RESUMO
BACKGROUND: Isoniazid preventive therapy (IPT) is highly effective in preventing TB disease; however, its long-term benefit in household contacts (HHCs) of infectious TB cases is unclear.METHODS: We conducted a retrospective analysis of two household contact studies in Vitoria, ES, Brazil, between 2008 and 2015. Households with smear-positive, culture-proven TB disease were enrolled. Eligible HHCs with tuberculin skin test (TST) indurations of ≥10 mm were referred to local TB clinics and IPT was started according to national guidelines. We reviewed the national dataset information system in January 2020 to identify HHCs with a diagnosis of TB disease. Time to event and Cox proportional regression analysis were conducted to identify factors associated with TB disease.RESULTS: Of the 1097 HHCs enrolled, 654 (60%) had TST ≥10 mm; 160 (24%) initiated IPT, of whom 115 (71.9%) completed IPT, which accounts for an overall completion rate of 18% among the population at risk; 42 (6%) TB cases were identified. IPT was associated with a 71% decrease in TB disease rates (HR 0.29, 95% CI 0.10-0.82; P = 0.02) among HHCs with TST ≥10 mm. IPT effect was sustained, as TB cases in HHCs without IPT occurred along the 7.9-year follow-up, whereas all four TB cases in HHCs with IPT were diagnosed within the first 3 years after exposureCONCLUSION: Isoniazid provides long-term protection for TB disease in household contacts of culture-proven TB cases.
Assuntos
Isoniazida , Teste Tuberculínico , Tuberculose , Humanos , Brasil/epidemiologia , Características da Família , Isoniazida/uso terapêutico , Estudos Retrospectivos , Tuberculose/prevenção & controleRESUMO
OBJECTIVE: To analyse the contribution of the Ogawa-Kudoh (O-K) swab culture method to the diagnosis of pulmonary tuberculosis (PTB) in four different regions of Brazil. DESIGN: This study was carried out in two phases. Phase 1 was designed to compare the direct swab culture method (O-K) with the culture concentrated method (N-acetyl-L-cysteine-sodium hydroxide [NALC-NaOH]); for this purpose, 569 sputum samples were cultured by both methods. Phase 2 was carried out to assess the contribution of the O-K method to the diagnosis of PTB in four different regions in Brazil, based on the evaluation of 19,163 sputum samples. RESULTS: In the first phase of the study, O-K culture had a sensitivity of 94.8% and specificity of 99.8% in cases confirmed by NALC-NaOH/Löwenstein-Jensen (LJ) culture. In the second phase of the study, the overall contribution of O-K culture compared to acid-fast bacilli (AFB) examination (AFB-/culture+) to the diagnosis of PTB was 29.8%. CONCLUSION: O-K culture contributes significantly to the diagnosis of smear-negative PTB. Importantly, this method allows the recovery of clinical isolates in areas where use of the standard culture centrifuge is impossible, indicating that the O-K swab culture method should become a standard method for TB diagnosis in these regions.
Assuntos
Escarro/microbiologia , Tuberculose Pulmonar/diagnóstico , Acetilcisteína/química , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Técnicas Bacteriológicas/métodos , Brasil/epidemiologia , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Sensibilidade e Especificidade , Hidróxido de Sódio/química , Tuberculose Pulmonar/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: To investigate risk factors for delayed sputum culture conversion to negative during anti-tuberculosis treatment, with an emphasis on smoking. DESIGN: Nested case-control study of adults with non-cavitary, culture-confirmed pulmonary tuberculosis (TB) participating in an anti-tuberculosis treatment trial in Brazil. A case of delayed culture conversion was a patient who remained culture-positive after 2 months of treatment. Odds ratios with 95% confidence intervals were calculated. RESULTS: Fifty-three cases and 240 control patients were analyzed. Smokers had three-fold greater odds of remaining culture-positive after 2 months of treatment (P = 0.007) than non-smokers, while smokers and ex-smokers who smoked >20 cigarettes a day had two-fold greater odds of remaining culture-positive after 2 months of treatment (P = 0.045). CONCLUSION: Cigarette smoking adversely affects culture conversion during anti-tuberculosis treatment. Support for smoking cessation should be considered to improve outcomes in TB control programs.
Assuntos
Mycobacterium tuberculosis/isolamento & purificação , Abandono do Hábito de Fumar , Fumar/efeitos adversos , Escarro/microbiologia , Tuberculose/tratamento farmacológico , Adolescente , Adulto , Antituberculosos/uso terapêutico , Brasil/epidemiologia , Intervalos de Confiança , Seguimentos , Humanos , Pessoa de Meia-Idade , Mycobacterium tuberculosis/efeitos dos fármacos , Razão de Chances , Prevalência , Estudos Retrospectivos , Fatores de Risco , Fumar/epidemiologia , Prevenção do Hábito de Fumar , Resultado do Tratamento , Tuberculose/epidemiologia , Tuberculose/microbiologia , Adulto JovemRESUMO
We assessed the effect of a double concentration of supplemental polymyxin B, amphotericin B, nalidixic acid, trimethoprim and azlocillin (PANTA) added to the Mycobacterial Growth Indicator Tube (MGIT) on contamination and positivity rates in 216 sputum cultures. Contamination rates were respectively 12.9% and 5.5% for samples processed using standard and double PANTA concentrations (P = 0.0001, McNemar's test). Thirty-five per cent of cultures performed using standard PANTA and 36.5% of those performed using two-fold PANTA concentrations were positive for Mycobacterium tuberculosis, compared to 25.9% of cultures inoculated on Ogawa medium. These results suggest that the use of MGIT with 2× PANTA may be useful in reducing culture contamination without reducing the diagnostic yield.
Assuntos
Antibacterianos/farmacologia , Técnicas Bacteriológicas/instrumentação , Equipamentos Descartáveis/microbiologia , Contaminação de Equipamentos/prevenção & controle , Mycobacterium tuberculosis/isolamento & purificação , Escarro/microbiologia , Tuberculose Pulmonar/diagnóstico , Anfotericina B/farmacologia , Azlocilina/farmacologia , Meios de Cultura , Relação Dose-Resposta a Droga , Humanos , Mycobacterium tuberculosis/crescimento & desenvolvimento , Ácido Nalidíxico/farmacologia , Polimixina B/farmacologia , Valor Preditivo dos Testes , Estudos Prospectivos , Trimetoprima/farmacologia , Tuberculose Pulmonar/microbiologiaRESUMO
OBJECTIVE: To investigate spatial patterns of the incidence of pulmonary tuberculosis (TB) and its relationship with socio-economic status in Vitoria, Espirito Santo, Brazil. DESIGN: In a 4-year, retrospective, territory-based surveillance study of all new pulmonary TB cases conducted in Vitoria between 2002 and 2006, spatial patterns of disease incidence were compared using spatial clustering statistics (Anselin's local indicators of spatial association [LISA] and Getis-Ord Gi* statistics), smoothed empirical Bayes estimates and model-predicted incidence rates. Spatial Poisson models were fit to examine the relationship between socio-economic status and TB incidence. RESULTS: A total of 651 TB cases were reported across 78 neighborhoods, with rates ranging from 0 to 129 cases per 100,000 population. Moran's I indicated strong spatial autocorrelation among incidence rates (0.399, P < 0.0001), and four areas of high incidence were identified by LISA and Gi* statistics. Smoothed spatial empirical Bayes estimates demonstrate that two of these areas range from 70 to 90 cases/100,000, while the other two range from 40 to 70 cases/100,000. TB incidence and socio-economic status had a significant curvilinear relationship (P = 0.02). CONCLUSIONS: Data derived from these spatial statistical tools will help TB control programs to allocate TB resources to those populations most at risk of increasing TB rates and to target areas where TB control efforts need to be concentrated.
Assuntos
Modelos Estatísticos , Tuberculose Pulmonar/epidemiologia , Teorema de Bayes , Brasil/epidemiologia , Análise por Conglomerados , Humanos , Incidência , Distribuição de Poisson , Estudos Retrospectivos , Fatores SocioeconômicosRESUMO
SETTING: Primary health clinics in Vitoria, Espirito Santo, Brazil. OBJECTIVE: To identify risk factors associated with patient and health care delays among patients seeking care at primary health clinics. METHODS: A prospective study among tuberculosis (TB) patients diagnosed in Vitoria between 1 January 2003 and 30 December 2007. A questionnaire ascertained the date of onset and duration of TB symptoms and medical records were reviewed. Between-group distributions of delay were compared and multivariate logistic regression was performed. RESULTS: Of 304 patients, 296 (97%) reported at least one TB symptom presenting for the first time to a qualified health service; 244 (80%) reported cough > 3 weeks. Median health care delay was 30 days (range 5-68), and median total delay was 110 days (range 26-784). Multivariate analysis revealed any cough (OR(adj) 7.35, 95%CI 2.40-22.5) and weight at TB diagnosis < 60 kg (OR(adj) 5.92, 95%CI 1.83-19.1) to be associated with patient delay of ≥ 30 days. Factors increasing risk of prolonged delay (≥ 90 days) were age ≥ 30 years (OR(adj) 1.93, 95%CI 1.09-3.43) and chest pain (OR(adj) 2.42, 95%CI 1.29-4.53). CONCLUSION: Improving health care workers' education regarding TB symptoms and implementing active case finding in targeted populations may reduce delays.
Assuntos
Tosse/diagnóstico , Diagnóstico Tardio/estatística & dados numéricos , Tuberculose Pulmonar/diagnóstico , Adulto , Fatores Etários , Brasil/epidemiologia , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Tosse/etiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Análise Multivariada , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Tuberculose Pulmonar/epidemiologiaRESUMO
This study compared the effect of using two different concentrations of sodium hydroxide (NaOH) in the N-acetyl-L-cysteine-sodium hydroxide (NALC-NaOH) method for sputum decontamination on smear and culture positivity and the proportion of contaminated cultures: 14% of cultures were contaminated using the standard final 1% NaOH concentration during processing compared to 11% contaminated cultures using a final 1.25% NaOH concentration (P < 0.008). The proportion of cultures positive for mycobacteria decreased from 21% to 11% for sputum processed with 1% and 1.25% final NaOH concentrations, respectively (P < 0.001). Our findings suggest that a small reduction in culture contamination did not justify the considerable loss of positive cultures.
Assuntos
Descontaminação/métodos , Hidróxido de Sódio/química , Escarro/microbiologia , Acetilcisteína/química , Técnicas Bacteriológicas , Humanos , Mycobacterium/isolamento & purificação , Estudos Prospectivos , Manejo de Espécimes , Tuberculose/diagnóstico , Tuberculose/microbiologiaRESUMO
Low-colony-number counts on solid media are considered characteristic of cross-contamination, although they are normally observed in true-positive cultures from some groups of patients. The aim of this study was to evaluate low-yield growth cultures as a microbiological marker for cross-contamination. We evaluated 106 cultures with <15 colonies from 94 patients, and the proportions of false-positive cultures were 0.9% per sample and 1.1% per patient, which indicates that low-yield growth is not a reliable marker of cross-contamination.
Assuntos
Mycobacterium tuberculosis/isolamento & purificação , Tuberculose/diagnóstico , Adulto , Idoso , Técnicas de Tipagem Bacteriana , Análise por Conglomerados , Contagem de Colônia Microbiana , Impressões Digitais de DNA , DNA Bacteriano/genética , Reações Falso-Positivas , Feminino , Genótipo , Humanos , Masculino , Polimorfismo de Fragmento de Restrição , Sensibilidade e EspecificidadeRESUMO
SETTING: Three mycobacteria reference laboratories in the south-eastern part of Brazil. OBJECTIVE: To evaluate the automated Mycobacteria Growth Indicator Tube (MGIT) for drug susceptibility testing of Mycobacterium tuberculosis. DESIGN: Performance of the automated BACTEC MGIT 960 (M960) system for testing M. tuberculosis susceptibility to streptomycin (SM), isoniazid (INH), rifampicin (RMP) and ethambutol (EMB) was evaluated with 95 clinical isolates and compared to the results of the radiometric BACTEC 460TB (B460) system, the proportion method (PM), and the resistance ratio method (RRM). Judicial susceptibility profiles of 88 isolates were defined based on two or more concordant results among B460, PM and RRM, and used as a reference for comparison with M960 results. RESULTS: Agreement rates between M960 and conventional methods were 95.2% with B460, 96.6% with the PM and 93.4% with the RRM. The lowest agreement rates were obtained for SM with the RRM and for EMB with B460. When comparing M960 with judicial susceptibility profiles, the agreement rate was 97.9%. The agreement rates obtained for INH and RMP were 99.2% and for SM and EMB they were 96.2% and 96.9%, respectively. The mean time to reporting the M960 results was 6.9 days. CONCLUSION: M960 offers great improvements when compared to the proportion and resistance ratio methods and would benefit patient treatment.
Assuntos
Antituberculosos/farmacologia , Testes de Sensibilidade Microbiana/instrumentação , Mycobacterium tuberculosis/efeitos dos fármacos , Autoanálise , Meios de Cultura , Etambutol/farmacologia , Humanos , Isoniazida/farmacologia , Testes de Sensibilidade Microbiana/métodos , Mycobacterium tuberculosis/crescimento & desenvolvimento , Reprodutibilidade dos Testes , Rifampina/farmacologia , Estreptomicina/farmacologiaRESUMO
From July 1995 to August 1998, mycobacterial blood cultures were obtained from 1032 HIV-infected patients seen at the Centro de Referência e Treinamento de AIDS (CRTA), Hospital São Paulo (HSP), and Centro de Referência de AIDS de Santos (CRAS). Overall, 179 episodes of mycobacteraemia were detected: 111 (62.0%) at CRTA, 50 (27.9%) at HSP, and 18 (10.1%) at CRAS. The frequency of positive cultures declined sharply from 22.6% in 1995 to 6.9% in 1998, consistent with the decrease in opportunistic infections following the publicly funded distribution of highly active antiretroviral therapy. In 1995, mycobacteraemia was more frequently due to Mycobacterium avium complex (59.2%) than Mycobacterium tuberculosis (28.6%), whereas in 1998 the relative frequencies were reversed (28.6 vs. 64.3% respectively), probably justified by the increased virulence of M. tuberculosis and the greater risk of invasive infection in less-immunocompromised patients, including patients unaware they are infected with HIV.