Piauí Central Laboratory of Public Health: frequency of mycobacterial species and epidemiological aspects, 2014-2015 / Laboratorio Central de Salud Pública de Piauí: frecuencia de especies micobacterianas y aspectos epidemiológicos, 2014-2015 / Laboratório Central de Saúde Pública do Piauí: frequência de espécies de micobactérias e aspectos epidemiológicos, 2014-2015

Background and Objectives: Knowledge about species diversity of non-tuberculous mycobacteria (NTM) and the frequency of tuberculosis (TB) is an important issue in rural-urban regions such as Piauí (northeast of Brazil), of low incidence rate of TB , can help to improve diagnosis and prevention strategies. The aim of this study is to examine some epidemiological aspects and the frequency of Mycobacterium tuberculosis (Mtb) and NTM isolated at the central public health reference laboratory, Dr. Costa Alvarenga, Piauí (LACEN-PI). Methods: Data records of all mycobacterosis and tuberculosis cases from January 2014 to March 2015 were analyzed. Results : Of the 20% (142/706) positive growths, 70% (99) were Mtb and 10% NTM. The remainde was of inadequate clinical samples, not allowing the identification of even the suspected NTM. The most frequent clinical form was pulmonary with TB patients younger than those infected with NTM (p = 0.001), the majority living in Teresina (52%). NTMs identified were M. abscessus (36%), M. avium, M. intracellulare, Mycobacterium sp. (14% each) and M. asiaticum, M. szulgai, M. kansasii 7% (each). Mtb drug resistance (7.8%) and TB co-infection with the human immunodeficiency virus (HIV-TB) found to be high (49%, 19/39). Conclusion: The frequencies of Mtb infection, drug resistance and HIV-TB co-infection are still underestimated and failures in the identification of NTM may decrease the actual frequency of these infections. Therefore, there is a need for improvements in TB control and in the diagnosis of NTMs in Piauí.(AU)

Justificativa e Objetivos: O conhecimento da diversidade de espécies de micobactérias não tuberculosas (MNT ) e a frequência da tuberculose (TB) é uma questão importante em regiões rurais-urbanas como o Piauí (nordeste do Brasil), com baixa incidência de TB, pode ajudar a melhorar o diagnóstico e estratégias de prevenção. O objetivo deste estudo é examinar alguns aspectos epidemiológicos e a frequência de Mycobacterium tuberculosis (Mtb) e MNT isolados, no Laboratório Central de Referência em Saúde Pública, Dr. Costa Alvarenga, Piauí (LACEN-PI). Métodos: Dados de todo s os casos de micobacterioses e tuberculose de janeiro de 2014 a março de 2015 foram analisados. Resultados: Dos 20% (142/706), de amostras com crescimento positivo 70% (99) foram Mtb e 10% MNT . O restante era de amostras clínicas inadequadas, não permitindo a identificação inclusive de MNT suspeitos. A forma clínica mais frequente foi pulmonar com pacientes TB mais jovens do que os infectados com MNT (p = 0,001), a maioria morando em Teresina (52%). As MNT s identificadas foram M. abscessus (36%), M. avium , M. intracellulare , M. sp. (14%, cada) e M. asiaticum, M. szulgai , M. kansasii 7% (cada). A droga resistência de Mtb (7,8%) e a co-infecção TB e vírus da imunodeficiência humana (HIV-TB) mostraram-se altas (49%, 19/39).Conclusão: As frequências de infecção por Mtb, de resistência a medicamentos e co-infecção HIV-TB ainda são subestimadas e as falhas na identificação de MNT podem diminuir a real frequência destas infecções . Portanto, há necessidade de melhorias no controle da TB e no diagnóstico de MNT s no Piauí.(AU)

Justificacion y objetivos: Conocer la diversidad de especies de micobacterias no tuberculosas (MNT) y la frecuencia de tuberculosis (TB) es tema importante en regiones rurales-urbanas como Piauí (noreste de Brasil) con baja tasa de incidencia de TB, y puede ayudar a mejorar el diagnóstico y las estrategias de prevenció. El objetivo de este estudio es examinar algunos aspectos epidemiológicos y la frecuencia de Mycobacterium tuberculosis (Mtb) y MNT aislado, en el laboratorio central de referencia de salud pública, Dr. Costa Alvarenga, Piauí (LACEN-PI). Métodos: Se analizaron los datos de todos los casos de micobacteriosis de enero de 2014 a marzo de 2015. Resultados: Del 20% (142/706), de las muestras con crecimiento positivo el 70% (99) fueron Mtb y el 10% MNT. El resto fue de muestras clínicas inadecuadas, no permitiendo la identificación de MNT incluso sospechosas. La forma clínica más frecuente fue la pulmonar y los pacientes con TB eran más jóvenes que los infectados con MNT (p = 0.001), la mayoría viviendo en Teresina (52%).Los MNT identificados fueron M.abscessus (36%), M.avium, M.intracellulare, Mycobacterium sp. (14% cada) y M.asiaticum, M.szulgai, M.kansasii 7% (cada ). La resistencia a los medicamentos de Mtb (7,8%) y la coinfección de TB y el virus de la inmunodeficiencia humana (VIH-TB) fueron altas (49%, 19/39 )Conclusión: Las frecuencias aún subestimadas de resistencia a los medicamentos, coinfección por VIH-TB y fallas de identificaciónidentificación de MNT pueden disminuir la frecuencia real de estas infecciones. Consecuentemente, es necesario mejorar el control y diagnóstico de TB y MNT en Piauí.(AU)

Intestinal parasitic infections in a lowincome urban community: prevalence and knowledge, attitudes and practices of inhabitants of Parque Oswaldo Cruz, Rio de Janeiro, Brazil

Intestinal parasitic infections (IPIs) are present in Brazil from upper-to low-income communities, with varying infection estimates; however, they affect those living in urban and rural poverty more severely, without adequate access to consistently safe drinking water, sanitation, waste disposal, medical access and education. Estimates show the need for establishing infection prevalence and socioeconomic features, along with population knowledge, attitudes and practices (KAP) regarding IPIs. The purpose of this study is to assess the prevalence and KAP regarding IPIs of residents of an urban low-income community (Parque Oswaldo Cruz/Amorim) of the Complexo de Manguinhos, Rio de Janeiro, Brazil. The Lutz sedimentation technique was used for parasite detection (n=1,121) and, to obtain data on community KAP regarding IPIs, a KAP survey, adapted from Mello et al. was applied (n=505). An overall prevalence of 20.7% was detected with protozoa composing 92.9% (n=235) of the positive samples. Questionnaires revealed generally correct knowledge but with several inconsistencies, unawareness of the association between the etiological agent and the disease, and uncertainty regarding own knowledge of the subject. The population understood the importance of prevention and was willing to utilize prevention strategies despite being unsure of how to prevent infection. Further studies are required to investigate best practices for improving health equity, community health empowerment and IPIs prevention in Rio de Janeiro, Brazil.

Heterogeneidade de resposta por IFN-γ a cepas clínicas de Mycobacterium tuberculosis em humanos / Heterogeneity in human IFN-γ responses to clinical Mycobacterium tuberculosis strains

Mycobacterium tuberculosis é um dos mais bem sucedidos patógenos do homem. As cepas virulentas são mais facilmente transmitidas, induzindo respostas imunes variáveis. Avaliamos a resposta celular tipo Th1, através da produção de IFN-γ, como resposta a cepas com padrões diversos em voluntários sadios. Nossos resultados mostraram que indivíduos com teste tuberculínico (TT) negativo já tiveram contato com algumas das cepas testadas, ao passo que indivíduos com TT positivo não responderam a todas as cepas testadas. Cepas resistentes induziram uma média menor de produção de IFN-γ que aquelas sensíveis. Uma possível aplicação prática disto seria que a produção de IFN-γ, em relação a uma cepa isolada específica, poderia auxiliar na previsão da resposta ao tratamento dos pacientes.

Mycobacterium tuberculosis is one of the most successful human pathogens. Highly virulent strains, which are more easily transmitted than are less virulent strains, elicit variable immune responses. We evaluated the Th1 responses (IFN-γ production) in healthy volunteers after stimulation with various strains. Our results show that the individuals with negative tuberculin skin test (TST) results were not necessarily naive to all of the strains tested, whereas individuals with positive TST results did not respond to all of the strains tested. Drug-resistant strains induced a lower mean level of IFN-γ production than did drug-sensitive strains. One possible practical application of this finding would be for the prediction of responses to treatment, in which it might be advantageous to have knowledge of the estimated IFN-γ production elicited by a specific isolated strain.

Evaluation of Lionex TB kits and mycobacterial antigens for IgG and IgA detection in cerebrospinal fluid from tuberculosis meningitis patients

To evaluate commercial Lionex TB together with four antigens of Mycobacterium tuberculosis (MPT-64, MT10.3, 16 kDa and 38 kDa) for IgG and IgA cerebrospinal fluid (CSF) detection in the diagnosis of tuberculosis meningitis (TBM) with CSF negative acid-fast bacilli staining, 19 cases of TBM, 64 cases of other infectious meningoencephalitis and 73 cases of other neurological disorders were tested by enzyme linked immunosorbent assay. IgA-MPT-64 and IgG Lionex showed the highest sensitivities, specificities, positive predictive value and negative predictive value (63.2 percent, 47.4 percent; 95 percent, 93.7 percent; 40 percent, 98 percent and 28.4 percent, 97.1 percent, respectively). However, while grey zone was 12.7 percent and 6 percent, respectively, lowering sensitivity but maintains high specificity (> 95 percent). High protein concentration in CSF was associated with antibody positivity CSF/HIV+ which did not influence the sensitivity of both tests. To our knowledge, this is the first description of IgA-MPT-64 and IgG Lionex antibodies in CSF-TBM and, although there is good specificity, adjustments are needed based on antigen composition to enhance sensitivity.

Molecular diversity of Mycobacterium tuberculosis strains in a slum area of Rio de Janeiro, Brazil / Diversidade molecular de cepas de Mycobacterium tuberculosis em uma região de favela da cidade do Rio de Janeiro

This retrospective molecular study involving restriction fragment length polymorphism, using insertion sequence 6110 as a marker, was conducted in order to provide an initial insight into the genetic diversity of Mycobacterium tuberculosis strains isolated in the slums of the Complexo de Manguinhos, located in the city of Rio de Janeiro, Brazil. Of the 67 strains evaluated, 23 (34.3 percent) were found to belong to clusters (total clusters, 10). Household and social chains of transmission were associated with clustering, in 20 percent and 60 percent, respectively. Living in the Conjunto Habitacional Programado 2 slum was associated with clustering. Although not significant, it is relevant that 26 percent of the clustered strains presented primary resistance. These findings, although possibly underestimating the prevalence due to the failure to analyze all strains, could help improve the local tuberculosis control program.

Este estudo retrospectivo envolvendo polimorfismo de fragmento de restrição e utilizando como marcador a seqüência de inserção 6110, foi realizado para fornecer informações iniciais quanto à diversidade genética das cepas de Mycobacterium tuberculosis isoladas em favelas do Complexo de Manguinhos, na cidade do Rio de Janeiro. Das 67 cepas isoladas, 23 (34,3 por cento) foram agrupadas em clusters (total de clusters, 10). A transmissão entre comunicantes domiciliares e extra-domicialiares estave associada a 20 por cento e 60 por cento dos clusters, respectivamente. Ser morador do Conjunto Habitacional Programado 2 foi associado à presença de clusters. Embora não significativo, é relevante o fato de que 26 por cento das cepas em cluster apresentaram resistência primária. Estes achados, embora possivelmente subestimados devido à impossibilidade de analisar todas as cepas, fornecem subsídios para a melhoria do programa local de controle da tuberculose.

Resistência a drogas em cepas de mycobacterium tuberculosis isoladas de amostras de escarro de pacientes ambulatoriais sintomáticos: Complexo de Manguinhos, Rio de Janeiro, Brasil / Drug resistance in mycobacterium tuberculosis strains isolated from sputum samples from symptomatic outpatients: Complexo de Manguinhos, Rio de Janeiro, Brazil

Para descrever a resistência a drogas em cepas de Mycobacterium tuberculosis isoladas de amostras de escarro de 263 pacientes suspeitos de tuberculose moradores do Complexo de Manguinhos, Rio de Janeiro, Brasil, as culturas positivas entre outubro de 2000 e dezembro de 2002 foram submetidas a teste de sensibilidade para isoniazida, rifampicina, estreptomicina, etionamida e etambutol. Resistência a qualquer das drogas foi encontrada em 21,4 por cento (16/75) dos pacientes diagnosticados com tuberculose. Destes, 50 por cento (8/16) eram casos novos e 50 por cento (8/16) eram casos com tratamento anterior. A tuberculose multirresistente foi encontrada em 10,6 por cento (8/75) do total de pacientes, estando associada a tratamento anterior em 8 por cento (6/75) deles. Nossos resultados podem ter sido subestimados, pois M. tuberculosis não pôde ser isolado em todas as amostras positivas para bacilos álcool-ácido resistentes. Contudo, eles pelo menos revelam parte do problema.

This study aimed to assess drug resistance in Mycobacterium tuberculosis strains isolated from sputum samples. To that end, sputum samples were collected from 263 patients suspected of having tuberculosis. All subjects lived in the Complexo de Manguinhos, which is located in the city of Rio de Janeiro, Brazil. Cultures testing positive between October of 2000 and December of 2002 were tested to determine strain susceptibility to isoniazid, rifampicin, streptomycin, ETHionamide, and ETHambutol. Of the 75 patients diagnosed with tuberculosis, resistance to at least one of the drugs was found in 16 (21.4 percent). Of those 16 patients, 8 (50 percent) were new cases, and 8 (50 percent) had previously been treated. Multidrug-resistant tuberculosis was identified in 8 (10.6 percent) of the 75 patients, being associated with previous treatment in 6 (8 percent). The incidence of multidrug-resistant tuberculosis might have been underestimated, since M. tuberculosis was not isolated from all of the samples testing positive for acid-fast bacilli. However, at least, our findings shed some light on the problem.

Do DNA extraction methods and Taq polimerase quality improve the double repetitive element (DRE) PCR typing method for Mycobacterium tuberculosis strains?

Double repetitive element (DRE) PCR amplification is a simple Mycobacterium tuberculosis typing method, however amplification failure or poor resolution of bands commit its efficacy. In order to verify if whether or not these features could be minimized by improving DNA extraction procedures or Taq polymerise quality, DRE-PCR was performed on 24 M. tuberculosis DNA samples extracted by heat-shock, mechanical and enzymatic methods applying conventional and hot start Taq pol. We demonstrated that when dealing with the Mycobacterium tuberculosis DRE-PCR typing method, Taq pol of better quality might be more important to improve amplification than the DNA extraction method.

Amplificação de duplo elemento repetido (DRE) por PCR é um método simples para tipagem de Mycobacterium tuberculosis, entretanto falha ou a baixa resolução das bandas na amplificação compromete a eficiência do método. Com o objetivo de verificar se estes problemas podem ou não ser minimizados pela utilização de diferentes procedimentos de extração de DNA ou de qualidades de Taq polimerase, DRE-PCR foi ensaiado em 24 amostras de DNA de M. tuberculosis extraídos pelos métodos de choque-térmico, - mecânico e enzimático utilizando Taq polimerase convencional e hot start Taq pol. Foi demonstrado que a qualidade da Taq pol utilizada talvez seja mais importante para uma melhor amplificação que o método de extração de DNA empregado.

Um estudo retrospectivo dos aspectos epidemiológicos da tuberculose na comunidade do Complexo de Manguinhos localizado em área urbana do Rio de Janeiro, Brasil, 2000-2002 / A retrospective study of the epidemiological aspects of tuberculosis in the Complexo de Manguinhos, an urban slum area in Rio de Janeiro, Brazil, 2000-2002

To describe some aspects of tuberculosis in a low-income community (the Complexo de Manguinhos, in Rio de Janeiro, Brazil), a retrospective study was carried out. Of the 290 cases reported in the 2000-2002 period, 75.8 percent were new cases. The annual incidence rates were 157/100,000 (2000), 205/100,000 (2001), and 145/100,000 (2002). Although there was a tendency toward a decrease in the number of cases over the period studied, the difference was not significant, suggesting that tuberculosis continues to be endemic in the area. Therefore, despite the existence of local public health care services, more efficient strategies should be implemented in order to increase the effectiveness of tuberculosis control programs in the area.

Para descrever alguns aspectos da tuberculose em favelas, foi realizado um estudo retrospectivo no Complexo de Manguinhos, Rio de Janeiro (RJ) Brasil. Em um total de 290 casos notificados entre 2000 e 2002, 75,8 por cento eram casos novos. A taxa de incidência foi de 157, 205 e 145/100.000, respectivamente. Embora tenha sido observada tendência de diminuição dos números de casos no período de estudo, esta não foi significante, sugerindo manutenção da endemia. Portanto, embora exista um serviço de saúde no local, estratégias mais eficientes devem ser implantadas para auxiliar o Programa de Controle da tuberculose.

Cell proliferation and interferon-gamma response to recombinant MBP-3, NarL, MT-10.3, and 16kDa Mycobacterium tuberculosis antigens in Brazilian tuberculosis patients

Human pulmonary tuberculosis (TB) is a worldwide public health problem. In resistant individuals, control of the infection mainly requires development of a Th1 cell immune response with production of cytokines, of which interferon-gamma (IFN-gamma)plays an important role. Several antigens from Mycobacterium tuberculosis complex has been described for use in vaccine development or for diagnostic purposes, however little evaluation has been done in endemic area for TB. The proliferative and IFN-gamma human T cell immune responses, to four recombinant proteins (MBP-3, NarL, MT-10.3, 16 kDa) and PPD, of 38 Brazilian TB patients (6 untreated and 32 treated) and 67 controls (38 positive and 29 negative tuberculin skin test - TST) were compared. The highest reactivity mean rate was obtained with PPD followed by 16 kDa in TB patients. While most of the patients (87 percent) and controls (> 64 percent) respond to the PPD, 16kDa was more specifically recognized (> 21 percent) although less sensitive (54 percent). When TB patients were divided according to treatment status, opposite to PPD, higher average level of IFN-gamma was induced by 16kDa in untreated (505 pg/ml) compared to treated TB patients and TST+ (269.8 pg/ml x 221.6pg/ml, respectively), although the difference was not significant. These data show that in contrast with the other recombinant proteins, the stimulatory potency of 16kDa to induce proliferative and INF-gamma response was more effective and is more recognized by active TB untreated patients, eliciting in control individuals a more selective immune response than PPD.

Mycobacterium avium restriction fragment lenght polymorphism-IS IS1245 and the simple double repetitive element polymerase chain reaction typing method to screen genetic diversity in Brazilian strains

Simple double repetitive element polymerase chain reaction (MaDRE-PCR) and Pvu II-IS1245 restriction fragment length polymorphism (RFLP) typing methods were used to type 41 Mycobacterium avium isolates obtained from 14 Aids inpatients and 10 environment and animals specimens identified among 53 mycobacteria isolated from 237 food, chicken, and pig. All environmental and animals strains showed orphan patterns by both methods. By MaDRE-PCR four patients, with multiple isolates, showed different patterns, suggesting polyclonal infection that was confirmed by RFLP in two of them. This first evaluation of MaDRE-PCR on Brazilian M. avium strains demonstrated that the method seems to be useful as simple and less expensive typing method for screening genetic diversity in M. avium strains on selected epidemiological studies, although with limitation on analysis identical patterns except for one band.

Antimicrobial susceptibility determined by the E test, Lõwenstein-Jensen proportion, and DNA sequencing methods among Mycobacterium tuberculosis isolates discrepancies, preliminary results

Mycobacterium tuberculosis strains resistant to streptomycin (SM), isoniazid (INH), and/or rifampin (RIF) as determined by the conventional Lõwenstein-Jensen proportion method (LJPM) were compared with the E test, a minimum inhibitory concentration susceptibility method. Discrepant isolates were further evaluated by BACTEC and by DNA sequence analyses for mutations in genes most often associated with resistance to these drugs (rpsL, katG, inhA, and rpoB). Preliminary discordant E test results were seen in 75 percent of isolates resistant to SM and in 11 percent to INH. Discordance improved for these two drugs (63 percent) for SM and none for INH when isolates were re-tested but worsened for RIF (30 percent). Despite good agreement between phenotypic results and sequencing analyses, wild type profiles were detected on resistant strains mainly for SM and INH. It should be aware that susceptible isolates according to molecular methods might contain other mechanisms of resistance. Although reproducibility of the LJPM susceptibility method has been established, variable E test results for some M. tuberculosis isolates poses questions regarding its reproducibility particularly the impact of E test performance which may vary among laboratories despite adherence to recommended protocols. Further studies must be done to enlarge the evaluated samples and looked possible mutations outside of the hot spot sequenced gene among discrepant strains.

Ocorrência de micobactérias em suínos de abate clandestino no Rio de Janeiro, Brasil / Occurrence of mycobacteria in swine of clandestine slaughter in Rio de Janeiro, Brazil

O estudo das micobactérias atípicas, em especial das que compõem o complexo Mycobaterium avium (MAC), vem crescendo em função de sua associação com diferentes tipos de patologias, principalmente em pacientes imunodeprimidos. Suínos podem atuar como reservatórios destes microorganismos e o exame destes animais em uma região específica permite avaliar a situação epidemiológica das micobacterioses na população humana e das espécies animais. Foram examinados 73 suínos abatidos no ambiente de criação, sem a devida inspeção sanitária. Isolaram-se 21 amostras, sendo sete amostras de crescimento rápido, seis pertencentes MAC e uma Mycobacterium scrofulaceum.Foram ainda identificadas 14 de micobactérias atípicas de crescimento rápido, classificas em M. flavescens (4 amostras), M. chitae (3 amostras), M. peregrinum (2 amostras), M. fortuitum (2 amostras) e M. diernhferi (1 amostra). Consideramos os índices de isolamento vefificados bastante altos, especialmente tendo em vista que esses animais são consumidos diretamente sem qualquer espécie de fiscalização sanitária ou de tratamento prévio dos produtos. Desta forma, consideramos que os animais oriundos de abate cladestino representam importante risco de contaminação ambiental e da população humana exposta a micobactérias em geral e, especialmente, às do MAC.

Non-tuberculous mycobacteria I: one year clinical isolates identification in Tertiary Hospital Aids Reference Center, Rio de Janeiro, Brazil, in pre highly active antiretroviral therapy era

The aim of this study was to determine the prevalence of non-tuberculous mycobacteria (NTM) isolates at University Hospital, Reference Center for Aids in Rio de Janeiro, Brazil, during one year. We used standard biochemical tests for species identification and IS1245 PCR amplification was applied as a Mycobacterium avium specific identification marker. Four hundred and four specimens from 233 patients yielded acid-fast bacilli growth. M. tuberculosis was identified in 85 percent of the patients and NTM in 15 percent. NTM disseminated infection was a common event correlated with human immunodeficiency virus (HIV) infected patients and only in HIV negative patients the source of NTM was non sterile site. M. avium complex (MAC) was biochemically identified in 57.8 percent (49/83) of NTM isolates, most of them from sterile sites (75.5 percent), and in 94 percent (46/49) the IS 1245 marker specific for M. avium was present. Twenty NTM strains showed a MAC biochemical pattern with the exception of a urease-positive (99 percent of MAC are urease-negative), however IS1245 was detected in 96 percent of the strains leading to their identification as M. avium. In this group differences in NTM source was not significant. The second most frequently isolated NTM was identified as M. scrofulaceum (7.2 percent), followed by M. terrae (3.6 percent), M. gordonae (2.4 percent), M. chelonae (1.2 percent), M. fortuitum (1.2 percent) and one strain which could not be identified. All were IS1245 negative except for one strain identified as M. scrofulaceum. It is interesting to note that non-sterile sites were the major source of these isolates (92.8 percent). Our finding indicated that M. avium is still the major atypical species among in the MAC isolates recovered from Brazilian Aids patients without highty active antiretroviral therapy schema. Some discrepancies were seen between the identification methods and further investigations must be done to better characterize NTM isolates using other phenotypic and genotypic methods

Aspectos epidemiológicos da tuberculose no Complexo de Manguinhos, Rio de Janeiro, Brasil: Estudo retrospectivo no período de 1986 a 1994 / The tuberculosis epidemiological aspects in Manguinhos Complex, Rio de Janeiro, Brazil: A retrospective study from 1986-1994

Introdução: o objetivo deste trabalho foi descrever a situação epidemiológica da tuberculose em área favelada (complexo da Manguinho), através de um estudo retrospectivo dos casos de tuberculose atendidos no Centro de Saúde Escola Germano Sinval Faria (CSEGSF), da Escola Nacional de Saúde Pública (ENSP), Fundação Oswaldo Cruz (FIOCRUZ) no Rio de Janeiro. Material e Métodos: no período entre 1986 a 1994 foram registrados 274 casos, com aumento anual do número de casos concentrados na duas comunidades mais pobres da área estudada. Resultados: houve predominância das formas pulmonares (240/274, 87,6%), a doença foi prevalente em indivíduos do sexo masculino e da faixa etária produtiva (21 a 40 anos, 49,6 %). A baciloscopia do escarro foi positiva em 63 % dos pacientes submetidos a este exame. Foi observado que 33 % dos pacientes que receberam tuberculostáticos e abandonaram o tratamento, dentre estes, 22% tinham baciloscopia inicial positiva. O risco de recaída entre os pacientes que abandonaram o tratamento foi três vezes maior que entre os que tiveram alta por cura. Conclusões: estes dados mostram que apesar da área de Manguinhos estar localizada em uma zona urbana provida de serviço assintencial de saúde, a tuberculose permanece como um problema de saúde pública. Estratégias mais eficazes de controle da tuberculose, tais como busca ativa, tratamento supervisionado e melhorias das condições sócio-econômico-sanitárias da população, necessitam ser urgentemente consideradas.

Diagnóstico sorológico da tuberculose pulmonar na infância / Serological diagnosis of pulmonary tuberculosis in children

Introdução: o diagnóstico bacteriológico da tuberculose (TB) pulmonar na infância é difícil pois a doença cursa com pequeno número de bacilos. Objetivo deste estudo foi contribuir para o diagnóstico de tuberculose pulmonar na infância através de método sorológico. Material e métodos: empregou-se teste ELISA para pesquisa de anticorpos lgG anti PPD, em soros de 48 crianças e adolescentes de 0 a 13 anos, sendo: 29 com tuberculose pulmonar (grupo 1) e 19 não tuberculosos, assintomáticos, comunicantes de pacientes tuberculosos (grupo2). Resultados: o valor médio da densidade óptica do Elisa no grupo 1 foi 0,11 e no grupo 2, 0,03. Estes resultados permitiram calcular a sensibilidade do teste em 52% [IC. 0.37-0.73] e a especificidade em 95% [IC. 0.87-1.00]. A análise do desempenho do teste em relação às formas radiológicas, mostrou que nas crianças do grupo 2, cujas radiografias de tórax eram normais, o valor médio do Elisa foi 0,026; nas do grupo 1, com forma gânglio-pulmonar, encontra-se 0,080, com a forma radiológica pulmonar, 0,099 e com padrão miliar, 0,172 (p <0,001), apontando para maior positividade do ELISA nas formas mais extensas de tuberculose. Conclusão: o teste sorológico permitiu boa discriminação entre doentes e não doentes, face à sua elevada especificidade e, por sua moderada sensibilidade, poderia contribuir para o diagnóstico de tuberculose pulmonar em crianças, em casos selecionados através de diagnóstico clínico-radiológico e epidemiológico.

Introduction: the bacteriologic diagnosis of pulmonary tuberculosis (TB) in children is difficult because the bacillary population is small in this group of patients. The aim of this study was to contribute for the diagnosis of childhood pulmonary tuberculosis. Material and methods: it was used an enzyme-linked immunosobert assay (ELISA) to detect IgG antibodies anti PPD in sera of 48 children and adolescents, ranging in age between 0 and 13 years. The series was divided into 2 groups: 29 children with pulmonary tuverculosis (Group 1) and 19 asymptomatic children, without pulmonary tuberculosis, contacts of patients with pulmonary tuberculosis (Group 2). Results: the average value for ELISA optical density in Group 1 was 0.11 and in Group 2 it was 0.03. These results determined test sensitivity = 52% [CI. 037-0.73] and specificity = 95%[CI. 0.87-1.00]. Analysis of the test performance when related to radiological patterns showed that in Group 2 children i.e., with normal chest radiograms, the average value for ELISA was 0.026; in Group 1, children with primary complex it was 0.08, children with pulmonary tuberculosis in children, in select cases by means of clinical and radiological and epidemiological findings.

Multiple isolates from Aids patients: aspects of an analysis by a genotypic marker and antimicrobial susceptibilities variations

Twenty-one Mycobacterium avium multisolates, from ten human immunodeficiency virus-infected patients, were typed by restriction fragment length polymorphism using as marker the IS1245 and characterized by minimum inhibitory concentration for nine different antibiotics. Two out of four patients harboring multisolates with different fingerprint profile, were therefore considered as having a polyclonal infection, since their isolates were taken from sterile site. This result confirms that polyclonal infection caused by M. avium occurs with a nonnegligenciable frequency. Analyzing the multisolates susceptibility profile of each patient it was observed that most of them were infected with strains having appreciably different antimicrobial susceptibility patterns, no matter what the genotypic pattern of the strains was. These results have strong implication for the treatment of the patients.

Analysis of Mycobacterium avium complex serovars isolated from AIDS patients from Southeast Brazil

The purpose of this study was to assess the distribution of Mycobacterium avium serovars isolated from AIDS patients in Sao Paulo and Rio de Janeiro. Ninety single site or multiple site isolates from 75 patients were examined. The most frequent serovars found were 8 (39.2 per cent), 4 (21.4 per cent) and 1 (10.7 per cent). The frequency of mixed infections with serovar 8 or 4 was 37.8 per cent. Among the 90 strains examined, M. intracellulare serovars (7 strains) and M. scrofulaceum (4 strains) were found in 11 isolates (12 per cent) indicating that M. avium (88 per cent) was the major opportunistic species in the M. avium complex isolates in Brazilian AIDS patients.