RESUMO
OBJECTIVE: To describe the incidence of tuberculosis (TB) in the hospital area of Seville-South between 1990 and 1999. METHOD: Study of the incidence of TB in the area's population between 1990 and 1999 by way of periodic survey of informants who were likely to see cases. RESULTS: The annual incidence of TB rose from 1990 (26.64/105) to its peak in 1992 (38.3/105), stabilized between 1992 and 1995, and later fell to 15.7/105 in 1999. Bacillary cases followed a similar pattern, with a peak of 13.76/105 in 1992 and a low of 6.06/105 in 1998. The annual incidence of TB-AIDS rose between 1990 (2.63/105) and 1995 (9.08/105), and then fell to 4.13/105 by 1999. The highest incidences were in the 25-to-34-year-old range in the periods from 1990 to 1993 (50.74/105) and 1994 to 1996 (61.49/105), whereas the incidence decreased among 55-to-64-year-olds (28.55/105) from 1997 to 1999. The age distribution was affected by rates in the TB-AIDS group, which contributed 48%, 50% and 55% in each period, respectively, for individuals in the 25-to-34-year-old range. CONCLUSIONS: The annual incidence of TB was 41,1% lower in 1999 than in 1990, as a result of the marked decrease beginning in the middle of the decade. The impact of TB-AIDS patients on the evolution of annual incidence and on age distribution was considerable throughout the decade.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Tuberculose/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais , Espanha/epidemiologiaRESUMO
OBJECTIVE: To analyze the outcome of treating initial tuberculosis (ITB) in the hospital district south of Seville (Spain). MATERIAL AND METHOD: A descriptive study of treatment outcome in cases of ITB in our district between 1 January 1994 and 31 December 1998. Outcome was classified according to World Health Organization guidelines:successful (S) potentially unsuccessful (PU), exitus (EX) and transferred out (T).Four hundred fifty-four patients (mean age 35 years) were enrolled; 22% were HIV+ and 21% were intravenous drug users (IVDU). Treatment was self-administered in all cases, with 98% being given the standard prescription of 6 or 9 drugs. No subsequent case history was found for 15 cases, such that outcome could not be assessed. RESULTS: Of the 439 evaluable cases, outcome was S for 74% (326/439), PU for 16% (70/439), EX for 8% (36/439) and T for 6. Outcome for HIV + patients was poorer than for HIV- patients (S: 35/98 versus 291/341, p < 0.00005;PU: 40/98 versus 30/341, p < 0.00005), and the mortality rate of HIV+ patients was higher than that of HIV- patients (EX:18/98 versus 18/341, p < 0.0008). Among those classified PU,no cases of treatment failure were recorded and up to 78% (31/40)were cases of loss of follow-up or abandonment. The variable most closely related to PU was IVDU status (OR = 10.5, p < 0.00005). CONCLUSION: a) Outcomes for the general population are acceptable. b)A marginal group has been identified as characterized by two variables, HIV+ and IVDU, which are the factors associated with poorer outcome of self-administered treatment, indicating that supervised treatment is advisable in cases where those factors are present.
Assuntos
Antituberculosos/uso terapêutico , Tuberculose Pulmonar/tratamento farmacológico , Adulto , Idoso , Quimioterapia Combinada , Infecções por HIV/complicações , Humanos , Pessoa de Meia-Idade , Análise de Regressão , Fatores de Risco , Espanha/epidemiologia , Resultado do Tratamento , Tuberculose Pulmonar/mortalidadeRESUMO
OBJECTIVE: The objectives of this study were to know the prevalence of hepatitis C virus (HCV) in a population of pregnant women, to evaluate the vertical transmission rates of HCV in a prospective study and to determine the repercussions and consequences in children born to infected mothers. PATIENTS AND METHODS: A total of 6556 pregnant women were tested for HCV antibodies from January 1993 to August 1995. We followed 50 babies born to infected mothers for at least 12 months (mean 15 months). Serological assays employed included a screening ELISA II confirmed with immunoblot. Viral detection was performed by qualitative and quantitative PCR for HCV-RNA. RESULTS: Fifty-nine pregnant women were AcHCV(+). This represents a seroprevalence of 0.9%. Of the 50 babies followed, 6 were PCR(+) and 44 were PCR(-). The risk of transmission is correlated with the titer of HCV-RNA in the mother. All mothers of infected babies were HIV (-). CONCLUSIONS: The rate of prevalence in our pregnant women population is 0.9%. We found a vertical transmission rate of 12%. The high serum HCV-RNA titers in the mothers are a risk factor of transmission of HCV. The viremia in the children does not predict the apparition of the clinical disease, although they can exhibit intermittent increases of transaminases.
Assuntos
Hepatite C/transmissão , Transmissão Vertical de Doenças Infecciosas , Feminino , Hepatite C/diagnóstico , Hepatite C/epidemiologia , Humanos , Lactente , Recém-Nascido , Leite Humano/virologia , Gravidez , Prevalência , Estudos ProspectivosRESUMO
Cerebrospinal fluid (CSF) anti-mycobacterial antigen 60 (A60) IgM, IgG and IgA in patients affected by meningitis of different etiologies were assayed as a rapid diagnostic test in cases of tuberculous meningitis. A commercial EIA was used to test 127 CSF samples classified as follows: tuberculous meningitis (n = 27 CSF samples from 16 patients, 6 of them with AIDS), pyogenic meningitis (n = 13), non-tuberculous aseptic meningitis (n = 43) and 44 normal CSF samples (16 of them from HIV-positive patients, 8 of whom had extraneurological tuberculosis). Anti-A60 IgM was positive only in two cases (1 tuberculous meningitis and 1 self-resolving aseptic meningitis). Positive CSF anti-A60 IgG and IgA were observed in eight and nine out of 16 patients with tuberculous meningitis, but only in four and five out of 13 samples studied prior to or in the first ten days of treatment, respectively. Most of the patients with false-positive IgG and IgA (16%) had pyogenic meningitis, but without intrathecal synthesis of antibodies. In patients with aseptic meningitis, the finding of CSF anti-A60 IgG plus IgA, initially or during follow-up, can be used as a diagnostic criterion for tuberculous meningitis, with a specificity of 100%, a positive predictive value of 1, and a negative predictive value of 0.81. However, its sensitivity is only 50% in immunocompetent patients and 16% in patients with AIDS.