Hemoptisis secundaria a tuberculosis pulmonar complicada con pseudoaneurisma de Rasmussen. Reporte de un caso en pediatría. / Hemoptysis in Pulmonary Tuberculosis Complicated by Rasmussen's Pseudoaneurysm. A Pediatric Case Report.

Presentamos el caso de un niño de 12 años que consultó por hemoptisis, sin otros sín- tomas asociados. Se realizó radiografía de tórax (patológica), laboratorio con aumen- to moderado de reactantes de fase aguda, PPD (negativa), esputos x 3 con bacilosco- pias negativas y tomografía de tórax con contraste i.v. que mostró imágenes de árbol en brote en todos los lóbulos y una imagen de dilatación vascular de una rama de la ar- teria pulmonar en lóbulo superior izquierdo. Se plantearon diagnósticos diferenciales: malformación vascular primaria o lesión secundaria a infección. La angiografía digital permitió confirmar el pseudoaneurisma y embolizarlo. Luego de 17 días, 2/3 cultivos de esputo fueron positivos para Mycobacterium tuberculosis. El niño realizó tratamiento antituberculoso con drogas de primera línea con evolución clínica favorable. Este caso resalta la importancia de considerar el pseudoaneurisma de Rasmussen en- tre las posibles complicaciones de un paciente con tuberculosis y hemoptisis recurren- te o masiva.

We present the case of a 12-year-old boy admitted to the hospital due to hemoptysis without other symptoms. We performed a Thorax X-Ray (pathological), laboratory with elevated acute phase reactants, TST (negative), sputum x 3 with negative smear and computed tomography angiography showing a tree-in-bud pattern in all lobes, and di-latation of a brunch of the pulmonary artery in the upper left lobe. We considered pri-mary vascular anomaly or lesion due to infection as a differential diagnosis. The patient underwent digital angiography and therapeutic embolization of this pseudoaneurysm. After seventeen days, 2/3 of the sputum cultures were positive for Mycobacterium tu-berculosis. The patient received standard anti-TB therapy with favorable evolution. This case highlights the importance of considering complications such as Rasmussen's pseudoaneurysm in patients with pulmonary tuberculosis and recurrent or massive hemoptysis.

Prevalencia de infección tuberculosa latente e incidencia de viraje tuberculínico en contactos escolares mayores de 5 años en la Ciudad Autónoma de Buenos Aires / Prevalence of latent tuberculosis infection and incidence of tuberculin conversion among school contacts older than 5 years in the City of Buenos Aires

Introducción. La tuberculosis continúa siendo un problema frecuente en contextos de vulnerabilidad socioeconómica. El objetivo principal fue establecer la prevalencia de infección latente y viraje tuberculínico en contactos escolares de casos de tuberculosis. Población y métodos. En un área programática del sur de la ciudad, se evaluó la prevalencia de infección y viraje tuberculínico de 691 niñas, niños y adolescentes utilizando la prueba cutánea de tuberculina. Se investigó la asociación entre pérdida de seguimiento por parte del equipo de salud y características demográficas, escolares y asistencia inicial, y se describió el grado de adherencia cuando la quimioprofilaxis con isoniacida fue indicada. Resultados. Según las definiciones consideradas, la prevalencia de infección latente fue entre el 3,4 % (IC95 %: 2,3-5,2) y el 11,6 % (IC95 %: 9,3-14,4) de los 610 contactos con al menos una prueba cutánea aplicada. La incidencia de viraje tuberculínico se encontró entre el 0,3 % y el 6,8 % de los 294 evaluados. La edad mayor de 18 años, la mayor prevalencia de necesidades básicas insatisfechas en la comuna escolar, la pertenencia al turno escolar vespertino, la negatividad en la baciloscopia del caso índice y la ausencia de aplicación de la prueba cutánea inicial se asociaron con pérdida de seguimiento del contacto. Conclusiones. La incidencia de viraje tuberculínico en contactos escolares fue baja. La adherencia a isoniacida continúa siendo limitada. Se identificaron factores asociados con la pérdida de seguimiento de contactos que podrían orientar estrategias necesarias para mejorar este proceso.

Introduction. Tuberculosis continues to be a common problem in settings of socioeconomic vulnerability. Our primary objective was to establish the prevalence of latent infection and tuberculin conversion among school contacts of tuberculosis cases. Population and methods. In a programmatic area in the south of the City of Buenos Aires, the prevalence of latent infection and tuberculin conversion was assessed in 691 children and adolescents using the tuberculin skin test. The association between loss to follow-up by the health care team and the demographic, school, and baseline care characteristics was studied, and the level of adherence when isoniazid chemoprophylaxis was indicated was described. Results. According to established definitions, the prevalence of latent infection was between 3.4% (95% confidence interval [CI]: 2.3­5.2) and 11.6% (95% CI: 9.3­14.4) in the 610 contacts with at least one skin test. The incidence of tuberculin conversion was between 0.3% and 6.8% in the 294 assessed participants. Age older than 18 years, a higher prevalence of unmet basic needs in the school district, attending the afternoon school shift, negative sputum smear results in the index case, and absence of baseline skin test were associated with contact lost to follow-up. Conclusions. The incidence of tuberculin conversion among school contacts was low. Adherence to isoniazid treatment remains limited. Factors associated with loss of contact tracing were identified, which may guide strategies necessary to improve this process.

Avances en tuberculosis en el 54° Congreso Chileno de enfermedades respiratorias. 3a parte: Prevención de la tuberculosis activa mediante el tratamiento de la tuberculosis latente / Advances in tuberculosis at the 54th Chilean Congress of Respiratory Diseases. Part 3: prevention of active tuberculosis by treating latent tuberculosis

La infección tuberculosa latente (ITL) es un estado asintomático de la infección por Mycobacterium tuberculosis incapaz de transmitir la infección a otros, pero con el potencial de originar una tuberculosis (TBC) activa en el infectado, especialmente ante la presencia de factores de riesgo inmunológico. Es importante en personas de riesgo de desarrollar TBC reconocer la ITL utilizando test como la reacción a la tuberculina (PPD o TST) y los ensayos de liberación de Interferón-γ (IGRAs). Sin embargo, estos tests tienen limitaciones en su capacidad de predicción de riesgo de evolución de infección a enfermedad lo que conlleva a tener que tratar muchas personas para evitar algún caso de enfermedad. Nuevos tests se encuentran en desarrollo para mejorar la sensibilidad de reconocimiento de la ITL, distinguir infecciones recientes (que tienen el mayor riesgo de progresión a enfermedad) e incluso con la capacidad de detectar enfermedad subclínica o inicial. Para reducir la probabilidad de enfermar por TBC se utilizan tratamientos preventivos con fármacos, pero la cobertura mundial de esta terapia es reducida y la adherencia a terapias auto-administradas, como en el caso del uso de isoniazida diaria oral, es también baja. Otro problema de esta terapia son los riesgos de reacciones adversas (hepatitis, erupciones cutáneas) aunque no frecuentes. La recomendación de terapia actual de la ITL incluye el uso de rifamicinas y sus derivados. La asociación de isoniazida con rifapentina en una dosis semanal durante tres meses, administrada bajo supervisión, es la terapia de primera línea para mayores de 2 años, mostrando menos riesgo de hepatotoxicidad y mayor adherencia.

Latent Tuberculosis infection (LTBI) is the asymptomatic state of infection caused by Mycobacterium tuberculosis. Although untransmissible, LTBI can progress to active tuberculosis (TB), especially in people with immune risk factors. It is important to recognize LTBI in people at risk of developing TB; tuberculin skin test (PPD or TST) or interferon-γ release assays (IGRAs) are current diagnostic tests. However, these tests have limitations in their ability to predict subjects who will evolve from infection to disease; consequently, a large number of people with LTBI need treatment to avoid a reduced number of future TB disease cases. Newer tests are under development to improve the sensitivity in recognizing LTBI, distinguish recent infections with highest risk of progression to disease, and even be able to detect initial subclinical disease. Antimicrobial preventive treatment effectively reduces the probability of getting sick with TB, but worldwide availability of TB preventive therapy is limited, and adherence to self-administered therapies, as in the case of the use of daily oral isoniazid, is low. Adverse reactions risk (hepatitis, skin rash) although infrequent, is another problem with these therapies. Currently, LTBI management guidelines include regimens with use of rifamycins and their derivatives. The combination of isoniazid and rifapentine in a weekly dose for three months administered under supervision is the first line choice for LTBI therapy in those over 2 years of age, showing less hepatoxicity risk and greater adherence.

Tuberculosis latente: diagnóstico y tratamiento actual / Latent tuberculosis: current diagnosis and treatment

Resumen La infección tuberculosa latente (TL) afecta al 23% de la población y constituye un reservorio de tuberculosis (TBC) ya que 10% progresa hacia una TBC. La TL se reconoce por pruebas como la tuberculina (PPD o TST) y los ensayos de liberación de Interferón gama (IGRAs). La sensibilidad de IGRAs (versión Quantiferon TB Gold plus) es 94% y del PPD 77%. La especificidad del Quantiferon TB Gold Plus es 97% y del PPD 68%. El valor predictivo de progresión a TBC activa de estas pruebas es bajo (PPD: 1,5%, IGRAs: 2,7%) pero mejora en personas de alto riesgo de contraer TBC (PPD: 2,4%, IGRAs: 6,8%). Las personas con pruebas negativas que posteriormente presentan viraje (prueba positiva) tienen mayor riesgo de progresión a TBC activa. Estas pruebas son útiles en el seguimiento de contactos intradomiciliarios, extranjeros de países con altas tasas de TBC, inmunosuprimidos, enfermedad renal crónica, diabetes, silicosis y secuelas pulmonares de TBC no tratada. En la terapia de TL se utiliza isoniazida (H) auto-administrada por plazos de 6 a 12 meses con eficacia protectora de 60% y riesgo de toxicidad hepática de 2% pero con baja adherencia (50-70%). La asociación de H con rifapentina en dosis única semanal durante 12 semanas tiene eficacia de 81%, adherencia de 82% y baja toxicidad hepática (0,4%). Nuevos biomarcadores de TL y vacunas que mejoren la inmunidad en TL se encuentran en estudio. El tratamiento de la TL puede reducir la incidencia de TBC a largo plazo.

Latent tuberculosis infection (LT) affects 23% of the population and constitutes a reservoir of tuberculosis (TB) as 10% progresses to TB. LT is recognized by tests such as tuberculin (PPD or TST) and Interferon gamma release assays (IGRAs). The sensitivity of IGRAs (Quantiferon TB Gold plus version) is 94% and PPD 77%. The specificity of Quantiferon TB Gold Plus is 97% and PPD 68%. The predictive value of progression to active TB of these tests is low (PPD: 1.5%, IGRAs: 2.7%) but improves in people at high risk of contracting TB (PPD: 2.4%, IGRAs: 6.8%). People with negative tests who subsequently turn around (positive) have a higher risk of progression to active TB. These tests are useful in the follow-up of intra-household contacts, foreigners from countries with high rates of TB, immunosuppressed, chronic kidney disease, diabetes, silicosis and pulmonary sequelae of untreated TB. In LT therapy, self-administered isoniazid (H) is used for periods from 6 to 12 months with protective efficacy of 60% and risk of liver toxicity of 2%, but with low adherence (50-70%). The association of H with rifapentine in a single weekly dose for 12 weeks has efficacy of 81%, adherence of 82% and low liver toxicity (0.4%). New LT biomarkers and vaccines that improve immunity in LT are under study. Treatment of LT may reduce the incidence of TB in the long term.

Latent tuberculosis infection in family members in household contact with active tuberculosis patients in Semarang City, Central Java, Indonesia

A quarter of the world's population is infected with Mycobacterium tuberculosis (M.tb), 10% of cases develop active tuberculosis (TB), and 90% have a latent TB infection. Family members of TB patients have the highest potential for latent TB infection. This study aims to identify latent TB infection and risk factors in family members within the household contacts of active TB patients. This study used a crosssectional study design with a contact tracing method. The selected subjects were 138 people from 241 total family members of 112 active TB patients. Subjects underwent a tuberculin skin test (TST), using 2 units of tuberculin (TU) purified protein derivative (PPD) 0.1 mL (PT. Bio Farma Persero, Bandung, Indonesia). Data risk factors were collected during home visits. Data were analyzed using the chi-square test and multiple logistic regression. A total of 63.8% (88/138) of family members of active TB patients' household contacts had latent TB infection. The type of occupation of laborers/ farmers/fishers is the most dominant risk factor associated with latent TB infection (AOR: 7.04; 95% CI: 1.70­29.02), followed by unqualified bedroom density (<8 m2/2 people) (AOR: 5.33; 95% CI: 2.44­ 12.71) and contact duration ≥5 hours/day (AOR: 4.70; 95% CI:1.33­16.66). Latent TB infection in family members of active TB patients' household contacts was quite high. Occupation type, contact duration, and bedroom density were simultaneously confirmed as the main risk factors related to latent TB infection. Therefore, it is recommended to identify and prevent latent TB infection in family members in household contact with active TB patients.

Diagnosis of goat tuberculosis using tuberculinization and molecular techniques

Tuberculosis is an infectious, chronic, and worldwide disease. It has been known since the beginning of humanity and still negatively influences public health and livestock, especially, in Brazil, in the northeast. Etiologic agents are the mycobacteria of the Mycobacterium tuberculosis complex, which is the most important in mammals' involvement. The state of Bahia has 68.7% of its territory located in the semiarid region and holds the largest goat herd in the country. Goat breeding is a social and economic activity that adds value to this region. Up to the present, data on goat tuberculosis is unknown in this state. Thus, this study seeks data on tuberculosis prevalence in goats in a semiarid region of Bahia by using the comparative tuberculin test and multiplex polymerase chain reaction (PCR). A total of 600 adult animals of both sexes were evaluated. A prevalence of 0.33% (2/600) and 33.33% (1/3) properties were found for positive animals. Each assessed property had a questionnaire to analyze the epidemiological data management and relevant aspects for the disease occurrence. To confirm the positive tuberculin test results, PCR was used to detect and identify the pathogenic mycobacteria involved in the infection. It is concluded that most of the properties performing goat breeding in the region show low technification levels and promote farming between different species. Low prevalence of the disease alerts preventive measures to avoid major proportion situations that could influence the goat breeding in the state.

Análise da tuberculose latente no Estado do Pará / Analisys of latent tuberculosis in the state of Pará

A tuberculose é uma doença que apesar de ter meios diagnósticos disponíveis e tratamento acessível no Sistema Único de Saúde ainda é considerada um grave problema de saúde pública no país, deixando o Brasil entre os países com maior carga da doença no mundo. Um quarto da população mundial está infectada pelo bacilo de Koch, e em sua maioria irão permanecer na condição de estarem com o que se denomina de infecção latente pelo Mycobacterium tuberculosis-ILTB, porém 10% desses irão adoecer ao longo da vida, mantendo a transmissão da doença. Uma das estratégias recomendadas é tratar alguns grupos considerados vulneráveis ao adoecimento, como contatos de doentes. O país não possuía um sistema de informação oficial de notificações desses tratamentos apesar de recomendar a notificação desde 2014. O objetivo desse estudo é analisar o cenário epidemiológico das pessoas em tratamento para infecção pelo Mycobacterium tuberculoses notificadas no sistema de informação das pessoas em tratamento de ILTB, implantado em 2018 no Brasil. Estudo transversal realizado no estado do Pará, tendo como população os casos notificados nos anos 2019 e 2020. Os dados são apresentados através de tabelas, onde utiliza-se estatística descritiva, e aplicados os testes do qui- quadrado e o teste G, calculados a razão de prevalência considerando os valores mais frequentes em variáveis definidas pelo autor. Os grupos com maior frequência foram os contatos e pessoas vivendo com HIV/Aids e os fatores associados a maior prevalência foram: ser do sexo feminino, raça parda, estar entre 31 a 50 anos de idade e residir na região Metropolitana I. Outros grupos que não apresentaram percentual elevado no banco analisado, mas que tem sua importância na prevenção do adoecimento são os profissionais de saúde, considerados vulneráveis pela exposição frequente, diabéticos, renais crônicos e profissionais de instituição de longa permanência. O encerramento dos casos foi descrito, demonstrando queda de um ano a outro nos tratamentos completos, assim como diminuição no número de notificações, o que demonstra a influência da pandemia nas atividades de controle da doença. Ao relacionarmos as variáveis epidemiológicas dos casos notificados, tendo como parâmetro a variável sexo, houve diferença estatística na idade, já que mulheres com idade ≥ 51 anos tiveram um registro bem acima de homens na mesma faixa etária. A identificação e tratamento da infecção latente de tuberculose é uma das estratégias prioritárias para controle da doença, pois evita o adoecimento e transmissão, quebrando, assim, a cadeia epidemiológica, para tanto é necessário ampliar a oferta tanto do diagnóstico quanto do tratamento preventivo nos grupos recomendados

Tuberculosis is a disease that, despite having diagnostic means available and treatment available in the Unified Health System, is still considered a serious public health problem in the country, leaving Brazil among the countries with the highest burden of the disease in the world. A quarter of the world's population is infected by Koch's bacillus, and most of them will remain in the condition of having what is called latent infection by Mycobacterium tuberculosis-ILTB, but 10% of these will become ill throughout their lives, maintaining the disease transmission. One of the recommended strategies is to treat some groups considered vulnerable to illness. The country did not have an official information system for notifications of these treatments, despite recommending notification since 2014. The objective of this work is to analyze the epidemiological scenario of people undergoing treatment for Mycobacterium tuberculosis infection reported in the information system of people undergoing treatment for LTBI, implemented in 2018 in Brazil. It is a cross-sectional and quantitative study carried out in the state of Pará, having as a population the cases reported in the years 2019 and 2020. The data are presented through tables, where we use descriptive statistics, and the chi-square tests and the G test were used, being the prevalence ratio was calculated considering the most frequent values in variables defined by the author. It was found that the most frequent groups were contacts and people living with HIV/AIDS and among the factors associated with higher prevalence were: being female, mixed race, being between 31 and 50 years of age and residing in the region. Metropolitan I. Other groups that did not present a high percentage in the analyzed bank, but which are important in preventing illness are health professionals, considered vulnerable due to frequent exposure, diabetics, chronic kidney disease professionals and long-stay institution professionals. The closure of cases was described, showing a drop from one year to another in complete treatments, as well as a decrease in the number of notifications, which demonstrates the influence of the pandemic on disease control activities. When relating the epidemiological variables of the reported cases, having sex as the dependent variable, there was a statistical difference in age, since women aged ≥ 51 years had a record well above men in the same age group. The identification and treatment of latent tuberculosis infection is one of the priority strategies to control the disease, as it avoids illness and transmission, thus breaking the epidemiological chain recommended.

Terapias biológicas y tuberculosis en pediatría / Biological therapies and tuberculosis in pediatrics

En los últimos años, ha habido un aumento sostenido del uso de terapias inmunomoduladoras como las terapias biológicas y en un período más reciente, de las terapias con moléculas pequeñas. Estos tratamientos constituyen un factor de riesgo más para enfermar de tuberculosis en adultos y aunque en menor grado, también en niños, especialmente con el uso de anti TNF-α, por lo que antes de iniciar una terapia biológica, hay que descartar la tuberculosis activa y la latente. En el tratamiento de una tuberculosis activa producida por un biológico se debe prolongar la etapa de continuación a 9 meses. Es importante el seguimiento clínico prolongado en años de quienes usan o han completado el uso de estas terapias. Hay que posponer la vacunación BCG en los hijos de madres que usaron terapias biológicas durante la gestación hasta la edad 6 a 12 meses de los niños. El foco de esta revisión está centrado en la tuberculosis por progresión de una forma latente a una activa o por un contacto estrecho con una persona con tuberculosis pulmonar en pacientes que reciben terapias biológicas anti TNF alfa de uso inmunoreumatológico.

In recent years, there has been a sustained increase in the use of immunomodulatory therapies such as biologic therapies and, more recently, small molecule therapies. Those therapies have become another risk factor for tuberculosis in adults and, although to lesser degree, also in children, especially some of them, such as anti-TNF α. Before starting biological therapy, active tuberculosis and latent tuberculosis must be ruled out. In the treatment of active tuberculosis caused by a biologic, the continuation stage should be extended to 9 months. Long-term clinical follow-up in years of those who use them or have completed their use, is important. BCG vaccine should be postponed in children of mother who used biologic therapies during pregnancy until the children ́s age 6 to 12 months. The focus of this review is centered on tuberculosis due to progression from a latent to an active form or due to close contact with a person with pulmonary tuberculosis in patients receiving anti-TNF alpha biological therapies for immunorheumatology use.

Conversión de prueba cutánea de derivado proteico purificado durante el tratamiento con anti-TNF / Skin test conversion of purified protein derivative during treatment with anti-TNF

Introducción: los anti-TNF-α se asocian con mayor riesgo de desarrollar tuberculosis (TB). La prueba del derivado proteico purificado (purified protein derivative, PPD) se emplea para diagnosticar infección de tuberculosis latente (ITL). Se recomienda el cribado para TB previo al inicio de terapia anti-TNF-α y el seguimiento para evaluar la posible conversión de la PPD durante el tratamiento. El tratamiento de la ITL puede reducir el riesgo de desarrollar enfermedad activa en un 90%. Objetivos: actualmente los resultados de conversión de la PPD y su interpretación durante el tratamiento anti-TNF-α son variables, por tal motivo nos propusimos conocer la frecuencia de conversión de la PPD en este grupo de pacientes de nuestro medio. Materiales y métodos: realizamos un estudio descriptivo, observacional y retrospectivo que incluyó pacientes >18 años, diagnosticados con enfermedad reumática, tratados con anti-TNF-α. Resultados: se incluyeron 54 pacientes (46,7 ± a 12 años), de los cuales 36, presentaron diagnóstico de artritis reumatoidea, seis de artritis idiopática juvenil, cinco de espondilitis anquilosante, tres de artritis psoriásica, tres de uveítis y uno de queratitis intersticial. Los tratamientos fueron: 30 adalimumab, 17 certolizumab, siete etanercept, 44 metotrexato, 19 leflunomida, nueve hidroxicloroquina, dos sulfasalazina, dos azatioprina, uno mofetil micofenolato y glucocorticoides (28 de 54); la conversión de la PPD ocurrió en un solo paciente. Conclusiones: en el presente trabajo la seroconversión fue baja en contraste con otras series. La prueba de PPD es un método accesible, ampliamente disponible, adecuado y sensible para diagnosticar ITL.

Introduction: anti-TNF-α are associated with an increased risk of developing tuberculosis (TB). Purified protein derivative (PPD) is used to demonstrate a latent TB infection (LTBI). Screening is recommended for TB prior to the onset of anti-TNF-α and monitoring evaluating possible conversion of PPD during treatment. Treatment of LTBI can reduce the risk of active disease development by up to 90%. Objectives: currently the results of PPD conversion and its interpretation during anti-TNF-α treatment are variable and that is why we set out to know the frequency of conversion of PPD in this group of patients in our environment. Materials and methods: a descriptive, analytical, observational, retrospective study was conducted. Including patients >18 years old, diagnosed with rheumatic disease, treated with anti-TNF-α. Results: 54 patients were included (46.7 ± to 12 years), of which 36 presented a diagnosis of rheumatoid arthritis, 6 juvenile idiopathic arthritis, 5 ankylosing spondylitis, 3 psoriatic arthritis, 3 uveitis, 1 interstitial keratitis. The treatments were: 30 adalimumab, 17 certolizumab, 7 etanercept, 44 methotrexate, 19 leflunomide, 9 hydroxychloroquine, 2 sulfasalazine, 2 azathioprine, 1 mycophenolate mofetil and glucocorticoids (28/54). PPD conversion took place in 1 patient. Conclusions: in the present study, seroconversion was low in contrast to other series. The PPD test is an accessible, widely available, adequate and sensitive method for diagnosing LTBI, which the rheumatologist should use in his daily practice.

Latent tuberculosis screening before kidney transplantation in the South of Brazil / Rastreamento de tuberculose latente antes do transplante renal no Sul do Brasil

Abstract Background: Tuberculosis (TB) is a prevalent infection after kidney transplantation (KT) in high-burden countries. Latent tuberculosis infection (LTBI) screening includes previous TB history, chest radiograph findings, and tuberculin test (TST) and/or interferon-gamma release assays (IGRAs) results. We aimed to compare our routine LTBI screening of KT candidates and living donors (LD) with their IGRA results, and evaluate if this would improve isoniazid (INH) treatment referral. Methods: We evaluated adult KT candidates and LD with complete routine LTBI screening and QuantiFERON-TB® Gold In-Tube (QFT) testing. Blood samples were collected from April 4th, 2014 to October 31st, 2018, with follow-up until October 31st, 2019. Results: There were 116 KT recipients, with 30% QFT-positive results. Positive QFT was associated with past TB history (p=0.007), positive TST (p<0.0001), residual radiographic lesions (p=0.003), and diabetes (p=0.035). There were 25 LD, 40% had positive QFT. Positive QFT was associated with a positive TST (p=0.002). Positive QFT results increased INH referral in 80%. Post-transplant TB incidence was 2.6% in a median follow-up of 2 (1-33) months. No variables were associated with post-transplant TB. TB patients had inferior, although non-significant, 5-year graft survival (66.7% vs. 76.5%) (p = 0.402). Conclusion: In the present study, the association of QFT to our routine LTBI screening incremented INH treatment referral, but there was still a high incidence of post-transplant TB, possibly related to other forms of infection, such as new exposure and donor transmission.

Resumo Histórico: Tuberculose (TB) é uma infecção relativamente comum pós-transplante renal (TR) em países com alta prevalência da doença. O rastreamento de infecção latente por tuberculose (ILTB) inclui histórico prévio de TB, achados de radiografia do tórax, resultados do teste tuberculínico (TT) e/ou de ensaio de liberação de interferon-gama (IGRAs). Nosso objetivo foi comparar nossa avaliação de rotina de candidatos ao TR e doadores vivos (DV) com seus resultados de IGRA, avaliando se aumentaria o encaminhamento para tratamento com isoniazida (INH). Métodos: Avaliamos candidatos adultos ao TR e DV com rastreamento para ILTB de rotina completo e coleta de testes QuantiFERON-TB® Gold In-Tube (QFT). Coletamos amostras sanguíneas de 4 de Abril, 2014 - 31 de Outubro, 2018, com acompanhamento até 31 de Outubro, 2019. Resultados: Avaliamos 116 receptores de TR, 30% sendo QFT-positivo. QFT positivo foi associado ao histórico prévio de TB (p=0,007), TT positivo (p<0,0001), lesões radiográficas residuais (p=0,003), diabetes (p=0,035). Avaliamos 25 DV, 40% apresentaram QFT positivo. QFT positivo foi associado a TT positivo (p=0,002). Resultados positivos do QFT aumentaram o encaminhamento para INH em 80%. A incidência de TB pós-transplante foi 2,6% em uma mediana de acompanhamento de 2 (1-33) meses. Nenhuma variável foi associada à TB pós-transplante. Pacientes com TB tiveram sobrevida do enxerto em 5 anos inferior, embora não-significativa (66,7% vs. 76,5%) (p = 0,402). Conclusão: Neste estudo, a associação do QFT à nossa avaliação de ILTB de rotina aumentou o encaminhamento para tratamento com INH, mas ainda houve alta incidência de TB pós-transplante, possivelmente relacionada a outras formas de infecção, como nova exposição e transmissão pelos doadores.

Seguimiento de los contactos de casos de tuberculosis / Follow-up of Contacts of Tuberculosis Cases

Introducción: La tuberculosis constituye la principal causa de muerte en el mundo por enfermedad infecciosa. Objetivo: Verificar el cumplimiento de las acciones de control de foco de los contactos de casos de tuberculosis. Métodos: Estudio descriptivo, transversal. Universo constituido por los 338 contactos identificados de 10 casos de tuberculosis. Los datos procedieron de encuestas epidemiológicas, base de datos de morbilidad y tarjetas de notificación de la unidad municipal de higiene y epidemiologia del municipio Boyeros. Se utilizaron las variables: edad, sexo, nivel educacional y ocupación. Se identificaron los factores de vulnerabilidad en los contactos y se verificó cumplimiento del examen médico, los complementarios, realización y resultado de prueba de tuberculina, quimioprofilaxis y seguimiento. Resultados: Prevaleció el sexo masculino (64,2 por ciento) y los mayores de 65 años (46,7 por ciento). Los grupos vulnerables más frecuentes fueron los contactos en unidades de salud con internamiento prolongado y más de 60 años (87,2 por ciento y 62,1 por ciento, respectivamente). No se detectó el número real de contactos y convivientes ni fue investigado el 100 por ciento. Las pruebas de tuberculina realizadas arrojaron el mayor porciento de no reactores, el 90 por ciento de los contactos recibieron quimiprofilaxis y su seguimiento fue deficiente. Conclusiones: La no detección oportuna de los contactos y convivientes de casos de tuberculosis y los incumplimientos de su estudio constituyeron las principales deficiencias de los controles de foco realizados. El seguimiento de los contactos fue inadecuado, lo que pudiera propiciar la aparición de nuevos casos de tuberculosis en el municipio(AU)

Introduction: Tuberculosis is worldwide the main cause of death due to infectious disease. Objective: To verify compliance with outbreak control actions associated with contacts of tuberculosis cases. Methods: Descriptive and cross-sectional study. The universe was made up of the 338 contacts identified from ten cases of tuberculosis. The data came from epidemiological surveys, morbidity database and notification cards of the municipal hygiene and epidemiology unit of Boyeros Municipality. The following variables were used: age, sex, educational level and occupation. The vulnerability factors in the contacts were identified, as well as compliance with medical examination, complementary tests, performance and result of tuberculin test, chemoprophylaxis and follow-up. Results: The male sex (64.2 percent) and people over 65 years of age (46.7 percent) prevailed. The most frequent vulnerable groups were contacts in health units with prolonged hospitalization and aged over 60 years (87.2 percent and 62.1 percent, respectively). The actual number of contacts and partners was not detected, nor 100 percent of them were investigated. The tuberculin tests carried out showed the highest percentage of non-reactors. 90 percent of the contacts received chemoprophylaxis and their follow-up was poor. Conclusions: There was no timely detection of the contacts and cohabitants of tuberculosis cases and no compliance with their study, which constituted the main deficiencies of the outbreak controls carried out. The follow-up of the contacts was inadequate, which could lead to the appearance of new cases of tuberculosis in the municipality(AU)

A simple protocol for tuberculin skin test reading certification / Um protocolo simples para a certificação da leitura da prova tuberculínica / Un protocolo simple para la certificación de la lectura de la prueba cutánea de tuberculina

Although tuberculosis preventive therapy is one of the cornerstones for eliminating the disease, many barriers exist in the cascade of care for latent tuberculosis infection, including the need to certify healthcare professionals for reading tuberculin skin tests (TST). This paper proposes and evaluates a simple protocol for TST reading training. Primary care workers from different backgrounds received a 2-hour theoretical course, followed by a practical course on bleb reading. Blebs were obtained by injecting saline into sausages and then in volunteers. A certified trainer then evaluated the effectiveness of this protocol by analyzing the trainees' ability to read TST induration in clinical routine, blinded to each other's readings. Interobserver agreement was analyzed using the Bland-Altman test. The trainees' reading accuracy was calculated using two cut-off points - 5 and 10mm - and the effect of the number of readings was analyzed using a linear mixed model. Eleven healthcare workers read 53 saline blebs and 88 TST indurations, with high agreement for TST reading (0.07mm average bias). Sensitivity was 100% (94.6; 100.0) at 5mm cut-off and 87.3% (75.5; 94.7) at 10mm cut-off. The regression model found no effect of the number of readings [coefficient: -0.007 (-0.055; 0.040)]. A simple training protocol for reading TST with saline blebs simulations in sausages and volunteers was sufficient to achieve accurate TST induration readings, with no effect observed for the number of readings. Training with saline blebs injected into voluntary individuals is safer and easier than the traditional method.

A terapia preventiva da tuberculose é uma das bases para a eliminação da tuberculose. Entretanto, existem muitas barreiras na cascata de cuidados da infecção latente de tuberculose, incluindo a necessidade de certificação dos profissionais de saúde para a leitura da prova tuberculínica (PPD). Aqui, propomos e avaliamos um protocolo simples para capacitação na leitura do PPD. Profissionais na atenção primária com diferentes formações receberam um curso teórico de duas horas, seguido por um curso prático sobre a leitura da enduração. Nas sessões práticas, as pápulas foram obtidas pela injeção de solução salina em salsichas, e depois em voluntários. Depois, a eficácia do protocolo foi avaliada por um instrutor credenciado, com base na capacidade do aluno de ler a enduração do PPD na rotina clínica (em formato duplo-cego em relação às respectivas leituras). A concordância inter-observador foi analisada com o teste de Bland-Altman. A acurácia das leituras dos alunos foi calculada com dois pontos de corte: 5 e 10mm. O efeito do número de leituras foi analisado com um modelo linear misto. Onze profissionais de saúde leram 53 pápulas de solução salina e 88 endurações de PPD. A concordância na leitura dos PPDs foi alta (média de 0,07mm de viés). A sensibilidade foi 100% (94,6; 100,0) com o ponto de corte de 5mm e 87,3% (75,5; 94,7) com o ponto de corte de 10mm. No modelo de regressão, não houve efeito do número de leituras [coeficiente: -0,007 (-0,055; 0,040)]. Um protocolo simples de treinamento em leitura da prova tuberculínica com simulações usando pápulas criadas com solução salina em salsichas e em voluntários foi suficiente para alcançar leituras acuradas da enduração da prova, sem efeito observado pelo número de leituras. O treinamento com pápulas criadas com solução salina em voluntários é mais seguro e mais fácil, comparado com o treinamento tradicional.

La terapia preventiva de la tuberculosis es una de las piedras angulares para la erradicación de la tuberculosis. No obstante, existen muchas barreras en la cascada de cuidado de una infección latente de tuberculosis, incluyendo la necesidad de certificación, en el caso de los profesionales de atención en salud, para la lectura de la prueba cutánea de tuberculina (TST). Aquí proponemos y evaluamos un protocolo simple para el entrenamiento en la lectura de TST. Trabajadores de salud de atención primaria de diferentes contextos recibieron un curso de 2 horas teórico, seguido de una práctica en la lectura de la ampolla. Las ampollas se obtienen inyectado una solución salina en salchichas y luego en voluntarios. Posteriormente, la eficacia de este protocolo fue evaluada mediante un formador certificado a través de la habilidad del personal en formación para la lectura de induración del TST en la rutina clínica, con lecturas cegadas entre ellos. Se analizó la concordancia entre los observadores usando el test Bland-Altman. La precisión de la lectura por parte del personal en formación se calculó usando dos puntos de corte: 5 y 10mm. El efecto del número de lecturas fue analizado usando un modelo lineal mixto. Once trabajadores de salud leyeron 53 soluciones salinas en ampollas y 88 induraciones TST. La concordancia en la lectura del TST fue alta (0,07mm promedio de sesgo). La sensibilidad fue de un 100% (94,6; 100,0) usando los 5mm de corte y 87,3% (75,5; 94,7) usando los 10mm de corte. En el modelo de regresión, no hubo efecto del número de lecturas [coeficiente: -0,007 (-0,055; 0,040)]. Un simple protocolo de entrenamiento para la lectura TST con simulaciones, usando solución salina en ampollas en salchichas y voluntarios fue suficiente para alcanzar lecturas precisas de induración TST, sin efectos observados por el número de lecturas. El entrenamiento con ampollas salinas en personas voluntarias es más seguro y más fácil que el entrenamiento tradicional.

Incidencia de infección tuberculosa latente en un estudio de contactos escolares comparando dos puntos de corte de la prueba de tuberculina / Incidence of Latent Tuberculosis Infection in a Study of School Contacts Comparing Two Cut-off Points of the Tuberculin Test

Introducción: El riesgo de infección tuberculosa se asocia a contacto estrecho y prolongado. En las escuelas el contacto diario, aulas con poca ventilación o retraso diagnóstico del caso índice, podrían contribuir al contagio. Objetivo: Conocer la incidencia de infección tuberculosa latente (ITBL) en contactos escolares comparando dos puntos de corte en la prueba de tuberculina (PPD): ≥ 10 mm y ≥ 5 mm. Determinar el grado de cumplimiento en la realización de estudios de catastro y de quimioprofilaxis (QP). Materiales y métodos: Se realizó el análisis retrospectivo de contactos escolares de TB bacilífera, en adolescentes de 12 a 19 años, correspondientes al área programática del Hospital Parmenio Piñero entre febrero 2016 a diciembre 2017. La evaluación incluyó radiografía de tórax (RxT), laboratorio y PPD. Se analizaron 2 puntos de corte de PPD: ≥ 10mm y ≥ 5mm, repitiéndose a los 3 meses en aquellos con resultado negativo. Se indicó QP primaria con isoniazida a todos los contactos, y secundaria en aquellos con PPD+ basal o conversores al tercer mes. Se estimó cumplimiento de QP si tomaban > 80% de la pauta indicada. Resultados: de 373 estudiantes a evaluar, 331 (89%) realizaron los estudios, se diagnosticó TB en 4 (1.2%) a partir de RxT y fueron excluidos. En los 327 restantes, edad promedio 15 ± 1,6 años, hubo 132 (40%) hombres. La PPD basal fue ≥ 10 mm en 20 (6.1%) casos, siendo más frecuente en el grupo de 16-19 años vs 12-15 años: 10.7% vs 3.1%; p = 0,004. No hubo diferencia significativa al considerar el sexo. Realizaron 135 (45%) la segunda PPD encontrándose 3 conversiones (2.2%). Se indicó QP primaria a todos y secundaria a 23, el cumplimiento fue 57% y 26% respectivamente, sin asociación significativa con edad o sexo. Se reportaron 4 eventos adversos (1.2%): polineuritis (n = 2), alergia cutánea e intolerancia digestiva. Con PPD ≥ 5mm dieron positivo 63 (19.3%), siendo más frecuente en varones: 26.5% vs 14.4%, p = 0.006; y en 16-19 vs 12-15 años: 28.2% vs 13.2%; p < 0.001. Con la segunda PPD se observaron 3 conversiones (2,2%). Conclusión: Encontramos un 6,1% de ITBL considerando PPD+ ≥ 10 mm y 19,3% con PPD ≥ 5 mm. El cumplimiento en la realización de la segunda PPD fue bajo, como también en completar el esquema de QP secundaria.

Incidence of Latent Tuberculosis Infection in a Study of School Contacts Comparing Two Cut-off Points of the Tuberculin Test / Incidencia de infección tuberculosa latente en un estudio de contactos escolares comparando dos puntos de corte de la prueba de tuberculina

Introduction: The risk of tuberculosis infection is associated with close and prolonged contact. Daily contact, poorly ventilated classrooms or delay in diagnosing the index case in a school setting could contribute to contagion. Objective: To know the incidence of latent tuberculosis infection (LTBI) in school contacts comparing two cut-off points of the tuberculin test (PPD, Purified Protein Derivative): ≥ 10mm and ≥ 5mm. To determine the degree of compliance with the performance of control and chemoprophylaxis (ChP) studies. Materials and Methods: We carried out a retrospective analysis of bacillary TB school contacts in teenagers between 12 and 19 years old of the Programmatic Area of the Hospital Parmenio Piñero between February 2016 and December 2017. The evaluation included chest x-ray, lab tests and PPD. We analyzed 2 cut-off points of the PPD: ≥ 10mm and ≥ 5mm, and repeated the test after 3 months in cases with negative results. Primary ChP with isoniazid was indicated for all the contacts, and secondary ChP for those with basal PPD+ or conversion at the third month. We considered ChP compliance in cases where patients followed > 80% of the indicated regime. Results: 331 (89%) of 373 students to be evaluated participated in the study. TB was diagnosed in 4 students (1.2%) through chest x-ray, and they were excluded. Within the remaining 327, the mean age was 15 ± 1.6 years, and 132 (40%) were male. The basal PPD was ≥ 10mm in 20 cases (6.1%), being more frequent in the group of 16-19 years versus the 12-15 years: 10.7% vs. 3.1%; p = 0.004. There wasn't any significant difference regarding sex. 135 contacts (45%) did the second PPD, and 3 conversions were found (2.2%). Primary ChP was indicated for everyone, and secondary ChP for 23 contacts, with 75% and 26% compliance respectively, and without any significant association with age or sex. 4 adverse events were reported (1.2%): polineuritis (n=2), skin allergy and food intolerance. 63 contacts (19.3%) were positive PPD, with PPD ≥ 5mm, being more frequent in males: 26.5% vs. 14.4%, p = 0.006; and in 16-19 vs. 12-15 years: 28.2% vs. 13.2%; p < 0.001. With the second PPD we observed 3 conversions (2.2%). Conclusion: We found 6.1% of LTBI considering a PPD+ ≥ 10mm and 19.3% with PPD ≥ 5mm. Compliance with the second PPD and the secondary ChP scheme was low.

Comparação do ensaio de inteferon-gamma e teste cutâneo tuberculínico para diagnóstico de tuberculose latente em profissionais de saúde de um centro de referência terciária para tuberculose do Estado da Bahia / Comparation of the interferon gamma release assay and tuberculin skin test for diagnosis of latent tuberculosis in health professionals at a tertiary tuberculosis reference center, State of Bahia

Introdução: o Teste Cutâneo Tuberculínico (TCT) tem sido utilizado como diagnóstico para a Tuberculose Infecção Latente (TBIL). Os profissionais de saúde, principalmente os que trabalham com assistência a pacientes com tuberculose (TB), têm risco elevado de contrair a doença ou a TBIL. Normas de biossegurança e qualificação da equipe de trabalho são fundamentais para o controle da Tb entre os profissionais de saúde. Atualmente testes diagnósticos mais específicos para a TBIL têm sido utilizados como alternativa para o padronizado TCT, dentre eles o QuantiFERON-TB Gold (QTF®). Objetivo: comparar e avaliar os resultados obtidos no QTF® e Teste Cutâneo Tuberculínico dos profissionais de saúde de um centro de referência terciário para Tuberculose. Metodologia: o projeto foi aprovado pelo Comitê de Ética em Pesquisa da Fundação Bahiana Desenvolvimento Científico e pelo Comitê de Ética em Pesquisa da instituição hospitalar. Foi utilizado o banco de dados do setor de medicina ocupacional da Instituição e os 87 voluntários que atenderam aos critérios do estudo foram categorizados e distribuídos em dois grupos: TCT negativo (<5mm) e TCT positivo (>5mm). Foi realizada coleta de sangue para o teste QTF®. Resultados: dos 47 profissionais de saúde TCT negativo 53,2% tiveram resultado QTF negativo. Dos 40 profissionais TCT positivo, 67,5% apresentaram resultado QTF® positivo. O grau de concordância do índice kappa foi de 0,24. Conclusão: O QTF® não mostrou uma especificidade superior quando comparado ao TCT.

Introduction: tuberculin Skin test (TST) is a test used to Latent tuberculosis Infection (LTBI) diagnosis. Health professional, principally those that work with tuberculosis (TB) patients, have a high risk of contract and developing the disease or LTBI. Biosecurity norms and professional qualification are fundamentals to TB control in care centers. Actually some diagnosis tests with higher specificity of LTBI are used as an alternative to the TST, such as QuantiFERON-TB Gold (QTF®). Objective: to compare and evaluate the results obtained in the Quantiferon-TB Gold® and TST, of health professionals from a tertiary referral center for Tuberculosis. Methodology: the project was approved by a Research Ethics Committee of FBDC, and by the CEP of the hospital institution. The data base of the occupational medicine sector and the health professionals were categorized and distributed in two groups: Negative Tuberculin test and Positive Tuberculin test. The 93 volunteers who met the criteria and agreed to participate, signed the consent form, with subsequent data collection. A blood collection was also performed to perform Quantiferon-TB Gold® test. Results: of the 47 PS negative Tuberculin test, 53.2% had negative Quantiferon-TB Gold® results and 46.8% positive. Of the health professional positive Tuberculin test, 32.5% presented negative Quantiferon-TB Gold® result and 67.5% positive. Conclusion: quantiferon-TB Gold® did not show superior specificity when compared to Tuberculin test on this coorte.

Tuberculosis in childhood and adolescence: a view from different perspectives / Tuberculose na infância e adolescência: um olhar sob perspectivas diferentes

Abstract Objective To describe the epidemiological situation of tuberculosis in children under 19 years of age in Brazil and to review the latest publications on disease risk, diagnosis, treatment, and prevention. Source of data Notifiable Diseases Information System (2018), World Health Organization estimates, and PubMed articles selected using the descriptor "Tuberculosis," delimited by type of study, period, age, and language. Synthesis of data In 2018, in Brazil, 9.4% of notifications were in children under 19 years. The pulmonary form predominated in 80.1% of the cases. The cure rate was 76.8%, lethality was 0.8%, and abandonment was 10.4%. The prevalence of drug-resistant tuberculosis (2011-2016) was 0.5%. It has been found that the risk of disease can reach up to 56% in children under 5 years, influenced by helminth co-infections, malaria, chronic viral infections, live attenuated virus vaccines, and hypovitaminosis D. Exposure to a bacilliferous patient for periods shorter than 30 minutes is sufficient for the development of infection and/or disease. In Brazil, microbiological screening is recommended, but the use of the scoring system, modified in 2019, has been maintained. Studies on infection detection have supported the use of the tuberculin skin test. In the treatment, the great advance was the introduction of dispersible formulations, adjustment of the recommended doses, and shortened regimens for latent infection. Several vaccine studies (stages 1-3) are ongoing, but no BCG-licensed substitute has been implemented yet. Conclusions There has been progress in treatment, but major challenges need to be overcome to improve diagnosis, monitoring, and outcome of cases, aiming to eliminate tuberculosis.

Resumo Objetivo Descrever a situação epidemiológica da tuberculose nos menores de 19 anos no Brasil e revisar as últimas publicações sobre risco de adoecimento, diagnóstico, tratamento e prevenção. Fonte dos dados Banco de notificação Brasil (2018), estimativas da Organização Mundial da Saúde e artigos do PubMed selecionados pelo descritor Tuberculosis, delimitaram-se tipo de estudo, período, idade e língua. Síntese dos dados Em 2018, no Brasil, 9,4% das notificações foram nos menores de 19 anos. Predominou a forma pulmonar em 80,1% dos casos. A taxa de cura foi de 76,8%, letalidade 0,8% e abandono 10,4%. A prevalência de tuberculose drogarresistente (2011 a 2016) foi 0,5%. Encontrou-se que o risco de adoecimento pode chegar até 56%, nos menores de cinco anos, influenciado por coinfecções com helmintos, malária, infecções virais crônicas, vacinas de vírus vivos atenuados e hipovitaminose D. A exposição ao doente bacilífero por períodos menores de 30 minutos é suficiente para o desenvolvimento de infecção e/ou doença. No Brasil, recomenda-se a pesquisa microbiológica, porém mantem-se o uso do Sistema de Pontuação, modificado em 2019. Estudos sobre detecção da infecção respaldaram o uso da prova tuberculínica. No tratamento, o grande avanço foi a introdução das formulações dispersíveis, adequação das doses preconizadas e esquemas encurtados para infecção latente. Vários estudos de vacinas (fases de 1 a 3) estão em andamento, mas ainda sem substituto licenciado para a BCG. Conclusões Observaram-se progressos no tratamento, porém ainda há grandes desafios para melhorar o diagnóstico, monitoramento e desfecho dos casos em busca da eliminação da tuberculose.

Estrategia de pesquisa sistemática y seguimiento prolongado revela alto número de nuevas infecciones tuberculosas en contactos adultos en la Región Metropolitana, Chile / Systematic screening of adult household contacts of patients with active pulmonary tuberculosis reveals high rates of new infections during follow-up

Background: Contact investigation is cardinal in the control of tuberculosis (TB) since it helps to stop its transmission. In Chile, the National TB Program strategy does not include latent TB infection testing, regular chemoprophylaxis or follow-up in adults. Active TB was found in only 1.2% of contacts at country-level during 2018. Aim: To evaluate the performance of a systematic screening of adult household contacts with targeted chemoprophylaxis and prolonged active follow-up. Material and Methods: Prospective cohort of household contacts in Santiago. Two face-to-face visits (at 0 and 12 weeks) that included QuantiFERON TB-Gold plus tests (QFT), chest radiography (CXR) at 0 and 24 weeks and, periodic text messaging or phone call follow-up for up to 48 weeks were implemented. Contacts with positive QFT were referred for TB chemoprophylaxis. Results: A total of 200 contacts were enrolled, 69% were migrants. At baseline evaluation, 45% had a positive QFT result and 1.6% had co-prevalent active TB. At follow-up, 13% contacts further converted to QFT (+), and 5.1% more were diagnosed with active TB (mean follow-up time 32 weeks). Of these 10 further active TB cases, 6 (60%) had a negative QFT and all (100%) had normal CXR at baseline; while three cases occurred in QFT converters. Conclusions: In this cohort of household contacts, 6.7 % were diagnosed with active TB (more than 2/3 at follow-up) and 13% had a late QFT (+) conversion. Active and prolonged contacts' follow-up are essential to detect new infections and tackle the TB epidemic in Chile.

Bovine tuberculosis: diagnosis in dairy cattle through the association of analyzes / Tuberculose bovina: diagnóstico em bovinos leiteiros através da associação de análises

Tuberculosis is a chronic anthropozoonosis of worldwide occurrence, caused by the bacterium Mycobacterium tuberculosis and its variants. In Brazil, the National Program for the Control and Eradication of Brucellosis and Tuberculosis in cattle, is responsible for diagnosing and the correctly allocate positive animals, but there is still a lack of definitive diagnosis of the disease. This study described the use of five diagnostic tools that can be used, preferably together, for the confirmation of suspected cases. These tools included the clinical examination comparative cervical tuberculin test, macroscopic findings during the slaughtering and histopathology of the damaged tissues followed by histochemistry. We evaluated a total of 211 dairy cattle, where 15.1% (32/211) had classic clinical signs of bovine tuberculosis, 74 (35%) showed reactivity in the comparative cervical tuberculin test. Of the total number of animals, 141 (66.8%) were referred for sanitary slaughter due to legal and control issues in the outbreaks of the disease. In the follow-up of slaughtering and inspection of viscera and carcasses, 74 (52.5%) had macroscopic lesions compatible with bovine tuberculosis, while 67 (47.5%) showed no visible changes. During the inspection, fragments of lymph nodes and liver and lung parenchyma were collected from five cattle with macroscopic lesions and five with no lesions. The histopathological analysis showed numerous areas of caseous necrosis with or without central calcification and granulomatous inflammatory infiltrate. In the special staining of Ziehl-Neelsen, numerous acid-fast bacilli were evidenced in all cases.(AU)

A tuberculose é uma antropozoonose crônica de ocorrência mundial, causada pela bactéria Mycobacterium tuberculosis e suas variantes. No Brasil existe o Programa Nacional de Controle e Erradicação da Brucelose e Tuberculose em bovinos que viabiliza o diagnóstico e a destinação correta dos animais positivos, porém ainda há carência quanto ao diagnóstico da doença. Assim, este trabalho descreve a utilização de cinco ferramentas diagnósticas para a confirmação de casos suspeitos de tuberculose. As ferramentas utilizadas compreenderam o exame clínico, teste tuberculínico cervical comparativo, os achados macroscópicos durante o abate sanitário e a histopatologia dos tecidos lesados seguido de histoquímica. O estudo avaliou um total de 211 bovinos leiteiros, dos quais 15,1% (32/211) apresentaram sinais clínicos clássicos de tuberculose bovina, 35,1% (74/211) apresentaram reatividade no teste tuberculínico cervical comparativo, e 143 animais (67,8%) foram encaminhados para abate sanitário devido a questões legais e de controle nos focos da doença. No acompanhamento do abate e inspeção sanitária de vísceras e carcaças verificou-se que 51,8% (74/143) dos bovinos abatidos apresentavam lesões macroscópicas compatíveis com tuberculose bovina, enquanto 48,2% (69/143) não apresentavam alterações visíveis. Durante a inspeção foram coletados fragmentos de linfonodos e parênquima de fígado e pulmão de cinco bovinos com lesões macroscópicas e de cinco sem lesões, que na análise histopatológica apresentaram numerosas áreas de necrose caseosa com ou sem calcificação central e infiltrado inflamatório granulomatoso. Na coloração de Ziehl-Neelsen foram evidenciados numerosos bacilos álcool-ácido resistentes em todos os casos. Assim, diante dos resultados obtidos verifica-se que as análises empregadas no presente estudo foram de extrema importância para o diagnóstico acurado de tuberculose em bovinos.(AU)

Clinical features of children with immunodeficiency and / 中国当代儿科杂志

OBJECTIVE@#To study the clinical features of @*METHODS@#A retrospective analysis was performed on the medical data of children with immunodeficiency and @*RESULTS@#The onset age in the PID group was significantly lower than those in the control and SID groups (@*CONCLUSIONS@#Children with immunodeficiency and