ABSTRACT
From January 1995 to August 1997 we evaluated prospectively the clinical presentation, laboratory findings and short-term survival of smear-positive pulmonary tuberculosis (TB) patients who sought care at our hospital. After providing informed, written consent, the patients were interviewed and laboratory tests were performed. Information about survivorship and death was collected through September 1998. Eighty-six smear-positive pulmonary TB patients were enrolled; 26.7 percent were HIV-seropositive. Seventeen HIV-seronegative pulmonary TB patients (19.8 percent) presented chronic diseases in addition to TB. In the multiple logistic regression analysis a CD4+ cell count <= 200 cell/mm was independently associated with HIV seropositivity. In the Cox regression model, fitted to all patients, HIV seropositivity and age > or = 50 years were independently associated with decreased survival. Among HIV-seronegative persons, the presence of an additional disease increased the risk of death of almost six-fold. Use of antiretroviral drugs was associated with a lower risk of death among HIV-seropositive smear-positive pulmonary TB patients (RH = 0.32, 95 percent CI 0.10-0.92). In our study smear-positive pulmonary TB patients had a low short-term survival rate that was strongly associated with HIV infection, age and co-morbidities. Therapy with antiretroviral drugs reduced the short-term risk of death among HIV-seropositive patients after TB diagnosis
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , AIDS-Related Opportunistic Infections , Tuberculosis, Pulmonary , AIDS-Related Opportunistic Infections , Brazil , Developing Countries , Follow-Up Studies , Hospitals, General , Hospitals, University , Logistic Models , Multivariate Analysis , Prospective Studies , Risk Factors , Tuberculosis, PulmonaryABSTRACT
From January 1995 to August 1997 we evaluated prospectively the clinical presentation, laboratory findings and short-term survival of smear-positive pulmonary tuberculosis (TB) patients who sought care at our hospital. After providing informed, written consent, the patients were interviewed and laboratory tests were performed. Information about survivorship and death was collected through September 1998. Eighty-six smear-positive pulmonary TB patients were enrolled; 26.7% were HIV-seropositive. Seventeen HIV-seronegative pulmonary TB patients (19.8%) presented chronic diseases in addition to TB. In the multiple logistic regression analysis a CD4+ cell count <= 200 cell/mm was independently associated with HIV seropositivity. In the Cox regression model, fitted to all patients, HIV seropositivity and age > or = 50 years were independently associated with decreased survival. Among HIV-seronegative persons, the presence of an additional disease increased the risk of death of almost six-fold. Use of antiretroviral drugs was associated with a lower risk of death among HIV-seropositive smear-positive pulmonary TB patients (RH = 0.32, 95% CI 0.10-0.92). In our study smear-positive pulmonary TB patients had a low short-term survival rate that was strongly associated with HIV infection, age and co-morbidities. Therapy with antiretroviral drugs reduced the short-term risk of death among HIV-seropositive patients after TB diagnosis.
Subject(s)
AIDS-Related Opportunistic Infections/mortality , Tuberculosis, Pulmonary/mortality , AIDS-Related Opportunistic Infections/complications , Adolescent , Adult , Aged , Brazil/epidemiology , Developing Countries , Epidemiologic Studies , Female , Hospitals, General , Hospitals, University , Humans , Male , Middle Aged , Tuberculosis, Pulmonary/complicationsABSTRACT
Introdução: existem escassos dados sobre o risco de infecção pelo mycobacterium tuberculosis entre profissionais de saúde (PS) em países em desenvolvimento. Estudo conduzido com o objetivo de para avaliar o risco ocupacional de infecção tuberculosa num hospital geral, no Rio de Janeiro, Brasil. Material e métodos: no período entre fevereiro de 1994 a setembro de 1994 foi realizado um inquérito da prova tuberculínica (PT) em um estudo transversal seguido de outro longitudial. Os PS responderam a um questionário padronizado e foram submetidos a duas etapas da PT. Resultados: entre 1250 PS que participaram da primeira fase do estudo, 649 (52%) apresentaram PT positiva (i.e. ³ 10mm), o fenômeno "booster" ocorreu em 7,8% (35/449) deles e esteve significativamente associados apenas ao relato de tuberculose prévia na família (OR: 3,29; 1,39-7,68, p= 0,004). Durante o período de estudo, 32 (8.7%) apresentaram conversão à prova tuberculínica entre os 368 PS seguidos pelo menos por 12 meses. Na regressão logística do estudo transversal apenas a idade superior a 30 anos (OR: 1,88; 1,35-3,47, p= 0,0001), a escolaridade inferior a 8 anos (OR: 1,44; 1,09 - 672, p= 0,02) e pertencer a categoria de enfermagem (OR: 1,55; 1,21 -4,78, p=0,01) permaneceram significativamente associados ao resultado positivo da PT. No estudo longitudinal, os PS com idade superior a 30 anos apresentaram menor risco de conversão à PT (RR: 0,37, 0,23-0,89, p=0,01) enquanto pertencer a categoria profissional de médico e enfermagem este risco foi significantemente maior (RR:4,21, 1,17-8,94, p= 0,03). Conclusões: estes resultados sugerem um elevado risco ocupacional de TB e sinaliza para uma urgente implementação de medidas de biossegurança em hospitais gerais que atendem pacientes com tuberculose.