Tuberculosis en la Ciudad de la Habana, 1995-1999

Diagnostic validity of an expert tuberculosis commission that assists the diagnosis of bacteriologically negative suspected TB cases in Havana, Cuba

The Provincial Tuberculosis Commission of Havana, Cuba, a multi-speciality committee, assists clinicians in diagnosing bacteriologically negative tuberculosis (TB). At its weekly meetings, clinicians present the files of suspected TB cases for discussion, diagnosis and recommendations. This prospective study assessed the validity of the diagnoses made by the Commission by comparing the diagnoses made with diagnoses ascertained after one year of follow-up. Between October 2002 and December 2003, 126 patients suspected to have TB but who were bacteriologically negative completed diagnostic work at the Commission. Fifty-three (42%) were diagnosed as TB cases. The definite diagnosis of 116 patients (92%) was ascertained after one year of follow-up. Six patients diagnosed by the Commission as TB cases were suffering from other diseases, while one patient diagnosed with pneumonia had a definite diagnosis of pulmonary TB. The diagnostic sensitivity and specificity of the Commission were 98% (95% CI 93-100) and 92% (95% CI 85-98), respectively. The Provincial Tuberculosis Commission of Havana can be considered a valuable tool for the diagnosis of TB in patients suspected of TB but who are bacteriologically negative. A comparable approach, adapted to the local conditions, could prove useful in other epidemiological and healthcare settings.

Diagnóstico bacteriológico de la tuberculosis en Argentina: resultados de una encuesta nacional

Con el objetivo de evaluar recursos, prácticas y medidas de bioseguridad utilizados en el diagnóstico bacteriológico de tuberculosis y determinar la utilidad y alcance de las técnicas empleadas, se llevó adelante una encuesta transversal a laboratorios del sector público de Argentina utilizando un cuestionario estructurado. El análisis de los resultados mostró que la densidad de centros de microscopía y cultivo se encuentra al nivel o encima de lo recomendado por Organización Mundial de la Salud. El programa de control de calidad de microscopía cubre mayoritariamente los laboratorios con alta carga de trabajo. El promedio de baciloscopías/paciente fue bajo (1,6). El 25% de los laboratorios de cultivo empleaban protección respiratoria inadecuada. El aporte del cultivo a la confirmación de casos pulmonares en las jurisdicciones estuvo asociado a la proporción de muestras cultivadas. Globalmente, el porcentaje de pacientes pulmonares baciloscopía-negativa que fue confirmado bacteriológicamente fue de 18.9%; mientras que la may-oría de los casos extrapulmonares se confirmó sólo por cultivo (71,3%). Es prioritario aún el incremento del número de esputos estudiados por baciloscopía y cultivo, así como aumentar la cobertura de programa de control de calidad de microscopía; es fundamental proveer al personal de laboratorio de adecuada protección respiratoria y evaluación médica regular.

Screening for pulmonary tuberculosis in Teresópolis, RJ, Brazil: the search for respiratory symptomatic patients in emergency service of "Hospital das Clínicas de Teresópolis Costantino Ottaviano, Fundação Educacional Serra dos Órgãos"

The aim of the present study was to investigate the detection percentage of tuberculosis among patients that are respiratory symptomatic (TB suspects). In this work, we present the preliminary results of research carried out at "Hospital das Clínicas de Teresópolis Costantino Ottaviano da Fundação Educacional Serra dos Órgãos (FESO)" from November 2003 to April 2004. Among the 40 respiratory symptomatic individuals identified and referred to the Tuberculosis Control Program in Teresópolis, two (5.0%) were characterized as smear-positive. These results confirm reports in the literature and underscore the need for and importance of this strategy.

Recent tuberculosis advances in Latin America

PURPOSE OF REVIEW

Tuberculosis kills more people than any other infection. Despite advances in diagnostic methods and greater understanding of the reasons for treatment failure, tuberculosis remains common throughout Latin America.

RECENT FINDINGS

The impact of HIV and multidrug resistance on tuberculosis control has been enormous. HIV-positive patients may be at 10 times greater risk of multidrug resistant tuberculosis than HIV-negative patients. Hopefully, improved diagnostic techniques will allow more rapid diagnosis of tuberculosis and new colorimetric systems are being developed that will enable expedited drug-sensitivity testing. However, in alarming reports, only 58% of patients were treated with the recommended treatment regime in a Brazilian study, and dropout from treatment in parts of Bolivia was common. Many failings could be combated by rigorous education of patients and physicians. In an encouraging advance, multidrug resistant tuberculosis was successfully treated in a community-based programme, saving an estimated 90% of the cost of hospital-based treatment. An opportunity to identify treatment failure earlier is demonstrated by the finding that 2 months after the initiation of therapy, positive smears were found in only 3% of those whose treatment was successful, but 74% of those whose treatment failed.

SUMMARY

The importance of inexpensive and widely available drugs to treat HIV and multidrug resistant tuberculosis in Latin America is clear. The need for rapid, affordable tests for tuberculosis diagnosis, and for easy drug sensitivity testing is also evident. Finally, improving treatment success is achievable even in the resource poor setting.