Performance of diagnostic tests for pulmonary tuberculosis in indigenous populations in Brazil: the contribution of Rapid Molecular Testing / Desempenho de testes para o diagnóstico de tuberculose pulmonar em populações indígenas no Brasil: a contribuição do Teste Rápido Molecular

ABSTRACT Objective: To evaluate the accuracy of rapid molecular testing as a diagnostic tool and estimate the incidence of smear-positive pulmonary tuberculosis among the indigenous population. Methods: This is an epidemiological study based on secondary data. We calculated the incidence of smear-positive pulmonary tuberculosis between January 1st, 2011 and December 31, 2016, and the performance of bacilloscopy and rapid molecular testing in diagnosing pulmonary tuberculosis compared to sputum culture (standard test). Results: We included 4,048 cases of indigenous people with respiratory symptoms who provided sputum samples for analysis. Among them, 3.7%, 6.7%, and 3.7% had positive results for bacilloscopy, sputum culture, and rapid molecular testing, respectively. The mean incidence of pulmonary tuberculosis was 269.3/100 thousand inhabitants. Rapid molecular testing had 93.1% sensitivity and 98.2% specificity, compared to sputum culture. Bacilloscopy showed 55.1% sensitivity and 99.6% specificity. Conclusions: Rapid molecular testing can be useful in remote areas with limited resources and a high incidence of tuberculosis, such as indigenous villages in rural regions of Brazil. In addition, the main advantages of rapid molecular testing are its easy handling, fast results, and the possibility of detecting rifampicin resistance. Together, these attributes enable the early start of treatment, contributing to reduce the transmission in communities recognized as vulnerable to infection and disease.

RESUMO Objetivo: Avaliar a acurácia do teste rápido molecular como ferramenta diagnóstica e estimar a incidência de casos pulmonares positivos entre a população indígena. Métodos: Estudo epidemiológico baseado em dados secundários. Foi calculada a incidência de casos de tuberculose pulmonar positiva entre 1° de janeiro de 2011 e 31 de dezembro de 2016, e o desempenho da baciloscopia e do teste rápido molecular no diagnóstico de tuberculose pulmonar, em comparação à cultura de escarro (teste padrão). Resultados: Foram incluídos 4.048 casos de indígenas considerados sintomáticos respiratórios, que forneceram amostras de escarro para análise. Destes, 3,7%, 6,7% e 3,7% apresentaram resultados positivos para baciloscopia, cultura e teste rápido molecular, respectivamente. A incidência média de tuberculose pulmonar foi de 269,3/100 mil habitantes. A sensibilidade do teste rápido molecular, em relação à cultura, foi 93,1% e a especificidade foi 98,2%. A baciloscopia apresentou sensibilidade 55,1% e especificidade 99,6%. Conclusões: O teste rápido molecular pode ser útil em áreas remotas, com recursos limitados e incidência de tuberculose elevada, como as aldeias indígenas nas áreas rurais do país. Ademais, o teste rápido molecular apresenta como principais vantagens o fácil manuseio, os resultados rápidos e a possibilidade de identificar a resistência à rifampicina. Em conjunto, esses atributos facilitam o início do tratamento precoce, contribuindo para reduzir a transmissão em comunidades reconhecidamente vulneráveis à infecção e à doença.

Antropologia das doenças transmissíveis: interpretações do contágio e diferenças culturais / Anthropology of communicable diseases: interpretations of contagion and cultural differences

Este livro apresenta os resultados de diversas pesquisas realizadas pelo autor sobre o tema do contágio ao longo das últimas duas décadas, em diversos países. Trata-se de material inédito na língua portuguesa e reorganizado no intuito de identificar um único fio condutor e elementos comuns entre material recolhido em contextos socioculturais bem diversificados, bem diferenciados.Os diversos capítulos expõem, a seu modo, conclusões parcialmente publicadas em periódicos e capítulos de livros

Concordance between IFNγ gene +874 A/T polymorphism and interferon-γ expression in a TB-endemic indigenous setting

Abstract INTRODUCTION: Interferon-γ (IFN-γ) plays a crucial role in resistance to mycobacterial diseases; accordingly, variants of the gene encoding this cytokine may be associated with elevated risk of contracting pulmonary tuberculosis (TB). METHODS: Blood samples were collected from 135 Warao indigenous individuals with newly diagnosed sputum culture-positive TB. Of these, 24 were diagnosed with active tuberculosis (ATB). The study comprised 111 participants, who were grouped as follows: 1) 14 tuberculin skin test (TST)-positive Warao indigenous individuals and 4 that were QuantiFERON-TB?Gold In-Tube (QFT-IT) test-positive, collectively comprising the latent TB infection group (LTBI), n = 18), and 2) healthy controls who were QFT-IT- and TST-negative, comprising the control group (CTRL, n = 93). Detection of the IFN γ gene (IFNG) +874A/T polymorphism was performed via PCR and quantification of IFNG expression via qPCR. RESULTS: Relative to indigenous and white Americans, ATB and CTRL groups had a higher frequency of the IFNG SNP (+874A): 23 (95.8%) and 108 (97.3%), respectively. Indigenous Warao individuals homozygous for the IFNG (+874) A allele exhibited 3.59-fold increased risk of developing TB (95% confidence interval, 2.60-4.96, p =0.0001). A decreased frequency of the AT genotype was observed in individuals with pulmonary TB (4.16%) and controls (0.90%). The frequency of the TT genotype was decreased among controls (1.80%); none of the patients with TB were found to have this genotype. The differences in IFNG expression between the groups, under unstimulated and stimulated conditions, were not statistically significant. CONCLUSIONS: Preliminary results demonstrate concordance between IFNG +874 A/A genotype and low expression of IFNG.

Magnitude da tuberculose pulmonar na população fronteiriça de Mato Grosso do Sul (Brasil), Paraguai e Bolívia / Pulmonary tuberculosis among residents of municipalities in Mato Grosso do Sul State, Brazil, bordering on Paraguay and Bolivia / Magnitud de la tuberculosis pulmonar en la población fronteriza de Mato Grosso do Sul (Brasil), Paraguay y Bolivia

Este estudo analisou a magnitude da tuberculose pulmonar no período de 2007 a 2010 em municípios sul-mato-grossenses fronteiriços ao Paraguai e à Bolívia. Na região de fronteira, as taxas de incidência (49,1/100 mil habitantes), de mortalidade (4,0/100 mil) e de abandono do tratamento (11,3%) foram 1,6, 1,8 e 1,5 vez maiores do que na região não fronteiriça. Entre indígenas da fronteira, as taxas de incidência (253,4/100 mil habitantes), mortalidade (11,6/100 mil) e coinfecção por HIV (1,9/100 mil) foram, respectivamente, 6,4, 3,2 vezes e 1,9 vez maiores do que entre os não indígenas nesta região. Estar na região de fronteira revelou-se fator de proteção contra coinfecção por HIV. Constatou-se associação entre ser indígena e não abandonar o tratamento. Conclui-se que a população residente nesses municípios de fronteira vivencia elevado risco de adoecimento, de morte e de abandono do tratamento de tuberculose pulmonar, o que requer ações diferenciadas de vigilância em saúde.

This study analyzed the epidemiological profile of pulmonary tuberculosis from 2007 to 2010 in municipalities (counties) in Mato Grosso do Sul State, Brazil, that border on Paraguay and Bolivia. In the border region, the incidence rate (49.1/100,000 inhabitants), mortality rate (4.0/100,000 inhabitants), and treatment dropout rate (11.3%) were 1.6, 1.8, and 1.5 times higher than in the non-border region. Among indigenous individuals in the border region, the rates for incidence (253.4/100,000 inhabitants), mortality (11.6/100,000 inhabitants), and HIV/TB co-infection (1.9/100,000 inhabitants) were 6.4, 3.2, and 1.9 times higher than in non-indigenous individuals in this region. Living in the border regions was inversely associated with HIV/TB co-infection. Indigenous ethnicity was associated statistically with not abandoning TB treatment. The study concludes that the population residing in these municipalities along the border is exposed to high risk of pulmonary TB and TB mortality and treatment dropout, thus requiring special health surveillance interventions.

Este estudio examinó la magnitud de la tuberculosis pulmonar del 2007 al 2010 en los municipios de Mato Grosso do Sul (Brasil) limítrofes con Paraguay y Bolivia. En la región fronteriza, las tasas de incidencia (49,1/100.000 habitantes), mortalidad (4,0/100.000) y abandono del tratamiento (11,3%) fueron 1,6, 1,8 y 1,5 veces más altas que en la región no fronteriza. En la región fronteriza, las tasas de incidencia (253,4/100.000 habitantes), mortalidad (11,6/100.000) y co-infección por el VIH (1,9/100.000) entre residentes indígenas fueron 6,4, 3,2 y 1,9 veces más altas que en la población no indígena. Vivir en la región fronteriza resultó ser un factor protector contra la co-infección por el VIH. Se identificó asociación entre ser indígena y no abandonar el tratamiento. Los resultados mostraron que la población de estos municipios fronterizos está sujeta a un alto riesgo de enfermedad, muerte y abandono del tratamiento de la tuberculosis pulmonar, lo que requiere acciones de vigilancia de la salud específicas para este contexto.

Tuberculosis in indigenous children in the Brazilian Amazon / Tuberculose em crianças indígenas da Amazônia brasileira / Tuberculosis en niños indígenas en el Amazonas Brasileño

OBJECTIVE: Assess the epidemiological aspects of tuberculosis in Brazilian indigenous children and actions to control it. METHODS: An epidemiological study was performed with 356 children from 0 to 14 years of age in Rondônia State, Amazon, Brazil, during the period 1997-2006. Cases of TB reported to the Notifiable Diseases Surveillance System were divided into indigenous and non-indigenous categories and analyzed according to sex, age group, place of residence, clinical form, diagnostic tests and treatment outcome. A descriptive analysis of cases and hypothesis test (χ²) was carried out to verify if there were differences in the proportions of illness between the groups investigated. RESULTS: A total of 356 TB cases were identified (125 indigenous, 231 non-indigenous) of which 51.4% of the cases were in males. In the indigenous group, 60.8% of the cases presented in children aged 0-4 years old. The incidence mean was much higher among indigenous; in 2001, 1,047.9 cases/100,000 inhabitants were reported in children aged < 5 years. Pulmonary TB was reported in more than 80% of the cases, and in both groups over 70% of the cases were cured. Cultures and histopathological exams were performed on only 10% of the patients. There were 3 cases of TB/HIV co-infection in the non-indigenous group and none in the indigenous group. The case detection rate was classified as insufficient or fair in more than 80% of the indigenous population notifications, revealing that most of the diagnoses were performed based on chest x-ray. CONCLUSIONS: The approach used in this study proved useful in demonstrating inequalities in health between indigenous and non-indigenous populations and was superior to the conventional analyses performed by the surveillance services, drawing attention to the need to improve childhood TB diagnosis among the indigenous population.

OBJETIVO: Avaliar os aspectos epidemiológicos da tuberculose em crianças indígenas brasileiras e as ações para seu controle. MÉTODOS: Estudo epidemiológico com 356 crianças de 0 a 14 anos de idade, em Rondônia, Amazônia, Brasil, de 1997 a 2006. Os casos, registrados no Sistema de Informação de Agravos de Notificação, foram classificados em indígenas e não indígenas, e analisados segundo sexo, faixa etária, local de residência, forma clínica, exames diagnósticos e resultado do tratamento. Foi realizada análise descritiva dos casos e teste de hipótese (χ²) para verificar se houve diferenças nas proporções de adoecimento entre os grupos investigados. RESULTADOS: Foram identificados 356 casos de tuberculose (125 indígenas e 231 não indígenas), dos quais 51,4% em meninos. Nos indígenas, 60,8% dos casos foram notificados em < 5 anos. A incidência média foi maior entre os indígenas: 1.047,9 casos/100.000 habitantes < 5 anos, no ano de 2001. A forma pulmonar foi registrada em mais de 80,0% dos casos e a cura ultrapassou 70,0% em ambos os grupos. Cultura e exame histopatológico foram utilizados em apenas 10,0% dos pacientes. Houve três casos de coinfecção com HIV em não indígenas e nenhum em indígenas. A detecção dos casos foi classificada como insuficiente e/ou regular em mais de 80,0% das notificações em indígenas, mostrando que a maioria dos diagnósticos foi baseada na radiografia de tórax. CONCLUSÕES: A abordagem empregada mostrou-se útil para ilustrar desigualdades em saúde entre indígenas e não indígenas, demonstrando-se superior às análises convencionais realizadas nos serviços de vigilância. Fica evidente a necessidade de um aprimoramento da investigação diagnóstica entre as crianças indígenas.

OBJETIVO: Evaluar los aspectos epidemiológicos de la tuberculosis en niños indígenas brasileños y las acciones para su control. MÉTODOS: Estudio epidemiológico con [356] niños de 0 a 14 años de edad, en Rondonia, Amazonas, Brasil, de 1997 a 2006. Los casos registrados en el Sistema de Información de Agravios de Notificación, se clasificaron en indígenas y no indígenas, y se analizaron según sexo, grupo etario, lugar de residencia, forma clínica, exámenes diagnósticos y resultado del tratamiento. Se realizó análisis descriptivo de los casos y prueba de hipótesis (χ²) para verificar si hubo diferencias en las proporciones de la enfermedad entre los grupos investigados. RESULTADOS: Se identificaron 356 casos de tuberculosis (125 indígenas y 231 no indígenas), de los cuales, 51,4% en niños varones. En los indígenas, 60,8% de los casos fueron notificados en < 5 años. La incidencia promedio fue mayor entre los indígenas: 1.047,9 casos/100.000 habitantes < 5 años, en el año de 2001. La forma pulmonar fue registrada en más de 80,0% de los casos y la cura ultrapasó 70,0% en ambos grupos. Cultivo y examen histopatológico fueron utilizados en sólo 10,0% de los pacientes. Hubo tres casos de coinfección con VIH en no indígenas e ninguno en indígenas. La detección de los casos fue clasificada como insuficiente y/o regular en más de 80,0% de las notificaciones en indígenas, mostrando que la mayoría de los diagnósticos estuvo basada en la radiografía de tórax. CONCLUSIONES: El abordaje empleado se evidenció útil para ilustrar desigualdades en salud entre indígenas y no indígenas, demostrándose superior a los análisis convencionales realizados en los servicios de vigilancia. Se hace incuestionable la necesidad de perfeccionar la investigación diagnóstica entre los niños indígenas.

Diagnóstico da tuberculose em indígenas menores de quinze anos por meio de um sistema de pontuação em Mato Grosso do Sul / Scoring system for the diagnosis of tuberculosis in indigenous children and adolescents under 15 years of age in the state of Mato Grosso do Sul, Brazil

OBJETIVO: Avaliar o processo diagnóstico da tuberculose pulmonar em indígenas menores de 15 anos, por meio do Sistema de Pontuação do Ministério da Saúde Modificado (SP-MSm), em crianças e adolescentes com resultados negativos na baciloscopia. MÉTODOS: Estudo descritivo retrospectivo de 49 casos de tuberculose em indígenas menores de 15 anos no estado do Mato Grosso do Sul entre 2007 e 2010. RESULTADOS: Dos 49 pacientes, 27 (56%) eram menores de 5 anos, 33 (67%) apresentavam sintomas sugestivos de tuberculose, 24 (49%) tinham baixo peso, e 36 (73,5%) haviam sido vacinados com BCG. O teste tuberculínico foi reator em 28 pacientes (57%). Dentre esses, 18 (64%) apresentaram enduração > 10 mm. Foram realizadas radiografias de tórax em 37 pacientes (76%), sendo que 31 (84%) fizeram apenas um exame. Desses 37 pacientes, os achados radiológicos eram sugestivos de tuberculose em 16 (43%), de infiltrado/condensação em 10 (27%) e normais em 4 (11%). As Equipes de Saúde Indígena foram responsáveis pelo diagnóstico em 31 (63%) dos casos, mas o SP-MS original só foi utilizado em 14 (45%). Os escores do SP-MSm foram determinados em 30 pacientes (61%). Dos 30 casos pontuados, os resultados dos escores indicaram diagnóstico de tuberculose muito provável, possível e pouco provável em 16 (53%), 11 (37%) e 3 (10%), respectivamente. CONCLUSÕES: A proporção de diagnóstico muito provável e possível foi concordante com o diagnóstico padrão do serviço (90%), evidenciando a aplicabilidade epidemiológica do SP-MSm para o diagnóstico da tuberculose pulmonar em indígenas, de forma compatível com a realidade do serviço de saúde prestado.

OBJECTIVE: To evaluate the process of diagnosing pulmonary tuberculosis in smear-negative indigenous children and adolescents under 15 years of age with the modified Brazilian National Ministry of Health Scoring System (mBNMH-SS). METHODS: This was a retrospective descriptive study involving 49 indigenous patients under 15 years of age with tuberculosis, treated between 2007 and 2010 in the state of Mato Grosso do Sul, Brazil. RESULTS: Of the 49 patients, 27 (56%) were under 5 years of age, 33 (67%) had symptoms suggestive of tuberculosis, 24 (49%) were underweight, and 36 (73.5%) had been BCG vaccinated. The tuberculin skin test was positive in 28 patients (57%), 18 (64%) of whom had an induration > 10 mm. Chest X-rays were performed in 37 (76%) of the patients, 31 (84%) of whom had only one chest X-ray taken. Among those 37 patients, the radiological findings were suggestive of tuberculosis in 16 (43%), infiltration/condensation in 10 (27%), and normal in 4 (11%). The Indigenous Health Care Teams made the diagnosis in 31 (63%) of the cases, using the original BNMH-SS in only 14 (45%). We calculated the mBNMH-SS scores for 30 (61%) of the 49 patients. Among the 30 cases scored, a diagnosis of tuberculosis was found to be highly likely, possible, and unlikely in 16 (53%), 11 (37%), and 3 (10%), respectively. CONCLUSIONS: The proportion of highly likely and possible diagnoses was consistent with the standard proportion of cases diagnosed by the teams (90%), demonstrating the epidemiological applicability of the mBNMH-SS for the diagnosis of pulmonary tuberculosis in the indigenous population, within the scenario of the health care provided.

Fatores preditores para o abandono do tratamento da tuberculose pulmonar preconizado pelo Ministério da Saúde do Brasil na cidade de Porto Alegre (RS) / Pulmonary tuberculosis treatment regimen recommended by the Brazilian National Ministry of Health: predictors of treatment noncompliance in the city of Porto Alegre, Brazil

OBJETIVO: Determinar os fatores preditores de abandono do tratamento da tuberculose pulmonar, preconizado pelo Ministério da Saúde do Brasil, em pacientes bacilíferos virgens de tratamento atendidos na cidade de Porto Alegre (RS). MÉTODOS: Estudo de caso-controle envolvendo seis unidades básicas de saúde de referência para o tratamento da tuberculose em Porto Alegre, com a revisão dos prontuários de todos os casos de abandono do tratamento por parte de pacientes com tuberculose pulmonar bacilíferos e virgens de tratamento entre 2004 e 2006. Os pacientes incluídos no estudo foram pareados com pacientes com características semelhantes e cujo desfecho foi de cura. Foram realizadas análises univariada e multivariada. RESULTADOS: Dos 2.098 pacientes incluídos no estudo, 218 (10,4 por cento) abandonaram o tratamento. De acordo com a modelo da análise multivariada utilizado, as associações mais significantes para o abandono do tratamento foram o etilismo (com ou sem a concomitância de uso de drogas ilícitas), a infecção por HIV, o fato de o paciente não residir com familiares e o baixo nível de escolaridade. Na análise univariada, indivíduos mais jovens e de etnia não branca também se revelaram significativos para o abandono do tratamento. Gênero e ocorrência de efeitos adversos da medicação não mostraram associação com o abandono. CONCLUSÕES: Na população estudada, alcoolismo, infecção por HIV e o fato de o paciente não residir com familiares foram os fatores preditores mais importantes para o abandono do primeiro tratamento da tuberculose pulmonar.

OBJECTIVE: To determine the predictors of noncompliance with the pulmonary tuberculosis treatment regimen recommended by the Brazilian National Ministry of Health, in previously treatment-naïve patients with active tuberculosis treated in the city of Porto Alegre, Brazil. METHODS: This was a case-control study involving six referral primary health care clinics for tuberculosis in Porto Alegre. We reviewed the medical charts of all previously treatment-naïve patients with active pulmonary tuberculosis who were noncompliant with the treatment between 2004 and 2006. Those were paired with other patients having similar characteristics and having been cured. We conducted univariate and multivariate analyses. RESULTS: Of the 2,098 patients included, 218 (10.4 percent) became noncompliant with the treatment. In the multivariate analysis, the factors most strongly associated with treatment noncompliance were being an alcoholic (with or without concomitant use of illicit drugs), being HIV-infected, not residing with family members, and having a low level of education. In the univariate analysis, treatment noncompliance was also significantly associated with being younger and with being non-White. Gender was not significantly associated with treatment noncompliance; nor was the occurrence of adverse effects of the drugs included in the regimen. CONCLUSIONS: In the population studied, being an alcoholic, being HIV-infected, and not residing with family members were the major predictors of noncompliance with treatment for pulmonary tuberculosis among previously treatment-naïve patients.

Comparison of serological responses in two different populations with pulmonary tuberculosis

Observational studies on the humoural immune responses of the Warao indigenous people from Delta Amacuro, an isolated area, were compared with urban residents of the Venezuelan capital. Mycobacterium tuberculosis-specific reactivities (IgM, IgE, sIgA, IgG and IgG subclasses) were measured by ELISA using PPD and 38-kDa M. tuberculosis antigens. A total of 294 individuals were studied, 162 Warao (indigenous people) and 132 Creole (non-indigenous people). The patient group consisted of 87 Warao patients and 58 Creole patients, while the control group consisted of 75 Warao controls and 74 Creole controls. Combinations among the isotypes studied were performed. The findings showed that for the Warao people, sensitivity to the combination including anti-PPD IgG and IgE was 92.0 percent, while for the Creole people, sensitivity to the combination including anti-PPD IgG but more so anti-PPD IgG1 and IgG2 was 90.0 percent. Simple tests were able to show higher specificities, which were population-specific; specificities were anti-PPD IgG3, 100.0 percent and anti-PPD IgM, 97.4 percent for the Warao and Creole peoples, respectively. In conclusion, while simple tests reached high specificity, the multi-isotype tests improved sensitivity; the latter shows this approach may be useful in diagnostic testing.

[Incidence rate of pulmonary tuberculosis among different ethnicities in Golestan province from 1999 to 2003]

Over the last few years, the province of Golestan has ranked second among all Iranian provinces in terms of TB prevalence after Sistan and Balochestan. The present study was done with the aim of evaluating the incidence of TB among different ethnic groups residing in Golestan. In a descriptive study, all TB patients including sputum smear-positive and negative, extra-pulmonary, and milliary cases were evaluated from 1999 to 2003. The incidence of all types of TB was compared among different ethnicities in the province. Forty-seven percent of the 2773 cases registered for Golestan Province in the Communicable Disease Control Center from1999 to 2003 were male. As regards the type of disease, 62.7% of the cases were sputum smear-positive, 16.4% were smear-negative, 20.7% had extra-pulmonary disease, and 0.1% was milliary TB cases. The incidence rate of all types of TB was 36 per 100000 populations and the rate did not show any significant changes over the study period. As for the ethnic distribution of the cases, more than 50% of all TB cases were observed among Sistanis and Baluches, who together account for only 20% of all Golestan residents. The incidence in Sistanis was ten times that in Turks and Kurds, six times that in Persians, 4 times the rate in Torkamans, and 2.5 times that in Afghans living in the same region. The incidence rate of tuberculosis was significantly different among various ethnicities of Golestan province, being highest in Sistanis

Levels of complement C3 and C4 components in Amerindians living in an area with high prevalence of tuberculosis

The levels of complement C3 and C4 components were determined in non-indigenous (creoles) and indigenous (Warao) populations, the latter with an extremely high tuberculosis (TB) rate. Serum samples from 209 adults were studied and classified in 4 groups taking into account tuberculin skin tests (TST): (1) the group of Warao patients (58 positive for the TST, WP TST+ and 9 negative for the TST, WP TST-), (2) the group of creole patients (34 positive for the TST, CP TST+ and 9 negative for the TST, CP TST-), (3) the group of healthy Warao controls (38 positive and 14 negative for TST, WC TST+ and WC TST-, respectively), (4) the creole controls (26 positive and 21 negative for the TST, CC TST+ and CC TST-, respectively). With respect to the results concerning the measurement of both complement C3 and C4 components with the exception of the WC TST and the CC groups, the WP TST+ and WP TST- as well as WC TST+ groups showed a significant frequency of individuals with decreased levels of complement C3 component (20.6, 33.3, and 26.3 percent, respectively) and also C4 component (12.0, 11.1, and 13.3 percent, respectively) in comparison to both creole patients (CP TST+, 8.82 percent and CP TST-, 0 percent and CP TST+, 5.88 percent and CP TST-, 0 percent) for C3 and C4, respectively. The study of these parameters carried out in 15 Warao subjects with active infection, before and after anti-TB chemotherapy,statisticallyconfirmedthat the effective chemotherapy did not restore normal levels of the complement C3 and C4 components among Warao patients. Aditional tests for hepatitis B or hepatitis C infection, and the profile of the hepatic proteins were not associated to the deficiency in production of the complement components.In conclusion, the results show that within the Warao population, a high percentage of subjects exhibit decreased levels of both complement C3 and C4 components independent of latent or active infection and the status of TST.

Creencias y consecuencias sociales de la tuberculosis pulmonar en dos comunidades indígenas del estado de Oaxaca: una aproximación cualitativa / Popular beliefs on lung tuberculosis and their social consequences in two indigenous communities of the State of Oaxaca: a qualitative approximation

Introducción. El repunte de la tuberculosis a nivel mundial se debe a diversas causas, siendo las diferentes percepciones culturales de los grupos sociales con respecto a esta enfermedad, los que han influido en esta alza. En México, la tuberculosis se encuentra entre los primeros 20 lugares de morbimortalidad, siendo el estado de Oaxaca uno de los más afectados, ocupando los tres primeros lugares de mortalidad a nivel nacional, y cerca del 68 por ciento de estas defunciones ocurren en zonas índigenas. Objetivos. Descripción de creencias y consecuencias sociales de la tuberculosis, en dos comunidades indígenas de Oaxaca. Material y métodos. Estudio descriptivo en dos diferentes comunidades indígenas de Oaxaca. Utilización del método etnográfico, apoyado con herramientas cualitativas. Discusiones familiares, entrevistas abiertas con informantes clave y reconstrucción de la carrera del enfermo (historias de vida), tomando un marco muestral de 28 familias mixtecas y 84 zapotecas, seleccionadas al azar. Resultados. La tuberculosis fue desconocida por más del 80 por ciento de las familias. Los enfermos perciben a esta enfermedad como "Enfriamiento" y "Brujería", la adeherencia al tratamiento se hizo en etapas avanzadas y viven la tuberculosis como rechazo social, siendo el abandono y el aislamiento las principales consecuencias. Conclusiones. El concepto de "enfermedad" y de "tuberculosis pulmonar" en estos dos grupos étnicos es percibida de forma diferente al otorgado por los médicos, por ende las acciones de prevención y control a realizar deben considerar la cultura de cada grupo social

Prevalence of tuberculosis in Vietnamese migrants: the experience of the Orderly Departure Program.

This study aimed to describe the Internal Organization for Migration (IOM) tuberculosis screening and treatment program in Ho-Chi-Minh City (Vietnam); and to review the prevalence of tuberculosis and treatment outcome in a cohort of Vietnamese migrants and refugees prior to their departure. From 1 November 1992 to 1 June 1993, prospective migrants and refugees bound to the United States, Australia, and Canada underwent medical examination by IOM in Ho-Chi-Minh City. Screening for tuberculosis was based on chest x-rays, and the diagnosis was confirmed by smear examination. Smear-positive patients received short-course chemotherapy, directly supervised, with isoniazid, rifampicin, ethambutol, and pyrazinamide. Out of 39,581 persons screened, 322 were smear-positive (641 per 100,000), and started treatment. Follow-up varied from a minimum of 12 months to a maximum of 18 months. At that time, 265 (82%) were cured, while the remaining either continued treatment with first-line drugs (24), started second-line treatment (17), or failed to be cured for various reasons (16). This report confirms the efficacy of short course chemotherapy and directly observed treatment for tuberculosis, in the context of one of the largest screening programs for prospective migrants. Follow-up in receiving countries would help clarify risk factors for both new infection and relapse of tuberculosis.