Objetivou-se avaliar a acessibilidade ao diagnóstico da tuberculose nos serviços de saúde em Vitória (ES). Estudo transversal realizado em 2009 com doentes de tuberculose, utilizando o instrumento Primary Care Assessment Tool. Análise estatística com Teste Qui-quadrado (p < 0,05). Em relação à porta de entrada, notou-se que o serviço de saúde mais procurado foi Atenção Básica (37,6%); a maioria dos diagnósticos ocorreu nas Unidades de Referência do Programa de Controle da Tuberculose (61,3%). Houve evidência de associação entre primeiro serviço de saúde procurado e fatores tempo de demora na obtenção de consulta neste (p = 0,0182), hipótese diagnóstica feita pelo primeiro serviço de saúde procurado (p = 0,0001), solicitação exame de escarro (p = 0,0003), solicitação exame de Raios-X (p = 0,0159), encaminhamento para Raios-X em outro serviço (p = 0,0001), diagnóstico pelo mesmo serviço de saúde (p = 0,0001), exames realizados no próprio serviço de saúde que diagnosticou tuberculose (p = 0,0018), proximidade do domicílio (p = 0,0001). Portanto, a identificação de lacunas importantes na acessibilidade ao diagnóstico de tuberculose parece estar relacionada às dificuldades operacionais de organização da atenção à saúde.

This study sought to assess the accessibility to the diagnosis of tuberculosis in health services in Victoria, state of Espírito Santo. It featured a cross-sectional study conducted in 2009 of patients with tuberculosis using the Primary Care Assessment Tool and statistical analysis with the Chi-square test (p <0,05). In relation to initial access to care, it was seen that the health service of first access most sought was Primary Care (37.6%), with most diagnoses occurring in the Tuberculosis Control Program Reference Units (61.3%). There was evidence of association between first health service accessed and the factors of time delay in: obtaining consultation at the first health service sought (p = 0.0182); diagnosis made by the first health service sought (p = 0.0001); request for sputum exam (p = 0,0003); request for X-ray exams (p = 0.0159); referral for X-rays at another institution (p = 0.0001); diagnosis by the same health service (p = 0.0001); exams conducted by the same health service that initially diagnosed tuberculosis (p = 0.0018); and proximity to the home (p = 0.0001). Therefore, the identification of important gaps in accessibility to diagnosis of tuberculosis seems to be related to the operational difficulties of organization of health care.

Objetivou-se avaliar a acessibilidade ao diagnóstico da tuberculose nos serviços de saúde em Vitória (ES). Estudo transversal realizado em 2009 com doentes de tuberculose, utilizando o instrumento Primary Care Assessment Tool. Análise estatística com Teste Qui-quadrado (p < 0,05). Em relação à porta de entrada, notou-se que o serviço de saúde mais procurado foi Atenção Básica (37,6%); a maioria dos diagnósticos ocorreu nas Unidades de Referência do Programa de Controle da Tuberculose (61,3%). Houve evidência de associação entre primeiro serviço de saúde procurado e fatores tempo de demora na obtenção de consulta neste (p = 0,0182), hipótese diagnóstica feita pelo primeiro serviço de saúde procurado (p = 0,0001), solicitação exame de escarro (p = 0,0003), solicitação exame de Raios-X (p = 0,0159), encaminhamento para Raios-X em outro serviço (p = 0,0001), diagnóstico pelo mesmo serviço de saúde (p = 0,0001), exames realizados no próprio serviço de saúde que diagnosticou tuberculose (p = 0,0018), proximidade do domicílio (p = 0,0001). Portanto, a identificação de lacunas importantes na acessibilidade ao diagnóstico de tuberculose parece estar relacionada às dificuldades operacionais de organização da atenção à saúde.

This study sought to assess the accessibility to the diagnosis of tuberculosis in health services in Victoria, state of Espírito Santo. It featured a cross-sectional study conducted in 2009 of patients with tuberculosis using the Primary Care Assessment Tool and statistical analysis with the Chi-square test (p <0,05). In relation to initial access to care, it was seen that the health service of first access most sought was Primary Care (37.6%), with most diagnoses occurring in the Tuberculosis Control Program Reference Units (61.3%). There was evidence of association between first health service accessed and the factors of time delay in: obtaining consultation at the first health service sought (p = 0.0182); diagnosis made by the first health service sought (p = 0.0001); request for sputum exam (p = 0,0003); request for X-ray exams (p = 0.0159); referral for X-rays at another institution (p = 0.0001); diagnosis by the same health service (p = 0.0001); exams conducted by the same health service that initially diagnosed tuberculosis (p = 0.0018); and proximity to the home (p = 0.0001). Therefore, the identification of important gaps in accessibility to diagnosis of tuberculosis seems to be related to the operational difficulties of organization of health care.

Realizou-se um estudo comparativo para avaliar a contaminação em culturas de amostras matinais de escarro coletadas em domicílio sob condições recomendadas atualmente e amostras coletadas sob supervisão após orientação e educação dos pacientes. Os grupos de coleta domiciliar e supervisionada produziram 43 e 76 amostras, respectivamente. A taxa de contaminação foi aproximadamente 3 vezes maior nas amostras coletadas em domicílio do que naquelas coletadas sob supervisão (37% vs.13%; p < 0,05; OR = 0,25). As simples medidas educacionais e de higiene descritas podem reduzir a taxa de contaminação de amostras de escarro coletadas para culturas diagnósticas.

A comparative study to evaluate contamination in cultures of morning sputum samples, comparing those collected at home under currently recommended conditions and those collected under supervision after patient orientation and education. The home and supervised collection groups produced 43 and 76 sputum samples, respectively. The contamination rate was nearly 3-times higher among samples collected at home than among those collected under supervision (37% vs. 13%, p < 0.05; OR = 0.25). The simple educational and hygiene measures described can decrease the contamination rate among sputum samples collected for diagnostic culture.

We evaluated the ability of a PCR assay to identify Mycobacterium tuberculosis complex (MTBC) from positive BACTEC® 12B broth cultures. A total of 107 sputum samples were processed and inoculated into Ogawa slants and BACTEC® 12B vials. At a growth index (GI) > 30, 1.0 ml of the 12B broth was removed, stored, and assayed with PCR. Molecular results were compared to those obtained by phenotypic identification methods, including the BACTEC® NAP method. The average times required to perform PCR and NAP were compared. Of the 107 broth cultures evaluated, 90 were NAP positive, while 91 were PCR positive for MTBC. Of particular interest were three contaminated BACTEC® 12B broth cultures yielding microorganisms other than acid-fast bacilli growth with a MTBC that were successfully identified by PCR, resulting in a mean time of 14 days to identify MTBC before NAP identification. These results suggest that PCR could be used as an alternative to the NAP test for the rapid identification of MTBC in BACTEC® 12B cultures, particularly in those that contained both MTBC and nontuberculous mycobacteria.

O método de amplificação de DNA baseado na reação em cadeia da ligase (Abbott LCx MTB) foi avaliado para detecção do Mycobacterium tuberculosis em espécimes pulmonares. Os resultados do LCx MTB foram comparados aos resultados de baciloscopia, cultura e diagnóstico clínico para cada paciente. Um total de 297 espécimes (escarro e lavado broncoalveolar) de 189 pacientes foram testadas. Os valores de sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo do LCX vs cultura foram 92,7%, 93%, 67,8% e 98,7%, respectivamente. Quando comparados ao diagnóstico clínico, os valores de sensibilidade, especificidade, VPP e VPN para o LCx foram 88,9%, 96,8%, 86,5% e 97,4%, respectivamente. A sensibilidade do LCx MTB foi de 75% para as amostras com baciloscopia negativa e cultura positiva. Os resultados indicam que o teste LCx MTB é simples, rápido, eficiente e pode ser utilizado como um recurso complementar para o diagnóstico da tuberculose.

A ligase chain reaction DNA amplification method for direct detection of Mycobacterium tuberculosis (Abbott LCx MTB) in respiratory specimens was evaluated. Results from LCx MTB Assay were compared with those from acid fast bacilli smear, culture, and final clinical diagnosis for each patient. A total of 297 respiratory specimens (sputum and bronchial lavage) from 193 patients were tested. The sensitivity, specificity, positive predictive value and negative predictive value of LCx vs culture were 92.7%, 93%, 67.8% and 98.7%, respectively. When compared to the clinical final diagnosis, the sensitivity, specificity, PPV and NPV for LCx were 88.9%, 96.8%, 86.5% and 97.4%, respectively. The sensitivity of LCx MTB assay was 75% for smear-negative, culture positive samples. The results indicate that LCx MTB assay is a rapid, simple and valuable technique as a complementary tool for the diagnosis of tuberculosis.