Fatores associados à cura e ao abandono do tratamento da tuberculose na população privada de liberdade / Factors associated with recovery and the abandonment of tuberculosis treatment in the incarcerated population

RESUMO: Objetivo: Este estudo objetivou investigar os fatores associados aos desfechos de cura e abandono na população privada de liberdade com tuberculose. Métodos: Estudo quantitativo, observacional e analítico. Realizado com dados oriundos do Sistema de Informação de Agravos de Notificação (Sinan), de tuberculose da população privada de liberdade nos anos de 2007 a 2016 no estado da Paraíba. Foram incluídas as notificações de indivíduos maiores de 18 anos notificados como "casos novos" e como encerramento por "cura" ou "abandono". Excluíram-se aqueles que até dezembro de 2016 não tinham a situação de encerramento. Realizaram-se estatísticas bivariada e multivariada, por meio de regressão de Poisson. Resultados: Com 614 notificações, a maioria foi do sexo masculino (93,8%). Na análise bivariada, houve associação estaticamente relevante dos desfechos com síndrome da imunodeficiência adquirida (p = 0,044), sorologia para vírus da imunodeficiência humana (p = 0,048) e não realização de baciloscopia de acompanhamento (p = 0,001). Na análise multivariada ajustada, a síndrome da imunodeficiência adquirida (risco relativo - RR = 1,998; intervalo de confiança de 95% - IC95% 1,078 - 3,704; p = 0,028) e a não realização de baciloscopia de acompanhamento (RR = 5,211; IC95% 2,158 - 12,583; p < 0,001*) permaneceram significativamente associadas ao desfecho de abandono. Conclusão: Os desfechos de cura e abandono estão associados principalmente com a realização ou não da baciloscopia de acompanhamento e com a síndrome da imunodeficiência adquirida.

ABSTRACT: Objective: This study aimed to investigate the factors associated with the outcomes of recovery and abandonment in the incarcerated population with tuberculosis. Methods: A quantitative and observational analytical study was performed with data from the Notification Disease Information System (Sinan), tuberculosis data from the incarcerated population in the state of Paraiba from 2007 to 2016; Notifications of individuals over the age of 18, reported as "new cases" and the outcome, "recovery" or "abandonment" status were included. Those people who until December 2016 had no outcome information were excluded. Analyses were performed using bivariate and multivariate statistics from the Poisson regression. Results: Of the 614 notifications, most were male (93.8%). In the bivariate analysis, there was a statistically relevant association of outcomes with Acquired Immunodeficiency Syndrome (p = 0.044), Human Immunodeficiency Virus (HIV) serology (p = 0.048) and lack of completion of follow-up bacilloscopy (p = 0.001). In the adjusted multivariate analysis, Acquired Immunodeficiency Syndrome (RR = 1.998; 95%CI 1.078 - 3.704; p = 0.028) and lack of completion of follow-up bacilloscopy (RR = 5.251; 95%CI 2.158 - 12.583; p <0.001*) remained significantly associated with the dropout outcome. Conclusion: Recovery and abandonment outcomes were mainly associated with whether the follow-up bacilloscopy was performed or not and Acquired Immunodeficiency Syndrome.

Mycobacterium bovis en fauna silvestre de la cuenca lechera de Santa Fe, Argentina / Mycobacterium bovis in wildlife of the dairy regions of Santa Fe (Argentina)

El control y la erradicación de la tuberculosis bovina basados en la detección de los animales infectados y su inmediata faena permitió lograr progresos satisfactorios en varios países y regiones, pero no todos pudieron lograrlo debido principalmente a la presencia de fauna silvestre infectada con Mycobacterium bovis. La Argentina aplica desde 1999 estas mismas premisas y ha logrado avances en los rodeos lecheros, aunque no se ha evaluado el factor ambiental como la fauna silvestre. El objetivo de este trabajo fue determinar si la fauna silvestre de la cuenca lechera de Santa Fe está infectada con M. bovis. Se realizó la captura/sacrificio de fauna silvestre presente en 5 rodeos lecheros con altos niveles de reaccionantes positivos a la prueba de tuberculina. Sobre 95 mamíferos silvestres examinados, se aisló M. bovis de 7 individuos de comadreja overa (Didelphis albiventris), de uno de zorro gris (Lycolapex gimnocercus) y de uno de rata (Rattus norvegicus). Los sitios anatómicos que produjeron estos aislamientos variaron de acuerdo con las especies; en ninguno de los ejemplares evaluados se observaron lesiones macroscópicas de tuberculosis. Los espoligotipos de M. bovis aislados con mayor frecuencia de los animales silvestres correspondieron a los tipos 34 (4 aislamientos) y 12 (3 aislamientos); el primero es el más corrientemente aislado del ganado en Argentina. Se discute en este estudio el papel de la comadreja overa (D. albiventris) como hospedador circunstancial de M. bovis

Control eradication campaigns of bovine tuberculosis based on the «test and slaughter¼ approach were successful in many countries and regions; however, in some areas the infection persists and one of the main reasons is Mycobacterium bovis infection in wild life species. Argentina has applied the same approach since 1999, achieving progress in dairy cattle herds. Nonetheless, the wildlife role has never been investigated. The objective of this study was to determine if wildlife from the Santa Fe dairy area is infected with M. bovis. Wildlife species having a positive tuberculin skin test were captured in five dairy farms. Ninety five wildlife mammals were captured; M. bovis was recovered from 7 possums (Didelphys albiventris), from one fox (Lycolapex gimnocercus) and from one rat (Rattus norvegicus). None of the animals exhibited macroscopic lesions. The most frequently isolated M. bovis spoligotypes were types 34 (4 isolates) and 12 (3 isolates). Spoligotype 34 is the most frequently isolated type in Argentine cattle. The role of D. albiventris as spillover host of M. bovis is discussed in this study

Diagnóstico bacteriológico de la tuberculosis en Argentina: resultados de una encuesta nacional / Bacteriological diagnosis of tuberculosis in Argentina: results of a national survey

Con el objetivo de evaluar recursos, prácticas y medidas de bioseguridad utilizados en el diagnóstico bacteriológico de tuberculosis y determinar la utilidad y alcance de las técnicas empleadas, se llevó adelante una encuesta transversal a laboratorios del sector público de Argentina utilizando un cuestionario estructurado. El análisis de los resultados mostró que la densidad de centros de microscopía y cultivo se encuentra al nivel o encima de lo recomendado por Organización Mundial de la Salud. El programa de control de calidad de microscopía cubre mayoritariamente los laboratorios con alta carga de trabajo. El promedio de baciloscopías/paciente fue bajo (1,6). El 25 por ciento de los laboratorios de cultivo empleaban protección respiratoria inadecuada. El aporte del cultivo a la confirmación de casos pulmonares en las jurisdicciones estuvo asociado a la proporción de muestras cultivadas. Globalmente, el porcentaje de pacientes pulmonares baciloscopía-negativa que fue confirmado bacteriológicamente fue de 18.9 por ciento; mientras que la may-oría de los casos extrapulmonares se confirmó sólo por cultivo (71,3 por ciento). Es prioritario aún el incremento del número de esputos estudiados por baciloscopía y cultivo, así como aumentar la cobertura de programa de control de calidad de microscopía; es fundamental proveer al personal de laboratorio de adecuada protección respiratoria y evaluación médica regular.

In order to assess laboratory resources, practices, and biosafety measures during mycobacterial testing and determine the usefulness and scope of mycobacterial techniques, a cross-sectional survey of public laboratories was conducted in Argentina using a structured questionnaire. Sputum smear analysis showed that both smear and culture testing centers are being provided at or above the WHO recommended density for such facilities. The microscopy quality assessment program covered most high-demand laboratories. Mean number of sputum smears per patient was low (1.6). The use of inadequate personal respiratory protection was identified in 25 percent of culture laboratories. Jurisdictions that cultured a higher proportion of their smear-tested sputa identified a higher proportion of smear-negative cases. The percentage of smear negatives among all bacteriologically confirmed pulmonary cases was 18.9 percent, while most extrapulmonary cases were confirmed by culture (71.3 percent). In conclusion, increasing the number of sputa studied by microscopy and culture (while expanding the coverage of the quality assessment program) is a priority; adequate respiratory protection and regular medical evaluation of laboratory staff is still needed in some laboratories.

Application of enzyme amplified mycobacterial DNA detection in the diagnosis of pulmonary & extra-pulmonary tuberculosis.

BACKGROUND & OBJECTIVES: As isolation of Mycobacterium tuberculosis in culture requires a long time, there is a need for simple rapid method for direct detection of M. tuberculosis from clinical specimens. Amplified nucleic acid hybridization assays such as polymerase chain reaction (PCR) have shown promising results. In the present study, the sensitivity of PCR assay was assessed over smear microscopy for rapid diagnosis of tuberculosis in pulmonary and extra-pulmonary samples from patients suspected to have tuberculosis. METHODS: A total of 37 clinical samples from patients with pulmonary tuberculosis and 133 from patients with extra-pulmonary tuberculosis were subjected to Ziehl-Neelsen staining for smear preparation and PCR for detection of mycobacterial DNA. RESULTS: It was observed that 100 per cent of acid fast bacilli (AFB) positive and 35.7 per cent of AFB negative pulmonary samples and 82.76 per cent of AFB positive and 56.73 per cent of AFB negative extra-pulmonary samples were positive for mycobacterial DNA detection. Total positivity rates of DNA amplification method in pulmonary and extra-pulmonary samples were 75.67 per cent and 61.7 per cent respectively which were significantly higher in comparison with AFB positivity, which was 62.16 per cent in pulmonary and 21.8 per cent in extra-pulmonary samples (P < 0.05 and P < 0.001 respectively). INTERPRETATION & CONCLUSION: Routine application of DNA amplification method in diagnosis of AFB negative patients with pulmonary or extra-pulmonary tuberculosis may be a useful tool for detection of M. tuberculosis.

Rapid diagnosis of vaginal carriage of group B beta haemolytic streptococcus by an enrichment cum antigen detection test.

BACKGROUND & OBJECTIVES: Group B beta haemolytic streptococcus (GBS) is a frequent colonizer of the maternal genital tract causing peripartum fever, puerperal sepsis, neonatal sepsis and neonatal meningitis. The conventional methods for detection of maternal colonization take 24-48 h. We made an attempt to standardize a rapid enrichment cum antigen detection test to screen pregnant women for GBS colonization in less than 8 h, so as to enable early institution of measures to prevent neonatal sepsis. METHODS: Vaginal swabs of 100 women >36 wk of gestation were inoculated onto enrichment broth (Todd Hewitt broth with lysed horse blood and antibiotics). After incubation for 1,2,4,6, and 18 h, the broth was cultured on sheep blood agar. In culture positive cases, the enrichment broth was subjected to antigen detection by latex agglutination test (LAT). For further evaluation of the rapid test, another group of 100 pregnant women were screened for GBS carriage by 6 h enrichment broth culture followed by antigen detection test. RESULTS: Five of the first group yielded GBS on culture and all were positive for GBS antigen after 6 h enrichment. Thirteen of the second group were positive for the antigen, but GBS could be isolated in ten only. This enrichment cum antigen detection test showed sensitivity, specificity, and positive and negative predictive values of 100, 98.4, 83.3 and 100 per cent respectively and could detect as few as 10(3) cfu/ml organisms. Maternal vaginal carriage of GBS was 7.5 per cent (15/200). INTERPRETATION & CONCLUSION: Six hours of enrichment followed by antigen detection proved to be a rapid and reliable method for detection of GBS colonization. This test is easy to perform making it an ideal test for screening GBS vaginal colonization at labour and starting chemoprophylaxis, where indicated on the same day, before the woman is discharged.

Encuesta sobre los métodos de diagnóstico microbiológico de la infección urinaria / Survey on methods for the microbiological diagnosis of urinary tract infection

La infeccióm del tracto urinario (ITU), patología infecciosa altamente prevalente, debe ser confirmada por un diagnóstico microbiológico. El Comité de Microbiología Clínica de la Sociedad Chilena de Infectología realizó una encuesta retrospectiva para conocer la situación actual de algunos laboratorios asistenciales sobre metodología y criterios diagnósticos empleados empleados en el diagnóstico de ITU. Respondieron la encuesta 15 centros hospitalarios y laboratorios privados recopilándose información sobre 49.632 urocultivos. Es destacable que la totalidad de los laboratorios consideraron como criterio microbiológico de ITU un recuento microbiano > 100.000 ufc/ml. No fue posible analizar datos con recuentos inferiores por no disponerse de datos métodos sobre obtención de muestra, resultados del estudio microscópico (sedimiento urinario) concominate y sintomatología clínica. Utilizando este criterio diagnóstico la positividad varió entre 2,3 por ciento en varones y 33 por ciento en mujeres, porcentajes con una mayor dispersión en niños. Sólo 13 por ciento de las intituciones procesaron la muestra de orina en conocimiento del tiempo transcurrido desde la obtención de la muestra. Todos los laboratorios utilizaron el mismo criterio para considerar contaminada una muestra: > 3 microorganismo; algunos de ellos registraron 17 por ciento de contaminación. Si bien esta encuesta fue retrospectiva limitando la calidad del diagnóstico de situación, ella motivó al Comite de Microbiología Clínica a elaborar recomendaciones para el diagnóstico microbiológico de la infección urinaria