ABSTRACT
ABSTRACT Objective: to analyze the flow of care to the person with symptoms of tuberculosis and the results achieved in the detection of cases in Primary Health Care units of two municipalities of Rio Grande do Sul. Method: descriptive of mixed methods, developed between 2013 and 2016. We used secondary data of 69 units and semi-structured interviews with 10 professionals. Descriptive statistical analysis and content analysis were used. Results: it was observed that the fragmented flow of attention to the respiratory symptoms in Pelotas resulted in low detection of cases by Primary Care, 8.8% of the diagnoses of the municipality. The Sapucaia do Sul flow presents continuity of care, and Primary Care performed 50% of the diagnoses of the municipality. Conclusion: the organization of flows by municipal management was instrumental in promoting or limiting the commitment of Primary Health Care teams in coordinating care and consequently in achieving the goals of disease control.
RESUMEN Objetivo: analizar el flujo de atención a la persona con síntomas de tuberculosis y los resultados alcanzados en la detección de casos en unidades de Atención Primaria a la Salud de dos municipios de Rio Grande do Sul. Método: descriptivo de métodos mixtos, desarrollado entre 2013 y 2016. Utilizando datos secundarios de 69 unidades y entrevistas semiestructuradas con 10 profesionales. Se utilizaron el análisis estadístico descriptivo y el análisis de contenido. Resultados: se observó que el flujo fragmentado de atención al sintomático respiratorio, en Pelotas, resultó en baja detección de casos por la Atención Primaria, el 8,8% de los diagnósticos del municipio. El flujo de Sapucaia del Sur presenta continuidad de la asistencia, y la Atención Primaria realizó el 50% de los diagnósticos del municipio. Conclusión: la organización de los flujos, por la gestión municipal, fue determinante para promover o limitar el compromiso de los equipos de la Atención Primaria a la Salud en la coordinación de la asistencia, y consecuentemente en el logro de las metas de control de la enfermedad.
RESUMO Objetivo: analisar o fluxo de atenção à pessoa com sintomas de tuberculose e os resultados alcançados na detecção de casos, em unidades de Atenção Primária à Saúde de dois municípios do Rio Grande do Sul. Método: descritivo de métodos mistos, desenvolvido entre 2013 e 2016. Utilizando dados secundários de 69 unidades e entrevistas semiestruturadas com 10 profissionais. Foram empregadas a análise estatística descritiva e a análise de conteúdo. Resultados: observou-se que o fluxo fragmentado de atenção ao sintomático respiratório, em Pelotas, resultou em baixa detecção de casos pela Atenção Primária, 8,8% dos diagnósticos do município. O fluxo de Sapucaia do Sul apresenta continuidade da assistência, e a Atenção Primária realizou 50% dos diagnósticos do município. Conclusão: a organização dos fluxos, pela gestão municipal, foi determinante para promover ou limitar o comprometimento das equipes da Atenção Primária à Saúde na coordenação da assistência, e consequentemente no alcance das metas de controle da doença.
Subject(s)
Humans , Primary Health Care/methods , Tuberculosis/diagnosis , Tuberculin Test/statistics & numerical data , Tuberculosis/physiopathology , Tuberculosis/epidemiology , Brazil/epidemiology , Tuberculin Test/methods , Mass Screening/methods , Qualitative ResearchABSTRACT
En este reporte se describe un caso de tuberculosis intestinal (TBCI) de difícil decisión diagnóstica y terapéutica, en el cual se indicó un protocolo de tratamiento anti TBC durante 6 meses con resolución clínica, paraclínica y endoscópica(AU)
In this report we describe a case of intestinal Tuberculosis of difficult diagnostic and therapeutic decision which received anti-TBC treatment for 6 months with clinical, paraclinical and endoscopic resolution(AU)
Subject(s)
Humans , Male , Adult , Tuberculosis/physiopathology , Diagnostic Imaging , Clinical Protocols , Ulcer , Ciprofloxacin/therapeutic use , Colitis , Rifaximin/therapeutic useABSTRACT
Tuberculosis (TB) is an infectious disease in which the molecular typing methods allow to have important information about the dynamics of transmission and to assist properly in disease control. Although the ERIC-PCR (Enterobacterial repetitive intergenic consensus-PCR) assay is fast and easy to perform, scarce studies have reported its use in epidemiological studies in TB outbreaks. In this study, we aimed to genotype Mycobacterium tuberculosis and M. bovis isolates by ERIC-PCR and compare its discriminatory power with two other classically used methods: 12 loci-MIRU (Mycobacterial Interspersed Repetitive Units) and Spoligotyping. The M. tuberculosis isolates studied were from northwestern and southwestern and M. bovis from northwestern Parana, Brazil. ERIC-PCR rendered banding patterns with great diversity (1 to 12 bands) of molecular sizes, ranging from 100 to 1600 bp. ERIC-PCR showed to be fast, simple and affordable to differentiate isolates. ERIC-PCR would be an important tool in the epidemiology of TB as screening in case of outbreak, which demands rapid intervention. However if any doubt persist, as it may occur with the application of only one genotypic method, other genotyping methods should be applied and carefully interpreted, always with additional epidemiological information.
Subject(s)
Polymerase Chain Reaction , Mycobacterium bovis/isolation & purification , Mycobacterium tuberculosis/isolation & purification , Tuberculosis/physiopathology , Epidemiology , Molecular Typing/methods , Genotyping Techniques/methodsABSTRACT
Pulmonary tuberculosis (TB) is the most common type of TB in children. Extrapulmonary tuberculosis is also prevalent (about 30-40 percent of cases) and it can occur in a variety of anatomical sites. This study presents a review of the literature on the main clinical manifestations of extrapulmonary tuberculosis in children, its diagnosis and treatment. At the end, some reflections on the importance of BCG for prevention are presented.
La tuberculosis (TB) pulmonar es el tipo más común de TB en niños. La tuberculosis extrapulmonar también es frecuente (alrededor de 30-40 por ciento de los casos) y se puede presentar en una gran variedad de sitios anatómicos. Se hace una revisión de la literatura sobre las principales manifestaciones clínicas extrapulmonares de la tuberculosis en niños, su diagnóstico y su tratamiento. Al final se hacen algunas reflexiones sobre la importancia de la BCG para su prevención.
Subject(s)
Humans , Male , Female , Child , Tuberculosis/diagnosis , Tuberculosis/physiopathology , Tuberculosis/therapy , Antitubercular Agents/therapeutic use , BCG Vaccine , Tuberculosis, Cutaneous , Tuberculosis, Lymph Node , Tuberculosis, Meningeal , Tuberculosis, Miliary , Tuberculosis, Osteoarticular , Tuberculosis, PleuralABSTRACT
La tuberculosis es uno de los padecimientos con mayor incidencia mundial. La infección se presenta cuando el Mycobacterium tuberculosis ingresa al organismo, y la enfermedad surge cuando se altera el estado inmunológico, nutricional y de vacunación. El diagnóstico en los niños se basa en el antecedente de contacto, la prueba de la tuberculina,la radiografía de tórax y el hallazgo microbiológico del bacilo; estos criterios ayudan a realizar un diagnóstico y tratamiento más tempranos, lo cual permite romper el ciclo biológicodel M. Tuberculosis y evitar el incremento en la morbimortalidad de una comunidad.
Subject(s)
Humans , Male , Female , Child , Mycobacterium tuberculosis , Tuberculosis/diagnosis , Tuberculosis/epidemiology , Tuberculosis/physiopathologyABSTRACT
Introdução: A TB é um grave problema de saúde pública mundial. A persistência da TB em escala internacional, a despeito da existência de estratégias terapêuticas eficazes, revela não apenas a diversidade de fatores envolvidos na sua determinação, mas, sobretudo, a complexidade do seu controle. A análise da mortalidade dos pacientes que apresentavam a TB como causa básica ou associada do óbito é uma ferramenta importante para melhor avaliação dos fatores determinantes do óbito nessa população. Objetivo: Descrever a mortalidade por tuberculose (TB) no Município de Campo Grande (MCG), MS, no período de 2001 a 2008. Metodologia: Estudo descritivo retrospectivo realizado no MCG, no período de 2001 a 2008. A partir de dados do SIM dos óbitos de pessoas residentes no MCG, foram incluídos no estudo aqueles que apresentaram na DO a TB registrada como CB de morte ou menção de TB em qualquer uma das linhas das Partes I ou II (TB como causa associada)...
Introduction: TB is a serious health problem all over the world. The endurance of TB in international scale, despite of the powerful therapeutic strategies, revels not just the variety of factors involved in your resolution, but the complexity of your control. The review of mortality of patients that have TB as the underlying cause of death or associated to death is an important instrument to better evaluation of determinant factors of death in this population. Objective: Describe the mortality by TB in the city of Campo Grande MS, in the period of 2001 to 2008. Results: TB was mentioned as the underlying causa of death in 103 deaths(49,7%) and as associated cause in 104 deaths (50,3%). The highest andslowest standardized mortality rate by age group happened in the years of 2002 and 2007, respectively. There was greater involvement of males (65%) in the age group between 40 and 59 years, and the most frequent clinical forms observed was pulmonary TB. Conclusion: With respect to TB as the underlying cause of death, there was a downward trend on the specific mortality rate in the period, as shown in others nationals literatures. Similar results about the mortality profile were found in other publications too. The evaluation of mortality by multiple causes allowed us to analyze, in an appropriated way, the deaths related to TB, and showed the confection HIV/TB as a factor that rises the risk of mortality in this population. The use of secondary data implies in limitations on mortality studies, considering the sub-notifications of TB deaths and the inadequate filling of mandatory report of SINAN, compromising the development of strategies to control this infection.
Subject(s)
Humans , Acquired Immunodeficiency Syndrome/mortality , Tuberculosis/epidemiology , Tuberculosis/physiopathology , Tuberculosis/mortality , Brazil , Epidemiology, Descriptive , Health Profile , Mortality , Social ClassABSTRACT
Background & objective: Many patients presenting with tuberculosis (TB) have underlying human immunodeficiency virus (HIV) co-infection. Routine HIV testing, however, is not a component of the national TB control programme in India. We sought to derive and validate a clinical prediction rule, based on clinical and laboratory parameters, to identify patients at high risk for HIV co-infection among those treated for active TB. Methods: Case records of adult patients with active TB treated between 1997 and 2003 at the All India Institute of Medical Sciences hospital, New Delhi were retrospectively reviewed. The data set was randomly split into a training set and a testing set. First a clinical prediction rule was derived by multivariable logistic regression on the training set and was subsequently validated on the testing set. Results: The study group comprised 1074 patients [training set 711 (66%), HIV co-infected 66 (9%); testing set 363 (34%), HIV co-infected 30 (8%)]. In the training set, male gender [odds ratio (95% CI) 5.31(1.52- 18.61)], axillary lymphadenopathy [9.71 (3.24-29.10)], anaemia [7.56 (2.48-23.05)], hypoalbuminaemia [3.67(1.31-10.26)], and reduced triceps skinfold thickness [2.91(0.95-8.89)] were independently associated with HIV co-infection. In the testing set, presence of any two of these five features was 94 per cent (95% CI 84-100%) sensitive and 54 per cent (49-60%) specific for predicting HIV co-infection; negative predictive value was 99 per cent (98-100%). Area under the receiver-operating characteristic curve was 0.93 (0.86-1.0) in the testing set. Interpretation & conclusions: A simple clinical prediction rule based on clinical and laboratory parameters could be used to identify a subgroup of patients, among those treated for active TB in a hospital setting, for targeted HIV testing.
Subject(s)
Adolescent , Adult , Area Under Curve , Comorbidity , HIV Infections/epidemiology , HIV Infections/physiopathology , Humans , India/epidemiology , Male , Middle Aged , Predictive Value of Tests , Risk Factors , Tuberculosis/complications , Tuberculosis/epidemiology , Tuberculosis/physiopathology , Young AdultABSTRACT
La tuberculosis está reconocida como uno de los principales problemas de salud pública en la mayoría de los países del mundo y en la actualidad considerada como enfermedad emergente. Por ello se decidió estudiar el comportamiento de la tuberculosis pulmonar en el Hospital Neumonólogico Gumersindo Sayago de la provincia de Santiago del Estero.El estudio es descriptivo, prospectivo y longitudinal. La población la conforman 840 casos y es de carácter intencional y estadística. Se describen las variables Independientes (edad, sexo, residencia) y Dependientes (Motivo de Consulta, Bacteriología, Evaluación por Cohortes) Se manejo fuentes secundarias, recopilando los datos en una matriz realizada en Microsoft, presentados en tablas simples y de doble entrada, gráficos aritméticos y mapas semaforizados elaborados en Office 2003, Microsoft Word y Excel y para la exposición en Power Point. La investigación comprende 8 años, y se obtuvieron los siguientes resultados en ese periodo: Resultaron del sexo masculino el 56 por ciento y el 44 por ciento femenino.La edad más afectada fue de los 55 a 59 años con 96 casos, seguido de 50 a 54 con 86 casos. El mayor registro fue en departamento capital (293), seguido por Banda (189) y los departamentos Robles y Río Hondo en el interior.Los centros urbanos tuvieron un 67.7 por ciento de los registros en relación al 32.2 por ciento identificados en la población rural. En la Clasificación Bacteriológica, tuvo confirmación etiológica el 74 por ciento de los casos, predominando el Examen Directo ante el Cultivo (+), un 24 por ciento resulto (-) y un 2 por ciento no se realizó. En Motivo de Consulta, los Sintomáticos Respiratorios alcanzaron el 97, 4 por ciento, Contacto 0,6 por ciento, Examen de Salud 1,9 y Otros 0,1En la Evaluación del Tratamiento se identifica un 73 por ciento de Éxito, 16 por ciento de Abandono, 6 por ciento Fallecidos y Trasladados el 5 por ciento.
Subject(s)
Humans , Male , Female , Behavior , /methods , Treatment Outcome , Tuberculosis , Tuberculosis, Pulmonary/parasitology , Tuberculosis, Pulmonary/therapy , Tuberculosis/physiopathology , Tuberculosis/therapy , Argentina , Diagnosis of Health Situation , Risk AssessmentABSTRACT
El presente módulo trata acerca de la historia de la tuberculosis (TB)y de la manera en que está afectando a la población, tanto a nivel mundial como en el Perú. Asimismo, explica cómo se propaga la TB de persona a persona (transmisión) y cómo se desarrolla en el organismo la enfermedad de la TB (patogénesis). Además, deberá conocer sobre la transmisión, patogénesis y el tratamiento de la TB. Como trabajador de salud, deberá comprender estos conceptos, de manera que los pueda poner en conocimiento a los pacientes que atiende
Subject(s)
Tuberculosis/physiopathology , Tuberculosis/history , Tuberculosis/prevention & control , PeruABSTRACT
La presente publicación describe sobre la detección de casos, una de las actividades más importantes para controlar la tuberculosis, ya que a través de ella podrá conocer quién o quiénes han desarrollado la enfermedad y, por lo tanto, saber con qué pacientes iniciar el tratamiento antituberculosis para cortar la cadena epidemiológica de transmisión de la enfermedad y recuperar la salud de las personas afectadas
Subject(s)
Case-Control Studies , Tuberculosis/diagnosis , Tuberculosis/physiopathology , Tuberculosis/prevention & control , PeruSubject(s)
Acquired Immunodeficiency Syndrome , Nervous System Diseases , Immunocompromised Host , Antiretroviral Therapy, Highly Active , AIDS-Related Opportunistic Infections , CD4 Lymphocyte Count , Meningitis, Cryptococcal/epidemiology , Meningitis, Cryptococcal/physiopathology , Meningitis, Cryptococcal/diagnosis , Meningitis, Cryptococcal/therapy , Neurosyphilis/epidemiology , Neurosyphilis/diagnosis , Neurosyphilis/therapy , Tuberculosis/epidemiology , Tuberculosis/physiopathology , Tuberculosis/diagnosis , Tuberculosis/therapy , Toxoplasmosis, Cerebral/epidemiology , Toxoplasmosis, Cerebral/physiopathology , Toxoplasmosis, Cerebral/diagnosis , Toxoplasmosis, Cerebral/therapyABSTRACT
El sueño es un estado fisiológico del que aún se desconocen con exactitud cuáles son sus funciones, aunque sus alteraciones se ven reflejadas en la vigilia del ser humano. Una de las alteraciones más frecuentes del sueño es el insomnio, el cual debe ser considerado como un síntoma y partiendo de esto, ubicarlo dentro de las distintas condiciones que pueden estar presentes, pues de ello dependerá el tratamiento correcto. El presente artículo describe brevemente algunas características del sueño normal, así como las condiciones más frecuentes en las que ocurre el insomnio y su tratamiento.
Subject(s)
Humans , Male , Female , Acquired Immunodeficiency Syndrome/epidemiology , Acquired Immunodeficiency Syndrome/physiopathology , Tuberculosis/complications , Tuberculosis/physiopathologyABSTRACT
La Tuberculosis (TBC) del Sistema Nervioso Central (SNC) y de sus cubiertas es una afección relativamente infrecuente en la población general, aunque en grupos de riesgo, particularmente en pacientes HIV positivos, el número de casos de neurotuberculosis ha aumentado significativamente y los exámenes neurorradiológicos contribuyen en gran medida a su diagnóstico. Se analizaron retrospectivamente las imágenes de Tomografía Computada (TC) y Resonancia Magnética (RM), obtenidas en 8 pacientes con diagnóstico confirmado de : meningitis tuberculosa (n=2); tuberculomas caseosos sólidos (n=3); tuberculoma no caseoso (n=1); absceso tuberculoso (n=1),y cerebritis TBC (n=1). Se discuten brevemente los mecanismos patogénicos de la enfermedad parenquimatosa y su correlación con las imágenes. Los hallazgos en TC y RM en los casos de meningitis son altamente sugestivos de lesión tuberculosa, mientras que en la afectación cerebral algunas características de los granulomas en RM, sin resultar específicas, inducen la inclusión de neurotuberculosis como probabilidad diagnóstica
Subject(s)
Humans , Male , Female , Child, Preschool , Adolescent , Adult , Middle Aged , Encephalitis/diagnosis , Magnetic Resonance Spectroscopy , Tomography, X-Ray Computed , Tuberculosis, Meningeal/diagnosis , Alcoholism/complications , Brain Abscess/diagnosis , Granuloma/diagnosis , Magnetic Resonance Imaging , Nitric Oxide Synthase , Nitric Oxide/adverse effects , Retrospective Studies , Acquired Immunodeficiency Syndrome/complications , Technology Assessment, Biomedical , Tuberculosis/physiopathologyABSTRACT
BACKGROUND: Tuberculosis is endemic in India and its prevalence is reported to be increasing in patients with human immuno-deficiency virus (HIV) infection. Several factors, including the level of immune deficiency, influence the clinical presentation of HIV-associated tuberculosis. METHODS: Between April 1994 and April 1996, 1820 patients with confirmed HIV infection were studied for their clinical, radiological and laboratory parameters. Severe weight loss was observed as a frequent presenting complaint. Hence, a case-control analysis was performed using severe weight loss as the presenting criterion among HIV-seropositive patients. RESULTS: Of the 1820 patients with HIV infection, 410 (23%) presented with severe weight loss of > 10% of body weight within the preceding month. Of these 410 patients, 176 (43%) had tuberculosis, 94 (23%) had chronic diarrhoea, and 89 (22%) had recurrent fever. Among 176 patients with tuberculosis, the following types of HIV-associated tuberculosis were seen: 115/176 (66%) had pulmonary, 49/176 (28%) had extrapulmonary tuberculosis; of these 49 cases with extrapulmonary tuberculosis 33 (18%) had disseminated tuberculosis, and 12/176 (7%) had both pulmonary and extrapulmonary involvement. In the group as a whole, 45/176 (25%) cases had disseminated tuberculosis. Clinical features of HIV-associated tuberculosis in decreasing order of frequency were chronic fever, chronic cough, lymphadenopathy and hepatosplenomegaly. The Mantoux skin test was significantly anergic among patients with extrapulmonary and disseminated tuberculosis (p = 0.001). CONCLUSIONS: There was a significant correlation between severe weight loss and tuberculosis (RR 17.5), chronic diarrhoea (RR 12.8) and recurrent fever (RR 4.5). The diagnostic value of the Mantoux skin test among HIV-associated tuberculosis is reduced, more so among those with extrapulmonary and disseminated forms.