Tuberculosis farmacorresistente y diabetes: estudio de casos y controles en un hospital peruano

Introducción: la tuberculosis farmacorresistente sigue siendo endémica y un importante problema de salud pública a nivel mundial, lo que resulta en una alta morbilidad. Las personas con diabetes son más susceptibles a las infecciones debido a la inmunosupresión, por lo que es importante reconocer los factores que predisponen a la tuberculosis farmacorresistente. Objetivo: identificar a la diabetes como factor asociado a la tuberculosis farmacorresistente en pacientes del Programa de prevención y control de la tuberculosis de un hospital peruano nivel II-2 del 2015 al 2021. Metodología: se realizó un estudio analítico de casos y controles, pareados por edad y sexo, se incluyó 66 pacientes con tuberculosis farmacorresistente (casos) y 198 pacientes con tuberculosis sensible (controles). Se utilizó la prueba de chi-cuadrado para el análisis bivariado y el cálculo del Odds Ratio. Se utilizó la regresión logística múltiple para el análisis multivariado. Resultados: el 9,1% de los casos y el 4% de los controles tenían diabetes, con OR 2,48 (IC 95% 0,68 - 8,47) y sin diferencias significativas. En el análisis multivariado, la diabetes fue estadísticamente significativa, aumentando el OR a 3,40 (IC 95% 1,01 - 11,49; p= 0,01). Conclusión: la diabetes se asoció con un mayor riesgo de tuberculosis farmacorresistente en pacientes del Programa de prevención y control de la tuberculosis en un hospital peruano nivel II-2.

Introduction: Drug-resistant tuberculosis continues to be endemic and a major public health problem worldwide, resulting in high morbidity. People with diabetes are more susceptible to infections due to immunosuppression, threfpre it is important to recognize the factors that predispose to drug-resistant tuberculosis. Objective: To identify diabetes as a factor associated with drug-resistant tuberculosis in patients of the Tuberculosis Prevention and Control Program of a level II-2 Peruvian hospital from 2015 to 2021. Methodology: An analytical case-control study was carried out, matched by age and sex, including 66 patients with drug-resistant tuberculosis (cases) and 198 patients with sensitive tuberculosis (controls). The chi-square test was used for the bivariate analysis and Odds Ratio calculation was also made. Multiple logistic regression was used for multivariate analysis. Results: 9.1% of the cases and 4% of the controls had diabetes, with OR 2.48 (95% CI 0.68 - 8.47) and without significant differences. In the multivariate analysis, diabetes was statistically significant, increasing the OR to 3.40 (95% CI 1.01 - 11.49; p= 0.01). Conclusion: Diabetes was associated with an increased risk of drug-resistant tuberculosis in patients of the Tuberculosis Prevention and Control Program at a level II-2 Peruvian hospital.

Changes of lymphocyte subsets in smear-negative pulmonary tuberculosis

Background and Aims: The host immune system plays an important role in the pathogenesis and defense mechanism of Mycobacterium tuberculosis (Mtb). This study aimed to explore the different changes in the immune system between smear-negative pulmonary tuberculosis (PTB) and smear-positive PTB patients. Materials and Methods: A total of 85 active PTB patients and 50 healthy adults were enrolled. The participants were divided into smear-negative PTB, smear-positive PTB, and control groups. Chest computed tomography (CT) and lymphocyte subgroup counts in peripheral blood were measured in all participants. Results: There were higher numbers of CD4 + T-cells, NK cells, and pulmonary cavities in the smear-positive PTB group, whereas the numbers of B-ells were significantly increased in the smear-negative PTB group. Conclusions: Smear-negative PTB showed fewer pulmonary cavities, mild inflammatory response, lower numbers of immune cells, and higher numbers of B- cells.

An Analysis of The Trend of Incidences and Fatality of Pulmonary Tuberculosis in East Java from 2015-2020: A Lesson From COVID-19

Background: Pulmonary tuberculosis is still a public health problem, and surveillance data analysis has not been done much. Recently a global pandemic of COVID-19 has the potential in disturbing TB elimination pro-grams and treatment. This study aims to comprehensively analyse the incidence rate (IR) and Case Fatality Rate (CFR) of pulmonary tuberculosis in East Java from 2015–2020 and during COVID-19 and the strategies for optimizing tuberculosis disease control. Methodology: The study analyzed annual surveillance data using an analytical descriptive design. The Varia-bles were analyzed with Spearman correlation with a level of evidence of 95% (p<0.05). Results: The prevalence of pulmonary tuberculosis in East Java fluctuated from 2015–2020. In 2020 and dur-ing the COVID-19 pandemic, the number of cases and morbidity rates increased. Statistic results confirm the presence of a significant correlation between the values of Incidence rate (IR) and Case Fatality rate (CFR) (p = 0.032), IR and Treatment Success Rate (TSR) (p = 0.020), and CFR and TSR (p = 0.002). Population density is not correlated with the number of new cases (p = 0.667). Treatment rates have increased to 51%; cure and treatment rates have decreased to 76% and 89%, respectively, and there was a 4% increase in mortality dur-ing COVID-19. Conclusions: COVID-19 has tremendously affected the treatment of pulmonary TB cases in East Java, Indone-sia by increasing the incidence rate and decreasing the fatality rate. The pandemic promotes fear in the com-munity to check their medical status and improve the quality of their health in East Java.

Ca-125: A Useful Marker to Distinguish Pulmonary Tuberculosis from Bacterial Pneumonia

Background: Ca-125 is a large molecular-weight glycoprotein synthesized by different cells originating from the coelomic epithelium. Although classically it has been used to monitor the course of ovarian epithelial cancer, there are other established circumstances associated with high serum Ca -125 levels and pulmonary tuberculosis is one of them. Diagnosing pulmonary tuberculosis, which is not bacteriologically positive often very challenging. Because many procedures are available for such cases but they are of limited use because some of them are lengthy or expensive or need sophisticated equipment, highly skilled personnel, etc. Serum CA-125 is a rapid, relatively inexpensive investigation. Objective: The present study aimed to assess the role of CA-125 in distinguishing pulmonary TB from bacterial pneumonia. Methods: This analytical cross-sectional study was conducted in the Department of Medicine, Dhaka Medical College Hospital for the period of March 2018 to September 2020.100 pulmonary tuberculosis patients were taken in group I, and 100 bacterial pneumonia patients were taken in group II according to selection criteria. Informed written consent was taken from each of the participants. All were subjected to detail clinical and demographic history along with thorough physical examination. Relevant investigations were done including serum CA-125. All final data were collected in the semi-structured and pretested case record form. After data collection, data were checked for errors, and analysis was done. Results: In this study, the mean CA-125 value was 62.29 (SD±31.51) IU/mL in group I(pulmonary tuberculosis). In group II (bacterial pneumonia) mean value was 22.95(±8.25) IU/mL. The mean value of CA-125 was significantly higher (p-value <0.001) in group I patients compared to group II. About 59.0% of patients in group I had a high level of serum CA-125 which had a significant difference from group II (p<0.001). ROC analysis of CA-125 in the diagnosis of patients with active pulmonary tuberculosis showed a cut-off value of ?31.7 IU/mL had sensitivity, specificity, PPV, NPV, PLR, NLR, and accuracy of 72%, 87%, 84.7%, 75.7%, 5.54%, 0.321%, and 79.5% respectively. Conclusion: This study’s findings stated that serum CA-125 may be a useful marker in distinguishing PTB from bacterial pneumonia. Therefore, further study with a more generalized study population is recommended.

An 8-year-old boy with diffuse cystic pulmonary tuberculosis: An intriguing story

Diffuse cystic lung disease due to pulmonary tuberculosis (TB) is rare. We describe an 8-year-old boy who presented with acute onset respiratory distress while on a compliant anti-tubercular treatment for a recently diagnosed pulmonary TB. On clinical examination, hypoxemia, clubbing, and features of the right-sided heart failure were observed. High-resolution computed tomography of the chest revealed extensive cystic lung parenchymal changes with ground glassing and consolidation, and echocardiography indicated the presence of pulmonary arterial hypertension. His treatment included supplemental oxygen, sildenafil, prednisolone, and anti-tubercular drugs. At the two-year follow-up, the patient showed complete clinical recovery and resolution of cysts on the chest X-ray.

Miliary Tuberculosis with Addisons Disease - in old case of pulmonary tuberculosis, and tuberculosis of seminal vesicles - A rare case report

Addison's disease is a rare endocrinal disorder that was first described by Thomas Addison in 1855. Addison抯 disease occurs as a result of a lack of production of adrenocortical hormones, which is a rare but fatal disease if left untreated. The two most common causes of Addison's disease are autoimmune adrenalitis and tuberculosis which refer to hypoadrenalism caused by total or near total destruction or dysfunction of both adrenal cortices. Usual manifestations involve chronic fatigue, muscle weakness, loss of appetite, nausea, vomiting, diarrhoea, hypotension, and hyper pigmentation of the skin. A substantial proportion of patients presenting with extra-pulmonary tuberculosis (TB) have urogenital TB (UG-TB), which is easily under diagnosed because of non-specific symptoms, which are chronic and have cryptic protean clinical manifestations. Most of the clinician are not aware of the possibility of UG � TB. Calcification of seminal vesicle found in this case is a rare condition, which is commonly associated with diabetes, hyperparathyroidism, and genitourinary tuberculosis. We here in report a rare case of adrenal insufficiency due to miliary tuberculosis involving adrenal gland, old pulmonary tuberculosis and genitourinary tuberculosis (seminal vesicles calcification) in a 31 year old male person. He presented with multiple episodes of vomiting, and giddiness which wasalso accompanied with atypical hyperpigmentation. His symptoms resolved after starting anti tuberculous therapy.

Comparison of different diagnostic modalities for isolation of Mycobacterium Tuberculosis among suspected tuberculous lymphadenitis patients / Comparação de diferentes modalidades de diagnóstico para isolamento de Mycobacterium tuberculosis entre pacientes com suspeita de linfadenite tuberculosa

Abstract Tuberculosis is a communicable disease with high morbidity and mortality rates in developing countries. The study's primary objective is to compare conventional methods such as acid-fast bacillus (AFB) culture and microscopy with rapid diagnostic methods. The secondary objective is to compare histopathological and microbiological findings in suspected patients with tubercular lymphadenitis. A total of 111 samples (August 2018 to September 2019) of lymph nodes were processed for AFB microscopy, AFB cultures, drug-susceptibility testing (DST), histopathology, and Xpert Mycobacterium Tuberculosis (MTB)/resistance to Rifampin (RIF) assays. Out of 111 lymph node samples, 6 (5.4%) were positive for AFB smear microscopy, 84 (75.6%) were positive for AFB culture, 80 (70.7%) were positive on Gene Xpert, and 102 (91.8%) were indicative of tuberculosis for histopathology studies. Mycobacteria growth indicator tube (MGIT) culture positivity was 84 (75.6%) higher than solid Lowenstein-Jensen (LJ) culture 74 (66.6%). Positive cultures underwent phenotypic DST. Two cases were Multidrug-resistant (MDR) on DST, while three cases were Rifampicin resistant on Gene Xpert. The sensitivity of Genexpert was (62%) against the conventional AFB culture method. The poor performance of conventional lymphadenitis diagnostic methods requires early and accurate diagnostic methodology. Xpert MTB/RIF test can help in the treatment of multidrug-resistant TB cases. Nonetheless, rapid and conventional methods should be used for complete isolation of Mycobacterium tuberculosis.

Resumo A tuberculose é uma doença transmissível com altas taxas de morbimortalidade nos países em desenvolvimento. O objetivo principal do estudo é comparar métodos convencionais, como cultura de bacilo álcool-ácido resistente (BAAR) e microscopia, com métodos de diagnóstico rápido. O objetivo secundário é comparar os achados histopatológicos e microbiológicos em pacientes com suspeita de linfadenite tubercular. Um total de 111 amostras (agosto de 2018 a setembro de 2019) de gânglios linfáticos foi processado ​​para microscopia de AFB, culturas de AFB, teste de susceptibilidade a drogas (DST), histopatologia e Xpert Mycobacterium tuberculosis (MTB)/ensaios de resistência à rifampicina (RIF). Das 111 amostras de linfonodos, 6 (5,4%) foram positivas para baciloscopia de AFB, 84 (75,6%) foram positivas para cultura de AFB, 80 (70,7%) foram positivas para o GeneXpert e 102 (91,8%) foram indicativas de tuberculose para estudos histopatológicos. A positividade da cultura do tubo indicador de crescimento de micobactérias (MGIT) foi 84 (75,6%), maior que a cultura sólida de Lowenstein-Jensen (LJ), 74 (66,6%). As culturas positivas foram submetidas a DST fenotípico. Dois casos eram multirresistentes (MDR) ao DST, enquanto três casos eram resistentes à rifampicina no GeneXpert. A sensibilidade do GeneXpert foi 62% contra o método convencional de cultura AFB. O fraco desempenho dos métodos convencionais de diagnóstico de linfadenite requer metodologia de diagnóstico precoce e precisa. O teste Xpert MTB/RIF pode ajudar no tratamento de casos de tuberculose multirresistente. No entanto, métodos rápidos e convencionais devem ser usados ​​para o isolamento completo do Mycobacterium tuberculosis.

Tuberculose: principais fatores associados ao abandono do tratamento / Tuberculosis: main factors associated with treatment abandonment / Tuberculosis: principales factores asociados al abandono del tratamiento

O abandono do tratamento de tuberculose é uma questão relevante e preocu- pante na saúde pública mundial. Mediante uma revisão integrativa, esse estudo busca identificar os possíveis fatores que levam ao abandono do tratamento. Foi realizada pes- quisa em estudos indexados nas bases de dados: Biblioteca Virtual em Saúde (BVS) e Scientific Eletronic Library Online (SciELO), no período de 2017 a 2021, utilizando-se os seguintes descritores (DeCS): tuberculose, agente antituberculose e tuberculose pul- monar. Ao fim, foram selecionados onze estudos, publicados nos idiomas português, es- panhol e inglês. Os resultados mostraram que o abandono está relacionado a fatores de diversas esferas, com destaque para as esferas social, da saúde e a do próprio tratamento. Como perfil das pessoas dos casos de abandono, em geral, observou-se que elas são eco- nomicamente ativas, com faixa etária entre 15 e 49 anos, possuem baixa escolaridade, baixa renda e é comum que os usos abusivos de álcool e drogas sejam apresentados como comorbidades relevantes. Portanto, o trabalho evidenciou os principais fatores associados ao abandono do tratamento de tuberculose e a importância da participação de diferentes atores como forças que somarão para diminuir a ocorrência do problema em questão.

The abandonment of tuberculosis treatment is a relevant and worrisome issue in public health worldwide. Through an integrative review, this study seeks to iden- tify the possible factors that lead to treatment dropout. A search was carried out in studies indexed in the databases: Virtual Health Library (BVS) and Scientific Electronic Library Online (SciELO), from 2017 to 2021, using the following descriptors (DeCS): tuberculo- sis, antitubercular agentes and pulmonary tuberculosis. Finally, eleven studies, published in Portuguese, Spanish and English, were selected. The results showed that abandonment is related to factors from different spheres, with emphasis on the social, health and treat- ment spheres. As for the profile of people in cases of abandonment, in general, it was observed that they are economically active, aged between 15 and 49 years old, have low education, low income and it is common for alcohol and drug abuse to be presented as relevant comorbidities. Therefore, the work highlighted the main factors associated with the abandonment of tuberculosis treatment and the importance of the participation of dif- ferent actors as forces that will add to reduce the occurrence of the problem in question. KEYWORDS: Tuberculosis; Antitubercular Agents; Pulmonary Tuberculosis.

El abandono del tratamiento de la tuberculosis es un tema relevante y pre- ocupante en la salud pública mundial. A través de una revisión integradora, este estudio busca identificar los posibles factores que conducen al abandono del tratamiento. Se rea- lizó una búsqueda en estudios indexados en las bases de datos: Biblioteca Virtual en Salud (BVS) y Scientific Electronic Library Online (SciELO), de 2017 a 2021, utilizando los siguientes descriptores (DeCS): tuberculosis, agente antituberculoso y tuberculosis pul- monar. Al final, fueron seleccionados once estudios, publicados en portugués, español e inglés. Los resultados mostraron que el abandono está relacionado con factores en dife- rentes esferas, con énfasis en las esferas social, de salud y de tratamiento. Como perfil de las personas en casos de abandono, en general, se observó que son económicamente acti- vas, con edades entre 15 y 49 años, baja escolaridad, bajos ingresos y es común que el abuso de alcohol y drogas se presenten como comorbilidades relevantes. Por lo tanto, el trabajo destacó los principales factores asociados al abandono del tratamiento de la tuber- culosis y la importancia de la participación de diferentes actores como fuerzas que se sumarán para disminuir la ocurrencia del problema en cuestión.

Uma rara apresentação de cisto de paratireoide / A rare presentation of parathyroid cyst / Una rara presentación de quiste paratiroideo

O abandono do tratamento de tuberculose é uma questão relevante e preocu- pante na saúde pública mundial. Mediante uma revisão integrativa, esse estudo busca identificar os possíveis fatores que levam ao abandono do tratamento. Foi realizada pes- quisa em estudos indexados nas bases de dados: Biblioteca Virtual em Saúde (BVS) e Scientific Eletronic Library Online (SciELO), no período de 2017 a 2021, utilizando-se os seguintes descritores (DeCS): tuberculose, agente antituberculose e tuberculose pul- monar. Ao fim, foram selecionados onze estudos, publicados nos idiomas português, es- panhol e inglês. Os resultados mostraram que o abandono está relacionado a fatores de diversas esferas, com destaque para as esferas social, da saúde e a do próprio tratamento. Como perfil das pessoas dos casos de abandono, em geral, observou-se que elas são eco- nomicamente ativas, com faixa etária entre 15 e 49 anos, possuem baixa escolaridade, baixa renda e é comum que os usos abusivos de álcool e drogas sejam apresentados como comorbidades relevantes. Portanto, o trabalho evidenciou os principais fatores associados ao abandono do tratamento de tuberculose e a importância da participação de diferentes atores como forças que somarão para diminuir a ocorrência do problema em questão.

Treatment abandonment for tuberculosis is a relevant and pressing public health issue worldwide. Through an integrative review, this study seeks to identify pos- sible factors leading to treatment abandonment. We searched studies indexed in the fol- lowing databases: Virtual Health Library (VHL) and Scientific Electronic Library Online (SciELO), from 2017 to 2021, using the following descriptors (DeCS): tuberculosis, antituberculosis agent and pulmonary tuberculosis. In the end, eleven studies were selec- ted, published in Portuguese, Spanish and English languages. The results showed that the abandonment is related to factors of several spheres, especially the social, health and tre- atment spheres. As a profile of the people in the abandonment cases, in general, it was observed that they are economically active, between 15 and 49 years old, have low edu- cation, low income, and it is common that the abuse of alcohol and drugs are presented as relevant comorbidities. Therefore, the work showed the main factors associated with the abandonment of tuberculosis treatment and the importance of the participation of dif- ferent actors as forces that will add up to reduce the occurrence of the problem in question. KEY WORDS: Tuberculosis; Antituberculosis Agent; Pulmonary Tuberculosis.

El abandono del tratamiento de la tuberculosis es una cuestión relevante y acuciante en la salud pública mundial. Mediante una revisión integradora, este estudio pretende identificar los posibles factores que conducen al abandono del tratamiento. Se buscaron estudios indexados en las siguientes bases de datos: Virtual Health Library (BVS) y Scientific Electronic Library Online (SciELO), desde 2017 hasta 2021, utili- zando los siguientes descriptores (DeCS): tuberculosis, agente antituberculoso y tubercu- losis pulmonar. Al final, se seleccionaron once estudios publicados en portugués, español e inglés. Los resultados mostraron que el abandono está relacionado con factores de di- versas esferas, especialmente la social, sanitaria y de tratamiento. Como perfil de las per- sonas en casos de abandono, en general, se observó que son económicamente activas, tienen entre 15 y 49 años, baja escolaridad, baja renta y es común que el abuso de alcohol y drogas se presenten como comorbilidades relevantes. Por lo tanto, el trabajo mostró los principales factores asociados al abandono del tratamiento de la tuberculosis y la impor- tancia de la participación de diferentes actores como fuerzas que sumarán para reducir la ocurrencia del problema en cuestión.

Sindemia de Covid-19 e tuberculose pulmonar durante período pandêmico: impactos na saúde pública brasileira / Covid-19 syndemic and pulmonary tuberculosis during the pandemic period: impacts on brazilian public health / Tuberculosis pulmonar y sindrome covid-19 durante el periodo pandémico: impactos en la salud pública brasileña

Objetivo: Examinar e mapear as evidências científicas sobre o impacto da sindemia de COVID-19 e tuberculose pulmonar durante período pandêmico no Brasil. Metodologia: Scoping Review, baseado nos procedimentos recomendados pelo Instituto Joanna Briggs. Estabeleceu-se a pergunta norteadora: "Qual o impacto da pandemia de COVID-19 e fatores associados ao aumento de casos de Tuberculose Pulmonar no Brasil durante período pandêmico?". Foram realizadas buscas em três bases de dados nacionais e internacionais, sobre trabalhos publicados até dezembro de 2022. Dos 819 estudos encontrados, 20 foram selecionados para leitura na íntegra, resultando em uma amostra final de 11 estudos analisados. Resultados: As 11 publicações analisadas foram publicadas de 2020 a 2022 durante período pandêmico, de âmbito nacional e internacional com delineamento de estudos experimentais, do tipo ensaio clínico com randomização. A maioria dos estudos incluídos, 7 (70%) foram publicados no ano de 2022. Quanto ao tipo de estudo, 40% eram estudos transversais, 03 estudos (30%) eram do tipo estudo retrospectivo, observacional. Apenas 3 eram estudos ecológico de série temporal no qual estes evidenciaram que o Brasil e suas macrorregiões apresentaram tendência temporal crescente para a notificação de TB no período pré-pandêmico. Segundo Berra et al. (2022) apenas a Região Nordeste apresentou tendência temporal decrescente de casos curados. Para o abandono do tratamento, todas as regiões, exceto o Nordeste, apresentaram um aumento nos números de casos, e em relação ao óbito, o Brasil e a Região Nordeste apresentaram tendência temporal crescente.

Objective: To examine and map the scientific evidence on the impact of the COVID-19 syndemic and pulmonary tuberculosis during the pandemic period in Brazil. Methodology: Scoping Review, based on procedures recommended by the Joanna Briggs Institute. The guiding question was established: "What is the impact of the COVID-19 pandemic and factors associated with the increase in cases of Pulmonary Tuberculosis in Brazil during the pandemic period?". Searches were carried out in three national and international databases, on works published until December 2022. Of the 819 studies found, 20 were selected for full reading, resulting in a final sample of 11 analyzed studies. Results: The 11 analyzed publications were published from 2020 to 2022 during the pandemic period, nationally and internationally with experimental study design, of the clinical trial type with randomization. Most of the studies included, 7 (70%) were published in the year 2022. As for the type of study, 40% were cross-sectional studies, 03 studies (30%) were retrospective, observational studies. Only 3 were ecological time series studies in which they showed that Brazil and its macro-regions showed an increasing temporal trend for TB notification in the pre-pandemic period. According to Berra et al. (2022) only the Northeast Region showed a decreasing temporal trend of cured cases. For treatment abandonment, all regions, except the Northeast, showed an increase in the number of cases, and in relation to death, Brazil and the Northeast Region showed an increasing temporal trend. KEYWORDS: Pulmonary Tuberculosis; COVID-19; Impact.

Objetivo: Examinar y mapear la evidencia científica sobre el impacto de la epidemia de COVID-19 y de la tuberculosis pulmonar durante el período pandémico en Brasil. Metodología: Scoping Review, basado en los procedimientos recomendados por el Instituto Joanna Briggs. Se estableció la pregunta guía "¿Cuál es el impacto de la pandemia de COVID-19 y los factores asociados al aumento de casos de Tuberculosis Pulmonar en Brasil durante el período pandémico?". Se realizaron búsquedas en tres bases de datos nacionales e internacionales, sobre trabajos publicados hasta diciembre de 2022. De los 819 estudios encontrados, 20 fueron seleccionados para lectura completa, resultando en una muestra final de 11 estudios analizados. Resultados: Las 11 publicaciones analizadas fueron publicadas entre 2020 y 2022 durante el periodo pandémico, a nivel nacional e internacional con diseño de estudio experimental, del tipo ensayo clínico con aleatorización. La mayoría de los estudios incluidos, 7 (70%) fueron publicados en el año 2022. En cuanto al tipo de estudio, 40% fueron estudios transversales, 03 estudios (30%) fueron retrospectivos, observacionales. Solamente 3 fueron estudios de series temporales ecológicas en los cuales mostraron que Brasil y sus macrorregiones presentaron una tendencia temporal creciente para la notificación de TB en el período prepandémico. Según Berra et al. (2022) sólo la Región Nordeste mostró una tendencia temporal decreciente de casos curados. Para el abandono del tratamiento, todas las regiones, excepto la Nordeste, mostraron un aumento en el número de casos, y en relación a la muerte, Brasil y la Región Nordeste mostraron una tendencia temporal creciente. PALABRAS CLAVE: Tuberculosis Pulmonar; COVID-19; Impacto.

Cooperación social y ofertas terapéuticas en la lucha contra la tuberculosis en la Ciudad de México, década de 1940 / Social cooperation and therapeutic offers in the fight against tuberculosis in Mexico City, the 1940s decade

Resumen En México, la decidida y sistemática participación de la sociedad civil en la lucha contra la tuberculosis inició en 1939, al crearse el Comité Nacional de Lucha contra la Tuberculosis. Su plural conformación y las labores que desempeñó le distinguieron de las asociaciones y de ligas antituberculosas creadas en décadas previas en diferentes países de las Américas. En este artículo se presentará un primer acercamiento a la plural conformación de ese organismo y se estudiarán algunas de las acciones que impulsó durante su primera década de funcionamiento, un momento en el que también fue particularmente prolífica la coexistencia de diferentes terapéuticas para tratar a los individuos con esa enfermedad.

Abstract The determined and systematic participation of civil society in the fight against tuberculosis in Mexico began in 1939 when the National Committee for the Fight against Tuberculosis was created. Its plural conformation and tasks distinguished it from the anti-tuberculosis associations and leagues created in previous decades in different countries of the Americas. This article will present a first approach to the plural conformation of this organism and will study some of the actions that it promoted during its first decade of operation, in which the coexistence of different therapeutics to treat individuals was also particularly prolific with that disease.

Distribuição dos casos de tuberculose no Paraná: um estudo ecológico, 2018-2021 / Distribución de casos de tuberculosis en Paraná, Brasil: un estudio ecológico, 2018 a 2021 / Distribution of tuberculosis cases in the state of Paraná: an ecological study, Brazil, 2018-2021

Objetivo: analisar a distribuição dos casos de tuberculose no Paraná, Brasil, entre 2018 e 2021. Métodos: estudo ecológico, sobre dados secundários oriundos de notificações compulsórias; descrição das taxas de detecção por 100 mil habitantes segundo regiões de saúde do estado; cálculo das variações percentuais entre 2018-2019 e 2020-2021. Resultados: foram registrados 7.099 casos, observando-se maiores taxas nas regionais de Paranaguá (52,4/100 mil em 2018-2019; 38,2/100 mil em 2020-2021) e Foz do Iguaçu (34,4/100 mil em 2018-2019; 20,5/100 mil em 2020-2021), e menores em Irati (6,3/100 mil em 2018-2019; 8,8/100 mil em 2020-2021) e Francisco Beltrão (8,5/100 mil em 2018-2019; 7,6/100 mil em 2020-2021); em 2020-2021, houve queda nas variações percentuais dessas taxas em 18 regionais e aumento em quatro, destacando-se, respectivamente, Foz do Iguaçu (-40,5%) e Cianorte (+53,6%). Conclusão: foram observadas taxas elevadas nas regionais do litoral e da tríplice fronteira; houve declínio das taxas de detecção no período pandêmico.

Objective: to analyze the distribution of tuberculosis cases in the state of Paraná, Brazil, between 2018 and 2021. Methods: this was an ecological study using secondary data obtained from compulsory notifications; detection rates per 100,000 inhabitants were described according to health regions in the state; percentage changes between 2018-2019 and 2020-2021 were calculated. Results: a total of 7,099 cases were registered. The highest rates were observed in the health regions of Paranaguá (52.4/100,000 in 2018-2019; 38.2/100,000 in 2020-2021) and Foz do Iguaçu (34.4/100,000 in 2018-2019; 20.5/100,000 in 2020-2021), and the lowest rates in Irati (6.3/100,000 in 2018-2019; 8.8/100,000 in 2020-2021) and Francisco Beltrão (8.5/100,000 in 2018-2019; 7.6/100,000 in 2020-2021); in 2020-2021, it could be seen a decrease in percentage changes in 18 health regions, while there was an increase in four of them, especially Foz do Iguaçu (-40.5%) and Cianorte (+53.6%). Conclusion: high rates were found in the coastal and triple border regions; and there was a decline in detection rates in the pandemic period.

Objetivo: analizar la distribución de casos de tuberculosis en Paraná de 2018 a 2021. Métodos: estudio ecológico utilizando datos secundarios de notificaciones obligatorias. Se describieron las tasas de detección por 100.000 habitantes según las regiones de salud de Paraná. Se calcularon los cambios porcentuales entre 2018-2019 y 2020-2021. Resultados: se registraron 7.099 casos, observándose tasas más altas en las regiones de Paranaguá (52,4/100.000 en 2018-2019 y 38,2/100.000 en 2020-2021) y Foz do Iguaçu (34,4/100.000 en 2018-2019 y 20,5/100.000 en 2020-2021) y menor en Irati (6,3/100.000 en 2018-2019 y 8,8/100.000 en 2020-2021) y Francisco Beltrão (8,5/100.000 en 2018-2019 y 7,6/100.000 en 2020-2021). En 2020-2021, hubo descenso en 18 regiones y aumento en cuatro, con destaque para Foz do Iguaçu (-40,5%) y Cianorte (+53,6%). Conclusión: se encontraron altas tasas para las regiones de la costa y la triple frontera, además de una disminución en la detección durante el período de pandemia.

O estigma como fonte da construção social do conceito de tuberculose pulmonar: perspectiva dos enfermeiros / El estigma como fuente de la construcción social del concepto de tuberculosis pulmonar: perspectiva de las enfermeras / Stigma as a source of the social construction of the concept of pulmonary tuberculosis: perspective of nurses

Objetivos: descrever a construção social do conceito social da tuberculose pulmonar que, na pesrpetiva de enfermeiros, emerge de conceitos alicerçados no estigma. Método: estudo descritivo, de abordagem qualitativa, com 12 enfermeiros de centros de diagnóstico pneumológico do Norte de Portugal. Dados colhidos nos meses de novembro de 2020 e janeiro de 2021 por entrevista semiestruturada, posteriormente analisados pela metodologia de análise de conteúdo. Resultados: dos discursos dos participantes emerge o conceito da tuberculose pulmonar. O entendimento da doença está envolto de mitos e tabus, com prognóstico sombrio, causa medo de contágio, de morte, pavor, vergonha, afastamento, isolamento social e negação da doença. Entre enfermeiros, falar de tuberculose é tema a evitar, é área que causa confusão e medo. Considerações finais: a conceção da palavra tuberculose persiste enraizada em conceitos e preconceitos. O estigma social permanece na sua essência e faz perpetuar o seu conceito negativo, até à atualidade.

Objetivos: describir la construcción social del concepto social de la tuberculosis pulmonar que, desde la perspectiva de enfermeros, emerge de conceptos basados en el estigma. Método: estudio descriptivo, de abordaje cualitativo, con 12 enfermeros de centros de diagnóstico pneumológico del Norte de Portugal. Datos recogidos en los meses de noviembre de 2020 y enero de 2021 por entrevista semiestructurada, posteriormente analizados por la metodología de análisis de contenido. Resultados: de los discursos de los participantes emerge el concepto de la tuberculosis pulmonar. El entendimiento de la enfermedad está envuelto de mitos y tabúes, con pronóstico sombrío, causa miedo de contagio, de muerte, pavor, vergüenza, alejamiento, aislamiento social y negación de la enfermedad. Entre enfermeras, hablar de tuberculosis es tema a evitar, es área que causa confusión y miedo. Consideraciones finales: la concepción de la palabra tuberculosis persiste enraizada en conceptos y prejuicios. El estigma social permanece en su esencia y hace perpetuar su concepto negativo, hasta la actualidad.

Objective: to describe the social construction of the social concept of pulmonary tuberculosis that, from the perspective of nurses, emerges from concepts based on stigma. Method: descriptive study, qualitative approach, with 12 nurses from centers of pneumological diagnosis in northern Portugal. Data collected in November 2020 and January 2021 by semi-structured interview, subsequently analyzed by content analysis methodology. Results: from the participants' discourses, the concept of pulmonary tuberculosis emerges. The understanding of the disease is surrounded by myths and taboos, with a bleak prognosis, causes fear of contagion, death, fear, shame, estrangement, social isolation and denial of the disease. Among nurses, talking about tuberculosis is a topic to avoid, it is an area that causes confusion and fear. Final considerations: the concept of the word tuberculosis persists rooted in concepts and prejudices. Social stigma remains at its core and perpetuates its negative concept to the present day.

Control de la tuberculosis pulmonar en el personal de Enfermería en instituciones hospitalarias / Control of Pulmonary Tuberculosis among the Nursing Personnel in Hospital Institutions

Introducción: La tuberculosis pulmonar es uno de los problemas de salud pública más importante a nivel mundial. El personal de la salud tiene mayor probabilidad de contraer la infección con Mycobacterium tuberculosis por su exposición incrementada a pacientes con la enfermedad. Objetivo: Sistematizar el control de la tuberculosis pulmonar en el personal de enfermería en instituciones hospitalarias. Métodos: Revisión integrativa en las bases de datos SciELO y Medline, mediante los descriptores (DeCS): "tuberculosis/tuberculose", "Personal de Enfermería/pessoal de enfermagem/health personnel", "prevención/prevencao/prevention", a través de los operadores booleanos AND y OR. Se establecen las categorías de análisis para una mejor organización del conocimiento. Se establecieron como criterios de inclusión, artículos completos en español, portugués e inglés, que refirieran de manera clara la metodología y los resultados obtenidos. Se incluyeron 10 referencias, que evidencian que existen diversos factores para la transmisión del bacilo de la tuberculosis, en el personal de atención en salud, como el número de pacientes con tuberculosis pulmonar atendidos al año. Es esencial la concientización de las medidas para su control. Diversas publicaciones documentan experiencias de la aplicación de medidas de control, con sus respectivas recomendaciones, mediante el análisis de sus ventajas, desventajas y en algunos casos, de su rentabilidad. Conclusiones: Las evidencias científicas exponen que las medidas de control de la tuberculosis en las instituciones hospitalarias son una estrategia eficaz para prevenir la transmisión de la enfermedad al personal de enfermería(AU)

Introduction: Pulmonary tuberculosis is one of the most important public health problems worldwide. The healthcare personnel are more likely to contract infection with Mycobacterium tuberculosis, because of their increased exposure to patients with the disease. Objective: To systematize the control of pulmonary tuberculosis among the nursing personnel in hospital institutions. Methods: An integrative review in the SciELO and Medline databases was carried out, using the Health Sciences Descriptors (DeCS) tuberculosis/tuberculose [tuberculosis], Personal de Enfermería/pessoal de enfermagem/health personnel [nursing personnel], prevención/prevenção/prevention, through the Boolean operators AND and OR. The analysis categories were established for better knowledge organization. The established inclusion criterions were complete articles published in Spanish, Portuguese and English, which clearly referred to the methodology and obtained results. Ten references were included, showing that there are several factors for the transmission of the tuberculosis bacillus in the health care personnel, as being the number of patients with pulmonary tuberculosis attended per year. Awareness-raising is essential concerning measures for its control. Publications document experiences regarding the application of control measures, with their respective recommendations, by analyzing their advantages, disadvantages and, in some cases, their cost-effectiveness. Conclusions: Scientific evidence show that tuberculosis control measures in hospital institutions are an effective strategy for preventing transmission of the disease to nursing personnel(AU)

Concepções sobre tratamento e diagnóstico da tuberculose pulmonar para quem a vivencia / Concepciones sobre el tratamiento y diagnóstico de la tuberculosis pulmonar para quienes la padecen / Conceptions about treatment and diagnosis of pulmonary tuberculosis for those who experience it

Resumo Objetivos analisar as concepções de pessoas que vivenciam o tratamento e o diagnóstico da tuberculose pulmonar. Método trata-se de uma pesquisa descritiva e exploratória, com abordagem qualitativa, desenvolvida em um Centro de Saúde Escola de Belém (Pará) com 30 pacientes. Os dados foram coletados durante o período de setembro de 2019 a janeiro de 2020 por meio de entrevista semiestruturada com o auxílio de um roteiro contendo seis perguntas, assim como a observação das informações contidas no prontuário e no livro de controle de registro da tuberculose. Para a análise dos resultados, foi utilizada a técnica de Análise de Conteúdo segundo a perspectiva de Bardin. Resultado identificou-se que o reduzido conhecimento sobre a doença e a presença de concepções negativas influenciam, de forma significativa, a busca por cuidados ou a adesão ao tratamento, interferindo nas atividades diárias e laborais. Conclusão conclui-se que persiste a necessidade de os doentes (res)significarem a tuberculose durante o tratamento, sendo fundamental que a equipe de saúde conheça tais concepções, a fim de subsidiar cuidados que contemplem aspectos físicos e biopsicossociais ante o Programa de Controle da Tuberculose da unidade.

Resumen Objetivos analizar las concepciones de las personas que viven el tratamiento y diagnóstico de la tuberculosis pulmonar. Método se trata de una investigación descriptiva y exploratoria con abordaje cualitativo, desarrollada en un Centro de Salud Escolar de Belém (Pará), con 30 pacientes. Los datos fueron recogidos durante el período de septiembre de 2019 a enero de 2020 a través de una entrevista semiestructurada con la ayuda de un guion con seis preguntas, así como la observación de las informaciones contenidas en el prontuario y en el libro de control de registro de la tuberculosis. Para analizar los resultados se utilizó una técnica de análisis de contenido según la perspectiva de Bardin. Resultado se identificó que el escaso conocimiento sobre la enfermedad y la presencia de concepciones negativas influyen, de forma significativa, en la búsqueda de cuidados o la adhesión al tratamiento, interfiriendo en las actividades diarias y laborales. Conclusión se concluye que persiste la necesidad de los pacientes de (re)significar la tuberculosis durante el tratamiento, y del equipo tratante, de conocer tales concepciones, para subsidiar cuidados que contemplen aspectos físicos y biopsicosociales ante el Programa de Control de la Tuberculosis de la unidad.

Abstract Objectives to analyze the conceptions of people experiencing treatment and diagnosis of pulmonary tuberculosis. Method this is a descriptive and exploratory research with a qualitative approach, developed in a School Health Center of Belém (Pará) with 30 patients. Data was collected during the period from September 2019 to January 2020 through a semi-structured interview with the aid of a script containing six questions, as well as the observation of the information contained in the medical record and in the tuberculosis record control book. For the analysis of the results, the Content Analysis technique was used according to Bardin's perspective. Result it was identified that the reduced knowledge about the disease and the presence of negative conceptions influence, in a significant way, the search for care or the adherence to treatment, interfering in daily and work activities. Conclusion it is concluded that the need for patients to (re)mean tuberculosis during treatment persists, and it is essential that the health team knows such conceptions in order to provide care that contemplates physical and bio-psychosocial aspects before the Tuberculosis Control Program of the unit.

Aspectos clínico-epidemiológicos de pacientes con tuberculosis, Guantánamo 2013-2018

Introducción: A pesar de los esfuerzos de la ciencia para la eliminación de la tuberculosis, esta es considerada actualmente una enfermedad reemergente. En provincia Guantánamo no se encontraron investigaciones referida a este tema. Objetivo: Describir los aspectos clínico-epidemiológicos de pacientes con tuberculosis en el periodo comprendido de 2013-2018 en la provincia de Guantánamo. Método: Se realizó un estudio descriptivo, transversal retrospectivo de pacientes con tuberculosis. El universo de estudio quedó constituido por 103 pacientes (N꓿103) constatados en la base de datos del programa Centro Provincial de Higiene, Epidemiología y Microbiología Guantánamo. Las variables estudiadas fueron: edad, sexo, grupo de riesgo, municipio al que pertenece y formas clínicas. Se utilizó como medida de resumen la frecuencia absoluta y relativa. Resultados: El mayor número de pacientes con tuberculosis se encontró en el grupo de 40-49 años (28,16 %), se destacó el grupo de 50-59 del sexo masculino con un 15,53 %. El municipio que más casos aportó fue el de Guantánamo con 67 (65,04 %), seguido de Jamaica con 10 casos (9,70 %). De los pacientes diagnosticados: 43 fueron fumadores (50,0 %), 19 alcohólicos (22,10 %) y 11 desnutridos (12,79 %). Se obtuvo como resultado que 72 pacientes (69,90 %) presentaron la forma pulmonar y 31 (30,10 %) presentaron la forma extrapulmonar. Conclusiones: A pesar de una adecuada red de diagnóstico, tratamiento y seguimiento de la tuberculosis en la provincia de Guantánamo, existen condiciones que determinan la ocurrencia de esta: factores socioeconómicos, sanitarios e individuales inadecuados, hacinamiento, desnutrición, alcoholismo, predisponen a la enfermedad.

Introduction: Despite the scientific efforts to eliminate tuberculosis, it is currently considered as a reemerging disease. In Guantánamo province, no research closely related to the subject was found. Objective: To describe the clinical-epidemiologic aspects of patients with tuberculosis in Guantánamo province, period 2013-2018. Method: A descriptive, retrospective cross-sectional study of patients with tuberculosis was carried out. The study involved a total of 103 patients (N꓿103) recorded in a database manages at the Centro Provincial de Higiene, Epidemiología y Microbiología of Guantánamo. The variables studied were as follow: age, sex, risk group, municipality to which patients belong and, clinical forms. The absolute and relative frequencies were used as summary statistics method. Results: The highest number of patients with tuberculosis was found in 40 to 49 years age group (28.16%), and the male sex stood out in the group of age 50 to 59 (15.53%). The municipality with the highest number of cases was Guantánamo with 67 patients (65.04%), followed by Jamaica municipality with 10 patients (9.70%). Forty three of all the patients diagnosed with tuberculosis (50,0%) were addicted to smoking, 19 (22,10%) addicted to alcohol, and 11 (12,79%) in malnutrition state. As a result in the study, it was found in 72 patients (69.90%) presence of pulmonary tuberculosis and extrapulmonary tuberculosis in 31 active patients (30.10%). Conclusions: Despite of an adequate network of diagnosis, treatment and tuberculosis follow-up in the province of Guantánamo, there are several factors that determine the presence of the disease: for instance, the inadequate use of socioeconomic, sanitary and individual factors, including also aspects like overcrowding, malnutrition, and alcoholism.

Introdução: Apesar dos esforços da ciência para eliminar a tuberculose, atualmente é considerada uma doença reemergente. Na província de Guantánamo, não foram encontradas investigações relacionadas a este tema. Objetivo: Descrever os aspectos clínico-epidemiológicos de pacientes com tuberculose no período de 2013-2018 na província de Guantánamo. Método: Estudo descritivo, retrospectivo e transversal de pacientes com tuberculose. O universo do estudo foi composto por 103 pacientes (nº 103) encontrados no banco de dados do programa Centro Provincial de Higiene, Epidemiologia e Microbiologia de Guantánamo. As variáveis estudadas foram: idade, sexo, grupo de risco, município a que pertence e formas clínicas. Frequência absoluta e relativa foram usadas como medida sumária. Resultados: O maior número de doentes com tuberculose foi encontrado na faixa etária de 40 a 49 anos (28,16%), destacando-se a faixa de 50 a 59 anos do sexo masculino com 15,53%. O município que mais contribuiu com casos foi Guantánamo com 67 (65,04%), seguido de Jamaica com 10 casos (9,70%). Dos pacientes diagnosticados: 43 eram tabagistas (50,0%), 19 etilistas (22,10%) e 11 desnutridos (12,79%). Obteve-se como resultado que 72 pacientes (69,90%) apresentavam a forma pulmonar e 31 (30,10%) apresentavam a forma extrapulmonar. Conclusões: Apesar de uma rede adequada para o diagnóstico, tratamento e monitoramento da tuberculose na província de Guantánamo, existem condições que determinam sua ocorrência: fatores socioeconômicos, de saúde e individuais inadequados, superlotação, desnutrição, alcoolismo, predispõem à doença.

Comparison of different diagnostic modalities for isolation of Mycobacterium Tuberculosis among suspected tuberculous lymphadenitis patients / Comparação de diferentes modalidades de diagnóstico para isolamento de Mycobacterium tuberculosis entre pacientes com suspeita de linfadenite tuberculosa

Tuberculosis is a communicable disease with high morbidity and mortality rates in developing countries. The study's primary objective is to compare conventional methods such as acid-fast bacillus (AFB) culture and microscopy with rapid diagnostic methods. The secondary objective is to compare histopathological and microbiological findings in suspected patients with tubercular lymphadenitis. A total of 111 samples (August 2018 to September 2019) of lymph nodes were processed for AFB microscopy, AFB cultures, drug-susceptibility testing (DST), histopathology, and Xpert Mycobacterium Tuberculosis (MTB)/resistance to Rifampin (RIF) assays. Out of 111 lymph node samples, 6 (5.4%) were positive for AFB smear microscopy, 84 (75.6%) were positive for AFB culture, 80 (70.7%) were positive on Gene Xpert, and 102 (91.8%) were indicative of tuberculosis for histopathology studies. Mycobacteria growth indicator tube (MGIT) culture positivity was 84 (75.6%) higher than solid Lowenstein-Jensen (LJ) culture 74 (66.6%). Positive cultures underwent phenotypic DST. Two cases were Multidrug-resistant (MDR) on DST, while three cases were Rifampicin resistant on Gene Xpert. The sensitivity of Genexpert was (62%) against the conventional AFB culture method. The poor performance of conventional lymphadenitis diagnostic methods requires early and accurate diagnostic methodology. Xpert MTB/RIF test can help in the treatment of multidrug-resistant TB cases. Nonetheless, rapid and conventional methods should be used for complete isolation of Mycobacterium tuberculosis.

A tuberculose é uma doença transmissível com altas taxas de morbimortalidade nos países em desenvolvimento. O objetivo principal do estudo é comparar métodos convencionais, como cultura de bacilo álcool-ácido resistente (BAAR) e microscopia, com métodos de diagnóstico rápido. O objetivo secundário é comparar os achados histopatológicos e microbiológicos em pacientes com suspeita de linfadenite tubercular. Um total de 111 amostras (agosto de 2018 a setembro de 2019) de gânglios linfáticos foi processado para microscopia de AFB, culturas de AFB, teste de susceptibilidade a drogas (DST), histopatologia e Xpert Mycobacterium tuberculosis (MTB)/ensaios de resistência à rifampicina (RIF). Das 111 amostras de linfonodos, 6 (5,4%) foram positivas para baciloscopia de AFB, 84 (75,6%) foram positivas para cultura de AFB, 80 (70,7%) foram positivas para o GeneXpert e 102 (91,8%) foram indicativas de tuberculose para estudos histopatológicos. A positividade da cultura do tubo indicador de crescimento de micobactérias (MGIT) foi 84 (75,6%), maior que a cultura sólida de Lowenstein-Jensen (LJ), 74 (66,6%). As culturas positivas foram submetidas a DST fenotípico. Dois casos eram multirresistentes (MDR) ao DST, enquanto três casos eram resistentes à rifampicina no GeneXpert. A sensibilidade do GeneXpert foi 62% contra o método convencional de cultura AFB. O fraco desempenho dos métodos convencionais de diagnóstico de linfadenite requer metodologia de diagnóstico precoce e precisa. O teste Xpert MTB/RIF pode ajudar no tratamento de casos de tuberculose multirresistente. No entanto, métodos rápidos e convencionais devem ser usados para o isolamento completo do Mycobacterium tuberculosis.

Comparison of different diagnostic modalities for isolation of Mycobacterium Tuberculosis among suspected tuberculous lymphadenitis patients

Abstract Tuberculosis is a communicable disease with high morbidity and mortality rates in developing countries. The study's primary objective is to compare conventional methods such as acid-fast bacillus (AFB) culture and microscopy with rapid diagnostic methods. The secondary objective is to compare histopathological and microbiological findings in suspected patients with tubercular lymphadenitis. A total of 111 samples (August 2018 to September 2019) of lymph nodes were processed for AFB microscopy, AFB cultures, drug-susceptibility testing (DST), histopathology, and Xpert Mycobacterium Tuberculosis (MTB)/resistance to Rifampin (RIF) assays. Out of 111 lymph node samples, 6 (5.4%) were positive for AFB smear microscopy, 84 (75.6%) were positive for AFB culture, 80 (70.7%) were positive on Gene Xpert, and 102 (91.8%) were indicative of tuberculosis for histopathology studies. Mycobacteria growth indicator tube (MGIT) culture positivity was 84 (75.6%) higher than solid Lowenstein-Jensen (LJ) culture 74 (66.6%). Positive cultures underwent phenotypic DST. Two cases were Multidrug-resistant (MDR) on DST, while three cases were Rifampicin resistant on Gene Xpert. The sensitivity of Genexpert was (62%) against the conventional AFB culture method. The poor performance of conventional lymphadenitis diagnostic methods requires early and accurate diagnostic methodology. Xpert MTB/RIF test can help in the treatment of multidrug-resistant TB cases. Nonetheless, rapid and conventional methods should be used for complete isolation of Mycobacterium tuberculosis.

Resumo A tuberculose é uma doença transmissível com altas taxas de morbimortalidade nos países em desenvolvimento. O objetivo principal do estudo é comparar métodos convencionais, como cultura de bacilo álcool-ácido resistente (BAAR) e microscopia, com métodos de diagnóstico rápido. O objetivo secundário é comparar os achados histopatológicos e microbiológicos em pacientes com suspeita de linfadenite tubercular. Um total de 111 amostras (agosto de 2018 a setembro de 2019) de gânglios linfáticos foi processado para microscopia de AFB, culturas de AFB, teste de susceptibilidade a drogas (DST), histopatologia e Xpert Mycobacterium tuberculosis (MTB)/ensaios de resistência à rifampicina (RIF). Das 111 amostras de linfonodos, 6 (5,4%) foram positivas para baciloscopia de AFB, 84 (75,6%) foram positivas para cultura de AFB, 80 (70,7%) foram positivas para o GeneXpert e 102 (91,8%) foram indicativas de tuberculose para estudos histopatológicos. A positividade da cultura do tubo indicador de crescimento de micobactérias (MGIT) foi 84 (75,6%), maior que a cultura sólida de Lowenstein-Jensen (LJ), 74 (66,6%). As culturas positivas foram submetidas a DST fenotípico. Dois casos eram multirresistentes (MDR) ao DST, enquanto três casos eram resistentes à rifampicina no GeneXpert. A sensibilidade do GeneXpert foi 62% contra o método convencional de cultura AFB. O fraco desempenho dos métodos convencionais de diagnóstico de linfadenite requer metodologia de diagnóstico precoce e precisa. O teste Xpert MTB/RIF pode ajudar no tratamento de casos de tuberculose multirresistente. No entanto, métodos rápidos e convencionais devem ser usados para o isolamento completo do Mycobacterium tuberculosis.

Drug resistance surveillance in Mycobacterium tuberculosis in Jiaxing City / 预防医学

Objective@#To investigate the resistance of Mycobacterium tuberculosis to first-line anti-tuberculosis drugs in Jiaxing City, Zhejiang Province from 2017 to 2019, so as to provide insights into improvements of the therapeutic effect of pulmonary tuberculosis. @*Methods@#Data pertaining to pulmonary tuberculosis in Jiaxing City from 2017 to 2019 were collected from the Tuberculosis Surveillance System of Chinese Disease Prevention and Control Information System, including demographics, treatment classification, sputum culture and drug resistance. The spectrum, types and prevalence of drug resistance in M. tuberculosis to four first-line tuberculosis drugs, including isoniazid (INH), rifampicin (RFP), streptomycin (SM) and ethambutol (EMB), was analyzed using a descriptive epidemiological method.@*Results@#A total of 1 310 M. tuberculosis isolates were cultured from pulmonary tuberculosis patients in Jiaxing City from 2017 to 2019, and there were 259 M. tuberculosis isolates that were resistant to anti-tuberculosis drugs, with an overall drug resistance rate of 19.77%. The prevalence rates of drug resistance to INH, SM, RFP and EMB were 13.36%, 11.83%, 5.50% and 3.59%, respectively. The prevalence of drug resistance was lower in M. tuberculosis isolates from treatment-naïve patients than from retreated patients (18.45% vs. 34.58%, P<0.05). M. tuberculosis isolates presented high resistance to SM (4.50%) and INH alone (4.35%), the highest resistance to INH-SM combinations (3.28%), and the highest resistance to INH+RFP+SM combinations (1.83%). Sixteen isolates were resistant to all the four drugs, with a drug resistance rate of 1.22%. The proportions of resistance to a single drug, RFP resistance, multidrug resistance and resistance to two and more drugs were 10.31%, 5.50%, 4.73% and 4.73%, respectively. In addition, the prevalence of RFP resistance among all patients and treatment-naïve patients both showed a tendency towards a rise from 2017 to 2019 (P<0.05). The prevalence of RFP resistance (7.01% vs. 3.76%) and resistance to two and more drugs (6.01% vs. 3.25%) was both higher among interprovincial mobile tuberculosis patients than among local non-mobile patients (P<0.05). @*Conclusions@#The overall prevalence of drug resistance was lower in M. tuberculosis isolates in Jiaxing City from 2017 to 2019 than in Zhejiang Province, with INH and RFP resistance as predominant types.

Epidemiological investigation of a pulmonary tuberculosis outbreak involving six high schools / 预防医学

@#In September 2020, three pulmonary tuberculosis cases were identified during school physical examinations at a senior high school in a district (School B) of Hangzhou City. Immediate epidemiological surveys were performed by local district and Hangzhou Center for Disease Control and Prevention, and a pulmonary tuberculosis outbreak involving 9 cases in 6 schools were identified. All cases were once Grade 9 students in Class of 2019 at a junior high school (School A), and the source of infection might be a laboratory-confirmed cases (index case) in this class reported in April, 2019. Following exposure to index case, other cases developed disease onset or were screened after entering senior high schools. In November, 2020, tuberculin skin test and chest X-ray scan were performed to screen pulmonary tuberculosis among 43 students and teachers in a class of Grade 9 in Class of 2019 at School A, and 17 students strongly positive for tuberculin skin test were given prophylactic therapy. No pulmonary tuberculosis case were identified until June 2021. It is suggested that early epidemiological surveys facilitates the identification of the epidemiological correlation between cases. Active search for individuals with common exposure history and prophylactic therapy are required if a possible outbreak is found, which is helpful to avoid the spread of the outbreak.