Transmission and prevalence of drug-resistant tuberculosis in a Brazilian setting under a directly observed therapy short-course strategy.

INTRODUCTION: We aimed to estimate the prevalence and transmission of drug-resistant tuberculosis in a high-burden Brazilian setting under directly observed therapy short-course strategy. METHODS: Isolates of culture-confirmed pulmonary tuberculosis patients from Guarulhos, Brazil, diagnosed in October 2007-2011 were subjected to drug susceptibility and IS6110-restriction fragment length polymorphism testing. RESULTS: The overall resistance prevalence was 11.5% and the multi-drug resistance rate was 4.2%. Twenty-six (43.3%) of 60 drug-resistant isolates were clustered. Epidemiological relationships were identified in 11 (42.3%) patients; 30.8% of the cases were transmitted in households. CONCLUSIONS: Drug-resistant tuberculosis was relatively low and transmitted in households and the community.

Transmission and prevalence of drug-resistant tuberculosis in a Brazilian setting under a directly observed therapy short-course strategy

Abstract INTRODUCTION: We aimed to estimate the prevalence and transmission of drug-resistant tuberculosis in a high-burden Brazilian setting under directly observed therapy short-course strategy. METHODS: Isolates of culture-confirmed pulmonary tuberculosis patients from Guarulhos, Brazil, diagnosed in October 2007-2011 were subjected to drug susceptibility and IS6110-restriction fragment length polymorphism testing. RESULTS: The overall resistance prevalence was 11.5% and the multi-drug resistance rate was 4.2%. Twenty-six (43.3%) of 60 drug-resistant isolates were clustered. Epidemiological relationships were identified in 11 (42.3%) patients; 30.8% of the cases were transmitted in households. CONCLUSIONS: Drug-resistant tuberculosis was relatively low and transmitted in households and the community.

Speeding up the diagnosis of multidrug-resistant tuberculosis in a high-burden region with the use of a commercial line probe assay.

OBJECTIVE: To evaluate the rapid diagnosis of multidrug-resistant tuberculosis, by using a commercial line probe assay for rifampicin and isoniazid detection (LPA-plus), in the routine workflow of a tuberculosis reference laboratory. METHODS: The LPA-plus was prospectively evaluated on 341 isolates concurrently submitted to the automated liquid drug susceptibility testing system. RESULTS: Among 303 phenotypically valid results, none was genotypically rifampicin false-susceptible (13/13; 100% sensitivity). Two rifampicin-susceptible isolates harboured rpoB mutations (288/290; 99.3% specificity) which, however, were non-resistance-conferring mutations. LPA-plus missed three isoniazid-resistant isolates (23/26; 88.5% sensitivity) and detected all isoniazid-susceptible isolates (277/277; 100% specificity). Among the 38 (11%) invalid phenotypic results, LPA-plus identified 31 rifampicin- and isoniazid-susceptible isolates, one isoniazid-resistant and six as non-Mycobacterium tuberculosis complex. CONCLUSIONS: LPA-plus showed excellent agreement (≥91%) and accuracy (≥99%). Implementing LPA-plus in our setting can speed up the diagnosis of multidrug-resistant tuberculosis, yield a significantly higher number of valid results than phenotypic drug susceptibility testing and provide further information on the drug-resistance level.

Speeding up the diagnosis of multidrug-resistant tuberculosis in a high-burden region with the use of a commercial line probe assay / Agilizando o diagnóstico da tuberculose multirresistente em uma região endêmica com o uso de um teste comercial de sondas em linha

ABSTRACT Objective: To evaluate the rapid diagnosis of multidrug-resistant tuberculosis, by using a commercial line probe assay for rifampicin and isoniazid detection (LPA-plus), in the routine workflow of a tuberculosis reference laboratory. Methods: The LPA-plus was prospectively evaluated on 341 isolates concurrently submitted to the automated liquid drug susceptibility testing system. Results: Among 303 phenotypically valid results, none was genotypically rifampicin false-susceptible (13/13; 100% sensitivity). Two rifampicin-susceptible isolates harboured rpoB mutations (288/290; 99.3% specificity) which, however, were non-resistance-conferring mutations. LPA-plus missed three isoniazid-resistant isolates (23/26; 88.5% sensitivity) and detected all isoniazid-susceptible isolates (277/277; 100% specificity). Among the 38 (11%) invalid phenotypic results, LPA-plus identified 31 rifampicin- and isoniazid-susceptible isolates, one isoniazid-resistant and six as non-Mycobacterium tuberculosis complex. Conclusions: LPA-plus showed excellent agreement (≥91%) and accuracy (≥99%). Implementing LPA-plus in our setting can speed up the diagnosis of multidrug-resistant tuberculosis, yield a significantly higher number of valid results than phenotypic drug susceptibility testing and provide further information on the drug-resistance level.

RESUMO Objetivo: Avaliar o diagnóstico rápido de tuberculose multirresistente, utilizando um teste comercial de sondas em linha (LPA-plus), na rotina de um laboratório de referência de tuberculose. Métodos: O teste LPA-plus foi avaliado prospectivamente em 341 isolados simultaneamente submetidos ao teste de suscetibilidade aos antimicrobianos em meio líquido, pelo sistema automatizado. Resultados: Entre os 303 resultados fenotipicamente válidos, nenhum foi genotipicamente falso suscetível à rifampicina (13/13; 100% de sensibilidade). Dois isolados sensíveis à rifampicina apresentavam mutações no gene rpoB (288/290; especificidade de 99,3%), as quais, no entanto, não são associadas à resistência a rifampicina. O LPA-plus não identificou resistência à isoniazida em três isolados fenotipicamente resistentes (23/26; 88,5% de sensibilidade) e detectou todos os isolados sensíveis à isoniazida (277/277; especificidade de 100%). Entre os 38 (11%) resultados fenotípicos inválidos, o LPA-plus identificou 31 isolados sensíveis à rifampicina e à isoniazida, um resistente à isoniazida e seis como micobactérias não tuberculosas. Conclusões: O LPA-plus mostrou excelente concordância (≥91%) e acurácia (≥99%). Sua implementação pode acelerar o diagnóstico da tuberculose multirresistente, produzir número significativamente maior de resultados válidos do que o teste fenotípico de suscetibilidade aos antimicrobianos e fornecer informações adicionais sobre o nível de resistência aos fármacos.

Tuberculosis and latent infection in employees of different prison unit types.

OBJECTIVE: Estimate the prevalence of active tuberculosis and latent tuberculosis infection among the staff that is in contact and the staff that is not in contact with prisoners, and investigate factors associated with latent tuberculosis infection in this population. METHODS: Observational cross-sectional study, conducted from 2012 to 2015, in employees of different prison units in the municipality of Franco da Rocha, SP. It consisted of the application of a questionnaire, application and reading of the tuberculin test, sputum smear microscopy, sputum culture, and radiological examination. The association between the qualitative variables was calculated by the Pearson's chi-squared test. The sociodemographic and clinical-epidemiological factors related to the latent tuberculosis infection were evaluated by the logistic regression with the odds ratios (OR) calculation and their respective intervals with 95% of confidence (95%CI). RESULTS: A total of 1,059 employees were examined, 657 (62.0%) of prisons, 249 (23.5%) of CASA Foundation units and 153 (14.5%) of custodial and psychiatric treatment hospitals. The tuberculin test was applied and read for 945 (89.2%) professionals. Of these, 797 (84.3%) were contacts of detainees and 148 (15.7%) were not. Among prison staff, the factors associated with latent tuberculosis infection were: contact with detainee (OR = 2.12, 95%CI 1.21-3.71); male gender (OR = 1.97, 95%CI 1.19-3.27); between 30 and 39 years old (OR = 2.98, 95%CI 1.34-6.63), 40 to 49 years old (OR = 4.32, 95%CI 1.94-9.60), and 50 to 59 years old (OR = 3.98, 95%CI 1.68-9.43); nonwhite color or race (OR = 1.89, 95%CI 1.29-2.78); and smoker (OR = 1.64, 95%CI 1.05-2.55). There were no positive test on sputum smear microscopy and culture. Of the 241 (22.8%) professionals who underwent radiological examination, 48 (19.9%) presented alterations of which 11 were suspected of tuberculosis. CONCLUSIONS: Prison employees who have direct contact with detainees are 2.12 times more likely to become infected with Mycobacterium tuberculosis in the work environment and consequently to become ill with tuberculosis and should be targeted for disease prevention and control.

Tuberculosis and latent infection in employees of different prison unit types / Tuberculose e infecção latente em funcionários de diferentes tipos de unidades prisionais

ABSTRACT OBJECTIVE Estimate the prevalence of active tuberculosis and latent tuberculosis infection among the staff that is in contact and the staff that is not in contact with prisoners, and investigate factors associated with latent tuberculosis infection in this population. METHODS Observational cross-sectional study, conducted from 2012 to 2015, in employees of different prison units in the municipality of Franco da Rocha, SP. It consisted of the application of a questionnaire, application and reading of the tuberculin test, sputum smear microscopy, sputum culture, and radiological examination. The association between the qualitative variables was calculated by the Pearson's chi-squared test. The sociodemographic and clinical-epidemiological factors related to the latent tuberculosis infection were evaluated by the logistic regression with the odds ratios (OR) calculation and their respective intervals with 95% of confidence (95%CI). RESULTS A total of 1,059 employees were examined, 657 (62.0%) of prisons, 249 (23.5%) of CASA Foundation units and 153 (14.5%) of custodial and psychiatric treatment hospitals. The tuberculin test was applied and read for 945 (89.2%) professionals. Of these, 797 (84.3%) were contacts of detainees and 148 (15.7%) were not. Among prison staff, the factors associated with latent tuberculosis infection were: contact with detainee (OR = 2.12, 95%CI 1.21-3.71); male gender (OR = 1.97, 95%CI 1.19-3.27); between 30 and 39 years old (OR = 2.98, 95%CI 1.34-6.63), 40 to 49 years old (OR = 4.32, 95%CI 1.94-9.60), and 50 to 59 years old (OR = 3.98, 95%CI 1.68-9.43); nonwhite color or race (OR = 1.89, 95%CI 1.29-2.78); and smoker (OR = 1.64, 95%CI 1.05-2.55). There were no positive test on sputum smear microscopy and culture. Of the 241 (22.8%) professionals who underwent radiological examination, 48 (19.9%) presented alterations of which 11 were suspected of tuberculosis. CONCLUSIONS Prison employees who have direct contact with detainees are 2.12 times more likely to become infected with Mycobacterium tuberculosis in the work environment and consequently to become ill with tuberculosis and should be targeted for disease prevention and control.

RESUMO OBJETIVO Estimar a prevalência de tuberculose ativa e de infecção latente da tuberculose entre funcionários contatos e não contatos de detentos, e investigar fatores associados à infecção latente da tuberculose nesta população. MÉTODOS Estudo observacional do tipo transversal, realizado no período de 2012 a 2015, em funcionários de diferentes unidades prisionais do município de Franco da Rocha, SP. Consistiu na aplicação de um questionário, aplicação e leitura da prova tuberculínica, baciloscopia e cultura dos escarros e exame radiológico. A associação entre as variáveis qualitativas foi calculada pelo teste qui-quadrado de Pearson e os fatores sociodemográficos e clínico-epidemiológicos relacionados à infecção latente da tuberculose foram avaliados pela regressão logística com o cálculo das odds ratios (OR) e seus respectivos intervalos com 95% de confiança (IC95%). RESULTADOS Foram examinados 1.059 funcionários, sendo 657 (62,0%) de penitenciárias, 249 (23,5%) de unidades da Fundação CASA e 153 (14,5%) de hospitais de custódia e tratamento psiquiátrico. Foi aplicada e lida a prova tuberculínica em 945 (89,2%) profissionais. Desses, 797 (84,3%) eram contatos de detentos e 148 (15,7%) não eram. Entre funcionários das penitenciárias, os fatores associados com a infecção latente da tuberculose foram os seguintes: ter contato com detento (OR = 2,12; IC95% 1,21-3,71); ser do sexo masculino (OR = 1,97; IC95% 1,19-3,27); estar na faixa etária entre 30 e 39 anos (OR = 2,98; IC95% 1,34-6,63), 40 a 49 anos (OR = 4,32; IC95% 1,94-9,60) e 50 a 59 anos (OR = 3,98; IC95% 1,68-9,43); ser da cor ou raça não branca (OR = 1,89; IC95% 1,29-2,78); e ser fumante (OR = 1,64; IC95% 1,05-2,55). Não houve exame positivo na baciloscopia e na cultura. Dos 241 (22,8%) profissionais que realizaram o exame radiológico, 48 (19,9%) apresentaram alterações, dos quais 11 eram suspeitos de tuberculose. CONCLUSÕES Os funcionários das penitenciárias que têm contato direto com os detentos têm 2,12 vezes mais chance de se infectar pelo Mycobacterium tuberculosis no âmbito de trabalho e, consequentemente, de adoecer por tuberculose, devendo ser alvos de ações de prevenção e controle da doença.

Uso de Inibidores de Fator de Necrose Tumoral (Anti-Tnf) e Adoecimento por Tuberculose / Inhibitors of Tumor Necrosis Factor (Anti-Tnf) And Tuberculosis

Introdução: as drogas anti-TNF (inibidoras do fator de necrose tumoral), usadas para tratar doenças autoimunes, podem aumentar o risco de reativação de infecções latentes, como tuberculose e outras infecções bacterianas e fúngicas. Objetivo: identificar os casos de tuberculose diagnosticados em pacientes que fizeram uso de anti-TNF, no período de 2006 a 2010. Métodos: Foi realizado um estudo retrospectivo e descritivo. A partir de uma lista de APACs (Autorização para Procedimentos de Alta Complexidade) de pacientes em uso de anti-TNF, fornecida pela Secretaria de Estado da Saúde – SP, fez-se busca na base de dados do TBweb (Sistema de Notificação e Acompanhamento dos Casos de Tuberculose), para identificar possíveis casos de tuberculose. Utilizou-se o software RecLink III, que implementa a técnica de relacionamento probabilístico de registros. Resultados: Dos 10.631 pacientes usuários de anti-TNF, foram identificados 57 casos de tuberculose notificados ao TBweb, cujo banco continha 76.079 registros. Os pacientes que apresentaram tuberculose depois do uso do anti-TNF foram 40, resultando em um coeficiente de incidência de 375,5 casos/100.000 pacientes em uso da droga; 9,6 vezes maior que o da população geral, de 39,2 casos/100.000 habitantes. Conclusão: Apesar das limitações do estudo, decorrentes do fato de se trabalhar com dados secundários, verificou-se aumento da incidência de tuberculose entre os pacientes submetidos ao tratamento com drogas anti-TNF, justificando-se a adoção de estratégias visando à prevenção da tuberculose e acompanhamento dos pacientes em tratamento com essas drogas...

Why do tuberculosis patients look for urgency and emergency unities for diagnosis: a study on social representation.

OBJECTIVE: To understand the social representations of patients and professionals working in the field of tuberculosis, on the reasons for seeking diagnosis and treatment in the emergency room and not in the primary health care units called Unidades Básicas de Saúde (UBS) or in the health program Programa de Saúde da Família near their residence. METHODS: The survey was conducted in the health services in the municipalities of São Paulo and Guarulhos, Brazil, in hospitals and UBS. We interviewed 20 patients and 20 employees of these units, using the Collective Subject Discourse methodology to analyze their statements. The question presented to the users was: "Why did you seek the urgent emergency hospital and not the UBS to see if you had tuberculosis?" For professionals it was asked: "Why do you think the patient seeks diagnosis in the hospital and not in the UBS?" RESULTS: As a result, two categories were found: (A) the cultural patterns; and (B) faults of the basic network. CONCLUSION: Analysis of the two explanatory dimensions show that the actions triggered by the health services should take into account the cultural patterns present in the social imaginary of the population; the health staff should receive training on specific knowledge of tuberculosis; there is a necessity of hiring human resources for the UBS and more inputs for programming.

Why do tuberculosis patients look for urgency and emergency unities for diagnosis: a study on social representation / Por que os pacientes de tuberculose procuram as unidades de urgência e emergência para serem diagnosticados: um estudo de representação social

Objective: To understand the social representations of patients and professionals working in the field of tuberculosis, on the reasons for seeking diagnosis and treatment in the emergency room and not in the primary health care units called Unidades Básicas de Saúde (UBS) or in the health program Programa de Saúde da Família near their residence. Methods: The survey was conducted in the health services in the municipalities of São Paulo and Guarulhos, Brazil, in hospitals and UBS. We interviewed 20 patients and 20 employees of these units, using the Collective Subject Discourse methodology to analyze their statements. The question presented to the users was: "Why did you seek the urgent emergency hospital and not the UBS to see if you had tuberculosis?" For professionals it was asked: "Why do you think the patient seeks diagnosis in the hospital and not in the UBS?" Results: As a result, two categories were found: (A) the cultural patterns; and (B) faults of the basic network. Conclusion: Analysis of the two explanatory dimensions show that the actions triggered by the health services should take into account the cultural patterns present in the social imaginary of the population; the health staff should receive training on specific knowledge of tuberculosis; there is a necessity of hiring human resources for the UBS and more inputs for programming. .

Objetivo: Conhecer as representações sociais de pacientes e profissionais que atuam na área de tuberculose sobre os motivos da busca de diagnóstico e tratamento nas unidades de urgência e emergência e não nas Unidades Básicas de Saúde (UBS) e no Programa de Saúde da Família próximos à sua residência. Métodos: A pesquisa foi realizada nos serviços de saúde dos municípios de Guarulhos e São Paulo, em unidades hospitalares e UBS. Foram entrevistados 20 pacientes e 20 funcionários dessas unidades e para a análise dos depoimentos foi utilizada a metodologia do Discurso do Sujeito Coletivo. A pergunta apresentada aos usuários foi "Por que o Sr.(a) procurou a urgência/emergência do hospital e não a UBS para saber se tinha tuberculose?" Aos profissionais foi perguntado "Por que você acha que o paciente busca diagnóstico no pronto-socorro/hospital e não na UBS?". Resultado: Como resultado encontramos duas grandes categorias explicativas: (A) Padrões culturais e (B) Falhas da rede básica. Conclusão: A análise das duas vertentes explicativas mostra que as ações desencadeadas pelos serviços de saúde devem levar em conta os padrões culturais presentes no imaginário social da população; que as equipes de saúde devem receber treinamento sobre conhecimentos específicos da tuberculose; que há necessidade de contratação de recursos humanos para as unidades básicas de saúde e mais insumos destinados à programação. .

Vigilância epidemiológica da paracoccidioidomicose no Estado de São Paulo, 2008 a 2011 / Epidemiological surveillance of paracoccidioidomycosis in the State of São Paulo, 2008 to 2011

A paracoccidioidomicose (PCM) é a principal micose sistêmica de caráterendêmico da América Latina, que acomete trabalhadores rurais, principalmente do sexo masculino. Visto não ser doença de notificação compulsória, não se dispõe de dados precisos sobre sua incidência e prevalência no país. Este artigotem como objetivo descrever a situação da PCM no Estado de São Paulo, noperíodo de 2008 a 2011, analisando os 166 casos informados por quatro dos doze ambulatórios de referência. Na tentativa de aprimorar as ações de controle e educação relacionadas a esta micose, visa informar e principalmente sensibilizar os profissionais, bem como orientar no cumprimento das normas que constam nas diretrizes do manual de recomendações deste agravo. A partir da análise de algumas das informações obtidas pode-se concluir que a PCM é endêmica no Estado de São Paulo, com uma média de 29,3 novos casos por ano. Além disso, o diagnóstico da doença seja por métodos micológicos ou imunológicos em crianças reforça a circulação do patógeno, ou seja, Paracoccidioides brasiliensisno Estado de São Paulo. Há, portanto, necessidade do aprimoramento do sistema de monitoramento, reforçando as Unidades de Referência, e o seguimento dos protocolos, promovendo capacitação periódica aos profissionais da saúde, além de sensibilizar os gestores

Tuberculosis and latent tuberculosis in prison inmates / Tuberculose e tuberculose latente na população prisional / Tuberculosis y tuberculosis latente en la población carcelaria

OBJECTIVE: To estimate the prevalences of tuberculosis and latent tuberculosis in inmates. METHODS: Observational study was carried out with inmates of a prison and a jail in the State of São Paulo, Southeastern Brazil, between March and December of 2008. Questionnaires were used to collect sociodemographic and epidemiological data. Tuberculin skin testing was administered (PPD-RT23-2TU/0.1 mL), and the following laboratory tests were also performed: sputum smear examination, sputum culture, identification of strains isolated and drug susceptibility testing. The variables were compared using Pearson's chi-square (Χ2) association test, Fisher's exact test and the proportion test. RESULTS: Of the 2,435 inmates interviewed, 2,237 (91.9 percent) agreed to submit to tuberculin skin testing and of these, 73.0 percent had positive reactions. The prevalence of tuberculosis was 830.6 per 100,000 inmates. The coefficients of prevalence were 1,029.5/100,000 for inmates of the prison and 525.7/100,000 for inmates of the jail. The sociodemographic characteristics of the inmates in the two groups studied were similar; most of the inmates were young and single with little schooling. The epidemiological characteristics differed between the prison units, with the number of cases of previous tuberculosis and of previous contact with the disease greater in the prison and coughing, expectoration and smoking more common in the jail. Among the 20 Mycobacterium tuberculosis strains identified, 95.0 percent were sensitive to anti-tuberculosis drugs, and 5.0 percent were resistant to streptomycin. CONCLUSIONS: The prevalences of tuberculosis and latent tuberculosis were higher in the incarcerated population than in the general population, and they were also higher in the prison than in the jail.

OBJETIVO: Estimar a prevalência da tuberculose e tuberculose latente em detentos. MÉTODOS: Estudo observacional foi realizado com detentos de uma penitenciária e de um centro de detenção provisória do Estado de São Paulo, SP, entre março e dezembro de 2008. Questionários foram utilizados para a coleta de dados sociodemográficos e epidemiológicos. O teste tuberculínico foi aplicado (PPD-RT23-2UT/0,1ml) e os seguintes exames laboratoriais foram realizados: baciloscopia de escarro, cultura de escarro, identificação das cepas isoladas e teste de sensibilidade às drogas antituberculose. As variáveis foram comparadas utilizando-se o teste de associação qui-quadrado de Person (Χ2), teste exato de Fisher e teste das proporções. RESULTADOS: Dos 2.435 detentos entrevistados, 2.237 (91,9 por cento) concordaram em submeter-se ao teste tuberculínico e destes, 73,0 por cento foram reatores. O coeficiente de prevalência da tuberculose foi de 830,6 por 100.000 detentos. Os coeficientes de prevalência foram de 1.029,5/100.000 detentos na penitenciária e de 525,7/100.000 detentos no centro de detenção provisória. As características sociodemográficas dos detentos nos dois grupos estudados foram semelhantes; a maioria dos detentos era jovem e solteiro com baixa escolaridade. As características epidemiológicas diferiram entre as unidades prisionais com o número de casos de tuberculose no passado e de contato prévio com doente maior na penitenciária e tosse, expectoração e hábito de fumar mais comum no centro de detenção. Entre as 20 cepas de Mycobacterium tuberculosis identificadas, 95,0 por cento foram sensíveis às drogas antituberculose e 5,0 por cento foram resistentes à estreptomicina. CONCLUSÕES: As prevalências da tuberculose e da tuberculose latente foram maiores na população carcerária do que na população geral; e também maiores na penitenciária do que no centro de detenção provisória.

OBJETIVO: Estimar la prevalencia de la tuberculosis y tuberculosis latente en detenidos. MÉTODOS: Estudio observacional realizado de marzo a diciembre de 200 con 4.435 detenidos de una penitenciaria y de un centro de detención provisional del Estado de Sao Paulo, sureste de Brasil, entre marzo y diciembre 2008. Cuestionarios fueron utilizados para colecta de datos sociodemográficos y epidemiológicos. Prueba tuberculina fue aplicada (PPD-RT23-2UT/0,1ml), así como los exámenes de laboratorio: baciloscopia de esputo, cultivo de esputo, identificación y prueba de sensibilidad a las drogas antituberculosis. Las variables fueron comparadas utilizándose la prueba de chi-cuadrado de Pearson, prueba exacta de Fisher y la prueba de las proporciones. RESULTADOS: De los 2.435 detenidos entrevistados, 2.237 (91,9 por ciento) concordaron a se someter a la prueba tuberculina y de estos, 73,0 por ciento reaccionaron. El coeficiente de incidencia de la tuberculosis fue de 830,6 por 100.000 detenidos. Los coeficientes de incidencia fueron de 1.029,5/100.000 detenidos en la penitenciaria y de 525,7/100.000 detenidos en el centro de detención provisional. Las características sociodemográficas de los detenidos de los dos grupos estudiados fueron semejantes; la mayoría de los detenidos era joven y soltero con baja escolaridad. Las características epidemiológicas se diferenciaron entre las unidades prisonales, con mayor número de casos de tuberculosis en el pasado y de contacto previo con enfermo en la penitenciaria; y mayor número de tos, expectoración y hábito de fumar en el centro de detención. Entre las 20 cepas de Mycobacterium tuberculosis identificadas, 95,0 por ciento fueron sensibles a las drogas antituberculosis y 5,0 por ciento fueron resistentes a la estreptomicina. CONCLUSIONES: Las prevalencias de la tuberculosis y de tuberculosis latente fueron mayores en la población carcelaria que en la población general; y mayores en la penitenciaria que en el centro de detención provisional.

Tuberculosis and latent tuberculosis in prison inmates.

OBJECTIVE: To estimate the prevalences of tuberculosis and latent tuberculosis in inmates. METHODS: Observational study was carried out with inmates of a prison and a jail in the State of São Paulo, Southeastern Brazil, between March and December of 2008. Questionnaires were used to collect sociodemographic and epidemiological data. Tuberculin skin testing was administered (PPD-RT23-2TU/0.1 mL), and the following laboratory tests were also performed: sputum smear examination, sputum culture, identification of strains isolated and drug susceptibility testing. The variables were compared using Pearson's chi-square (Χ2) association test, Fisher's exact test and the proportion test. RESULTS: Of the 2,435 inmates interviewed, 2,237 (91.9%) agreed to submit to tuberculin skin testing and of these, 73.0% had positive reactions. The prevalence of tuberculosis was 830.6 per 100,000 inmates. The coefficients of prevalence were 1,029.5/100,000 for inmates of the prison and 525.7/100,000 for inmates of the jail. The sociodemographic characteristics of the inmates in the two groups studied were similar; most of the inmates were young and single with little schooling. The epidemiological characteristics differed between the prison units, with the number of cases of previous tuberculosis and of previous contact with the disease greater in the prison and coughing, expectoration and smoking more common in the jail. Among the 20 Mycobacterium tuberculosis strains identified, 95.0% were sensitive to anti-tuberculosis drugs, and 5.0% were resistant to streptomycin. CONCLUSIONS: The prevalences of tuberculosis and latent tuberculosis were higher in the incarcerated population than in the general population, and they were also higher in the prison than in the jail.

[Latent tuberculosis among professionals with and without direct contact with inmates of two penitentiaries in the state of São Paulo, Brazil, 2008]. / Infecção tuberculosa latente em profissionais contatos e não contatos de detentos de duas penitenciárias do estado de São Paulo, Brasil, 2008.

INTRODUCTION: For groups of persons who remain confined, mainly in prisons, tuberculosis has always been a serious health problem, due to its transmission respiratory, putting in risk the professionals that work in a prison, especially the communicants of inmates. OBJECTIVE: To know the infection prevalence for the Mycobacterium tuberculosis among the employees communicating and no communicating of inmates of two prisons of the State of São Paulo. METHODS: This study consisted of the application of an individual questionnaire; application and reading of the tuberculin skin testing (TST); sputum smear examination and culture; identification and drug sensitivity testing; in the period of March the June of 2008. RESULTS: 277 (48.3%) employees of the 574 existent were examined. They were applied and read 248 (89.5%) TST (PPD-RT23 - 2TU/0.1 mL); of them, 194 were in employees that worked directly with the inmates, that is, were communicants and 54 were no communicants. Among the communicants, 62.4% presented induration larger than 10 mm and among the non communicants, 38.9% presented this measure of TST. There was not positive in the sputum smear examination or in the culture, that is, tuberculosis illness case was not identified enters the professionals, at the moment of the research. CONCLUSION: This study suggests that the communicant employees have a larger risk of if they infect for the M. tuberculosis and consequently of being sick of tuberculosis.

Infecção tuberculosa latente em profissionais contatos e não contatos de detentos de duas penitenciárias do estado de São Paulo, Brasil, 2008 / Latent tuberculosis among professionals with and without direct contact with inmates of two penitentiaries in the state of São Paulo, Brazil, 2008

INTRODUÇÃO: Para grupos de pessoas que permanecem confinadas, principalmente em presídios, a tuberculose sempre foi um grave problema de saúde, devido a sua transmissão respiratória, colocando em risco os profissionais que trabalham no sistema prisional, especialmente os contatos de detentos. OBJETIVO: Conhecer a prevalência de infecção pelo Mycobacterium tuberculosis entre os profissionais contatos e não contatos de detentos de duas penitenciárias do Estado de São Paulo. MÉTODOS: Este estudo consistiu na aplicação de um questionário individual; aplicação e leitura da prova tuberculínica; baciloscopia e cultura dos escarros, com posterior identificação e teste de sensibilidade às drogas antituberculose das cepas isoladas, no período de março a junho de 2008. RESULTADOS: Foram examinados 277 (48,3 por cento) profissionais dos 574 existentes. Foram aplicados e lidos 248 (89,5 por cento) testes tuberculínicos (PPD-RT23 - 2TU/0,1 mL), sendo que 194 foram em profissionais que trabalhavam diretamente com os detentos, ou seja, eram contatos e 54, em não contatos. Entre os contatos, 62,4 por cento apresentaram enduração maior que 10 mm e entre os não contatos, 38,9 por cento foram reatores ao teste tuberculínico. Não houve exame de escarro positivo na baciloscopia e na cultura, ou seja, não foi identificado nenhum caso de tuberculose doença entre os profissionais, no momento da pesquisa. CONCLUSÃO: Este estudo sugere que os profissionais que têm contato direto com os detentos, têm um risco maior de se infectar pelo M. tuberculosis e adoecer por tuberculose.

INTRODUCTION: For groups of persons who remain confined, mainly in prisons, tuberculosis has always been a serious health problem, due to its transmission respiratory, putting in risk the professionals that work in a prison, especially the communicants of inmates. OBJECTIVE: To know the infection prevalence for the Mycobacterium tuberculosis among the employees communicating and no communicating of inmates of two prisons of the State of São Paulo. METHODS: This study consisted of the application of an individual questionnaire; application and reading of the tuberculin skin testing (TST); sputum smear examination and culture; identification and drug sensitivity testing; in the period of March the June of 2008. RESULTS: 277 (48.3 percent) employees of the 574 existent were examined. They were applied and read 248 (89.5 percent) TST (PPD-RT23 - 2TU/0.1 mL); of them, 194 were in employees that worked directly with the inmates, that is, were communicants and 54 were no communicants. Among the communicants, 62.4 percent presented induration larger than 10 mm and among the non communicants, 38.9 percent presented this measure of TST. There was not positive in the sputum smear examination or in the culture, that is, tuberculosis illness case was not identified enters the professionals, at the moment of the research. CONCLUSION: This study suggests that the communicant employees have a larger risk of if they infect for the M. tuberculosis and consequently of being sick of tuberculosis.