio de um questionário padronizado, foi possível identificar o desempenho satisfatório dos serviços de atenção primária à saúde em Belo Horizonte em relação às ações de controle da tuberculose, na maioria das variáveis avaliadas nos eixos Estrutura e Processo.

Abstract: The World Health Organization highlights the importance of health services organization and performance in tuberculosis (TB) control activities. This study aimed to assess the performance of primary healthcare services in Belo Horizonte, Minas Gerais State, Brazil, in TB control activities in the dimensions Structure and Process, before and after the use of a validated instrument called Stratification by Degree of Clinical Risk and Tuberculosis Treatment Dropout (ERTB). This was a descriptive and prospective study with two interviews (455 professionals), the second of which after the ERTB. Performance classification was: ≤ 49.9%, critical; 50-79.9%, unsatisfactory, and ≥ 80%, satisfactory. The comparative assessment used the McNemar statistical test with p < 0.05. After risk stratification, most of the variables in each dimension improved significantly. The authors conclude that it was possible to identify satisfactory performance in most of the variables assessed in the Structure and Process dimensions in primary healthcare services in Belo Horizonte in relation to TB control activities, using a standardized questionnaire.

Resumen: La Organización Mundial de la Salud destaca la importancia de la organización y del desempeño de los servicios de salud en acciones de control de la tuberculosis. El objetivo de este estudio fue evaluar el desempeño de los servicios de atención primaria en salud en Belo Horizonte, Minas Gerais, Brasil, en relación con las acciones de control de la tuberculosis respecto a los ejes Estructura y Proceso, antes y después de la utilización del instrumento validado, denominado Estratificación por Grado de Riesgo Clínico y de Abandono del Tratamiento de la Tuberculosis (ERTB). Se trata de un estudio descriptivo y prospectivo, donde se realizaron dos entrevistas (455 profesionales), siendo que la segunda se produjo tras la ERTB. La clasificación del desempeño siguió los valores: ≤ 49,9%, críticos; entre 50 y 79,9%, insatisfactorios; y, ≥ 80%, satisfactorios. En la evaluación comparativa, se utilizó el test estadístico de McNemar, con p < 0,05. Tras la estratificación de riesgo, la mayor parte de las variables de cada eje mejoró significativamente. Concluimos que fue posible identificar el desempeño satisfactorio en la mayoría de las variables evaluadas en los ejes Estructura y Proceso de los servicios de atención primaria en salud en Belo Horizonte, en relación con las acciones de control de la tuberculosis mediante un cuestionario estandarizado.

https://doi.org/10.1590/0102-311x00112020 740 downloads

Avaliação do desempenho dos serviços de atenção primária à saúde no controle da tuberculose em metrópole do Sudeste do Brasil
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Rabelo, Juliana Veiga Costa

; Navarro, Pedro Daibert de

; Carvalho, Wânia da Silva

; Almeida, Isabela Neves de

; Oliveira, Camila Stefânie Fonseca

; Haddad, João Paulo Amaral

; Miranda, Silvana Spindola de

Cadernos de Saúde Pública

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2021, Volume 37 N. 3 elocation e00112020

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

https://doi.org/10.1590/0102-311x00112020

Pulmonary functional assessment: longitudinal study after treatment of pulmonary tuberculosis
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Nishi, Marina Pires

; Mancuzo, Eliane Viana

; Sulmonett, Nara

; Almeida, Isabela Neves de

; César, Aina Liz Alves

; Miranda, Silvana Spindola de

Revista do Instituto de Medicina Tropical de São Paulo

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2021, Volume 63 elocation e65

Abstract: En | Text: En | PDF: En

ABSTRACT Even when treated adequately, pulmonary tuberculosis can lead to pulmonary sequelae. Patients treated for PTB between 2012 and 2016 answered a standardized questionnaire and underwent chest radiography and spirometry, measurement of absolute pulmonary volume, Diffusing Capacity for Carbon Monoxide (DLCO) and the 6-min walk test (6MWT) on two occasions: within the first year after the end of treatment (follow-up 1), and one and two years after follow-up 1 (follow-up 2). A total of 55 patients they underwent spirometry, 23 (41.82%) had obstructive ventilatory disorder (OVD) and eight (14.5%) had moderate OVD. In total, 29 patients underwent pulmonary function tests (PFTs) and 24 patients underwent the 6MWT on two occasions. The functional changes after PTB treatment appear not to have varied between one and two years of follow-up. There was a correlation between low FEV1 and low DLCO (p<0.001); low DLCO and low 6MWT (p<0.001) and radiographic abnormalities and low FEV1 (p=0.033). The most frequently observed change in spirometry was found in patients with OVD.

https://doi.org/10.1590/s1678-9946202163065 164 downloads

Detection of Drug Resistant Mycobacterium Tuberculosis Strains Using Kit SIRE Nitratase®: a Multicenter Study
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Miranda, Silvana Spindola de

; Almeida, Isabela Neves de

; Mansur, Maria de Fátima Filardi Oliveira

; Figueredo, Lida Jouca de Assis

; Carvalho, Wânia da Silva

; Hadaad, João Paulo Amaral

; Diniz, Jaciara de Lourdes do Carmo Guimarães

; Groll, Andrea von

; Silva, Pedro Almeida da

; Lopes, Maria Luiza

; Santos, Marcelo Cordeiro dos

; Brito, Alexandra

; Mello, Fernanda Carvalho de Queiroz

; Malaquias, Thiago da Silva Santos

; Croda, Julio

; Pinhata, Juliana Maira Watanabe

; Oliveira, Rosângela Siqueira de

; Chimara, Erica

; Rossetti, Maria Lúcia

; Halon, Maria Laura

; Lourenço, Maria Cristina

; Medeiros, Reginalda Ferreira de Melo

; Montes, Fátima Cristina Onofre Fandinho

; Machado, Diana

; Viveiros, Miguel

; Kritski, Afrânio Lineu

Brazilian Archives of Biology and Technology

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2020, Volume 63 elocation e20190179

Abstract: En | Text: En | PDF: En

Abstract (1) Background: The Commercial Kit SIRE Nitratase® PlastLabor, is a drug susceptibility test kit used to detect Mycobacterium tuberculosis resistance to first-line TB treatment drugs. The present study aimed at evaluating its performance in a multicenter study. (2) Methods: To determine its accuracy, the proportion methods in Lowenstein Jensen medium or the BACTECTMMGITTM960 system was used as a gold standard. (3) Results: The study revealed that the respective accuracies of the kit with 190 M. tuberculosis clinical isolates, using the proportion methods in Lowenstein Jensen medium or BACTECTMMGITTM960 system as a gold standard, were 93.9% and 94.6%, 96.9% and 94.6%, 98.0% and 97.8%, and 98.0% and 98.9%, for streptomycin, isoniazid, rifampicin, and ethambutol, respectively. (4) Conclusion: Thus, the kit can rapidly screen resistance to streptomycin, isoniazid, rifampicin, and ethambutol. Additionally, it does not require sophisticated equipment; hence, it can be easily used in the laboratories of low and middle income countries.

https://doi.org/10.1590/1678-4324-2020190179 905 downloads

Genotype®MTBDRplus and Xpert®MTB/RIF in the diagnosis of tuberculosis and resistant tuberculosis: cost analysis in a tertiary referral hospital
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Soares, Valéria Martins

; Almeida, Isabela Neves de

; Vater, Maria Cláudia

; Alves, Suely

; Figueredo, Lida Jouca de Assis

; Scherer, Luciene

; Kritski, Afrânio Lineu

; Carvalho, Wânia da Silva

; Miranda, Silvana Spindola de

Revista da Sociedade Brasileira de Medicina Tropical

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2020, Volume 53 elocation e20190175

Abstract: En | Text: En | PDF: En

Abstract INTRODUCTION: The present study sought to assess the mean and activity based cost (ABC) of the laboratory diagnosis for tuberculosis through the application of conventional and molecular techniques-Xpert®MTB/RIF and Genotype®MTBDRplus-in a tertiary referral hospital in Brazil. METHODS: The mean cost and ABC formed the basis for the cost analysis of the TB laboratory diagnosis. RESULTS: The mean cost and ABC were US$ 4.00 and US$ 3.24, respectively, for a bacilloscopy; US$ 6.73 and US$ 5.27 for a Lowenstein-Jensen (LJ) culture; US$ 105.42 and US$ 76.56 for a drug sensitivity test (DST)-proportions method (PM) in LJ; US$ 148.45 and US$ 136.80 for a DST-BACTECTM MGITTM 960 system; US$ 11.53 and US$ 9.89 for an Xpert®MTB/RIF; and US$ 84.21 and US$ 48.38 for a Genotype®MTBDRplus. CONCLUSIONS: The mean cost and ABC proved to be good decision-making parameters in the diagnosis of TB and MDR-TB. The effective implementation of algorithms will depend on the conditions at each location.

https://doi.org/10.1590/0037-8682-0175-2019 1274 downloads

Factors associated with tuberculosis and multidrug-resistant tuberculosis in patients treated at a tertiary referral hospital in the state of Minas Gerais, Brazil
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Soares, Valéria Martins

; Almeida, Isabela Neves de

; Figueredo, Lida Jouca de Assis

; Haddad, João Paulo Amaral

; Oliveira, Camila Stefanie Fonseca de

; Carvalho, Wânia da Silva

; Miranda, Silvana Spindola de

Jornal Brasileiro de Pneumologia

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2020, Volume 46 N. 2 elocation e20180386

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

RESUMO Objetivo: Avaliar os fatores de risco de pacientes atendidos em um hospital de referência terciária para o desenvolvimento de tuberculose e tuberculose multirresistente (TBMR). Métodos: Estudo transversal baseado em dados obtidos de pacientes atendidos no Hospital Júlia Kubitschek, na cidade de Belo Horizonte (MG), entre outubro de 2012 e outubro de 2014. As variáveis utilizadas foram agrupadas em características sociodemográficas, comportamentais, clínicas e radiológicas. O desfecho considerado para verificar associações entre tuberculose e variáveis explicativas foi o tratamento prescrito para tuberculose. Para avaliar a associação entre a tuberculose resistente e as mesmas variáveis explicativas considerou-se a mudança de tratamento para TBMR. Resultados: Alcoolismo, padrão radiológico sugestivo de tuberculose, presença de comorbidades e presença de cavitações pulmonares foram fatores associados à tuberculose. A TBMR foi associada a tratamento prévio para tuberculose e presença de cavitações. Conclusões: Apesar dos importantes progressos na luta contra a tuberculose, é necessário um conjunto de ações articuladas que incluam medidas de proteção social e suporte aos pacientes.

ABSTRACT Objective: To evaluate the risk factors for the development of tuberculosis and multidrug-resistant tuberculosis (MDR-TB) in patients treated at a tertiary referral hospital. Methods: This was a cross-sectional study based on data obtained from patients treated at the Júlia Kubitschek Hospital, located in the city of Belo Horizonte, Brazil, between October of 2012 and October of 2014. We evaluated sociodemographic, behavioral, clinical, and radiological variables. The outcome considered to identify associations between tuberculosis and the explanatory variables was the treatment prescribed. To evaluate the associations between MDR-TB and the same explanatory variables, the change in MDR-TB treatment was considered. Results: The factors associated with tuberculosis were alcoholism, comorbidities, pulmonary cavitations, and a radiological pattern suggestive of tuberculosis. Cavitation and previous treatment for tuberculosis were associated with MDR-TB. Conclusions: Despite the significant progress made in the fight against tuberculosis, there is a need for coordinated actions that include social protection measures and patient support.

https://doi.org/10.36416/1806-3756/e20180386 1027 downloads

Prevalence of latent Mycobacterium tuberculosis infection in renal transplant recipients
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Maciel, Mônica Maria Moreira Delgado

; Ceccato, Maria das Graças

; Carvalho, Wânia da Silva

; Navarro, Pedro Daibert de

; Farah, Kátia de Paula

; Miranda, Silvana Spindola de

Jornal Brasileiro de Pneumologia

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dec 2018, Volume 44 N. 6 Pages 461 - 468

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

RESUMO Objetivo: Estimar a prevalência da infecção latente por Mycobacterium tuberculosis (ILTB) em transplantados renais e avaliar as associações sociodemográficas, comportamentais e clínicas com a prova tuberculínica (PT) positiva. Métodos: Estudo transversal, com pacientes com idade ≥ 18 anos, transplantados renais no Centro de Transplante Renal do Hospital das Clínicas da Universidade Federal de Minas Gerais, em Belo Horizonte (MG). Foram incluídos os pacientes submetidos a transplante renal que realizaram a PT no período entre janeiro de 2011 e julho de 2013. Quando o resultado da primeira PT foi negativo, uma segunda PT foi realizada. As análises bivariada e multivariada, por meio de regressão logística, foram utilizadas para determinar os fatores associados com PT positiva. Resultados: A amostra incluiu 216 pacientes. A taxa de prevalência para ILTB foi de 18.5%. Na análise multivariada, história de contato com caso de tuberculose e função do enxerto preservada (taxa de filtração glomerular estimada ≥ 60 ml/min/1,73 m2) foram associadas com PT positiva. O incremento da primeira PT para a segunda PT foi de 5,8%, considerado significante (p = 0,012). Conclusões: A prevalência da ILTB foi baixa nessa amostra de pacientes transplantados renais. A PT deve ser efetuada quando a função do enxerto renal estiver preservada. Uma segunda PT deve ser realizada quando a primeira PT for negativa.

ABSTRACT Objective: To estimate the prevalence of latent Mycobacterium tuberculosis infection (LTBI) in renal transplant recipients and to assess sociodemographic, behavioral, and clinical associations with positive tuberculin skin test (TST) results. Methods: This was a cross-sectional study of patients aged ≥ 18 years who underwent renal transplantation at the Renal Transplant Center of the Federal University of Minas Gerais Hospital das Clínicas, located in the city of Belo Horizonte, Brazil. We included renal transplant recipients who underwent the TST between January 2011 and July 2013. If the result of the first TST was negative, a second TST was administered. Bivariate and multivariate analyses using logistic regression were used to determine factors associated with positive TST results. Results: The sample included 216 patients. The prevalence of LTBI was 18.5%. In the multivariate analysis, history of contact with a tuberculosis case and preserved graft function (estimated glomerular filtration rate ≥ 60 mL/min/1.73 m2) were associated with positive TST results. TST induration increased by 5.8% from the first to the second test, which was considered significant (p = 0.012). Conclusions: The prevalence of LTBI was low in this sample of renal transplant recipients. The TST should be administered if renal graft function is preserved. A second TST should be administered if the first TST is negative.

https://doi.org/10.1590/s1806-37562017000000367 902 downloads

Evaluation of the Commercial Kit SIRE Nitratase for detecting resistant Mycobacterium tuberculosis in Brazil
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Miranda, Silvana Spindola de

; Almeida, Isabela Neves de

; Lopes, Maria Luiza

; Figueiredo, Jamilly dos Reis de

; Figueredo, Lida Jouca de Assis

; Kritski, Afrânio Lineu

; Carvalho, Wânia da Silva

; Mansur, Maria de Fátima Filardi Oliveira

Revista da Sociedade Brasileira de Medicina Tropical

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aug 2017, Volume 50 N. 4 Pages 550 - 553

Abstract: En | Text: En | PDF: En

Abstract INTRODUCTION: This study aimed to evaluate a new commercial kit, Kit SIRE Nitratase-PlastLabor, for testing the drug susceptibility of clinical Mycobacterium tuberculosis isolates. METHODS: The accuracy of the Kit SIRE Nitratase was evaluated by examining the susceptibility (streptomycin, isoniazid, rifampicin, and ethambutol) of 40 M. tuberculosis isolates, using the proportion method with Lowenstein-Jensen medium or the BACTEC MGIT 960 system. RESULTS: The detection accuracy for streptomycin, isoniazid, rifampicin, and ethambutol was 95%, 97.5%, 100%, and 80%, respectively. CONCLUSIONS: The exceptional accuracy demonstrated by Kit SIRE Nitratase for isoniazid and rifampicin makes the kit an attractive option for screening M. tuberculosis strain resistance.

https://doi.org/10.1590/0037-8682-0447-2016 1015 downloads

Prevalence of latent Mycobacterium tuberculosis infection in prisoners
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Navarro, Pedro Daibert de

; Almeida, Isabela Neves de

; Kritski, Afrânio Lineu

; Ceccato, Maria das Graças

; Maciel, Mônica Maria Delgado

; Carvalho, Wânia da Silva

; Miranda, Silvana Spindola de

Jornal Brasileiro de Pneumologia

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oct 2016, Volume 42 N. 5 Pages 348 - 355

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

RESUMO Objetivo: Determinar a prevalência e os fatores associados à infecção latente por Mycobacterium tuberculosis (ILTB) em pessoas privadas de liberdade no Estado de Minas Gerais. Métodos: Estudo de coorte transversal realizado em duas penitenciárias em Minas Gerais. Foi realizada a prova tuberculínica nos indivíduos que aceitaram participar do estudo. Resultados: Foram selecionados 1.120 indivíduos para a pesquisa. A prevalência da ILTB foi de 25,2%. Na análise multivariada, a ILTB esteve associada com relato de contato com caso de tuberculose ativa dentro da penitenciária (OR ajustada = 1,51; IC95%: 1,05-2,18) e uso de drogas inaláveis (OR ajustada = 1,48; IC95%: 1,03-2,13). Foram identificados 131 pacientes sintomáticos respiratórios (11,7%). O teste anti-HIV foi realizado em 940 (83,9%) dos participantes, sendo positivo em 5 indivíduos (0,5%). Dois casos de tuberculose ativa foram identificados no período do estudo. Conclusões: A prevalência de ILTB dentro das penitenciárias estudadas foi alta. Além disso, a ILTB estava associada ao relato de contato com casos de tuberculose e ao uso de drogas inaláveis. Nossos achados demonstram que é necessária a melhoria das condições de encarceramento e a utilização de outras estratégias, como a triagem por radiografia de tórax, para a descoberta de casos de tuberculose e redução da infecção pelo M. tuberculosis no sistema penitenciário.

ABSTRACT Objective: To determine the prevalence of and the factors associated with latent Mycobacterium tuberculosis infection (LTBI) in prisoners in the state of Minas Gerais, Brazil. Methods: This was a cross-sectional cohort study conducted in two prisons in Minas Gerais. Tuberculin skin tests were performed in the individuals who agreed to participate in the study. Results: A total of 1,120 individuals were selected for inclusion in this study. The prevalence of LTBI was 25.2%. In the multivariate analysis, LTBI was associated with self-reported contact with active tuberculosis patients within prisons (adjusted OR = 1.51; 95% CI: 1.05-2.18) and use of inhaled drugs (adjusted OR = 1.48; 95% CI: 1.03-2.13). Respiratory symptoms were identified in 131 (11.7%) of the participants. Serological testing for HIV was performed in 940 (83.9%) of the participants, and the result was positive in 5 (0.5%). Two cases of active tuberculosis were identified during the study period. Conclusions: Within the prisons under study, the prevalence of LTBI was high. In addition, LTBI was associated with self-reported contact with active tuberculosis patients and with the use of inhaled drugs. Our findings demonstrate that it is necessary to improve the conditions in prisons, as well as to introduce strategies, such as chest X-ray screening, in order to detect tuberculosis cases and, consequently, reduce M. tuberculosis infection within the prison system.

https://doi.org/10.1590/S1806-37562016000000001 4214 downloads

10.

In-house PCR with DNA extracted directly from positive slides to confirm or exclude the diagnosis of tuberculosis: focus on biosafety
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Almeida, Isabela Neves de

; Aleixo, Agdemir Valéria

; Carvalho, Wânia da Silva

; Miranda, Silvana Spindola de

Revista argentina de microbiología

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mar 2015, Volume 47 N. 1 Pages 47 - 49

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

The possibility to obtain DNA from smears is a valuable alternative to remedy the lack of samples when they are totally used for bacilloscopy; this technique solves the biosafety problem related to a possible accident with the transportation of flasks containing potentially transmissible clinical samples. Hence, the purpose of this study was to utilize the insertion sequence IS6110 for amplification of DNA from a smear-positive sample for tuberculosis (TB) diagnosis. Among the 52 positive bacilloscopies, sensitivity, specificity, positive predictive value and negative predictive value were 52.3 %, 100 %, 100 % and 89.7 %, respectively whereas accuracy was 90.7 %. The IS6110-based PCR for TB diagnosis developed in DNA extracted from a positive smear is a fast, simple, specific, and safe method.

La posibilidad de obtener ADN a partir de frotis es una valiosa alternativa para remediar la falta de muestras cuando estas son totalmente utilizadas para la baciloscopia; esta opción soluciona, además, el problema de bioseguridad asociado a la posibilidad de accidente al transportar frascos que contienen muestras clínicas potencialmente infectivas. Por lo tanto, el propósito de este estudio fue utilizar para el diagnóstico de la tuberculosis la secuencia de inserción IS6110 para amplificación del ADN a partir de frotis que resultaron positivos por baciloscopia. Del análisis de 52 baciloscopias positivas surge que la sensibilidad, la especificidad, el valor predictivo positivo y el valor predictivo negativo de esta técnica fueron, respectivamente, del 52,3 %, del 100 %, del 100 % y del 89,7 %; y la precisión fue del 90,7 %. La PCR IS6110 para el diagnóstico de tuberculosis, desarrollada con ADN extraído de frotis positivos, es un método rápido, simple, específico y seguro.

https://doi.org/10.1016/j.ram.2014.12.002 265 downloads

11.

Lymphadenitis caused by infection with an isoniazid- and rifampin-resistant strain of Mycobacterium bovis BCG in an infant with IFN-γ/IL-12 pathway defect
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Diniz, Lilian Martins Oliveira

; Guimarães, Tiago

; Oliveira, Maria das Graças Rodrigues de

; Pinto, Jorge Andrade

; Miranda, Silvana Spindola de

Jornal Brasileiro de Pneumologia

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apr 2014, Volume 40 N. 2 Pages 188 - 192

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

Relatamos um caso raro em uma lactente com três meses e meio de idade, portadora de imunodeficiência primária (defeito no eixo IFN-γ/IL-12), que apresentou linfadenite supurativa após a vacinação por Mycobacterium bovis BCG, cepa essa resistente a isoniazida e rifampicina. Após o tratamento com um esquema medicamentoso especial com isoniazida (de forma estratégica e limitada), etambutol, estreptomicina e IFN-γ, houve a cura completa das lesões.

We report a rare case in a female infant (age, 3.5 months) with primary immunodeficiency (IFN-γ/IL-12 pathway defect) who presented with suppurative lymphadenitis after Mycobacterium bovis BCG vaccination. The strain of M. bovis BCG identified was found to be resistant to isoniazid and rifampin. The patient was treated with a special pharmacological regimen involving isoniazid (in a limited, strategic manner), ethambutol, streptomycin, and IFN-γ, after which there was complete resolution of the lesions.

https://doi.org/10.1590/S1806-37132014000200014 4837 downloads

12.

Characteristics of tuberculosis in the state of Minas Gerais, Brazil: 2002-2009
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Augusto, Claudio Jose

; Carvalho, Wania da Silva

; Goncalves, Alan Douglas

; Ceccato, Maria das Gracas Braga

; Miranda, Silvana Spindola de

Jornal Brasileiro de Pneumologia

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jun 2013, Volume 39 N. 3 Pages 357 - 364

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

OBJETIVO: Analisar o perfil de casos de tuberculose no estado de Minas Gerais entre 2002 e 2009, segundo características sociodemográficas, clínicas e laboratoriais, assim como presença de comorbidades e mortalidade. MÉTODOS: Estudo epidemiológico descritivo com levantamento de dados dos casos notificados no Sistema de Informação de Agravos de Notificação e Sistema de Informação de Mortalidade entre 2002 e 2009. RESULTADOS: Foram notificados 47.285 casos de tuberculose nos anos estudados, com média de incidência 22,3/100.000 habitantes. Os indivíduos com tuberculose eram predominantemente da faixa etária de 20-49 anos (62,4%), do sexo masculino (67,0%) e tinham baixa escolaridade (18,5%). Casos novos, de recidiva e de retratamento representaram, respectivamente, 83,7%, 5,7% e 5,7% do total de casos. As proporções de cura, abandono do tratamento e tuberculose multirresistente foram, respectivamente, 73,1%, 11,2% e 0,2%, enquanto o coeficiente de mortalidade foi 12,9%. O tratamento diretamente observado (TDO) foi administrado em 21,8% dos casos. A baciloscopia e a cultura de escarro somente foram realizadas em 73.9% e 12,9% dos casos, respectivamente. A radiografia de tórax foi realizada em 90,5% dos casos. A forma pulmonar prevaleceu (83,9%). A comorbidade com alcoolismo, infecção pelo HIV e diabetes mellitus foi identificada em 17,2%, 8,3% e 3,8% dos casos, respectivamente. CONCLUSÕES: No período estudado, o número de casos novos, de abandono e de óbitos foi elevado, as comorbidades foram relevantes, e os exames básicos não foram realizados adequadamente para o diagnóstico da tuberculose. São necessários o trabalho multiprofissional, ampliação da estratégia TDO, maior conhecimento da distribuição da tuberculose em Minas Gerais e melhorias nos bancos de dados para que haja um melhor controle da doença no estado.

OBJECTIVE: To analyze the profile of tuberculosis cases reported between 2002 and 2009 in the state of Minas Gerais, Brazil, according to sociodemographic, clinical, and laboratory characteristics, as well as to comorbidities and mortality. METHODS: This was a descriptive, epidemiological study based on data obtained from the Brazilian Case Registry Database and the Brazilian Mortality Database for the 2002-2009 period. RESULTS: There were 47,285 reported cases of tuberculosis, corresponding to a mean incidence of 22.3/100,000 population. The individuals diagnosed with tuberculosis were predominantly in the 20- to 49-year age bracket and male (62.4% and 67.0%, respectively). Individuals with a low level of education accounted for 18.5% of the cases. New cases, cases of recurrence, and cases of retreatment accounted for 83.7%, 5.7%, 5.7%, respectively. The rates of cure and treatment noncompliance were 66.2% and 11.2%, respectively; multidrug-resistant tuberculosis was identified in 0.2% of the cases; and the mortality rate was 12.9%. The directly observed treatment, short-course (DOTS) strategy was applied in 21.8% of the cases. Sputum smear microscopy and culture were performed in only 73.9% and 12.9% of the cases, respectively. Chest X-rays were performed in 90.5% of the cases. Pulmonary tuberculosis was the predominant form (in 83.9%). Comorbidity with alcoholism, HIV infection, and diabetes mellitus were identified in 17.2%, 8.3%, and 3.8%, respectively. CONCLUSIONS: During the study period, the numbers of new cases, cases of treatment noncompliance, and deaths were high, comorbidities were common, and there was a failure to perform adequately basic tests for the diagnosis of tuberculosis. Multidisciplinary approaches, expanded use of the DOTS strategy, better knowledge of the distribution of tuberculosis, and improvements in the databases are needed in order to achieve better control of the disease in the state of Minas Gerais.

https://doi.org/10.1590/S1806-37132013000300013 4866 downloads Cited 8 times in SciELO

13.

Prevalence of latent tuberculosis infection and risk of infection in patients with chronic kidney disease undergoing hemodialysis in a referral center in Brazil
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Fonseca, Jane Corrêa

; Caiaffa, Waleska Teixeira

; Abreu, Mery Natali Silva

; Farah, Katia de Paula

; Carvalho, Wânia da Silva

; Miranda, Silvana Spindola de

Jornal Brasileiro de Pneumologia

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apr 2013, Volume 39 N. 2 Pages 214 - 220

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

OBJETIVO: Determinar a prevalência da infecção latente por Mycobacterium tuberculosis (ILMT) e o risco de infecção em pacientes com insuficiência renal crônica em um centro de hemodiálise. MÉTODOS: Foram incluídos no estudo 307 pacientes com insuficiência renal crônica em tratamento hemodialítico no Instituto Mineiro de Nefrologia, na cidade de Belo Horizonte (MG). Todos os pacientes foram submetidos a testes tuberculínicos (TTs). O efeito booster e a viragem tuberculínica foram avaliados. Se o primeiro TT (TT1) era negativo, um segundo (TT2) era realizado 1-3 semanas após o TT1 para investigar o efeito booster. Se o TT2 também era negativo, um terceiro (TT3) era realizado um ano após o TT2 para identificar a viragem tuberculínica. RESULTADOS: A prevalência da ILMT, quando considerado o ponto de corte de 5 mm de enduração, foi de 22,2% no TT1, com incremento de 11,2% no TT2. A prevalência da ILMT, quando considerado o ponto de corte de enduração de 10 mm, foi de 28,5% no TT1, com incremento de 9,4% no TT2. Um aumento significativo da prevalência da ILMT foi observado entre TT1 e TT2 (efeito booster) e entre TT2 e TT3 (p < 0,01 para ambos). Na nossa amostra, o risco médio anual de infecção foi de 1,19%. CONCLUSÕES: Na população estudada, a prevalência da ILMT foi alta, e o risco de infecção foi semelhante ao da população geral no Brasil, o que sugere infecção recente.

OBJECTIVE: To determine the prevalence of latent tuberculosis infection (LTBI) and the risk of infection in patients with chronic kidney disease treated at a hemodialysis center. METHODS: We included 307 patients with chronic kidney disease undergoing hemodialysis at the Mineiro Institute of Nephrology, located in the city of Belo Horizonte, Brazil. All of the patients were submitted to tuberculin skin tests (TSTs). We investigated the booster effect and TST conversion. If the initial TST (TST1) was negative, a second TST (TST2) was performed 1-3 weeks later in order to investigate the booster effect. If TST2 was also negative, a third TST (TST3) was performed one year after TST2 in order to determine whether there was TST conversion. RESULTS: When we adopted a cut-off induration of 5 mm, the prevalence of LTBI was 22.2% on TST1, increasing by 11.2% on TST2. When we adopted a cut-off induration of 10 mm, the prevalence of LTBI was 28.5% on TST1, increasing by 9.4% on TST2. The prevalence of LTBI increased significantly from TST1 to TST2 (booster effect), as well as from TST2 to TST3 (p < 0.01 for both). In our sample, the mean annual risk of infection was 1.19%. CONCLUSIONS: In the population studied, the prevalence of LTBI was high, and the mean annual risk of infection was similar to that reported for the general population of Brazil, which suggests recent infection.

https://doi.org/10.1590/S1806-37132013000200013 640 downloads

14.

Utilization of bacteriological culture for increased diagnostic performance at a tuberculosis reference center hospital
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Soares, Valéria Martins

; Carvalho, Wania Da Silva

; Miranda, Silvana Spindola De

Revista argentina de microbiología

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sep 2012, Volume 44 N. 3 Pages 173 - 176

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

The purpose of this study was to assess the increase in positive results of bacteriological diagnostic tests for tuberculosis with the utilization of culture at a referral hospital for tuberculosis (TB). A retrospective analysis was conducted based on the positive bacteriological results obtained at the Júlia Kubistchek Hospital. The number of bacteriological diagnoses was increased by 24.6 % with the utilization of culture of sputum samples and by 56.1% of bronchoalveolar lavage samples.With regard to pleural fluid, all six positive cultures were negative for bacilloscopy. Mycobacterium tuberculosis was isolated in 59.6 % of positive cultures. Since mycobacterial culture was not undertaken for all clinical samples, this procedure is an important laboratory routine at the Júlia Kubistchek Hospital in order to learn the real TB prevalence.

El objetivo de este estudio fue evaluar el aumento de la positividad en el diagnóstico bacteriológico de la tuberculosis mediante el uso del cultivo en un hospital de referencia para tuberculosis. Se realizó un análisis retrospectivo de los resultados bacteriológicos positivos en el Hospital Júlia Kubitschek de Belo Horizonte, Brasil. Hubo un incremento en el diagnóstico bacteriológico con cultivo del 24,6 % en las muestras de esputo y del 56,1 % en las muestras de lavado broncoalveolar. En líquido pleural, de 6 cultivos positivos, todos fueron negativos por baciloscopía. En 59,6 % de los cultivos positivos se aisló Mycobacterium tuberculosis. Se concluye que el cultivo para micobacterias es importante en la rutina de laboratorio del Hospital Júlia Kubitschek para el conocimiento de la verdadera prevalencia de tuberculosis, ya que este procedimiento no se realiza en todas las muestras clínicas.

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