ABSTRACT This study aimed to describe the rate of tuberculosis (TB) found by using the active search strategy in teenagers and youths in three youth detention centers. TB was screened through the active search algorithm with chest X-ray, the automated reading was carried out by artificial intelligence software, the GeneXpert Ultra MTB/RIF molecular test, and clinical evaluation. A total of 640 individuals were screened, 94 (14.6%) had an abnormal chest X-ray. Of those screened, we obtained 105 GeneXpert tests of which 94 had abnormal X-rays, 9 were respiratory symptomatic and 2 were on antiretroviral treatment with TB clinical picture. We obtained 8 (8.5%) cases of TB detected with GeneXpert, 7 with abnormal radiography and 1 with normal radiography. Finally, of these 8 cases, 3 were cases of rifampicin-resistant tuberculosis (RR-TB) (42.8%). The rate of screening by active search was 1250 per 100,000 screened, 10 times higher than the rate in the general population. We recommend the inclusion of youth detention centers as target groups for systematic screening and the development of interventions to reduce the risk of TB infection.

RESUMEN El objetivo fue describir la tasa de tuberculosis (TB) hallada por la estrategia de búsqueda activa en adolescentes y jóvenes en tres centros penitenciarios juveniles. Realizamos detección de TB a través de un algoritmo de búsqueda activa con toma de radiografía de tórax, lectura automatizada por software de inteligencia artificial, prueba molecular de GeneXpert Ultra MTB/RIF, y evaluación clínica. Se tamizaron 640 personas, 94 (14,6%) tuvieron una radiografía de tórax anormal. De los tamizados, se obtuvo 105 pruebas de GeneXpert de los cuales 94 tuvieron radiografía anormal, 9 fueron sintomáticos respiratorios y 2 estuvieron en tratamiento antirretroviral con cuadro clínico de TB. Obtuvimos 8 (8,5%) casos de TB detectados con GeneXpert, 7 con radiografía anormal y 1 con radiografía normal. Por último, de estos 8 casos, 3 fueron tuberculosis resistente a rifampicina (TB-RR) (42,8%). La tasa de tamizados por búsqueda activa fue de 1250 por 100 000 tamizados, siendo 10 veces más que la tasa en población general. Recomendamos la inclusión de centros penitenciarios juveniles como grupos de interés para búsqueda sistemática y desarrollar intervenciones para disminuir riesgo de contagio de TB.

RESUMEN El objetivo fue describir la tasa de tuberculosis (TB) hallada por la estrategia de búsqueda activa en adolescentes y jóvenes en tres centros penitenciarios juveniles. Realizamos detección de TB a través de un algoritmo de búsqueda activa con toma de radiografía de tórax, lectura automatizada por software de inteligencia artificial, prueba molecular de GeneXpert Ultra MTB/RIF, y evaluación clínica. Se tamizaron 640 personas, 94 (14,6%) tuvieron una radiografía de tórax anormal. De los tamizados, se obtuvo 105 pruebas de GeneXpert de los cuales 94 tuvieron radiografía anormal, 9 fueron sintomáticos respiratorios y 2 estuvieron en tratamiento antirretroviral con cuadro clínico de TB. Obtuvimos 8 (8,5%) casos de TB detectados con GeneXpert, 7 con radiografía anormal y 1 con radiografía normal. Por último, de estos 8 casos, 3 fueron tuberculosis resistente a rifampicina (TB-RR) (42,8%). La tasa de tamizados por búsqueda activa fue de 1250 por 100 000 tamizados, siendo 10 veces más que la tasa en población general. Recomendamos la inclusión de centros penitenciarios juveniles como grupos de interés para búsqueda sistemática y desarrollar intervenciones para disminuir riesgo de contagio de TB.

ABSTRACT This study aimed to describe the rate of tuberculosis (TB) found by using the active search strategy in teenagers and youths in three youth detention centers. TB was screened through the active search algorithm with chest X-ray, the automated reading was carried out by artificial intelligence software, the GeneXpert Ultra MTB/RIF molecular test, and clinical evaluation. A total of 640 individuals were screened, 94 (14.6%) had an abnormal chest X-ray. Of those screened, we obtained 105 GeneXpert tests of which 94 had abnormal X-rays, 9 were respiratory symptomatic and 2 were on antiretroviral treatment with TB clinical picture. We obtained 8 (8.5%) cases of TB detected with GeneXpert, 7 with abnormal radiography and 1 with normal radiography. Finally, of these 8 cases, 3 were cases of rifampicin-resistant tuberculosis (RR-TB) (42.8%). The rate of screening by active search was 1250 per 100,000 screened, 10 times higher than the rate in the general population. We recommend the inclusion of youth detention centers as target groups for systematic screening and the development of interventions to reduce the risk of TB infection.

In Mexico, despite the relatively high seroprevalence of Trypanosoma cruzi infection in humans in some areas, reported morbidity of Chagas disease is not clear. We determined clinical stage in 71 individuals seropositive to T. cruzi in the state of Puebla, Mexico, an area endemic for Chagas disease with a reported seroprevalence of 7.7%. Diagnosis of Chagas disease was made by two standardized serological tests (ELISA, IHA). Individuals were stratified according to clinical studies. All patients were submitted to EKG, barium swallow, and barium enema. Groups were identified as indeterminate form (IF) asymptomatic individuals without evidence of abnormalities (n = 34 cases); those with gastrointestinal alterations (12 patients) including symptoms of abnormal relaxation of the lower esophageal sphincter and absent peristalsis in the esophageal body, grade I megaesophagus, and/or megacolon; patients with clinical manifestations and documented changes of chronic Chagas heart disease who were subdivided as follows: mild (8 patients) - mild electrocardiographic changes of ventricular repolarization, sinus bradychardia); moderate (6 patients) - left bundle branch block, right bundle branch block associated with left anterior fascicular block); severe (8 patients) - signs of cardiomegaly, dilated cardiomyopathy); and the associated form (3 cases) that included presence of both cardiomyopathy and megaesophagus. These data highlight the importance of accurate evaluation of the prevalence and clinical course of Chagas disease in endemic and non-endemic areas of Mexico.