Prevalence of pulmonary mycoses in smear-negative patients with suspected tuberculosis in the Brazilian Amazon.

BACKGROUND: Pulmonary mycoses resemble clinically and radiologically chronic pulmonary tuberculosis. Studies describing the prevalence, etiology and clinical features of pulmonary mycosis are of crucial importance in the Brazilian Amazon. AIMS: To estimate the frequency of pulmonary mycoses in smear-negative tuberculosis patients; to describe their demographic, epidemiological, and clinical characteristics; and to evaluate diagnostic methods. METHODS: A cross-sectional study was conducted at two tuberculosis reference institutions in Amazonas, Brazil. We included 213 patients and collected clinical data, blood and induced sputum to perform serological, direct microscopy, microbiologic culture and PCR-based assays to identify infections caused by Aspergillus fumigatus, Paracoccidioides brasiliensis, Histoplasma capsulatum, Cryptococcus, and HIV. Chest computed tomography was also performed. RESULTS: Pulmonary mycoses were diagnosed in 7% (15/213) of the cases, comprising ten aspergillosis cases, three cases of paracoccidioidomycosis and one case each of histoplasmosis and cryptococcosis. Among the patients with pulmonary mycoses, 86.7% were former tuberculosis patients. The most significant clinical characteristics associated with pulmonary mycoses were cavity-shaped lung injuries, prolonged chronic cough and hemoptysis. CONCLUSIONS: Our study confirmed the high prevalence of pulmonary mycoses in smear-negative tuberculosis patients in the Brazilian Amazon.

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 Pneumological 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. Key words: tuberculosis, negative bacilloscopy, diagnosis, acceptability, opinions, CODIBAARNE(AU)

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)

Manual liquid culture on simple Middlebrook 7H9 or MGIT for the diagnosis of smear-negative pulmonary tuberculosis.

OBJECTIVES: To compare the performance of liquid culture on simple Middlebrook 7H9 to the one of manual mycobacterial growth indicator tube (MGIT) and solid culture on Ogawa for the diagnosis of smear-negative tuberculosis (SN-TB) in a high-burden, resource-constrained setting. METHODS: Sputum samples from patients with clinical suspicion of SN-PTB admitted to two-third-level hospitals in Lima between September 2005 and May 2008 were cultured in parallel on simple Middlebrook 7H9, manual MGIT and Ogawa. A case of SN-TB was defined as one with a positive culture in any medium. RESULTS: Among samples from 542 patients, 151 (28%) cases of SN-TB were identified. The sensitivity of Middlebrook 7H9 (0.76, 95% CI 0.69-0.83) was not substantially different from that of MGIT (0.85, 95% CI 0.79-0.91). Ogawa had the lowest sensitivity (0.63, 95% CI 0.55-0.71). The median turnaround time was similar for both liquid media (18 days), and it was shorter than that of Ogawa (30 days). CONCLUSIONS: Culture on simple Middlebrook 7H9 performs almost as well as MGIT, at a probably more affordable cost. Further studies on the cost-effectiveness of this overlooked technique should be performed.

Patrones radiológicos y diagnóstico definitivo de enfermos presuntivos de tuberculosis pulmonar con baciloscopia negativa / Radiological patterns and final diagnosis of patients presumptive of pulmonary tuberculosis with negative sputum smears

Introducción: el diagnóstico de la tuberculosis pulmonar en los enfermos con baciloscopia negativa es un reto en la práctica médica, basándose en la mayoría de los casos en elementos clínicos y radiográficos. En el Hospital Neumológico Benéfico Jurídico en La Habana funciona una comisión de expertos en el diagnóstico de la tuberculosis con baciloscopia negativa denominada CODIBAARNE. Objetivo: identificar los patrones radiológicos y el diagnóstico definitivo de enfermos presentados en esta comisión entre octubre de 2002 a diciembre de 2003. Métodos: se realizó un estudio descriptivo en una muestra de enfermos en el período señalado y que por la recomendación de la comisión CODIBAARNE pasaron a ser seguidos y estudiados en el Hospital Neumológico Benéfico Jurídico para definir sus diagnósticos. Los datos se obtuvieron del registro de pacientes y de las historias clínicas individuales de los enfermos. Resultados: la edad media de estos enfermos fue de 68,2 años, 57 por ciento era del sexo masculino. Los síntomas más frecuentes resultaron la tos (76 por ciento), el síndrome general (70 por ciento), y la expectoración (61 por ciento). Los patrones radiográficos más usuales fueron los infiltrados, con cavitaciones o sin estas (44 por ciento), y las lesiones fibróticas (34 por ciento). Los diagnósticos más comunes mostraron bronquiectasias (26 por ciento), seguidos por el de tuberculosis pulmonar con baciloscopia negativa (24 por ciento). Conclusiones: los resultados de esta investigación ponen de manifiesto la importancia del trabajo del grupo de expertos que constituyen la CODIBAARNE en relación con el diagnóstico de los casos de tuberculosis con baciloscopia negativa(AU)

Introduction: the diagnosis of pulmonary tuberculosis in sputum smears-negative patients is a challenge for today´s medical practice, mostly supported on clinical and radiographic elements. In Hospital Neumológico Benéfico Jurídico of Havana, there is an expert commission for the sputum smear-negative diagnosis of tuberculosis called CODIBAARNE. Objective: to identify the radiological patterns and the final diagnosis of patients submitted to this committee from October 2002 to December 2003. Methods: a descriptive study was conducted in a sample of patients within the above-mentioned period, who had been studied and followed-up in Hospital Neumológico Benéfico Jurídico in order to define their final diagnoses under the CODIBAARNE commission recommendation. Data were gathered from the register of patients and from the individual medical histories. Results: the average age of these patients was 68.2 years and 57 percent were males. The most frequent symptoms were cough (76 percent), general syndrome (70 percent) and expectoration (61 percent). The mostly seen radiographic patterns were infiltrates, with or without cavitation (44 percent) and fibrotic lesions (34 percent). The most common diagnoses showed bronchiectasia (26 percent), followed by sputum smears-negative pulmonary tuberculosis (24 percent). Conclusions: the results of this research work evinced the importance of the work by the group of experts in CODIBAARNE regarding the sputum smears-negative diagnosis of tuberculosis cases(AU)

Patrones radiológicos y diagnóstico definitivo de enfermos presuntivos de tuberculosis pulmonar con baciloscopia negativa / Radiological patterns and final diagnosis of patients presumptive of pulmonary tuberculosis with negative sputum smears

Introducción: el diagnóstico de la tuberculosis pulmonar en los enfermos con baciloscopia negativa es un reto en la práctica médica, basándose en la mayoría de los casos en elementos clínicos y radiográficos. En el Hospital Neumológico Benéfico Jurídico en La Habana funciona una comisión de expertos en el diagnóstico de la tuberculosis con baciloscopia negativa denominada CODIBAARNE. Objetivo: identificar los patrones radiológicos y el diagnóstico definitivo de enfermos presentados en esta comisión entre octubre de 2002 a diciembre de 2003. Métodos: se realizó un estudio descriptivo en una muestra de enfermos en el período señalado y que por la recomendación de la comisión CODIBAARNE pasaron a ser seguidos y estudiados en el Hospital Neumológico Benéfico Jurídico para definir sus diagnósticos. Los datos se obtuvieron del registro de pacientes y de las historias clínicas individuales de los enfermos. Resultados: la edad media de estos enfermos fue de 68,2 años, 57 por ciento era del sexo masculino. Los síntomas más frecuentes resultaron la tos (76 por ciento), el síndrome general (70 por ciento), y la expectoración (61 por ciento). Los patrones radiográficos más usuales fueron los infiltrados, con cavitaciones o sin estas (44 por ciento), y las lesiones fibróticas (34 por ciento). Los diagnósticos más comunes mostraron bronquiectasias (26 por ciento), seguidos por el de tuberculosis pulmonar con baciloscopia negativa (24 por ciento). Conclusiones: los resultados de esta investigación ponen de manifiesto la importancia del trabajo del grupo de expertos que constituyen la CODIBAARNE en relación con el diagnóstico de los casos de tuberculosis con baciloscopia negativa.

Introduction: the diagnosis of pulmonary tuberculosis in sputum smears-negative patients is a challenge for today´s medical practice, mostly supported on clinical and radiographic elements. In Hospital Neumológico Benéfico Jurídico of Havana, there is an expert commission for the sputum smear-negative diagnosis of tuberculosis called CODIBAARNE. Objective: to identify the radiological patterns and the final diagnosis of patients submitted to this committee from October 2002 to December 2003. Methods: a descriptive study was conducted in a sample of patients within the above-mentioned period, who had been studied and followed-up in Hospital Neumológico Benéfico Jurídico in order to define their final diagnoses under the CODIBAARNE commission recommendation. Data were gathered from the register of patients and from the individual medical histories. Results: the average age of these patients was 68.2 years and 57 percent were males. The most frequent symptoms were cough (76 percent), general syndrome (70 percent) and expectoration (61 percent). The mostly seen radiographic patterns were infiltrates, with or without cavitation (44 percent) and fibrotic lesions (34 percent). The most common diagnoses showed bronchiectasia (26 percent), followed by sputum smears-negative pulmonary tuberculosis (24 percent). Conclusions: the results of this research work evinced the importance of the work by the group of experts in CODIBAARNE regarding the sputum smears-negative diagnosis of tuberculosis cases.