Neural leprosy investigation using electroneuromyography and the ML Flow rapid test: a case report

ABSTRACT Neural leprosy, which is characterized by nerve involvement without visible skin lesions, presents a diagnostic challenge. This case report examined the significance of diverse diagnostic modalities in the identification of pure neural leprosy. A 28-year-old patient with symptoms of edema, pain, paresthesia, and diminished sensitivity in the lower limbs underwent various tests. A stilt skin smear yielded negative results on bacilloscopy, whereas a Fast ML Flow leprosy test and electroneuromyography supported the diagnosis. This discussion highlights the importance of accessible methods for early investigation. This study emphasizes the multidisciplinary approach and value of the Fast ML Flow leprosy test and electroneuromyography for diagnosing neural leprosy.

Bacilloscopy and polymerase chain reaction of slit-skin smears and anti-phenolic glycolipid-I serology for Hansen's disease diagnosis.

The bacilloscopy of the slit-skin smear (SSS) is the exclusive laboratory test associated with dermato-neurological evaluation for Hansen's disease (HD) diagnosis; however, it is negative in the majority of PB or primary neural forms. Thus, a PCR technique involving different sequences and target genes has been performed with an aim to increase the sensitivity and specificity of M. leprae identification, especially in patients with low bacillary loads. Additionally, serological assays based on antibody response reflect infection levels and indicate that this could be a simpler, less invasive technique for estimating M. leprae exposure. Serological tests and PCR have been shown to be more sensitive and accurate than the SSS. Our study aimed to measure accuracy and performance among the SSS and PCR of dermal scrapings stored on filter paper and APGL-I serology for diagnosis in HD. A cross-sectional study analyzing the medical records (n = 345) of an HD outpatient-dermatology clinic from 2014 to 2021 was conducted. Accuracy performance parameters, correlation, and concordance were used to assess the value among the SSS, PCR, and APGL-I exams in HD. The SSS presented 24.5% sensitivity, 100% specificity, 37.4% accuracy, and the lowest negative predictive value (21.5%). The PCR assay had 41, 100, and 51% sensitivity, specificity, and accuracy, respectively. PCR and APGL-I serology increased the detection of HD cases by 16 and 20.6%, respectively. PCR was positive in 51.3% of patients when the SSS was negative. The SSS obtained moderate concordance with PCR [k-value: 0.43 (CI: 0.33-0.55)] and APGL-I [k-value: 0.41 (CI: 0.31-0.53)]. A moderate positive correlation was found between the APGL-I index and the bacillary index (r = 0.53; P < 0.0001). Thus, the use of the SSS is a low sensitivity and accuracy method due to its low performance in HD detection. The use of PCR and serological tests allows for a more sensitive and accurate diagnosis of patients.

Performance of Bleach Method Sputum Smear Microscopy for the Diagnosis of Tuberculosis in a Highly Endemic District in Lima, Peru.

Background: Sputum smear microscopy (SSM) is a screening test used to diagnose tuberculosis (TB); however, its performance and sensitivity are relatively low, which can lead to false negatives. We designed a cross-sectional study to estimate the performance of SSM that includes a pretreatment based on sputum digestion with bleach (sodium hypochlorite) for the diagnosis of TB. Methods: We evaluated 73 sputum samples from patients with a diagnosis of TB confirmed by the Xpert MTB/RIF test and 114 samples from patients without TB. We performed sputum digestion using a 5% sodium hypochlorite solution, centrifuged at 2000 rpm for 15 min. We prepared smears for direct and bleach-treated SSM and used Ziehl−Neelsen staining. Results: The bleach-treated SSM obtained absolute identification of the cases of TB confirmed by the Xpert test, compared to 95.9% identified by the direct smear method (without bleach treatment). We also found a significant increase (p < 0.001) in the recovery of acid-fast bacilli (AFB) obtained by the bleach-treated SSM (293.8 ± 215.1 AFB) compared to the direct SSM method (222.9 ± 195.5 AFB). The AUC of the bleach-treated SSM and direct SSM was 100% and 96.6%, respectively. Conclusion: The bleach-treated SSM performs better than the direct SSM in identifying AFB and increasing the bacillary count in the sputum samples.

Hanseníase em gêmeos de 3 anos em Mato Grosso, Brasil: a importância da baciloscopia no diagnóstico / Leprosy in 3-year-old twin children in Mato Grosso, Brazil: the importance of bacilloscopy in the diagnosis

Introdução: o diagnóstico clínico da hanseníase em crianças é particularmente difícil. Relato de Caso: crianças gêmeas bivitelinas, com três anos de idade, eram contactantes de pai com hanseníase Virchowiana. Os dois pacientes têm lesões cutâneas bem definidas e irregulares, anteriormente tratadas como micoses e uma cicatriz de BCG. Foram confirmados positivos para Mycobacterium por análise histopatológica da pele. Discussão: especialmente, com menos de cinco anos, os diagnósticos de hanseníase são raros e difíceis porque simulam outras doenças. Esses diagnósticos são alarmes epidemiológicos para áreas endêmicas e mostram a importância dos sintomas em crianças e o rastreamento nos contactantes dos pacientes.

Introduction: the clinical diagnosis of leprosy in children is particularly difficult. Case Report: fraternal twins, three years old, were in contact with a father with Virchowian leprosy. Both patients have well-defined and irregular skin lesions previously treated as mycoses and a BCG scar. They were confirmed positive for Mycobacterium by histopathological analysis of the skin. Discussion:especially, with less than five years, leprosy diagnoses are rare and difficult because they simulate other diseases. These diagnoses are epidemiological alarms for endemic areas and show the importance of symptoms in children and tracking of patients' contacts.

Consumo de tabaco en una población con diagnóstico de tuberculosis pulmonar, Uruguay - 2018

Resumen: Introducción: La tuberculosis pulmonar es un problema de salud pública a nivel mundial. En Uruguay, la incidencia de esta enfermedad está en aumento. El tabaquismo es factor de riesgo para desarrollar tuberculosis y se asocia a negativización más tardía de las baciloscopías. Localmente, no hay estudios previos sobre la relación entre tuberculosis y tabaquismo. Los objetivos del trabajo son caracterizar a la población con diagnóstico de tuberculosis pulmonar en relación a su estatus tabáquico y establecer el efecto del tabaquismo en la negativización de las baciloscopías. Metodología: Estudio analítico, observacional, retrospectivo de cohortes, utilizando los datos del 2018 recabados por la Comisión Honoraria para la Lucha Antituberculosa y Enfermedades Prevalentes. Resultados: se analizaron 918 individuos. La frecuencia de fumadores fue de 5,7%, el 94,3% restante no registraban su estatus tabáquico específicamente sino en conjunto con otras drogas. Entre los varones 29,8% consumían drogas o tabaco, mientras que en las mujeres el porcentaje alcanzó 16,2%. Las personas alcoholistas fumaban con mayor frecuencia. Los individuos vulnerables socioeconómicamente tuvieron mayor frecuencia de consumo de drogas y tabaco. Los no fumadores tuvieron más baciloscopías negativas a los 6 meses, Odds Ratio (OR): 2,030; IC 95% (1,028 - 4,007). Conclusiones: La menor frecuencia de tabaquismo entre los pacientes con tuberculosis se debió probablemente a subregistro. Fumar es un factor de riesgo para persistencia de baciloscopías positivas por mayor tiempo. La vulnerabilidad socioeconómica asocia mayor frecuencia de consumo de drogas y tabaco entre las personas con tuberculosis.

Abstract: Introduction: Tuberculosis is a global public health problem. In Uruguay its incidence is increasing currently. Smoking is a risk factor to develop tuberculosis. It is also associated with lower negativization rates of bacilloscopies. This study evaluated the relationship between tuberculosis and smoking status in Uruguay. The objetives was to characterize the study population with diagnosis of pulmonary tuberculosis according to smoking status and to establish the association between smoking and the negativization of the bacilloscopies. Methodology: An analytical, observational, retrospective cohort study was performed, using the data from 2018 of the Comisión Honoraria para la Lucha Antituberculosa y Enfermedades Prevalentes. Results: 918 subject data were analyzed. The frequency of smoking was 5,7% and 94,3% had no smoking status specifically reported. Among men, 29,8% of subjects were drugs and tobacco users, while it reached 16,2% among women. Non-smokers had double chance of having negative bacilloscopies at 6 months of treatment compared to smokers, OR: 2,030; IC 95% (1,028-4,007). Alcohol users were found to smoke more. Deprived individuals had higher frequency of drugs and tobacco use. Conclusions: the lower frequency of smoking found in patients with tuberculosis was due to underreporting. Smoking could be a risk factor for longer periods until biological cures. Socioeconomic vulnerabilty is associated to greater frequency of drugs and tobacco use among people with tuberculosis.

Resumo: Introdução: A tuberculose pulmonar é um problema de saúde pública em todo o mundo. No Uruguai, a incidência desta doença está aumentando. O tabagismo é um fator de risco para o desenvolvimento de tuberculose e está associado à negativização posterior das baciloscopias. Localmente, não há registros anteriores da relação entre TBP e tabagismo. Este estudo busca demonstrar essa associação. Los objetivos caracterizar a população com diagnóstico de tuberculose pulmonar em relação ao tabagismo; descrever características demográficas e comorbidades; e estabelecer o efeito do tabagismo na negativização da baciloscopia. Método: Foi realizado um estudo analítico, observacional e retrospectivo de coorte, utilizando os dados de 2018 coletados pela Comissão Honorária de Combate à Tuberculose e Doenças Prevalentes. Resultados: Foram selecionados 918 indivíduos. A frequência de fumantes foi de 5,7%, os restantes 94,3% não registraram o tabagismo. 29,8% dos homes eram usuarios de drogas e tabaco. Os não fumantes tiveram duas vezes mais chances de ter baciloscopias negativas em 6 meses de tratamento. Os alcoólatras fumavam mais. Indivíduos socioeconomicamente vulneráveis apresentaram maior frequência de uso de drogas e tabaco. Os não fumantes tiveram mais baciloscopia negativa em 6 meses, Odds Ratio (OR): 2.030; IC de 95% (1,028 - 4,007). Conclusões: A menor frequência de tabagismo entre os pacientes com tuberculose deve-se à subnotificação. Fumar seria um fator de risco para persistência de baciloscopías positivas por mais tempo. A vulnerabilidade socioeconômica está associada a uma maior frequência de tuberculose, uso de drogas e tabaco.

Classification and general aspects of leprosy

Leprosy is a chronic infectious disease whose etiological agent is Mycobacterium leprae. Recently, Mycobacterium lepromatosis is also implicated as a causative agent and has been identified in different forms of the disesase. Leprosy is a comples disease from a clinical histopathological, and molecular point of view. The wide complex disease from a clinical, histopathological characteristics observed throughout the disease spectrum and reactions render it a challenging disease in clinical and pathological practice. This chapter discusses the main aspects of the disease and its hispathological classification. An important approach to the bacilloscopic examination, which is fundamental for the histopathological classification of the disease, showing its quantitative and qualitative aspects, is discussed. the various photographic panels demonstrate the bacillus' ability to parasitize different types of tissues and cells of the skin and other organs of the human body...

Indeterminate leprosy

Leprosy in its determinate from (I) is a clinical presentation of the disease preceding the forms described in the Ridley and Jopling (R & J) classification and any other special forms of leprosy or the reactions. In this chapter, the histopathological and bacilloscopic characteristics of the I form of leprosy are described, and the main differential diagnoses are discussed. The histopathological criteria that distinguish the I form from the other forms of leprosy and the reaction processes that may occur during the disease course are also discussed. The identification of the histopathological characteristics of I leprosy is of great importance with respect to the selection of the treatment. I leprosy should not be confused with other forms of leprosy, especially the multibacillary forms, wich require more prolonged treatment and wich can develop reaction phenomena, causing permanent sequelae.

Peripheral nerve biopsy: a tool still needed in the early diagnosis of neural leprosy?

BACKGROUND: The early recognition of neural impairment in leprosy, especially in primary neural forms, represents a challenge in clinical practice and a peripheral nerve biopsy may be required for diagnostic confirmation. This study aims to characterize the epidemiological, clinical, electroneuromyographic, laboratory and histopathological aspects of patients undergoing peripheral nerve biopsy during investigation of primary neural cases in leprosy. METHODS: A total of 104 patients with peripheral neuropathy who were referred to a national reference centre for leprosy were biopsied from 2014 to 2018. All cases underwent clinical, laboratory, histopathological and electroneuromyographic evaluations. RESULTS: Of 104 biopsied patients, leprosy was confirmed in 89.4% (93/104). The biopsied nerves were the ulnar (67.8% [63/93]), superficial fibular (21.5% [20/93]), sural (8.6% [8/93]), radial (1.1% [1/93]) and deep fibular (1.1% [1/93]). Twenty-nine percent (27/93) presented histopathological abnormalities and 4.4% (4/93) presented acid-fast bacilli. Nerve and superjacent skin quantitative polymerase chain reaction were positive in 49.5% (46/93) and 24.8% (23/93) of cases, respectively. Patients with multiple mononeuropathy had a higher frequency of histopathological abnormalities (p=0.0077). CONCLUSIONS: This study reinforces peripheral nerve biopsy's role as an important tool in the investigation of primary neural cases, contributing to the early diagnosis and also reducing diagnostic errors and the need for empirical treatment.

Análise de tendência histórica da evolução da hanseníase em Santa Catarina no período de 2001-2015 / Analysis of the histórical trend of leprosy evolution in a state in southern Brazil in the period 2001-2015

Introdução: A Hanseníase é uma doença infecciosa crônica causada pelo Mycobacterium leprae, também chamado de bacilo de Hansen. Em Santa Catarina, atualmente há baixos índices de morbidade decorrente de ações efetivas de combate à doença nos últimos vinte anos. Porém existem poucos estudos publicados que avaliem esses indicadores no estado em geral. Objetivos: Avaliar aspectos sociodemográficos e epidemiológicos da evolução da hanseníase no Estado de Santa Catarina, entre os anos de 2001 e 2015. Métodos: Estudo observacional do tipo ecológico, descritivo e analítico. Foram estudadas as características clínicas e epidemiológicas dos pacientes diagnosticados e notificados com hanseníase em Santa Catarina no período de 2001 a 2015. Resultados: No período avaliado, 3605 casos da doença foram notificados no estado. Dentre esses, a maior taxa de incidência da doença ocorreu em 2004, de 5,03/100.000 hab, e a menor em 2015, de 2,42/100.000 hab. A macrorregião que apresentou maior número de casos novos foi o Extremo Oeste, seguida do Planalto Norte. A maioria dos pacientes era do sexo masculino, correspondendo 57,82% dos casos e a faixa etária mais acometida foi dos 40 aos 59 anos de idade. Conclusão: É fundamental que medidas como a implementação de programas e estratégias de educação em saúde, sejam mantidas e aperfeiçoadas afim de reduzir cada vez mais as taxas de incidência da doença no Brasil e preconizar o seu diagnóstico precoce para se evitar o surgimento de possíveis sequelas e complicações.

Introduction: Leprosy is a chronic infectious disease caused by Mycobacterium leprae, also called Hansen's bacillus. In Santa Catarina, there are currently low morbidity rates due to effective actions to combat the disease in the last twenty years. However, there are few published studies that evaluate these indicators in the state in general. Objectives: To evaluate sociodemographic and epidemiological aspects of leprosy evolution in the State of Santa Catarina, between 2001 and 2015. Methods: Observational ecological, descriptive and analytical study. The clinical and epidemiological characteristics of the patients diagnosed and reported with leprosy in Santa Catarina from 2001 to 2015 were studied. Results: During the period evaluated, 3605 cases of the disease were reported in the state. Among these, the highest incidence rate of the disease occurred in 2004, from 5.03 / 100,000 inhabitants, and the lowest in 2015, from 2.42 / 100,000 inhabitants. The macro-region that presented the highest number of new cases was the Far West, followed by the North Plateau. The majority of the patients were male, 57.82% of the cases and the most affected age group was 40 to 59 years of age. Conclusion: It is fundamental that measures such as the implementation of health education programs and strategies be maintained and improved in order to reduce the incidence rates of the disease in Brazil and recommend its early diagnosis to avoid the appearance of possible sequelae and complications.

[Miliary tuberculosis]. / La miliaire tuberculeuse,une série rétrospective marocaine.

INTRODUCTION: Tuberculosis miliary is a severe and rare form of tuberculosis. It is often due to a haematogenous spread of the bacillus of Koch and represents less than 2 % of tuberculosis. PATIENTS AND METHODS: We conducted a retrospective study of 81 cases of tuberculous miliary collected at the Department of respiratory diseases of the Ibn Rochd university hospital in Casablanca between September 2003 and November 2016. RESULTS: A female predominance was noted with 58 % of the cases. The average age was 36 years. The history of tuberculosis was found in eight cases and tuberculous tuberculosis in eleven cases, postpartum in five cases, diabetes in three cases and trisomy 21 in one case. The clinical picture was dominated by altered general status in all cases, and fever in 69 cases (86 %). Chest x-ray showed a miliary aspect in all cases, cardiomegaly in two cases, pyopneumothorax in three cases, and opacities excavated in five other cases. The intradermal tuberculin reaction, performed in all cases, was positive in 26 cases, and sputum oscillations were positive in 21 cases. The dissemination report found cerebromeningeal involvement in nine cases, with cerebral tuberculomas in five cases, pericarditis in four cases, mediastinal and peripheral adenopathies in nine cases each. Bouchut tubercles were found in nine cases. Antibacillary therapy was started as a matter of urgency, according to the national TB control program with the old regimen (2SHRZ/7RH) and the new regimen (2RHZEb/7RH) in all cases. The outcome was good in 55 cases (68.9 %), 17 patients were lost to follow-up, and 11 deaths were reported. CONCLUSION: We insist on this work on the severity of the tuberculous miliary and the need for early and urgent therapeutic management.

qPCR detection of Mycobacterium leprae in biopsies and slit skin smear of different leprosy clinical forms

Abstract Leprosy, whose etiological agent is Mycobacterium leprae, is a chronic infectious disease that mainly affects the skin and peripheral nervous system. The diagnosis of leprosy is based on clinical evaluation, whereas histopathological analysis and bacilloscopy are complementary diagnostic tools. Quantitative PCR (qPCR), a current useful tool for diagnosis of infectious diseases, has been used to detect several pathogens including Mycobacterium leprae. The validation of this technique in a robust set of samples comprising the different clinical forms of leprosy is still necessary. Thus, in this study samples from 126 skin biopsies (collected from patients on all clinical forms and reactional states of leprosy) and 25 slit skin smear of leprosy patients were comparatively analyzed by qPCR (performed with primers for the RLEP region of M. leprae DNA) and routine bacilloscopy performed in histological sections or in slit skin smear. Considering clinical diagnostic as the gold standard, 84.9% of the leprosy patients were qPCR positive in skin biopsies, resulting in 84.92% sensitivity, with 84.92 and 61.22% positive (PPV) and negative (NPV) predictive values, respectively. Concerning bacilloscopy of histological sections (BI/H), the sensitivity was 80.15% and the PPV and NPV were 80.15 and 44.44%, respectively. The concordance between qPCR and BI/H was 87.30%. Regarding the slit skin smear, 84% of the samples tested positive in the qPCR. Additionally, qPCR showed 100% specificity, since all samples from different mycobacteria, from healthy individuals, and from other granulomatous diseases presented negative results. In conclusion, the qPCR technique for detection of M. leprae using RLEP primers proved to be specific and sensitive, and qPCR can be used as a complementary test to diagnose leprosy irrespective of the clinical form of disease.

qPCR detection of Mycobacterium leprae in biopsies and slit skin smear of different leprosy clinical forms.

Leprosy, whose etiological agent is Mycobacterium leprae, is a chronic infectious disease that mainly affects the skin and peripheral nervous system. The diagnosis of leprosy is based on clinical evaluation, whereas histopathological analysis and bacilloscopy are complementary diagnostic tools. Quantitative PCR (qPCR), a current useful tool for diagnosis of infectious diseases, has been used to detect several pathogens including Mycobacterium leprae. The validation of this technique in a robust set of samples comprising the different clinical forms of leprosy is still necessary. Thus, in this study samples from 126 skin biopsies (collected from patients on all clinical forms and reactional states of leprosy) and 25 slit skin smear of leprosy patients were comparatively analyzed by qPCR (performed with primers for the RLEP region of M. leprae DNA) and routine bacilloscopy performed in histological sections or in slit skin smear. Considering clinical diagnostic as the gold standard, 84.9% of the leprosy patients were qPCR positive in skin biopsies, resulting in 84.92% sensitivity, with 84.92 and 61.22% positive (PPV) and negative (NPV) predictive values, respectively. Concerning bacilloscopy of histological sections (BI/H), the sensitivity was 80.15% and the PPV and NPV were 80.15 and 44.44%, respectively. The concordance between qPCR and BI/H was 87.30%. Regarding the slit skin smear, 84% of the samples tested positive in the qPCR. Additionally, qPCR showed 100% specificity, since all samples from different mycobacteria, from healthy individuals, and from other granulomatous diseases presented negative results. In conclusion, the qPCR technique for detection of M. leprae using RLEP primers proved to be specific and sensitive, and qPCR can be used as a complementary test to diagnose leprosy irrespective of the clinical form of disease.

Poncet's disease mimicking rheumatoid arthritis in a patient with suspected Crohn's disease.

Poncet's disease is a rarely reported entity with an unknown pathogenesis. However, because it has a very favorable prognosis with antituberculosis drugs, we believe it should be considered as a differential diagnosis for patients with fever and polyarthritis of unknown cause, particularly if active tuberculosis is suspected.

Comisión de diagnóstico de casos sospechosos de tuberculosis con baciloscopia negativa: aceptabilidad del servicio por los médicos presentadores / Commission for the diagnosis of bacteriologically negative suspected tuberculosis cases: acceptability of the service by presenting physicians

Introducción: en etapa de eliminación de la tuberculosis, resulta de gran interés la identificación temprana de estos enfermos en cualquiera de sus formas, incluyendo aquellos con manifestaciones clínicas-radiológicas y microscopía negativa. Objetivos: conocer la frecuencia con que los médicos de diferentes servicios de salud presentan los expedientes clínicos de enfermos sospechosos de tuberculosis en la Comisión de Diagnóstico de enfermos de Tuberculosis con Baciloscopias Negativas (CODIBAARNE) del Hospital Neumológico Benéfico Jurídico de La Habana, la procedencia de dichos facultativos y sus opiniones sobre este servicio científico-técnico. Métodos: estudio descriptivo exploratorio. Para precisar la procedencia de los médicos presentadores, se aplicó un único formulario de encuesta. Resultados: en el 2004-05 se encuestaron 181 médicos y en el 2011, 40. De los primeros 181 encuestados, 118 (65,2 por ciento) procedían de 44 policlínicos de la atención primaria de salud y 63 (34,8 por ciento) de 17 hospitales de atención secundaria. Del primer grupo, 142 (78,5 por ciento) consideraron bueno y útil el servicio científico-técnico y 34 (19 por ciento) expresaron que era instructivo y aprendían con el servicio brindado. Del segundo grupo, 33 (82,5 por ciento) son Médicos Generales Integrales, y expresaron opiniones muy similares a las del primer grupo entrevistado. Conclusión: CODIBAARNE brinda extensa cobertura de servicios científico-técnicos a médicos de atención primaria y secundaria, que suscitan opiniones muy favorables de la gran mayoría de sus usuarios, considerándola como una herramienta complementaria para el diagnóstico de la tuberculosis con baciloscopia negativa(AU)

Introduction: in tuberculosis elimination an important role is played by early identification of all patients, including those with negative clinical-radiological and microscopy results. Objectives: determine the frequency with which physicians from various health services submit the medical records of patients with suspected tuberculosis to the Commission for the Diagnosis of Bacteriologically Negative Tuberculosis (CODIBAARNE) of Havana Benéfico Jurídico Pneuological Hospital, the institutional affiliation of those physicians and their opinions about this technical-scientific service. Methods: a descriptive exploratory study was conducted to determine the place of origin of presenting doctors. A unique survey form was used. Results: 181 doctors were surveyed in the period 2004-2005 and 40 in 2011. Of the former 181 doctors, 118 (65.2 percent) were from 44 primary health care polyclinics and 63 (34.8 percent) from 17 secondary health care hospitals. 142 (78.5 percent) evaluated the technical and scientific service as good and useful, and 34 (19 percent) said it was instructive. Of the second group 33 (82.5 percent) were comprehensive general physicians. Their opinions were very similar to those of the first group. Conclusion: CODIBAARNE provides extensive coverage of technical and scientific services to primary and secondary health care physicians, generating very favorable opinions among most of its users, who view it as a complementary tool for the diagnosis of bacteriologically negative tuberculosis(AU)

Control de calidad de la baciloscopia de esputo BAAR en laboratorios provinciales en Cuba / Quality control of acid fast bacilli of sputum smears microscopy in tuberculosis provincial reference laboratories in Cuba

Introducción: El laboratorio es un componente crítico en el diagnóstico, tratamiento, prevención y control de la tuberculosis. Objetivo: Analizar el comportamiento del control de calidad de la baciloscopia en los laboratorios de referencia provinciales de tuberculosis de Cuba, mediante el método de rechequeo de láminas a ciegas. Métodos: Se realizó el control de calidad, por el método de rechequeo de láminas, a 5 424 láminas de esputo BAAR recibidas en el Laboratorio Nacional de Referencia de Tuberculosis y Micobacterias del Instituto de Medicina Tropical Pedro Kourí, procedentes de los laboratorios de tuberculosis de los Centros Provinciales de Higiene, Epidemiología y Microbiología de Cuba, desde el año 2007 hasta 2009. Resultados: Se identificaron 54 errores de lectura; de ellos, 20 falsos positivos, 13 falsos negativos y 21 errores de codificación. La sensibilidad, especificidad y concordancia mostraron valores de 84,7, 99,6 y 99,4 porciento, respectivamente. La concordancia entre el Laboratorio Nacional de Referencia de Tuberculosis y Micobacterias del Instituto de Medicina Tropical Pedro Kourí y los laboratorios provinciales de tuberculosis evaluados fue de 99,4 porciento (Índice de kappa 0,8105) y la discordancia fue de solo el 0,6 pociento. Conclusiones: Los resultados sugieren una adecuada calidad del personal de los laboratorios provinciales para realizar el control de calidad de la BK de esputo BAAR. Se recomienda continuar con las visitas a los laboratorios de la red para detectar las deficiencias e implementar las medidas correctivas oportunas con el fin de seguir mejorando la calidad del diagnóstico de la baciloscopia y así eliminar la tuberculosis como problema de salud en Cuba(AU)

Introduction: The laboratory is a critical component in the diagnosis, treatment, prevention and control of tuberculosis. Objective: To analyze the behavior of quality control of bacilloscopy in provincial reference laboratories of Cuba, by the re-checkup of blind plates. Methods: The quality control was carried out by re-checkup method of plates at 5 424 plates of BAAR sputum received in the National Reference Laboratory of Tuberculosis and Mycobacteria of the Pedro Kourí Institute, originating in the laboratories of tuberculosis of Provincial Centers of Hygiene, Epidemiology and Microbiology of Cuba from 2007 to 2009. Results: Fifty four reading errors were identified; from them 20 false-positive, 13 false-negatives and 21 coding error. The sensitivity, specificity and concordance showed values of 84.7, 99.6 and 99.4 percent, respectively. The concordance between the NRLTB PKI and the provincial tuberculosis laboratories assessed was of 99.4 percent (Kappa rate 0.8105) and the discordance was only of 0.6 percent. Conclusions: Results suggest an appropriate staff quality of the provincial laboratories staff to carry out the quality control of BAAR sputum BK. It is recommended to continue with visits to network laboratories to detect the deficiencies and to implement appropriate corrective measures to go on with the diagnosis quality of BK and so to eliminate the TB as a health problem in Cuba(AU)

Control de calidad de la baciloscopia de esputo BAAR en laboratorios provinciales en Cuba / Quality control of acid fast bacilli of sputum smears microscopy in tuberculosis provincial reference laboratories in Cuba

Introducción: El laboratorio es un componente crítico en el diagnóstico, tratamiento, prevención y control de la tuberculosis. Objetivo: Analizar el comportamiento del control de calidad de la baciloscopia en los laboratorios de referencia provinciales de tuberculosis de Cuba, mediante el método de rechequeo de láminas a ciegas. Métodos: Se realizó el control de calidad, por el método de rechequeo de láminas, a 5 424 láminas de esputo BAAR recibidas en el Laboratorio Nacional de Referencia de Tuberculosis y Micobacterias del Instituto de Medicina Tropical Pedro Kourí, procedentes de los laboratorios de tuberculosis de los Centros Provinciales de Higiene, Epidemiología y Microbiología de Cuba, desde el año 2007 hasta 2009. Resultados: Se identificaron 54 errores de lectura; de ellos, 20 falsos positivos, 13 falsos negativos y 21 errores de codificación. La sensibilidad, especificidad y concordancia mostraron valores de 84,7, 99,6 y 99,4 porciento, respectivamente. La concordancia entre el Laboratorio Nacional de Referencia de Tuberculosis y Micobacterias del Instituto de Medicina Tropical Pedro Kourí y los laboratorios provinciales de tuberculosis evaluados fue de 99,4 porciento (Índice de kappa 0,8105) y la discordancia fue de solo el 0,6 pociento. Conclusiones: Los resultados sugieren una adecuada calidad del personal de los laboratorios provinciales para realizar el control de calidad de la BK de esputo BAAR. Se recomienda continuar con las visitas a los laboratorios de la red para detectar las deficiencias e implementar las medidas correctivas oportunas con el fin de seguir mejorando la calidad del diagnóstico de la baciloscopia y así eliminar la tuberculosis como problema de salud en Cuba

Introduction: The laboratory is a critical component in the diagnosis, treatment, prevention and control of tuberculosis. Objective: To analyze the behavior of quality control of bacilloscopy in provincial reference laboratories of Cuba, by the re-checkup of blind plates. Methods: The quality control was carried out by re-checkup method of plates at 5 424 plates of BAAR sputum received in the National Reference Laboratory of Tuberculosis and Mycobacteria of the Pedro Kourí Institute, originating in the laboratories of tuberculosis of Provincial Centers of Hygiene, Epidemiology and Microbiology of Cuba from 2007 to 2009. Results: Fifty four reading errors were identified; from them 20 false-positive, 13 false-negatives and 21 coding error. The sensitivity, specificity and concordance showed values of 84.7, 99.6 and 99.4 percent, respectively. The concordance between the NRLTB PKI and the provincial tuberculosis laboratories assessed was of 99.4 percent (Kappa rate 0.8105) and the discordance was only of 0.6 percent. Conclusions: Results suggest an appropriate staff quality of the provincial laboratories staff to carry out the quality control of BAAR sputum BK. It is recommended to continue with visits to network laboratories to detect the deficiencies and to implement appropriate corrective measures to go on with the diagnosis quality of BK and so to eliminate the TB as a health problem in Cuba

Perfil epidemiológico de pacientes com baciloscopia positiva para tuberculose pulmonar / Epidemiological profile of patients with positive sputum smears for pulmonary tuberculosis

JUSTIFICATIVA E OBJETIVOS: A tuberculose (TB) é uma doença de amplitude mundial, tão antiga quanto a humanidade. Estima-se que cerca de 50 milhões de pessoas no Brasil estejam infectadas com o M. tuberculosis. O estudo da epidemiologia da tuberculose pulmonar possibilita melhor compreensão sobre o comportamento da doença e sua manutenção na comunidade, ajudando a estimar o impacto das medidas de controle aplicadas. O objetivo deste estudo foi traçar o perfil epidemiológico dos pacientes com baciloscopia positiva, atendidos em um centro de referência para o tratamento desta doença. MÉTODO: Realizou-se estudo retrospectivo e descritivo, em que foram observadas 53 fichas de pacientes com baciloscopia positiva para tuberculose pulmonar atendidos em centro especializado no período de janeiro de 2005 a dezembro de 2008, com análise das associações da baciloscopia com as variáveis: sexo, faixa etária, grau de positividade e o tipo de alta. RESULTADOS: Observou-se que não houve diferença significativa em ambos os sexos acometidos pela tuberculose pulmonar. A faixa etária mais acometida foi entre 16 e 31 anos com 17 (69,2%) e 15 (55,5%), respectivamente, dos casos entre homens e mulheres. A maioria dos pacientes 30 (56,6%) apresentou diagnóstico positivo BAAR+. No presente estudo, chama a atenção o fato de que apenas 71,6% dos pacientes completaram o tratamento e foram avaliados como alta por cura comprovada. CONCLUSÃO: A investigação possibilitou conhecer as características da TB na população estudada, além de avaliar, indiretamente, o serviço de saúde dirigido ao controle da doença.

BACKGROUND AND OBJECTIVES: Tuberculosis (TB) is a world widespread illness, as ancient as humanity. An estimated 50 million Brazilians are infected with M. tuberculosis. Epidemiological studies on TB give better comprehension on this pathology behavior and its dynamics of transmission within communities, thus helping estimate the impact of the applied control measures in these settings. This study main goal was to draw an epidemiological profile of patients with positive bacilloscopy admitted at a public pulmonary TB specialty hospital for treatment. METHOD: 53 reports with information on patients admitted in pulmonary tuberculosis (TB) specialty public hospital from January 2005 until December 2008 were analyzed. In order to support this and other studies as well, we conducted a retrospective and descriptive study which analyzed associations between bacilloscopy and variables such as sex, age group, BAAR positivity and reasons for patients' discharge. RESULTS: There were no significant differences among male and female patients with positive bacilloscopy. The predominant age group of patients with positive bacilloscopy to pulmonary TB was 16 to 31 year-olds with 17 (69.2%) and 15 (55.5%), respectively between males and females. Most of the patients (n = 30; 56.6%) presented BAAR+. In this study, only 71.6 % the patients finished the treatment and got discharged by cure. CONCLUSION: This investigation permits an improved understanding of the characteristics of tuberculosis in the study population and enables an indirect evaluation of health service treatment of this disease.

Deteccion de Mycobacterium tuberculosis por métodos microbiologicos convencionales y caracteristicas del periodonto de un grupo de pacientes con tuberculosis

Objetivo: establecer la importancia del diagnóstico microbiológico de la Tuberculosis. Metodología: 15 pacientes que asistieron al servicio del Hospital Simón Bolívar, Caracas Venezuela, con cuadro clínico presuntivo de Tuberculosis pulmonar fueron estudiados a través del examen en cavidad bucal, radiografía de tórax, Baciloscopía (BK) y método de Petroff, tomando en consideración los signos y síntomas de cada uno de ellos. Resultados: 11 de las 15 muestras de esputo fueron BK (+) y 4 BK (-). Mycobacterium tuberculosis se aisló en 7 de las muestras incluyendo los pacientes que presentaron BK (-). Desde el punto de vista radiográfico, 10 pacientes presentaron lesión bilateral, 4 lesión unilateral y 1 fibrotorax. El examen en cavidad bucal permitió observar enfermedad periodontal de leve a moderada en 14 de los pacientes, 8 de ellos de manera localizada y 6 de manera generalizada. La detección de M. tuberculosis a través del BK sigue siendo un método de importancia para establecer en conjunto con los antecedentes, epidemiología, clínica, radiografía, serología e histopatología del paciente el diagnóstico definitivo de la tuberculosis, sin embargo, la técnica de PCR puede complementar dicho estudio.

Mycobacterium tuberculosis, aethiological agent of tuberculosis is a curved, aerobic, non sporulated and non motile rod that is a resistant aganaist dissecation effects. 15 patients were selected in this study who assited to Neumonology service located at Simón Bolívar Hospital, Caracas, Venezuela. These patients who had presuntive lung tuberculosis were studied considering their sings and simthomps. Oral cavities of each patient were studied considering their sings and sinthomps. Oral cavities of each patient were examinated and thorax Rx, Bacilloscopy (BK) and Petroff method were taked from each one in order to detect this rod. Our findings related that 11 out of 15 sputum samples were BK (+) and the other 4 were BK (-). M. tuberculosis was isolated in 7 samples, including BK (-) patients. Radiografically, 10 patients presented bilateral lesion, 4 presented unilateral lesion and 1 fibrothorax. Examination of oral cavities showed that 8 patients presented localizated periodontal disease and 6 presented generalizated periodontal disease. Detection of M. tuberculosis using BK continue to be an important method for identification of this bacteria, considering also epidemiological, clinical, radiographical, serological and histopathological studies in order to establish definitive diagnosis of TBC. Aditionally, Polimerase Chain Reaction (PCR) is an excellent method used to complement identification studies of this microorganism.

A influência do teste sorológico ML Flow na classificação da hanseníase / The influence of ML Flow test in leprosy classification

Estudo descritivo e exploratório correlacionando o ML Flow, a baciloscopia e a classificação em paucibacilar (PB) e multibacilar (MB), envolveu 1.041 casos novos com hanseníase em 13 municípios de Minas Gerais, de outubro de 2002 a março de 2004. A concordância entre o ML Flow e a classificação pelo número de lesões cutâneas e a baciloscopia foi moderada (Kappa:0,51 e 0,48, respectivamente) e, substancial (Kappa:0,77) com a classificação final. De janeiro de 2000 a março de 2004, a proporção de casos novos MB no Estado, passou de 78,1 para 65,8%. A queda no percentual de MB foi maior nos serviços participantes da pesquisa ML Flow (73,1 para 53,3%). A diferença de PB e MB nos serviços participantes e não participantes, de janeiro a março de 2004, foi estatisticamente significativa, indicando implicação direta e benéfica no tratamento e no controle da endemia em Minas Gerais.

This is a descriptive, exploratory study correlating ML Flow, bacilloscopy and classification of paucibacillary (PB) and multibacillary (MB), involving 1,041 new leprosy cases in 13 municipalities of Minas Gerais State, from October 2002 to March 2004. Agreement between ML Flow and the classification of the number of skin lesions and bacilloscopy was moderate (K:0.51 and K:0.48, respectively); and substantial for final classification (K:0.77). From January 2000 to March 2004, the proportion of new MB cases in Minas Gerais decreased from 78.1 to 65.8%. The reduction in the percentage of MB cases was higher in health centers that participated in the ML Flow study (73.1% to 53.3%). The difference between PB and MB in the participating and non-participating health centers from January to March 2004 was statistically significant. Implementation of the ML Flow test influenced the classification of patients, suggesting a direct and beneficial impact on patient treatment and the control of the leprosy endemic in Minas Gerais, Brazil.

Fatores de risco para a soropositividade do ML Flow em pacientes com hanseníase / Risk factors for ML Flow seropositivity in leprosy patients

O diagnóstico precoce da hanseníase, a correta classificação e o estudo dos fatores de risco relacionados à soropositividade, tornam-se importantes para o tratamento do doente e controle da endemia, especialmente, quando a responsabilidade pelo atendimento desses pacientes está sendo absorvida pelos serviços de atenção básica. Estudo descritivo e exploratório utilizando regressão logística avaliou a associação das variáveis: sexo, idade, modo de detecção, número de lesões cutâneas e de nervos acometidos, grau de incapacidade, baciloscopia, com o resultado do teste sorológico ML Flow, em 1.072 casos novos com hanseníase em 13 municípios de Minas Gerais. A soropositividade (50,7%) estava estatisticamente associada aos pacientes com 15 anos ou mais de idade (OR:2,6), mais de cinco lesões cutâneas (OR:7,5), mais de um nervo acometido (OR:2,4) e com baciloscopia positiva (OR:5,5 para IB<2 e OR:191,2 para IB>2), colaborando, assim, com a classificação e o tratamento adequados dos doentes.

The early diagnosis of leprosy, its correct classification and the risk factors related to seropositivity have become important for patient treatment and disease control, especially where the responsibility for treatment has been transferred to basic health care centers. This descriptive, exploratory study using logistic regression was undertaken to evaluate the association between the variables of sex, age, mode of detection, number of skin lesions and affected nerves, disability grade and bacilloscopy with the results of the ML Flow serological test in 1,072 new leprosy cases in 13 municipalities in Minas Gerais State. Seropositivity (50.7%) was statistically associated with patients 15 years-old or over (OR:2.6) and those with more than five skin lesions (OR:7.5), more than one affected nerve (OR:2.4) and a positive bacilloscopic index (OR:5.5 for 02), thus contributing to the appropriate classification and treatment of patients.