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The impact of ocular tuberculosis on vision after two months of intensive therapy
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Oliveira, Suzana Batista Vereza de

; Passos, Ângelo Ferreira

; Hadad, David Jamil

; Zbyszynski, Lorena

; Sousa de Almeida Júnior, Pedro

; Castellani, Luiz Guilherme Schmidt

; Dietze, Reynaldo

; Palaci, Moisés

Brazilian Journal of Infectious Diseases

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jun 2018, Volume 22 N. 3 Pages 159 - 165

Abstract: En | Text: En | PDF: En

ABSTRACT Tuberculosis is an infectious disease of global importance with major economic and social burden accounting for 25% of all avoidable deaths in developing countries. Extrapulmonary involvement may occur either in association with clinically apparent pulmonary tuberculosis or in isolation. This cross-sectional descriptive study aimed to evaluate the impact of ocular tuberculosis in visual acuity at baseline and after two months of intensive anti-tuberculous therapy. A sample of 133 pulmonary tuberculosis patients, seven disseminated tuberculosis, and three pleural tuberculosis patients was evaluated. All patients underwent routine ophthalmic evaluation, including assessment of visual acuity, biomicroscopy, applanation tonometry, indirect ophthalmoscopy, and fluorescent angiography as appropriate. None of the patients had impaired visual acuity due to tuberculosis. A rate of 4.2% (6/143) of ocular involvement was found. None of the patients with ocular involvement were HIV-infected. Of the six patients with ocular involvement, five met the diagnostic criteria for probable and one for possible ocular lesions. As for the type of ocular lesions, two patients had bilateral findings: one had sclerouveitis and the second had choroidal nodules. The other four patients presented with unilateral lesions: peripheral retinal artery occlusion in the right eye (one case), choroidal nodules in the left eye (one case), and choroidal nodules in the right eye (two cases). Patients progressed favorably after two month of intensive therapy, with no significant reduction in vision.

https://doi.org/10.1016/j.bjid.2018.03.005 531 downloads

Household members and health care workers as supervisors of tuberculosis treatment
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Maciel, Ethel Leonor Noia

; Guidoni, Leticia Molino

; Brioshi, Ana Paula

; Prado, Thiago Nascimento do

; Fregona, Geisa

; Hadad, David Jamil

; Molino, Lucilia Pereira

; Palaci, Moises

; Johnson, John L

; Dietze, Reynaldo

Revista de Saúde Pública

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apr 2010, Volume 44 N. 2 Pages 339 - 343

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

OBJETIVO: Comparar os resultados de cura por tuberculose entre pacientes supervisionados pelo membro familiar e pelo profissional de saúde. MÉTODOS: Estudo de coorte prospectiva de 171 pacientes de Vitória, ES, no período de 2004 a 2007. Cada paciente foi acompanhado por seis meses até a finalização do tratamento. Dos pacientes estudados, 59 pacientes tratados eram supervisionados por um membro familiar e 112 pelos profissionais de saúde. Foram avaliados dados sociodemográficos e clínicos dos pacientes. Diferenças entre os grupos de estudo foram avaliadas utilizando o teste qui-quadrado ou teste t de Student ao nivel de significância de 5%. RESULTADOS: A maioria dos sujeitos do estudo apresentaram bacioscopia positiva e cultura confirmada para tuberculose. Dois pacientes tinham sorologia positiva para HIV. Um número maior de pacientes no grupo supervisionado por profissionais de saúde não eram alfabetizados, comparado com aqueles pacientes do grupo supervisionado por membros familiares (p = 0,01). Todos os pacientes supervisionados por um familiar foram curados, frente a 90% dos pacientes supervisionados pelos profissionais de saúde (p=0,024). CONCLUSÕES: O sucesso do tratamento de tuberculose foi maior quando supervisionado por um familiar.

OBJECTIVE: To compare tuberculosis cure rates among patients supervised by household members or health care workers. METHODS: Prospective cohort study of 171 patients treated by the program in Vitoria, Southeastern Brazil, from 2004 to 2007. Each patient was followed-up for six months until the end of the treatment. Of the patients studied, a household member supervised 59 patients and healthcare workers supervised 112 patients. Patients' sociodemographic and clinic data were analyzed. Differences between groups were assessed using chi-square test or Student's t-test. Significance level was set at 5%. RESULTS: Most patients had smear positive, culture confirmed pulmonary tuberculosis. Two patients were HIV-positive. There were more illiterate patients in the healthcare-supervised group, in comparison to those supervised by their families (p=0.01). All patients supervised by a household member were cured compared to 90% of the patients supervised by health care workers (p = 0.024). CONCLUSIONS: Successful tuberculosis treatment was more frequent when supervised by household members.

OBJETIVO: Comparar los resultados de cura por tuberculosis entre pacientes supervisados por ele miembro familiar y por el profesional de salud. MÉTODOS: Estudio de cohorte prospectivo de 171 pacientes de Vitória, sureste de Brasil, en el período de 2004 a 2007. Cada paciente fue acompañado por seis meses hasta la finalización del tratamiento. De los pacientes estudiados, 59 pacientes tratados eran supervisados por un miembro familiar y 112 por los profesionales de salud. Fueron evaluados datos sociodemográficos y clínicos de los pacientes. Diferencias entre los grupos de estudio fueron evaluadas utilizando la prueba Chi-cuadrado o prueba t de Student al nivel de significancia de 5%. RESULTADOS: La mayoría de los sujetos de estudio presentaron bacioscopia positiva y cultivo confirmado para tuberculosis. Dos pacientes tenían serología positiva para HIV. Un número mayor de pacientes en el grupo supervisado por profesionales de salud no eran alfabetizados, comparado con aquellos pacientes del grupo supervisado por miembros familiares (p=0,01). Todos los pacientes supervisados por un familiar fueron curados, frente a 90% de los pacientes supervisados por los profesionales de salud (p=0,024). CONCLUSIONES: El éxito del tratamiento de tuberculosis fue mayor cuando se supervisó por un familiar.

2593 downloads

Household members and health care workers as supervisors of tuberculosis treatment
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Maciel, Ethel Leonor Noia

; Guidoni, Leticia Molino

; Brioshi, Ana Paula

; Prado, Thiago Nascimento do

; Fregona, Geisa

; Hadad, David Jamil

; Molino, Lucilia Pereira

; Palaci, Moises

; Johnson, John L

; Dietze, Reynaldo

Revista de Saúde Pública

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apr 2010, Volume 44 N. 2 Pages 339 - 343

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

3161 downloads

III Diretrizes para Tuberculose da Sociedade Brasileira de Pneumologia e Tisiologia
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Conde, Marcus Barreto

; Melo, Fernando Augusto Fiuza de

; Marques, Ana Maria Campos

; Cardoso, Ninarosa Calzavara

; Pinheiro, Valeria Goes Ferreira

; Dalcin, Paulo de Tarso Roth

; Machado Junior, Almério

; Lemos, Antonio Carlos Moreira

; Netto, Antônio Ruffino

; Durovni, Betina

; Sant'Anna, Clemax Couto

; Lima, Dinalva

; Capone, Domenico

; Barreira, Draurio

; Matos, Eliana Dias

; Mello, Fernanda Carvalho de Queiroz

; David, Fernando Cezar

; Marsico, Giovanni

; Afiune, Jorge Barros

; Silva, José Roberto Lapa e

; Jamal, Leda Fátima

; Telles, Maria Alice da Silva

; Hirata, Mário Hiroyuki

; Dalcolmo, Margareth Pretti

; Rabahi, Marcelo Fouad

; Cailleaux-Cesar, Michelle

; Palaci, Moises

; Morrone, Nelson

; Guerra, Renata Leborato

; Dietze, Reynaldo

; Miranda, Silvana Spíndola de

; Cavalcante, Solange Cesar

; Nogueira, Susie Andries

; Nonato, Tatiana Senna Galvão

; Martire, Terezinha

; Galesi, Vera Maria Nader

; Dettoni, Valdério do Valle

Jornal Brasileiro de Pneumologia

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oct 2009, Volume 35 N. 10 Pages 1018 - 1048

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

Diariamente novos artigos científicos sobre tuberculose (TB) são publicados em todo mundo. No entanto, é difícil para o profissional sobrecarregado na rotina de trabalho acompanhar a literatura e discernir o que pode e deve ser aplicado na prática diária juntos aos pacientes com TB. A proposta das "III Diretrizes para TB da Sociedade Brasileira de Pneumologia e Tisiologia (SBPT)" é revisar de forma crítica o que existe de mais recente na literatura científica nacional e internacional sobre TB e apresentar aos profissionais da área de saúde as ferramentas mais atuais e úteis para o enfrentamento da TB no nosso país. As atuais "III Diretrizes para TB da SBPT" foram desenvolvidas pela Comissão de TB da SBPT e pelo Grupo de Trabalho para TB a partir do texto das "II Diretrizes para TB da SBPT" (2004). As bases de dados consultadas foram LILACS (SciELO) e PubMed (Medline). Os artigos citados foram avaliados para determinação do nível de evidência científica, e 24 recomendações sobre TB foram avaliadas, discutidas por todo grupo e colocadas em destaque. A primeira versão das "III Diretrizes para TB da SBPT" foi colocada no website da SBPT para consulta pública durante três semanas, e as sugestões, críticas e o nível de evidência da referência científica que as embasavam foram avaliados e discutidos antes de serem incorporadas ou não ao texto final.

New scientific articles about tuberculosis (TB) are published daily worldwide. However, it is difficult for health care workers, overloaded with work, to stay abreast of the latest research findings and to discern which information can and should be used in their daily practice on assisting TB patients. The purpose of the III Brazilian Thoracic Association (BTA) Guidelines on TB is to critically review the most recent national and international scientific information on TB, presenting an updated text with the most current and useful tools against TB to health care workers in our country. The III BTA Guidelines on TB have been developed by the BTA Committee on TB and the TB Work Group, based on the text of the II BTA Guidelines on TB (2004). We reviewed the following databases: LILACS (SciELO) and PubMed (Medline). The level of evidence of the cited articles was determined, and 24 recommendations on TB have been evaluated, discussed by all of the members of the BTA Committee on TB and of the TB Work Group, and highlighted. The first version of the present Guidelines was posted on the BTA website and was available for public consultation for three weeks. Comments and critiques were evaluated. The level of scientific evidence of each reference was evaluated before its acceptance for use in the final text.

112639 downloads Cited 23 times in SciELO

Guided sputum sample collection and culture contamination rates in the diagnosis of pulmonary TB
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Maciel, Ethel Leonor Noia

; Prado, Thiago Nascimento do

; Peres, Renata Lyrio

; Palaci, Moises

; Johnson, John L.

; Dietze, Reynaldo

Jornal Brasileiro de Pneumologia

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may 2009, Volume 35 N. 5 Pages 460 - 463

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

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.

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Métodos convencionais e moleculares para o diagnóstico da tuberculose pulmonar: um estudo comparativo
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Lima, Stella Sala Soares

; Clemente, Wanessa Trindade

; Palaci, Moisés

; Rosa, Reinaldo Vieira

; Antunes, Carlos Maurício de Figueiredo

; Serufo, José Carlos

Jornal Brasileiro de Pneumologia

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dec 2008, Volume 34 N. 12 Pages 1056 - 1062

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

OBJETIVO: Comparar quatro métodos laboratoriais no diagnóstico de tuberculose pulmonar. MÉTODOS: Foram realizadas pesquisa direta pelas colorações de Ziehl-Neelsen e auramina, cultura para micobactérias em meio Löwenstein-Jensen (LJ) e polymerase chain reaction (PCR, reação em cadeia da polimerase) para Mycobacterium tuberculosis em 160 amostras de secreção respiratória de pacientes com suspeita de tuberculose pulmonar. As cepas isoladas foram identificadas por método radiométrico utilizando-se p-nitro-alfa-acetilamino-beta-hidroxipropiofenona (NAP) e métodos clássicos. A sensibilidade dos métodos foi comparada com o padrão ouro para o diagnóstico da tuberculose pulmonar, definido por critérios clínicos, radiológicos e microbiológicos. RESULTADOS: Dos 160 pacientes, 142 foram diagnosticados com tuberculose pulmonar de acordo com o padrão ouro. As técnicas de Ziehl-Neelsen e auramina, cultura em meio LJ e PCR apresentaram sensibilidade de 54,2%, 58,4%, 67,6% e 77,5%, respectivamente, quando comparados ao critério diagnóstico adotado. A especificidade dos quatro métodos foi de 100%. A concordância na identificação da micobactéria entre PCR e o método radiométrico utilizando NAP foi alta (96,8%). A sensibilidade da PCR foi de 50,8% nas amostras com baciloscopia negativa e de 98,8% naquelas com baciloscopia positiva. Nas amostras com resultados negativos na baciloscopia e cultura, a sensibilidade da PCR foi menor que nas com resultados positivos (25,6% e 99,0%, respectivamente). CONCLUSÕES: A PCR é método promissor no diagnóstico da tuberculose pulmonar, mesmo em amostras paucibacilares. Além disso, apresenta a vantagem da identificação simultânea e rapidez do resultado.

OBJECTIVE: To compare four laboratory methods in the diagnosis of pulmonary tuberculosis. METHODS: Respiratory secretion specimens were collected from 160 patients suspected of having pulmonary tuberculosis. Direct testing for Mycobacterium tuberculosis was carried out using Ziehl-Neelsen and auramine staining. In addition, culture in Löwenstein-Jensen (LJ) medium and polymerase chain reaction (PCR) were used. The strains isolated were identified by means of a radiometric method using p-nitro-alpha-acetylamino-beta-hydroxypropiophenone (NAP) and classical methods. The sensitivity of the methods was compared to the gold standard for the diagnosis of pulmonary tuberculosis, based on clinical, radiological and microbiological criteria. RESULTS: Of the 160 patients, 142 were diagnosed with pulmonary tuberculosis according to the gold standard. The sensitivity of Ziehl-Neelsen staining, auramine staining, culture in LJ medium and PCR was 54.2%, 58.4%, 67.6% and 77.5%, respectively, when compared with the diagnostic criterion adopted. All four methods presented 100% specificity. In the identification of mycobacteria, there was high (96.8%) concordance between PCR and the radiometric method using NAP. The sensitivity of PCR was 50.8% in samples with negative sputum smear microscopy results and 98.8% in those with positive results. The sensitivity of PCR was lower in specimens with negative results in sputum smear microscopy and culture than in those with positive results (25.6% and 99.0%, respectively). CONCLUSIONS: We found PCR to be a promising method for the diagnosis of pulmonary tuberculosis, even in paucibacillary specimens. Simultaneous identification and faster results are additional advantages of this method.

16861 downloads Cited 1 time in SciELO

Acurácia do lavado gástrico realizado em ambiente hospitalar e ambulatorial no diagnóstico da tuberculose pulmonar em crianças
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Maciel, Ethel Leonor Noia

; Dietze, Reynaldo

; Lyrio, Renata Peres

; Vinhas, Solange Alves

; Palaci, Moises

; Rodrigues, Rodrigo Ribeiro

; Struchiner, Claudio Jose

Jornal Brasileiro de Pneumologia

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jun 2008, Volume 34 N. 6 Pages 404 - 411

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

OBJETIVO: Comparar a acurácia do lavado gástrico (LG) realizado em ambiente hospitalar e ambulatorial no diagnóstico da tuberculose (TB) pulmonar em crianças. MÉTODOS: Estudo prospectivo realizado no Estado do Espírito Santo, Brasil, de 1999 a 2003. Um total de 230 crianças com suspeita de TB foi selecionado para realizar exame de LG em ambiente hospitalar (n = 103) ou em ambiente ambulatorial (n = 127). Desse total, 53 foram diagnosticadas como casos de TB e divididas em dois grupos: LG hospitalar (n = 30) e LG ambulatorial (n = 23). Todas as 53 crianças foram monitoradas por 6 meses para avaliação da acurácia do diagnóstico. A acurácia foi determinada com base na mudança do diagnóstico, na taxa de cura e no percentual de culturas positivas nos dois grupos estudados. RESULTADOS: A taxa de cura foi de 100% nos dois grupos, e não houve mudança de diagnóstico nas 53 crianças estudadas. Nenhuma diferença significativa foi encontrada entre os dois grupos estudados em relação ao achado do Mycobacterium tuberculosis (RR = 1,47; IC95%: 0,95-2,27; p = 0,095), apesar de o grupo LG ambulatorial ter apresentado o maior índice de cultura positivas. CONCLUSÕES: Nossos resultados mostram que a acurácia do LG realizado em ambiente hospitalar é semelhante à do realizado em ambiente ambulatorial, o que indica que a internação é necessária apenas em casos mais graves nos quais não se pode realizar o procedimento em ambiente ambulatorial.

OBJECTIVE: To compare gastric lavage (GL) performed in inpatients with GL performed in outpatients in terms of its accuracy in diagnosing pulmonary tuberculosis (TB) in children. METHODS: A prospective study was carried out in the state of Espírito Santo, Brazil, from 1999 to 2003. A total of 230 children suspected of having TB (103 inpatients and 127 outpatients) were selected to undergo GL. Those thus diagnosed with TB (n = 53) were divided into two groups: inpatient GL (n = 30) and outpatient GL (n = 23). All 53 children were monitored for 6 months in order to evaluate the accuracy of the diagnosis. Accuracy was determined based on any change in diagnosis, cure rate, and the percentage of positive cultures in the two groups studied. RESULTS: The cure rate was 100% in both groups, and there was no change in diagnosis in the 53 children studied. No significant difference was found between the two groups studied in terms of detection of Mycobacterium tuberculosis (RR = 1.47; 95% CI: 0.95-2.27; p = 0.095), although the outpatient group presented a greater rate of positive cultures. CONCLUSIONS: Our results show that the accuracy of GL performed in an inpatient setting is similar to that of GL performed in an outpatient setting. This indicates that hospitalization is required only in more severe cases in which GL cannot be performed as an outpatient procedure.

5278 downloads

Use of in-house PCR for identification of Mycobacterium tuberculosis in BACTEC broth cultures of respiratory specimens
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Gouveia, Ana Cláudia Carvalho

; Eisenach, Kathleen D.

; Vinhas, Solange Alves

; Ribeiro, Fabiola Karla Corrêa

; Peres, Renata Lyrio

; Dietze, Reynaldo

; Hadad, David Jamil

; Palaci, Moisés

Memórias do Instituto Oswaldo Cruz

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jun 2008, Volume 103 N. 4 Pages 386 - 391

Abstract: En | Text: En | PDF: En

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.

3610 downloads

Deteção de Mycobacterium tuberculosis em amostras clínicas por reação em cadeia da polimerase utilizando primers baseados na região intergênica plcB-plcC
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Pinto Júnior, Hermides

; Bica, Claudia Giuliano

; Palaci, Moisés

; Dietze, Reynaldo

; Basso, Luiz Augusto

; Santos, Diógenes Santiago

Jornal Brasileiro de Pneumologia

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aug 2007, Volume 33 N. 4 Pages 437 - 442

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

OBJETIVO: Desenvolver um sistema para o diagnóstico molecular da tuberculose por reação em cadeia da polimerase, do inglês polymerase chain reaction (PCR), pela construção de primers baseados na diferença da organização de uma região intergênica da fosfolipase (phospholipase) C (região plcB-plcC), que diferencia Mycobacterium tuberculosis das outras micobactérias. MÉTODOS: Um produto de PCR com o tamanho esperado (432 pb) foi obtido somente de M. tuberculosis e M. africanum. Um total de 33 isolados micobacterianos e 273 amostras clínicas de pacientes com suspeita de tuberculose foram examinados. Estes foram submetidos ao estudo comparativo da técnica de PCR contra o cultivo. RESULTADOS: Os dados mostraram 93,8% de exatidão para PCR contra o cultivo (p < 0,0001), 93,1% de sensibilidade (IC: 88,7-96,0) e especificidade de 96,4% (IC: 96,1-99,4). O valor de Kappa foi de 0,82, demonstrando um alinhamento perfeito para a verificação do grau de concordância entre os testes. CONCLUSÃO: O uso da região plcB-plcC para a amplificação por PCR é mostrado como uma ferramenta importante e de confiança para o diagnóstico específico de tuberculose nas amostras clínicas analisadas.

OBJECTIVE: To develop a system for the molecular diagnosis of tuberculosis by polymerase chain reaction (PCR), constructing primers based on the difference in gene organization of the intergenic region of phospholipase C (plcB-plcC region), which differentiates Mycobacterium tuberculosis from other mycobacteria. METHODS: A PCR product of the expected size (432 bp) was obtained from M. tuberculosis and M. africanum only. A total of 33 mycobacterial isolates and 273 clinical samples from patients suspected of having tuberculosis were examined. These were used in the comparative study of the PCR technique versus culture. RESULTS: For PCR versus culture, the data showed 93.8% accuracy (p < 0.0001), 93.1% sensitivity (CI: 88.7-96.0), and 96.4% specificity (CI: 96.1-99.4). The Kappa value (0.82) shows that there was a near-perfect concordance between the two tests. CONCLUSION: The use of the plcB-plcC region in PCR amplification was found to be an important and reliable tool for the specific diagnosis of tuberculosis in the samples analyzed.

3754 downloads

10.

Perfil epidemiológico dos casos de tuberculose multirresistente do Espírito Santo
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Vieira, Rafael da Cruz Araújo

; Fregona, Geisa

; Palaci, Moisés

; Dietze, Reynaldo

; Maciel, Ethel Leonor Noia

Revista Brasileira de Epidemiologia

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mar 2007, Volume 10 N. 1 Pages 56 - 65

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

Estudo retrospectivo de perfil dos casos de TBMR do Espírito Santo, entre 2000 e 2004. Identificou-se 61 pacientes com TBMR, sendo a amostra composta por 57 casos, que tiveram seus prontuários revisados para obtenção das variáveis estudadas. Estimou-se como prevalência para a TBMR combinada 0,87% (0,66 - 1,13; IC95%). O teste anti-HIV foi feito em 78,9% dos casos, sendo 11,1% positivos. Investigando co-morbidades, destacaram-se etilismo e tabagismo. Encontrou-se 11 casos de resistência primária (RI) e 46 de resistência adquirida (RA), com média de 2,3 ± 1,3 tratamentos anteriores. Em 35,1% dos casos houve relato de contato prévio conhecido com doente de tuberculose, enquanto em 67,9% não houve ou nega-se ter havido. Dez pacientes (17,5%) foram tratados com o esquema de 1ª linha, 18 (31,6%) com o de 2ª linha e 27 (47,4%) com o de 3ª linha. Dezoito (31,6%) tiveram tratamento auto-administrado, e 39 (68,4%) supervisionado. Quanto ao desfecho, houve cura em 33 casos (71,7%), abandono em 7 (15,2%) e óbito em 5 (10,9%), 1 caso de falência e 11 (19,3%) estão em tratamento. Dos 10 casos encerrados de RI, 80% (8/10) foram curados, contra 69,4% (25/36) dos casos de RA. Concluímos que a prevalência de TBMR é baixa no ES. A cura foi alcançada em 70% dos casos. As co-morbidades podem ser importante fator interveniente para um desfecho satisfatório do tratamento. Os resultados enfatizam a necessidade de busca, diagnóstico e realização de TSA para identificação da RI e a supervisão do tratamento de todos os casos de tuberculose.

This is a retrospective profile study of MRTB cases in Espírito Santo, between 2000 and 2004. Sixty-one patients were identified as MRTB, in a sample of 57 cases. All clinical charts of these cases were reviewed for the variables studied. The combined prevalence of MRTB was estimated as 0.87% (0.66 - 1.13; 95% CI). Anti-HIV tests were performed in 78.9% of cases, yielding 5 (11.1%) positive results. Regarding co-morbidity, alcoholism and smoking have a special importance. 11 cases (19.3%) of primary resistance (IR) were found, while 46 (80.7%) were cases of acquired resistance (AR), with an average of 2.3 ± 1.3 previous treatments. 35.1% of the cases informed a known previous contact with a person with tuberculosis, while for 67.9%, the contact was denied or was not the case. 10 patients (17.5%) had been treated with a 1st line regimen, 18 (31.6%) with a 2nd line one, and 27 (47.4%) with 3rd line. Eighteen (31.6%) had had self-administered treatment, while 39 (68.4%) had undergone supervised treatment. Outcome for 33 cases (71.7%) was cure, abandon for 7 (15.2%) and death for 5 (10.9%); there was one case of treatment failure and 11 (19.3%) were still in treatment. Of the 10 cases of IR with a defined outcome, 80% (8/10) were cured, against 69.4% (25/36) of AR cases. We concluded that the prevalence of MRTB is low in the state of Espírito Santo. Cure was reached in about 70% of all treatments. Associated co-morbidity can be a major drawback for satisfactory treatment outcome. Our results emphasize the need for case finding, search, diagnosis and performance of SAT for the identification of IR and implementation of supervised treatment for all tuberculosis cases.

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11.

Perfil epidemiológico dos casos de tuberculose multirresistente do Espírito Santo
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Vieira, Rafael da Cruz Araújo

; Fregona, Geisa

; Palaci, Moisés

; Dietze, Reynaldo

; Maciel, Ethel Leonor Noia

Revista Brasileira de Epidemiologia

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mar 2007, Volume 10 N. 1 Pages 56 - 65

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

5340 downloads

12.

Evaluation of a commercial test based on ligase chain reaction for direct detection of Mycobacterium tuberculosis in respiratory specimens
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Ribeiro, Fabíola Karla Corrêa

; Dettoni, Valdério do Valle

; Peres, Renata Lyrio

; Vinhas, Solange Alves

; Có, Tatiana Resende

; Dietze, Reynaldo

; Palaci, Moisés

Revista da Sociedade Brasileira de Medicina Tropical

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dec 2004, Volume 37 N. 6 Pages 431 - 435

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

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.

2449 downloads

13.

Atividade bactericida precoce: uma metodologia segura e necessária
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Palaci, Moises

; Hadad, David Jamil

; Dettoni, Valdério do Valle

; Dietze, Reynaldo

Jornal Brasileiro de Pneumologia

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apr 2004, Volume 30 N. 2 Pages 189 - 191

Abstract: Pt | Text: Pt | PDF: Pt

1354 downloads

14.

Analysis of Mycobacterium avium Complex Serovars Isolated from AIDS Patients from Southeast Brazil
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Saad, Maria Helena Féres

; Vincent, Veronique

; Dawson, David J

; Palaci, Moisés

; Ferrazoli, Lucilaine

; Fonseca, Leila de S

Memórias do Instituto Oswaldo Cruz

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jul 1997, Volume 92 N. 4 Pages 471 - 475

Abstract: En | Text: En | PDF: En

The purpose of this study was to assess the distribution of Mycobacterium avium serovars isolated from AIDS patients in São Paulo and Rio de Janeiro. Ninety single site or multiple site isolates from 75 patients were examined. The most frequent serovars found were 8 (39.2%), 4 (21.4%) and 1 (10.7%). The frequency of mixed infections with serovar 8 or 4 was 37.8%. Among the 90 strains examined, M. intracellulare serovars (7 strains) and M. scrofulaceum (4 strains) were found in 11 isolates (12%) indicating that M. avium (88%) was the major opportunistic species in the M. avium complex isolates in Brazilian AIDS patients

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15.

Mycobacterium avium complex (MAC) isolated from AIDS patients and the criteria required for its implication in disease
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Hadad, David Jamil

; Palhares, Maria Cecília de Almeida

; Placco, Anna Luiza Nunes

; Domingues, Carmem Silvia Bruniera

; Castelo Filho, Adauto

; Ferrazoli, Lucilaine

; Ueki, Sueli Yoko Mizuka

; Telles, Maria Alice da Silva

; Martins, Maria Conceição

; Palaci, Moisés

Revista do Instituto de Medicina Tropical de São Paulo

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oct 1995, Volume 37 N. 5 Pages 375 - 383

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

Anterior a pandemia de AIDS, o Complexo Mycobacterium avium (MAC) era responsável pela maioria das vezes, por pneumopatias acometendo pacientes com doença pulmonar crônica de base como enfisema e bronquite crônica36. Em 1981, com o advento da síndrome de imunodeficiência adquirida (SIDA), o MAC passou a representar uma das doenças bacterianas mais frequentes em pacientes com esta síndrome, sendo a doença disseminada a principal forma de manifestação clínica da infecção8. Entre Janeiro de 1989 e Fevereiro de 1991, no Setor de Micobactérias do Instituto Adolfo Lutz em São Paulo, o MAC foi isolado de 103 pacientes a partir do cultivo de diferentes espécimes estéreis e não estéreis processados, coletados de 2.304 pacientes atendidos no Centro de Referência e Treinamento AIDS e/ou Instituto de Infectologia Emilio Ribas. A doença disseminada foi diagnosticada em 29 destes, com base no isolamento do MAC a partir do sangue e/ou aspirado de medula óssea. Os outros 74 pacientes foram agrupados nas categorias altamente (5), moderadamente (26) e pouco sugestiva de doença (43) de acordo com os postulados de DAVIDSON (1989)10. Os diferentes critérios para valorizar o seu isolamento de espécimes estéreis e não estéreis são discutidos.

Before the AIDS pandemia, the Mycobacterium avium complex (MAC) was responsible in most cases for the pneumopathies that attack patients with basic chronic pulmonary diseases such as emphysema and chronic bronchitis36. In 1981, with the advent of the acquired immunodeficiency syndrome (AIDS), MAC started to represent one of the most frequent bacterial diseases among AIDS patients, with the disseminated form of the disease being the major clinical manifestation of the infection8. Between January 1989 and February 1991, the Section of Mycobacteria of the Adolfo Lutz Institute, São Paulo, isolated MAC from 103 patients by culturing different sterile and no-sterile processed specimens collected from 2304 patients seen at the AIDS Reference and Training Center and/or Emilio Ribas Infectology Institute. Disseminated disease was diagnosed in 29 of those patients on the basis of MAC isolation from blood and/or bone marrow aspirate. The other 74 patients were divided into categories highly (5), moderately (26) and little suggestive of disease (43) according to the criteria of DAVIDSON (1989)10. The various criteria for MAC isolation from sterile and non-sterile specimens are discussed.

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