Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 4.290
Filter
1.
Cad. Saúde Pública (Online) ; 38(3): e00008621, 2022. tab, graf
Article in English | LILACS | ID: biblio-1364633

ABSTRACT

This study aims to evaluate, via a mixed methods study, the implementation of the screening process for pulmonary tuberculosis (PTB) within indigenous population of the Department of Cauca, Colombia, during the 2016-2018 period. Indicators assessing the PTB screening process were elaborated and estimated. Subsequently, an evaluation of the indicators were performed based on a sampling process from health care providers of the municipalities with the highest and lowest PTB incidence and from key agents' perspective. Screening indicators were estimated and thematic analysis was performed based on the interviews conducted with key agents. Finally, a triangulation of quantitative and qualitative findings was performed. From the total population expected to have respiratory symptomatics (n = 16,711), the health care providers were able to identify 42.3% of them. Out of the individuals identified as respiratory symptomatics (n = 7,064), they were able to examine 93.2% (n = 6,585) with at least one acid-fast bacilli smear test. The reported positivity index from acid-fast bacilli smear test was 1.87%. The explanations from key agents revolved around the possibility of an overestimated targeted amount of respiratory symptomatics; insufficient personnel for the search of symptomatic individuals; high costs for the search in areas of difficult access; the need to request permissions from indigenous authorities; culturally ingrained stigma; use of traditional medicine and self-medication; and patient's personal beliefs. This study revealed barriers in the implementation of the screening process for PTB within the indigenous population from the Department of Cauca, mainly in the identifying process of the respiratory symptomatics.


El objetivo fue evaluar la implementación del proceso y los indicadores en las pruebas para detectar tuberculosis pulmonar (TBP) en población indígena del Departamento de Cauca, Colombia, durante el periodo de 2016-2018, a través de un estudio de métodos mixtos. Fueron elaborados y estimados indicadores para el tamizaje de TBP. Posteriormente, a través de un proceso de muestreo de los proveedores de cuidados de salud de las municipalidades con las incidencias más altas y más bajas de TBP, y desde la perspectiva de actores clave, se intentó encontrar una explicación para los resultados de la primera fase. Se estimaron los indicadores de las pruebas y se realizó un análisis temático de las entrevistas dirigidas a los actores clave. Finalmente, se realizó la triangulación de los hallazgos cuantitativos y cualitativos. Del total de sintomáticos respiratorios esperados (n = 16.711), los proveedores de servicios de salud fueron capaces de identificar a un 42,3% de ellos, y de estos sintomáticos respiratorios identificados (n = 7.064) fueron capaces de examinar un 93,2% (n = 6.585) con al menos una prueba de frotis de bacilos ácidorresistentes. El índice de positividad informado en la prueba de la flema analizada en el microscopio, mediante la prueba de frotis de bacilos ácidorresistentes, fue 1.87%. Las explicaciones de los actores clave giraron alrededor de la percepción de un objetivo posiblemente sobreestimado de sintomáticos respiratorios; insuficiente personal para la consulta; altos costes para las consultas en áreas geográficas de difícil acceso; solicitud de permisos a las autoridades indígenas; estigma; medicina tradicional, automedicación y creencias. Este estudio reveló barreras en la implementación de las pruebas para la TBP en la población indígena del Departamento de Cauca, principalmente en el proceso de identificación de sintomáticos respiratorios.


O estudo teve como objetivo avaliar a implementação do processo e os indicadores de triagem para tuberculose pulmonar (TBP) numa população indígena do Departamento de Cauca, Colômbia, no período 2016-2018. Foi realizado um estudo com métodos mistos. Foram elaborados e estimados os indicadores para triagem da TBP. Em seguida, procurou-se explicar os achados da primeira fase, com base em um processo de amostragem de provedores de saúde dos municípios com os coeficientes mais altos e mais baixos de incidência de TBP, e da perspectiva dos atores-chave. Os indicadores de triagem foram estimados e a análise foi realizada das entrevistas com os atores-chave. Finalmente, foi feita a triangulação dos achados quantitativos e qualitativos. Do total de sintomáticos respiratórios esperados (n = 16.711), o provedor de saúde conseguiu identificar 42,3%, e destes sintomáticos respiratórios identificados (n = 7.064) conseguiram examinar 93,2% (n = 6.585) com pelo menos um exame de escarro (teste de BAAR). O índice de positividade do teste de BAAR foi de 1,87%. As explicações dos atores chave giraram em torno da percepção de uma proporção possivelmente superestimada de sintomáticos respiratórios, pessoal insuficiente para a busca, custos elevados da busca em áreas de difícil acesso geográfico, solicitação de autorização pelas autoridades indígenas, estigma, medicina tradicional, automedicação e crenças. O estudo revelou barreiras para a implementação da triagem para TBP na população indígena do Departamento de Cauca, principalmente no processo de identificação de sintomáticos respiratórios.


Subject(s)
Humans , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/epidemiology , Indigenous Peoples , Brazil , Incidence , Colombia/epidemiology
2.
Rev. baiana saúde pública ; 45(3,supl.n.esp): 79-88, 28 dec. 2021.
Article in Portuguese | LILACS | ID: biblio-1352331

ABSTRACT

A tuberculose é uma doença infecciosa causada pelo Mycobacterium tuberculosis muito disseminada no Brasil. Tem preferência pelo acometimento pulmonar, embora vários outros órgãos possam ser afetados, como vasos linfáticos, trato geniturinário, ossos, articulações, sistema nervoso central, trato gastrointestinal e pericárdio. A pneumonia tuberculosa é uma forma rara, que se apresenta com consolidação alveolar, principalmente em lobo superior, podendo mimetizar um quadro de pneumonia pneumocócica. O objetivo deste ensaio é relatar o caso clínico de um indivíduo do sexo masculino com diagnóstico de pneumonia tuberculosa no Hospital Geral Roberto Santos (HGRS) e fazer uma breve revisão da literatura sobre o tema. O método utilizado para isso será o relato de caso clínico, com informações obtidas por meio de revisão de dados contidos em prontuário médico. Os resultados obtidos foram: paciente do sexo masculino, 19 anos, previamente hígido, não tabagista, natural de Recife, procedente de Salvador, admitido em agosto de 2019 no serviço de emergência do HGRS, com história de tosse produtiva de secreção amarelada, febre não mensurada e calafrios. O relato de caso descrito mostra uma apresentação atípica, rara e pouco comum de pneumonia tuberculosa/tuberculose pulmonar. A procura por diagnósticos diferenciais em quadros com resposta ruim à terapêutica inicialmente instituída é fundamental para evitar atrasos entre a realização do diagnóstico correto e a introdução das devidas medidas terapêuticas.


Tuberculosis is a highly prevalent infectious disease in Brazil, caused by Mycobacterium tuberculosis. Despite mostly affecting the lungs, it may also affect other organs, such as lymphatic vessels, genitourinary tract, bones, joints, central nervous system, gastrointestinal tract, and pericardium. A rare form of the disease, tuberculous pneumonia presents with alveolar consolidation, especially in the upper lobe, possibly mimicking pneumococcal pneumonia. This study sought to report the clinical case of a male individual diagnosed with Tuberculous Pneumonia at the Hospital Geral Roberto Santos, as well as to perform a brief literature review of subject. The study was conducted with data collected from the medical records of a male patient aged 19 years old, previously healthy, non-smoker, born in Recife and living in Salvador, admitted in August 2019 to the emergency service of Hospital Geral Roberto Santos with a history of productive cough yellowish sputum, unmeasured fever, and chills. The case report here described shows an atypical, rare, and uncommon presentation of Tuberculous Pneumonia/Pulmonary Tuberculosis. To avoid delays between the correct diagnosis and the introduction of the respective therapeutic measures, health professionals should search for differential diagnoses in conditions with poor response to the initially instituted therapy.


La tuberculosis es una enfermedad infecciosa causada por Mycobacterium tuberculosis muy prevalente en Brasil. Tiene preferencia por la afectación pulmonar, aunque pueden estar implicados muchos otros órganos, como vasos linfáticos, tracto genitourinario, huesos, articulaciones, sistema nervioso central, tracto gastrointestinal y pericardio. La neumonía tuberculosa es una forma rara, que se presenta con consolidación alveolar, especialmente en el lóbulo superior, que puede simular un cuadro de neumonía neumocócica. El objetivo de este ensayo es informar el caso clínico de un varón diagnosticado de Neumonía Tuberculosa en el Hospital Geral Roberto Santos y realizar una breve revisión de la literatura sobre el tema. El método utilizado para ello será elreporte de caso clínico con información obtenida mediante revisión de datos contenidos en historias clínicas. Los resultados obtenidos fueron: paciente varón de 19 años, previamente sano, no fumador, nacido en Recife, residente en Salvador, ingresado en agosto de 2019 en el servicio de urgencias del Hospital Geral Roberto Santos, con antecedente de tos productiva amarillenta, fiebre no medida y escalofríos. El reporte de caso aquí descrito muestra una presentación atípica, rara y poco común de neumonía tuberculosa/tuberculosis pulmonar. La búsqueda de diagnósticos diferenciales en condiciones con mala respuesta a la terapia inicialmente instituida es fundamental para evitar retrasos entre el diagnóstico correcto y la introducción de las respectivas medidas terapéuticas.


Subject(s)
Pneumonia, Pneumococcal , Tuberculosis, Pulmonary , Gastrointestinal Tract , Mycobacterium tuberculosis
4.
Alerta (San Salvador) ; 4(3): 118-114, jul. 29, 2021. ilus
Article in Spanish | LILACS, BISSAL | ID: biblio-1282939

ABSTRACT

Se presenta el caso de una paciente femenina de 5 años quien fue ingresada en el Hospital Nacional Benjamín Bloom, por presentar tos y fiebre persistente de 3 semanas, previo al ingreso en el centro hospitalario, la paciente curso con gastroenteritis aguda por lo que en el Hospital Nacional Zacamil, se sospechó fiebre tifoidea sin embargo al continuar febril y con tos fue transferida al hospital, durante el ingreso hospitalario se realizó el estudio para confirmar enfermedad tuberculosa presentando: prueba mantoux positiva (13 milimetros), radiografía de tórax con cavitación apical izquierda, baciloscopias positivas (16 puntos de los criterios de Stegen y Toledo), también se realizó una tomografía axial torácica computarizada que mostro lesión cavitada a nivel del lóbulo superior izquierdo segmento apical posterior de paredes gruesas tabicadas. Iniciando tratamiento con 4 fármacos antituberculosos (isoniacida, rifampicina, pirazinamida y etambutol), y posterior al egreso hospitalario el paciente continuo con el tratamiento durante 6 meses y presentando evolución clínica satisfactoria


We present the case of a 5-year-old female patient who was admitted to the Benjamin Bloom National Hospital, due to a 3-week persistent cough and fever, prior to admission to the hospital, the patient had acute gastroenteritis, so in the Hospital Nacional Zacamil, typhoid fever was suspected, however, as she continued to febrile and with a cough, she was transferred to the hospital, during hospital admission a study was carried out to confirm tuberculosis disease, presenting: positive mantoux test (13 millimeters), chest x-ray with left apical cavitation , positive smear microscopy (16 points of the Stegen and Toledo criteria), a computed thoracic axial tomography was also performed, which showed a cavitated lesion at the level of the upper left lobe posterior apical segment with thick septate walls. Starting treatment with 4 anti-tuberculosis drugs (isoniazid, rifampicin, pyrazinamide and ethambutol), and after hospital discharge the patient continued with the treatment for 6 months and presenting satisfactory clinical evolution


Subject(s)
Humans , Pediatrics , Tuberculosis , Tuberculosis, Pulmonary , Cavitation
6.
Rev. méd. Urug ; 37(1): e37106, mar. 2021. tab
Article in Spanish | LILACS, BNUY | ID: biblio-1289843

ABSTRACT

Resumen: A nivel mundial se estima que en 2018 hubo alrededor de 10 millones de nuevos casos de tuberculosis (TBC). La detección molecular es una herramienta diagnóstica crecientemente utilizada para el diagnóstico de TBC. Los predictores de riesgo para TBC pulmonar son variados y varían de acuerdo a la población estudiada. Los objetivos del presente trabajo fueron: evaluar la performance de la detección de M. tuberculosis por la técnica Xpert® MTB/RIF para el diagnóstico de TBC pulmonar y determinar los factores predictores de presencia de esta enfermedad en pacientes asistidos en el Hospital Pasteur de Montevideo. Se realizó un estudio descriptivo, observacional y transversal. Se incluyeron 254 pacientes, 68 con TBC pulmonar. La sensibilidad de la prueba Xpert® MTB/RIF para detectar M. tuberculosis fue 100% (IC 95%: 91,2-100) y la especificidad 95,1% (IC 95%: 83,9-98,7). En el análisis multivariado se evidenció que los predictores independientes para presencia de TBC pulmonar fueron: contacto cercano con otro caso de TBC (p<0,001), consumo de pasta base de cocaína (p=0,006) y presentarse con adelgazamiento (p<0,001). En suma, la prueba Xpert® MTB/RIF se comportó como una excelente herramienta diagnóstica en nuestra población con elevada prevalencia de TBC pulmonar. Los predictores independientes para esta enfermedad indican que en la población analizada las estrategias de control de esta enfermedad requieren un abordaje multidisciplinario.


Summary: According to global estimations, there were approximately 10 million new cases of tuberculosis in 2018. Molecular diagnosis constitutes a rapidly growing diagnostic tool for tuberculosis. Risk predictors for pulmonary tuberculosis are varied and they depend on the population studied. The study aimed to assess the performance of M. tuberculosis detection by use of Xpert® MTB/RIF diagnostic test to diagnose pulmonary tuberculosis and to identify predictive factors for this disease in patients assisted at Pasteur Hospital in Montevideo. A descriptive, observational and transversal study was conducted, which included 254 patients, 68 of which had pulmonary tuberculosis. Sensitivity of the Xpert MTB/RIF assay to detect M. tuberculosis was 100% (CI 95%: 91.2-100) and specificity 95.1% (CI 95%: 83.9-98.7). Multivariate analysis evidenced the following to be the independent predictors that detect pulmonary tuberculosis: close contact with other cases of tuberculosis (p<0.001), coca-paste consumption (p=0.006) and evidence of loss of weight (p<0,001). To sum up, the Xpert® MTB/RIF assay proved to be an excellent diagnostic tool in our population with a high prevalence of pulmonary tuberculosis. Independent predictors for this disease show that, in the population studied, control strategies require a multidisciplinary approach.


Resumo: Globalmente, estima-se que em 2018 ocorreram cerca de 10 milhões de novos casos de tuberculose (TB). A detecção molecular é uma ferramenta diagnóstica cada vez mais usada para seu diagnóstico. Os preditores de risco para TB pulmonar são diversos e variam de acordo com a população estudada. Os objetivos deste estudo foram: avaliar o desempenho da detecção do M. tuberculosis pela técnica Xpert MTB/RIF para o diagnóstico da TB pulmonar e determinar os fatores preditivos da presença desta doença em pacientes atendidos no Hospital Pasteur de Montevidéu. Foi realizado um estudo descritivo, observacional e transversal. 254 pacientes foram incluídos, 68 com TB pulmonar. A sensibilidade do teste Xpert® MTB/RIF para detectar M. tuberculosis foi de 100% (IC 95%: 91,2-100) e a especificidade de 95,1% (IC 95%: 83,9- 98,7). A análise multivariada mostrou que os preditores independentes para a presença de tuberculose pulmonar foram: contato próximo com outro caso de tuberculose (p <0,001), consumo de pasta base de cocaína (p = 0,006) e apresentar perda de peso (p <0,001). Em suma, o teste Xpert® MTB/RIF se comportou como uma excelente ferramenta diagnóstica em nossa população com alta prevalência de TB pulmonar. Os preditores independentes para essa doença indicam que, na população analisada, as estratégias de controle da doença requerem uma abordagem multidisciplinar.


Subject(s)
Humans , Tuberculosis, Pulmonary/diagnosis , Molecular Diagnostic Techniques , Mycobacterium tuberculosis , Predictive Value of Tests , Sensitivity and Specificity
7.
Int. j. med. surg. sci. (Print) ; 8(1): 1-9, mar. 2021. ilus
Article in Spanish | LILACS | ID: biblio-1151628

ABSTRACT

La terapia con fármacos antagonistas del factor de necrosis tumoral alfa ha sido beneficiosa en el tratamiento de varias enfermedades como las del tejido conectivo e inflamatorias del intestino, pero no está exenta de riesgos. Las principales complicaciones de estas drogas inmunosupresoras son las infecciones, y la tuberculosis pulmonar es una de las principales afecciones, que se pueden observar en los pacientes con este tipo de tratamiento.Se presentó una mujer de 31 años, atendida en el Hospital Clínico Quirúrgico Hermanos Ameijeiras, La Habana, Cuba, con antecedentes de colitis ulcerativa, que hace 3 meses recibe terapia con Infliximab. Acude al hospital por referir 4 días previos al ingreso, fiebre de 390 C dos veces al día, acompañándose de cefalea, pérdida del apetito y dolor en la región perineal. Se le realizó radiografía de tórax, donde se describe radiopacidad heterogénea que va desde el cuerno superior del hilio derecho hasta planos axilares, en la tomografía axial de tórax reportan consolidación en segmento anterior del lóbulo superior derecho con presencia de broncograma aéreo y en el lavado bronquial microbiológico para bacilos ácido-alcohol resistentes se informó codificación 8, positivo a Mycobacterium tuberculosis. El diagnóstico preciso de tuberculosis relacionada con el uso de fármacos antagonistas del factor de necrosis tumoral alfa requiere un alto índice de sospecha y una investigación detallada. Existe un alto grado de complejidad diagnóstica, por la existencia de un amplio espectro clínico y la necesidad de excluir otras enfermedades.


Tumor necrosis factor alpha antagonist drug therapy has been beneficial in the treatment of several diseases such as connective tissue and inflammatory bowel diseases, but it is not without risks. The main complications of these immunosuppressive drugs are infections, and pulmonary tuberculosis is one of the main conditions, which can be observed in patients with this type of treatment. A 31-year-old woman, treated at the Hermanos Ameijeiras Clinical Surgical Hospital, Havana, Cuba, with a history of ulcerative colitis, who has been receiving Infliximab therapy for 3 months, presented. He went to the hospital for referring 4 days prior to admission, a fever of 390 C twice a day, accompanied by headache, loss of appetite and pain in the perineal region. A chest X-ray was performed, which described heterogeneous radiopacity that goes from the upper horn of the right hilum to axillary planes, in the chest axial tomography they report consolidation in the anterior segment of the right upper lobe with the presence of air bronchogram and in the bronchial lavage microbiological for acid-fast bacilli coding 8, positive for mycobacterium tuberculosis was reported. Accurate diagnosis of tuberculosis related to the use of tumor necrosis factor alpha antagonist drugs requires a high index of suspicion and detailed investigation. There is a high degree of diagnostic complexity, due to the existence of a wide clinical spectrum and the need to exclude other diseases.


Subject(s)
Humans , Female , Adult , Tuberculosis, Pulmonary/diagnostic imaging , Infliximab/adverse effects , Immunosuppressive Agents/adverse effects , Tuberculosis, Pulmonary/etiology , Tomography, X-Ray Computed , Infections/etiology
9.
Rev. medica electron ; 43(1): 2727-2738, tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1156770

ABSTRACT

RESUMEN Introducción: hace más de un siglo, Robert Koch identificó el microorganismo que causa la tuberculosis en el hombre, el Mycobacterium tuberculosis. Sin embargo, aún constituye un grave problema epidemiológico a nivel mundial. Se presentó un estudio realizado en los pacientes ingresados en el Servicio de Infeccioso del Hospital Regional de Malabo. Objetivo: caracterizar los pacientes con tuberculosis ingresados en la primera fase de tratamiento antituberculoso. Materiales y métodos: se realizó un estudio descriptivo, retrospectivo de los pacientes ingresados en el Servicio de Tratamiento de Infecciosos del Hospital Regional de Malabo. Periodo correspondiente a los meses de enero a julio del 2016. El universo fue 172 pacientes con diagnóstico de tuberculosis en todas sus formas clínicas. Los datos se obtuvieron en las historias clínicas. Resultados: predominó el sexo masculino en el 57,5 % de los pacientes y el grupo etáreo de 25 a 34 años con el 33,7 %. La baciloscopia negativa representó el 67,9 % de los casos y el estado nutricional más frecuente fue el bajo peso con 50,09 %. La tuberculosis en su forma pulmonar predominó en el 95,9 % de los pacientes. El 65,6 % de los pacientes fueron VIH negativos. La mejoría clínico radiológica al terminar el tratamiento fue de un 87,7 %. Conclusiones: el 57,5 % de los pacientes fueron masculinos entre 25 y 34 años de edad. Predominó la Baciloscopia negativa y la tuberculosis en su forma pulmonar. La mejoría clínica radiológica fue superior al terminar el tratamiento (AU).


ABSTRACT Introduction: More than a century ago, Robert Koch identified the microorganism causing tuberculosis in people: Mycobacterium tuberculosis. But it is still a serious epidemiologic problem around the world. The authors presented a study carried out in patients admitted in the Infectious Service of the Regional Hospital of Malabo. Objective: to characterize the patients with tuberculosis admitted in the first stage of the anti-tuberculosis treatment. Materials and methods: a descriptive, retrospective study was carried out on the patients who were admitted in the Infectious Service of the Regional Hospital of Malabo in the period from January to July 2016. The universe were 172 patients with diagnosis of tuberculosis in all its clinical forms. Data were gathered from the clinical records. Results: male sex predominated in 57.5 % of the patients as it also did the 25-34 years-old age group with 33.7 %. Negative sputum smear represented 67.9 % of the cases and the most frequent nutritional status was the low weight with 50.9 %. Tuberculosis in its pulmonary form predominated in 95.9 % of the patients. 65.6 % of the patients were HIV negative. The clinical radiological improvement at the end of the treatment was 87.7 %. Conclusions: 57.5 % of the patients were male aged 25-34 years old. Negative sputum smear and the pulmonary form of tuberculosis predominated. The clinical radiological improvement was higher at the end of the treatment (AU).


Subject(s)
Humans , Tuberculosis, Pulmonary/epidemiology , Comprehensive Health Care , Hospital Care , Health Policy , Tuberculosis, Pulmonary/drug therapy , Epidemiology, Descriptive , Retrospective Studies
10.
Nursing (Säo Paulo) ; 24(273): 5243-5254, fev.2021.
Article in Portuguese | LILACS, BDENF | ID: biblio-1148497

ABSTRACT

Objetivo: analisar a distribuição dos óbitos por tuberculose pulmonar no estado do Amazonas. Método: trata-se de um estudo ecológico com dados secundários do Sistema de Informação de Mortalidade, durante o período de 2007 a 2017. O software QGIs foi utilizado para elaborar um mapa digital e o software RStudio para as análises estatísticas. Na análise dos dados foi aplicado a regressão linear múltipla, o índice de Moran Global e o teste multiplicador de Lagrange. Resultados: identificou-se 1.267 casos de óbitos por tuberculose pulmonar no estado do Amazonas. A maioria dos óbitos ocorreram no sexo masculino (64,64%); solteiros (47,43%); com faixa etária ≥ 60 anos (51,14%); raça/cor parda (71,11%). Verificou-se que não existe autocorrelação espacial através do índice de Moran Global (0.0094). Conclusão: A distribuição espacial dos óbitos ocorreu de forma heterogênea nas diferentes regiões do estado Amazonas, apresentando elevadas taxas de mortalidade durante o período de 2007 a 2017.(AU)


Objective: to analyze the distribution of deaths from pulmonary tuberculosis in the state of Amazonas. Method: it is an ecological study with secondary data from the Mortality Information System, during the period from 2007 to 2017. The QGIs software was used to create a digital map and the RStudio software for statistical analysis. In the data analysis, multiple linear regression, the Moran Global index and the Lagrange multiplier test were applied. Results: 1,267 cases of deaths from pulmonary tuberculosis were identified in the state of Amazonas. Most deaths occurred in males (64.64%); singles (47.43%); aged ≥ 60 years (51.14%); race / brown color (71.11%). It was found that there is no spatial autocorrelation using the Moran Global index (0.0094). Conclusion: The spatial distribution of deaths occurred heterogeneously in different regions of the state of Amazonas, with high mortality rates during the period from 2007 to 2017.(AU)


Objetivo: analizar la distribución de muertes por tuberculosis pulmonar en el estado de Amazonas. Método: se trata de un estudio ecológico con datos secundarios del Sistema de Información de Mortalidad, durante el período de 2007 a 2017. Se utilizó el software QGIs para crear un mapa digital y el software RStudio para análisis estadístico. En el análisis de datos se aplicó regresión lineal múltiple, el índice Moran Global y la prueba del multiplicador de Lagrange. Resultados: se identificaron 1.267 casos de defunciones por tuberculosis pulmonar en el estado de Amazonas. La mayoría de las muertes ocurrieron en hombres (64,64%); solteros (47,43%); edad ≥ 60 años (51,14%); raza / color marrón (71,11%). Se encontró que no existe autocorrelación espacial usando el índice Moran Global (0.0094). Conclusión: La distribución espacial de las defunciones ocurrió de manera heterogénea en diferentes regiones del estado de Amazonas, con altas tasas de mortalidad durante el período 2007 a 2017.(AU)


Subject(s)
Humans , Male , Female , Middle Aged , Tuberculosis, Pulmonary/mortality , Spatio-Temporal Analysis , Socioeconomic Factors , Brazil/epidemiology , Residence Characteristics , Ecological Studies , Health Information Systems
11.
Article in English | WPRIM | ID: wpr-921875

ABSTRACT

Computed tomography (CT) examination is the major measure for detecting and diagnosis of foreign bodies in human body. Although CT has high sensitivity in diagnosis of foreign body, some interference factors may still lead to missed diagnosis or misdiagnosis. Here we report a rare case that a bamboo stick accidentally pierced into the left chest of a young man who was drunk and unware of this hurt. The patient experienced cough, chest pain, fever, hemoptysis, and was misdiagnosed as primary and secondary tuberculosis based on chest CT examinations at a local hospital, although no tubercular bacillus detected by sputum smear. He subsequently received anti-tuberculous treatments in the following three years, but no improvement of his symptoms was observed. Until one month before his death, the bamboo stick was detected by spiral CT examination as well as three-dimensional image reconstruction at another hospital. Postmortem examination revealed pneumonia, pulmonary infarction, and abscess as the causes of his death. We analyze the potential reasons of misdiagnosis in this case, aiming to provide reference for the diagnosis and treatment of pulmonary inflammation associated with foreign body in the future.


Subject(s)
Abscess , Diagnostic Errors , Humans , Male , Pneumonia , Pulmonary Infarction , Tuberculosis, Pulmonary
12.
Article in Chinese | WPRIM | ID: wpr-887879

ABSTRACT

The primary and secondary tuberculosis features two completely different pathogenesis.At present,the pathogenesis of primary tuberculosis has been clear,whereas that of secondary tuberculosis remains unclear.In order to decipher the mechanism of secondary infection of


Subject(s)
Coinfection , Cord Factors , Humans , Mycobacterium tuberculosis , Tuberculosis , Tuberculosis, Pulmonary
13.
Article in English | WPRIM | ID: wpr-878330

ABSTRACT

Objective@#Prior pulmonary tuberculosis (PTB) on chest X-ray (CXR) was commonly found in infertile patients receiving examinations before @*Method@#We conducted a retrospective cohort study of 14,254 infertile patients who had received IVF-ET at Peking University Third Hospital in 2017. Prior PTB was defined as the presence of signs suggestive of old or inactive PTB on CXR, with or without a clinical TB history. Patients who had prior PTB on CXR but had not received a clinical diagnosis and anti-TB therapy were included for analysis. Live birth, clinical pregnancy, and miscarriage rates were compared between the untreated PTB and non-PTB groups.@*Results@#The untreated PTB group had significantly lower clinical pregnancy (31.7% @*Conclusions@#Untreated PTB was associated with adverse pregnancy outcomes after IVF-ET, especially in patients with unexplained infertility, highlighting the clinical significance of PTB in this specific patient population.


Subject(s)
Abortion, Spontaneous/epidemiology , Adult , China/epidemiology , Embryo Transfer/statistics & numerical data , Female , Fertilization in Vitro/statistics & numerical data , Humans , Infertility, Female/etiology , Live Birth/epidemiology , Middle Aged , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Outcome/epidemiology , Radiography, Thoracic , Retrospective Studies , Tuberculosis, Pulmonary/epidemiology , Young Adult
14.
Article in Spanish | LILACS, COLNAL | ID: biblio-1253869

ABSTRACT

La tuberculosis es la primera causa de mortalidad infectocontagiosa a nivel mundial. La tuberculosis pulmonar corresponde a la presentación más frecuente, sin embargo, el 15 % de los casos cursan con infección extrapulmonar, siendo raro el compromiso amigdalino. Este reporte de caso describe a un paciente de 39 años con odinofagia recurrente secundaria a amigdalitis por Mycobacterium tuberculosis, un raro caso de tuberculosis extrapulmonar. La amigdalitis es una infección leve y frecuente de la vía aérea superior, que responde adecuadamente al manejo antibiótico; sin embargo, cuadros recurrentes y prolongados, manifestaciones atípicas o pobre respuesta a la antibioticoterapia son características que obligan a la búsqueda de diagnósticos diferenciales, lo que lleva a considerar la presencia de Mycobacterium tuberculosis como agente etiológico, especialmente en países con alto índice de tuberculosis como Colombia


Tuberculosis is the leading cause of infectious mortality worldwide. The pulmonary one corresponds to the most frequent presentation, however up to 15% of tuberculosis cases present extrapulmonary involvement, tonsillar tuberculosis being rare. The following is a case report of a 39-year-old patient with recurrent odynophagia secondary to Mycobacterium tuberculosis tonsillitis, a rare form of extrapulmonary tuberculosis. Tonsillitis is a benign and extremely common infection of the upper airway. Such patients benefit from systemic antibiotics, although, recurrent episodes, prolonged odynophagia, atypical manifestations, or poor response to antimicrobial therapy forces consideration of diagnostic possibilities other than the obvious, including Mycobacterium tuberculosis as the etiological agent, especially in countries with the highest rates of tuberculosis.


Subject(s)
Humans , Male , Adult , Tuberculosis, Pulmonary/complications , Tonsillitis/microbiology , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/diagnostic imaging , Tonsillitis/drug therapy , Tonsillitis/diagnostic imaging , Anti-Bacterial Agents/therapeutic use
15.
Rev. Bras. Saúde Mater. Infant. (Online) ; 21(supl.2): 553-557, 2021. graf
Article in English | LILACS | ID: biblio-1279617

ABSTRACT

Abstract Introduction: although pediatric patients have comparatively fewer cases of COVID-19, children with Down Syndrome exhibit comorbidities such as immunodeficiency, diabetes and, in this perspective, are considered a population at risk for severe COVID-19. In addition, the literature also points to an unfavorable perspective on co-infection with Mycobacterium tuberculosis, considered an important comorbidity and a predictor of a worse clinical outcome. Description: female child, nine years old, with Down Syndrome, congenital heart disease and prematurity, with significant weight loss and intermittent fever for six months. A week ago, she had an intensification of fever, productive cough and mild respiratory distress. RT-PCR for SARS-CoV-2 detectable in nasopharynx swab, chest X-ray with diffuse alveolar infiltrate, chest CT with consolidations, excavation, solid micronodules in a sprouting tree pattern mainly in the right upper and lower lobes. Molecular rapid test for Mycobacterium tuberculosis detectable in gastric lavage. After specific treatment, the patient progressed well and was discharged from the hospital after 72 hours without fever and improvement in her breathing pattern. Discussion: despite the extensive pulmonary involvement, the patient did not require invasive ventilatory support and presented a satisfactory short-term outcome. Therefore, the relevance of the association of Tuberculosis and COVID-19 and other comorbidities in the pediatric age group still remains uncertain.


Resumo Introdução: apesar dos pacientes pediátricos apresentarem, comparativamente, menos casos da COVID-19, crianças com Síndrome de Down manifestam comorbidades como imunodeficiência, diabetes e, nessa perspectiva, são apontadas como população de risco para COVID-19 grave. Ademais, a literatura também sinaliza para um cenário desfavorável na coinfecção com Mycobacterium tuberculosis, considerada comorbidade importante e preditora para pior desfecho clínico. Descrição: criança de nove anos, sexo feminino, com Síndrome de Down, cardiopatia congênita e prematuridade, história de perda ponderal significativa e febre intermitente vespertina há seis meses. Há uma semana, apresentou intensificação da febre, tosse produtiva e desconforto respiratório leve. RT-PCR para SARS-CoV-2 em swab de nasofaringe detectável, radiografia de tórax com infiltrado alveolar difuso, tomografia de tórax com consolidações, focos de escavação, micronódulos sólidos em padrão de árvore em brotamento principalmente em lobos superior e inferior direitos. Teste rápido molecular para Mycobacterium tuberculosis detectável em lavado gástrico. Após início de tratamento específico, a paciente exibiu melhora clínica e de padrão respiratório e recebeu alta hospitalar após 72 horas afebril. Discussão: apesar do extenso comprometimento pulmonar, a paciente não necessitou de suporte ventilatório invasivo e apresentou um desfecho satisfatório em curto prazo. Portanto, a relevância da associação de tuberculose e COVID-19 e outras comorbidades na faixa etária pediátrica ainda permanecem incertas.


Subject(s)
Humans , Female , Child , Tuberculosis, Pulmonary/diagnosis , Comorbidity , Down Syndrome/complications , Coinfection , COVID-19/diagnosis , Mycobacterium tuberculosis , Risk Groups , Brazil/epidemiology
16.
J. bras. pneumol ; 47(2): e20200581, 2021. tab, graf
Article in English | LILACS | ID: biblio-1250206

ABSTRACT

ABSTRACT Objective: To assess the diagnostic performance of the Xpert MTB/RIF assay, a rapid molecular test for tuberculosis, comparing it with that of AFB staining and culture, in BAL fluid (BALF) samples from patients with clinically suspected pulmonary tuberculosis (PTB) who are sputum smear-negative or produce sputum samples of insufficient quantity. Methods: This was a retrospective study of 140 cases of suspected PTB in patients who were smear-negative or produced insufficient sputum samples and were evaluated at a tertiary teaching hospital in the city of Rio de Janeiro, Brazil. All of the patients underwent fiberoptic bronchoscopy with BAL. The BALF specimens were evaluated by AFB staining, mycobacterial culture, and the Xpert MTB/RIF assay. Results: Among the 140 patients, results for all three microbiological examinations were available for 73 (52.1%), of whom 22 tested positive on culture, 17 tested positive on AFB staining, and 20 tested positive on the Xpert MTB/RIF assay. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy for AFB staining were 68.1%, 96.1%, 88.2%, 87.5%, and 87.6%, respectively, compared with 81.8%, 96.1%, 90.0%, 92.4%, and 91.8%, respectively, for the Xpert MTB/RIF assay. The agreement between AFB staining and culture was 82.3% (kappa = 0.46; p < 0.0001), whereas that between the Xpert MTB/RIF assay and culture was 91.8% (kappa = 0.8; p < 0.0001). Conclusions: In BALF samples, the Xpert MTB/RIF assay performs better than do traditional methods, providing a reliable alternative to sputum analysis in suspected cases of PTB. However, the rate of discordant results merits careful consideration.


RESUMO Objetivo: Avaliar o desempenho diagnóstico do teste Xpert MTB/RIF - teste molecular rápido para tuberculose, comparando-o com o da pesquisa de BAAR e da cultura, em amostras de LBA de pacientes com suspeita clínica de tuberculose pulmonar (TBP) que apresentam baciloscopia de escarro negativa ou produzem amostras com quantidade insuficiente de escarro. Métodos: Estudo retrospectivo de 140 casos suspeitos de TBP em pacientes que apresentaram baciloscopia negativa ou produziram amostras de escarro insuficientes e foram avaliados em um hospital-escola terciário na cidade do Rio de Janeiro (RJ). Todos os pacientes foram submetidos à fibrobroncoscopia com LBA. Os espécimes de LBA foram avaliados por meio da realização de pesquisa de BAAR, cultura para micobactérias e teste Xpert MTB/RIF. Resultados: Entre os 140 pacientes, resultados de todos os três exames microbiológicos estavam disponíveis para 73 (52,1%), dos quais 22 apresentaram cultura positiva, 17, pesquisa de BAAR positiva, e 20, teste Xpert MTB/RIF positivo. A sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e precisão global da pesquisa de BAAR foram de 68,1%, 96,1%, 88,2%, 87,5% e 87,6%, respectivamente, contra 81,8%, 96,1%, 90,0%, 92,4% e 91,8%, respectivamente, do teste Xpert MTB/RIF. A concordância entre a pesquisa de BAAR e a cultura foi de 82,3% (kappa = 0,46; p < 0,0001), enquanto a concordância entre o teste Xpert MTB/RIF e a cultura foi de 91,8% (kappa = 0,8; p < 0,0001). Conclusões: Em amostras de LBA, o teste Xpert MTB/RIF tem melhor desempenho do que os métodos tradicionais, fornecendo uma alternativa confiável à análise do escarro em casos suspeitos de TBP. No entanto, a taxa de resultados discordantes merece uma reflexão cuidadosa.


Subject(s)
Humans , Tuberculosis , Tuberculosis, Pulmonary/diagnosis , Mycobacterium tuberculosis , Sputum , Tertiary Healthcare , Brazil , Retrospective Studies , Sensitivity and Specificity
18.
Rev. panam. salud pública ; 45: e20, 2021. tab, graf
Article in English | LILACS | ID: biblio-1252017

ABSTRACT

ABSTRACT Objective. Construct and evaluate the care cascade for pulmonary tuberculosis in the indigenous population of the department of Cauca (Colombia) and identify existing gaps. Methods. Mixed-methods sequential explanatory design. In the first phase, the pulmonary tuberculosis care cascade for the indigenous population of Cauca was evaluated. Data were obtained from secondary sources and all cases diagnosed from 1 January 2016 to 31 December 2017 were included. In the second phase, semi-structured interviews were done with nine program coordinators and 11 nursing auxiliaries to explain identified gaps. Absolute and percentage values were estimated for each of the steps and gaps in the care cascade. Quantitative and qualitative results were triangulated. Results. In 2016 and 2017, an estimated 202 patients with respiratory symptoms were expected to be positive and 106 cases of pulmonary tuberculosis were reported among the indigenous population of the department of Cauca. A gap of 47.5% was found for diagnosis, since only 52.5% of subjects were diagnosed in health services. This gap was explained by poor quality of samples and flawed smear techniques; flaws in correct identification of patients with respiratory symptoms; limited access to diagnostic methods, such as culture and molecular tests; and limited training and high turnover of personnel in health service provider institutions. Conclusions. The tuberculosis control program should focus actions on bridging the gap in case detection in the indigenous population.


RESUMEN Objetivo. Construir y evaluar la cascada de atención de la tuberculosis pulmonar en la población indígena del departamento del Cauca (Colombia) e identificar las brechas existentes. Métodos. Metodología mixta con diseño secuencial explicativo. En la primera fase se evaluó la cascada de atención de la tuberculosis pulmonar para la población indígena del Cauca. Se obtuvieron datos de fuentes secundarias y se incluyeron todos los casos diagnosticados entre el 1 de enero del 2016 y el 31 de diciembre de 2017. En la segunda fase, se aplicaron entrevistas semiestructuradas a nueve coordinadores de programa y 11 auxiliares de enfermería para explicar las brechas identificadas. Se estimaron los valores absolutos y porcentuales en cada uno de los pasos y las brechas de la cascada de atención. Se triangularon los resultados cuantitativos y cualitativos. Resultados. Durante 2016 y 2017 se estimaron 202 sintomáticos respiratorios esperados positivos y se notificaron 106 casos de tuberculosis pulmonar en la población indígena del departamento del Cauca. Se encontró una brecha de 47,5% para el diagnóstico, ya que solo 52,5% de los sujetos recibieron el diagnóstico en los servicios de salud. Las explicaciones a esta brecha fueron la mala calidad de muestras y fallas en la técnica del extendido, fallas en la correcta identificación del sintomático respiratorio, acceso limitado a métodos diagnósticos como cultivo y pruebas moleculares, así como capacitación escasa y rotación alta de personal al interior de las instituciones prestadoras de servicios de salud. Conclusiones. Las acciones del programa de control de tuberculosis deben enfocarse en reducir la brecha de detección de casos en la población indígena.


RESUMO Objetivo. Elaborar e avaliar a cascata de atenção da tuberculose pulmonar na população indígena do Departamento de Cauca (Colômbia) e identificar as lacunas existentes. Métodos. Metodologia mista com desenho sequencial explicativo. Na primeira fase, avaliamos a cascata de atenção da tuberculose pulmonar para a população indígena de Cauca. Os dados foram obtidos de fontes secundárias, incluindo todos os casos diagnosticados entre 1 de janeiro de 2016 e 31 de dezembro de 2017. Na segunda fase, realizamos entrevistas semiestruturadas com nove coordenadores do programa e 11 auxiliares de enfermagem para explicar as lacunas identificadas. Estimamos os valores absolutos e percentuais em cada uma das etapas e as lacunas na cascata de atenção. Os resultados quantitativos e qualitativos foram triangulados. Resultados. Nos anos de 2016 e 2017, foi estimada a ocorrência de 202 casos com sintomas respiratórios com diagnóstico esperado positivo; no entanto, os serviços de saúde só diagnosticaram e notificaram 106 casos de tuberculose pulmonar na população indígena do Departamento de Cauca. Portanto, identificamos uma lacuna diagnóstica de 47,5%, já que apenas 52,5% dos casos receberam um diagnóstico nos serviços de saúde. As explicações para esta lacuna foram a má qualidade das amostras e falhas na técnica de esfregaço, falhas na identificação correta dos sintomas respiratórios, acesso limitado aos métodos de diagnóstico, tais como cultura e testes moleculares, bem como capacitação deficiente e alta rotatividade de pessoal nas instituições de saúde. Conclusões. As ações do programa de controle da tuberculose devem se concentrar em reduzir a lacuna na detecção de casos na população indígena.


Subject(s)
Humans , Male , Adolescent , Adult , Middle Aged , Young Adult , Tuberculosis, Pulmonary/prevention & control , Operations Research , Indians, South American , Colombia , Indigenous Peoples
20.
Biomédica (Bogotá) ; 40(4): 626-640, oct.-dic. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1142429

ABSTRACT

Resumen. Introducción. La prueba Xpert MTB/RIF™ es una prueba molecular rápida para el diagnóstico de la tuberculosis y la resistencia a la rifampicina. Desde el 2010 es la recomendada por la Organización Mundial de la Salud (OMS) y, aunque fue introducida en Colombia en el 2012, se desconocen los resultados de su uso.Objetivo. Describir la cobertura y la fidelidad en el uso de la prueba Xpert MTB/RIF™ en pacientes con tuberculosis pulmonar en una ciudad con alta carga de la enfermedad en Colombia.Materiales y métodos. Se hizo un estudio retrospectivo descriptivo de casos del programa de tuberculosis en Cali entre el 2013 y el 2019. La cobertura se estimó como el total de pruebas empleadas en los casos registrados en el programa. La fidelidad se midió con base en los protocolos internacionales de uso de la Xpert MTB/RIF™. Además, se hizo un análisis de correspondencias múltiples entre la prueba y las variables sociodemográficas.Resultados. Se incluyeron 6.328 pacientes con tuberculosis pulmonar, de los cuales 181 eran resistentes a los fármacos. La cobertura total de la Xpert MTB/RIF™ durante el periodo de estudio fue de 10,3 % (n=655), con una variación anual entre 0,2 y 23 %. La fidelidad fue de 46,8 % para los grupos de mayor riesgo de tuberculosis multirresistente (TB-MDR). El uso de la prueba se relacionó con la condición de ser hombre, afrocolombiano, y tener entre 41 y 60 años de edad.Conclusiones. La cobertura de la prueba Xpert MTB/RIF™ en Cali es baja y su uso no responde a la priorización recomendada para su implementación. Se requieren estrategias para promover su uso adecuado, de manera que contribuya a la meta de poner fin a la tuberculosis.


Abstract. Introduction:The Xpert MTB/RIF™ is a rapid molecular test that diagnoses tuberculosis and rifampin resistance. Since 2010, it is recommended by the World Health Organization (WHO) and although it was introduced in Colombia since 2012, the results of its implementation are unknown.Objective: To describe the coverage and fidelity in the implementation of the Xpert MTB/RIF™ in patients with pulmonary tuberculosis in a city with a high burden for the disease in Colombia.Materials and methods: We conducted a retrospective, descriptive study of cases from a tuberculosis program in Cali between 2013 and 2019. We estimated the coverage as the total number of tests used compared to the cases registered in the program and the fidelity based on international Xpert MTB/RIF™ implementation protocols. We performed a multivariate analysis of multiple correspondences between the test and the sociodemographic variables.Results: We included 6,328 patients with pulmonary tuberculosis of whom 181 were drug-resistant. The Xpert MTB/RIF™ coverage was 10,3% (n=655) with an annual variation between 0.2% and 23%. Loyalty among the highest risk groups of MDR-TB was 46.8%. The use of the test was related to being an Afro-Colombian man between 41 and 60 years of age.Conclusions: The coverage of the Xpert MTB/RIF in Cali is low and its use does not follow the recommended prioritization for its implementation. Implementation strategies are required for its proper use to contribute to the goal of ending tuberculosis.


Subject(s)
Tuberculosis, Pulmonary , Molecular Diagnostic Techniques , Rifampin , Drug Resistance
SELECTION OF CITATIONS
SEARCH DETAIL