Aspectos clínicos e epidemiológicos da tuberculose em pacientes com HIV/aids / Clinical and epidemiological aspects of tuberculosis in patients with HIV/aids

RESUMO Objetivo: Avaliar aspectos clínicos e epidemiológicos da tuberculose em indivíduos HIV+ no estado de Alagoas. Métodos: Trata-se de estudo transversal e retrospectivo que analisou as notificações de coinfecção TB-HIV no período de 2001 a 2016 no estado de Alagoas, Brasil. Para elaboração de perfil da coinfecção foram empregadas variáveis clínicas e epidemiológicas dos casos novos de TB-HIV obtidas junto à Superintendência de Vigilância em Saúde do Estado de Alagoas. Resultados: Houve ascensão do número de coinfectados no período de 2001 a 2016. Os pacientes soropositivos residentes no Estado apresentaram-se como sendo a maioria do sexo masculino (74,2%), em idade economicamente produtiva (93,7%), com baixa escolaridade e de cor negra (92,5%). A tuberculose pulmonar foi a forma clínica mais presente (77,3%), seguida do subtipo extrapulmonar ganglionar periférico (7,5%). A estratégia diagnóstica mais elucidativa para o raciocínio clínico foi o exame radiográfico do tórax (72,5%). Houve óbito por tuberculose em 9,5% das investigações. O percentual de cura de casos novos de tuberculose em indivíduos HIV+ no estado de Alagoas ficou abaixo da meta de 85% pactuada pela OMS. Conclusão: Os resultados evidenciam a relevância epidemiológica da tuberculose como uma comorbidade de grande impacto na saúde dos indivíduos soropositivos para o HIV+ no âmbito estadual (AU)

ABSTRACT Objective: In this study, the objective was to evaluate the clinical and epidemiological aspects of tuberculosis in HIV+ individuals in the State of Alagoas. Methods: This was a cross-sectional and retrospective study that analyz-ed the reports of TB-HIV co-infection between 2001 and 2016 in the state of Alagoas, Brazil. To develop a profile of co-infection, clinical and epidemiological variables were used for new cases of HIV-TB obtained together with the Superintendence of Health Surveillance of the State of Alagoas. Results: There was a rise in the number of co-infected patients from 2001 to 2016. Seropositive patients living in the State were the majority male (74.2%), of economically productive age (93.7%), with low educational level and black (92.5%). Pulmonary tuberculosis was the most common clinical form (77.3%), followed by the peripheral ganglion extrapulmonary subtype (7.5%). The most diagnostic strategy for clinical reasoning was the radiographic examination of the thorax (72.5%). There was a TB death in 9.5% of the investigations. The percentage of cure of new cases of tuberculosis in HIV+ individuals in the state of Alagoas was below the 85% goal agreed by the WHO. Conclusion: The results evidenced the epide-miological relevance of tuberculosis as a comorbidity with a great impact on the health of seropositive individuals at the state level. (AU)

Análise temporal dos casos de coinfecção Tuberculose-HIV na população de um estado do Nordeste do Brasil / Temporal analysis of Tuberculosis-HIV coinfection cases in a state of northeast Brazil / Análisis temporal de los casos de coinfección Tuberculosis-VIH en la población de un estado del nordeste de Brasil

Justificativa e Objetivos: A coinfecção tuberculose-HIV (TB/HIV) tem figurado uma importante causa de óbitos e de atendimento médico-hospitalar-ambulatorial nos serviços de saúde em todo o mundo. Por isso, o objetivo deste estudo foi avaliar comportamento da coinfecção TB/HIV no estado de Alagoas. Métodos: Trata-se de estudo ecológico, de séries temporais, que analisou indicadores de coinfecção TB/HIV no período de 2001 a 2016. A área de estudo foi o estado de Alagoas, Brasil, e suas divisões administrativas de referência para o setor de saúde. A análise da evolução temporal empregou a variação percentual e o teste de Mann-Kendall. Resultados: No período de 2001 a 2016, foram notificados 996 casos novos de coinfecção TB/HIV no estado de Alagoas, correspondendo a 5,6% do total de casos de TB. O percentual de coinfecção TB-HIV elevou-se de 1,4% em 2001 a 14,6% em 2016, com variação e tendência positiva de 1180% (p<0,05). A incidência da coinfecção TB/HIV nesse mesmo período passou de 0,6% em 2001 a 2,0% em 2016, com variação e tendência positiva de 290% (p<0,05). Conclusão: As séries temporais da proporção e incidência de coinfecção TB/HIV apresentaram tendência crescente significativa para o estado de Alagoas no período de 2001 a 2016, associando a presença do HIV à ocorrência da TB na população.(AU)

Background and Objectives: Tuberculosis-HIV co-infection (TB/HIV) has been an important cause of death and medical-hospital-outpatient care in health services worldwide. Thus, the objective of this study was to evaluate the behavior of TB/HIV coinfection in the state of Alagoas, Brazil. Methods: This is an ecological, time-series study that analyzed indicators of TB/HIV co-infection between 2001 and 2016. The study area was the state of Alagoas, Brazil, and its administrative divisions of reference for the health sector. The analysis of the temporal evolution used percent variance and the Mann-Kendall trend test. Results: In the period from 2001 to 2016, 996 new cases of TB/HIV coinfection were reported in Alagoas, corresponding to 5.6% of the total TB cases. The percentage of TB/HIV coinfection increased from 1.4% in 2001 to 14.6% in 2016, with 1180% (p<0.05) variance and positive trend. The incidence of TB/HIV coinfection in the same period increased from 0.6% in 2001 to 2.0% in 2016, with 290% (p<0.05) variance and positive trend. Conclusion: The time series of the proportion and incidence of TB/HIV co-infection showed a significant increase in the state of Alagoas between 2001 and 2016, emphasizing the importance of HIV as a factor for the occurrence of TB in the population.(AU)

Justificación y Objetivos: La coinfección tuberculosis-VIH (TB/VIH) ha sido una causa importante de muerte y de atención médica-hospitalaria-ambulatoria en servicios de salud por todo el mundo. Por lo tanto, el objetivo de este estudio fue evaluar el comportamiento de la coinfección TB/VIH en el estado de Alagoas (Brasil). Métodos: Se trata de un estudio ecológico de series de tiempo en que analizó los indicadores de coinfección TB/VIH en el periodo de 2001 a 2016. El área de estudio fue el estado de Alagoas, Brasil, y sus divisiones administrativas de referencia para el sector de la salud. El análisis de la evolución temporal utilizó la variación porcentual y la prueba de Mann-Kendall. Resultados: En el período comprendido entre 2001 y 2016, se notificaron 996 nuevos casos de coinfección TB/VIH en el estado de Alagoas, lo que corresponde al 5,6% del total de casos de TB. El porcentaje de coinfección TB-VIH aumentó de 1,4% en 2001 a 14,6% en 2016, con una variación y una tendencia positiva del 1180% (p<0,05). La incidencia de coinfección TB/VIH en el mismo período aumentó de 0,6% en 2001 a 2,0% en 2016, con una tendencia positiva y una variación del 290% (p<0,05). Conclusión: Las series temporales de la proporción e incidencia de coinfección TB/VIH revelan un aumento significativo en el estado de Alagoas desde 2001 hasta 2016, lo que destaca la influencia del VIH como factor para la ocurrencia de TB en la población.(AU)

The epidemiology of scabies in an impoverished community in rural Brazil: presence and severity of disease are associated with poor living conditions and illiteracy.

BACKGROUND: We sought to study the epidemiology of scabies and to identify risk factors of severe disease in an impoverished rural community in northeast Brazil. METHODS: The study was designed as a repeated cross-sectional study based on two door-to-door surveys. One survey was carried out in the rainy season, the other in the dry season. The inhabitants of the community were examined for the presence of scabies and demographic, socioeconomic, and behavioral risk factors were assessed. Risk factors were analyzed using bivariate and multivariate regression analysis. RESULTS: The overall prevalence was 9.8% with no significant variation between seasons and the incidence was estimated to be 196/1000 person-years. The highest prevalence (18.2%) was observed in children younger than 4 years. Risk factors in the bivariate analysis were young age, presence of many children in the household, illiteracy, low family income, poor housing, sharing clothes and towels, and irregular use of shower. Age younger than 15 years, illiteracy, sharing of clothes, and living in the community for more than 6 months remained significant independent risk factors in multivariate regression analysis. LIMITATIONS: We used a clinical case definition; specificity and sensitivity were not verified. Men were underrepresented in the study population. CONCLUSIONS: In this impoverished community scabies is an important health problem characterized by continuous transmission throughout the year. The parasitic skin disease is embedded in a complex web of causation characterized by poor living conditions and a low level of education.

A study in a community in Brazil in which cutaneous larva migrans is endemic.

BACKGROUND: Cutaneous larva migrans (CLM) is a common but neglected parasitic skin disease in impoverished communities of the developing world. METHODS: To describe the clinical features and the morbidity associated with CLM, active-case finding was performed during rainy and dry seasons in a rural community in the state of Alagoas, Northeast Brazil. RESULTS: A total of 62 individuals received a diagnosis for CLM, and among them there were a total of 75 larval tracks. The number of tracks per person ranged from 1 to 3. Children <9 years old were affected significantly more often than other age groups (P<.001). Children had their lesions mainly on the buttocks, genitals, and hands, whereas in older patients, the majority of lesions were located on the feet. Twenty-four percent of the 75 lesions were superinfected. Bacterial superinfection was more common among children. All but 1 patient complained about itching, and 84% of the 62 patients complained about sleep disturbances. Itching was classified as being severe by 61% of patients. Approximately 40% of the 62 patients had attempted to treat their creeping eruption previously. Larvae moved forward 2.7 mm per day. There was a significant correlation between the length of the track and the duration of infestation ( rho =.53; P<.0001). CONCLUSIONS: CLM is a common parasitic skin disease in this rural community, with different topographic patterns of lesions in children and adults. CLM is associated with considerable morbidity. The length of the track can be used to estimate the duration of infestation.

Sexually transmitted infections in a female population in rural north-east Brazil: prevalence, morbidity and risk factors.

OBJECTIVES: To determine the prevalence of major sexually transmitted infections (STIs) and gynaecological morbidity in women of reproductive age living in rural communities in north-east Brazil and to assess risk factors associated with the presence of STIs. METHODS: A total of 341 women (84%) were examined gynaecologically and colposcopically. The gynaecological history was taken by means of a standardized, pre-tested questionnaire. Cervical smears were obtained and vaginal fluid was collected. Vulvovaginal candidiasis (VC), bacterial vaginosis (BV), trichomoniasis (TV) and syphilis seroreactivity were determined by standard laboratory techniques. Infections with Neisseria gonorrhoeae, Chlamydia trachomatis and human papilloma virus (HPV) were diagnosed by hybrid capture assays using vaginal lavage fluid. Odds ratios (OR) were calculated to assess risk factors associated with STIs. RESULTS: The prevalence of HPV, BV and TV was 26%, 15% and 10%, respectively. VC as well as infections with N. gonorrhoeae and C. trachomatis were detected in 6%; syphilis seroreactivity, in 3%. Multiple infections were very common, and 51% of women had at least one STI. Vaginal discharge, the predominant morbidity (56%), was significantly associated with BV (OR = 6.3; P < 0.001), vulvovaginal itching with VC (OR = 3.5; P < 0.05) and lower abdominal pain with C. trachomatis infection (OR = 2.6; P < 0.04). Colpitis was diagnosed in 27% of women and significantly associated with TV (OR = 3.5%; P < 0.001) and VC (OR = 2.9; P < 0.05). Being unmarried was a significant risk factor for having an STI (OR = 2.4; P < 0.05). Among unmarried women, age (<20 years) was a significant risk factor (OR = 3.3; P = 0.01). CONCLUSIONS: The STIs are highly prevalent in this female population in the rural hinterland of north-east Brazil and associated with considerable morbidity. In view of the expected spread of HIV from the urban centres at the coast to the interior there is an urgent need for providing STI-related health care and health education for adolescents and women in rural Brazil.

Estudo epidemiológico das doenças sexualmente transmissíveis em mulheres de comunidades rurais de Alagoas-Brasil / Study epidemiologic of the sexually transmitted diseases in rural community women of Alagoas

O objetivo central foi verificar, em populaçäo feminina de comunidades rurais de Alagoas, a prevalência da sífilis, das cervicites por Neisseria gonorrhoeae e Clamydia trachomatis, das colpites por Trichomonas vaginalis e por fungos e, das infecçöes pelo HPV e pelo vírus da hepatite B. A partir de um censo previamente realizado, participaram deste estudo 340 mulheres. Dessas, 27,0 por cento apresentaram pelo menos uma das DST curáveis e 27,3 apresentam infecções virais sendo a infecção pelo HPV, a DST mais freqüente em todas as faixas etárias seguida da tricomoníase, das cervicites gonocócica e clamídica. Mostram-se estatisticamente significativas as associaçöes da queixa de prurido vulvar com a vaginite fúngica (p<0,05), da queixa de dor pélvica com a cervicite clamídica (p<0,05), da colpite com diagnóstico de tricomoníase (p<0,001) e vaginite fúngica (p<0,05), assim como da identificaçäo de cervicite mucopurulenta (exame citológico cérvico-vaginal) com a detecçäo de DNA de C.trachomatis. Observa-se que 60 por cento das entrevistadas citam apenas a AIDS como DST. O estudo corrobora a informaçäo de serem as DST ainda um problema de saúde pública evidenciando que a populaçäo estudada apresenta alto índice de positividade de DST curáveis e virais (ainda näo curáveis), sendo alta a prevalência de infecçäo por HPV, T. vaginalis e N. gonorrhoeae.

Genital manifestations of schistosomiasis mansoni in women: important but neglected

Egg-induced lesions in the upper and the lower female reproductive tract are important complications of the infection with Schistosoma mansoni. The understanding of the pathophysiology, and pathology of genital lesions is only rudimentary, simple and reliable diagnostic tools are not at hand, epidemiological data do not exist and how to treat best the women effected, is not known. In view of recent advances in the understanding of genital lesions induced by S. haematobium the existing literature is critically analyzed and possible consequences of female genital schistosomiasis are outlined. We estimate that 6 to 27 per cent girls and women with intestinal schistosomiasis, at least temporarily, suffer from pathology induced by eggs sequestered somewhere in their genital organs. This is a mattern of concern and warrants more research into the epidemiology, pathology, diagnosis and therapy of this disease entity.