1
|
Guillén-Nepita AL, Vázquez-Marrufo G, Cruz-Hernández A, García-Oliva F, Zepeda-Gurrola RC, Vázquez-Garcidueñas MS. Detailed epidemiological analysis as a strategy for evaluating the actual behavior of tuberculosis in an apparently low-incidence region. Pathog Glob Health 2020; 114:393-404. [PMID: 32924885 DOI: 10.1080/20477724.2020.1813488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Tuberculosis control in developing regions with apparent low incidence, like the low-income Mexican state of Michoacán, with mean annual incidence rates below 10/100,000 inhabitants, requires knowledge of the actual behavior of the disease. This can be determined using an epidemiological profile at sub-regional level, allowing disclosure of the clinical and social factors that may be hampering efforts to control tuberculosis. In this work, a detailed epidemiological profile was outlined using data of all new monthly cases registered in the National System of Epidemiological Surveillance Database for Michoacán municipalities from 2000 to 2012. Cases were grouped by gender and age, and sociodemographic data were obtained both from the National Institute of Statistics and Geography and from the United Nations Development Programme. Correlations were calculated by Chi-square, Mann-Whitney U, and Kruskal-Wallis H tests. We observed no statistically significant differences between notification rates for the years 2000, 2005 and 2010 (χ2 = 0.222, p = 0.895). The percentage of cases is similar between all age groups older than 15, while some regions had low notification rates but high proportions of pediatric cases. Higher proportions of cases of extrapulmonary tuberculosis were observed in municipalities in northern Michoacán. No correlation was found between municipal Human Development Index values and municipal notification rates. Michoacán is undergoing an epidemiological transition with three regions having different epidemiological profiles and particular needs for effective prevention and containment of tuberculosis. Our work shows the importance of the spatial scale of epidemiological profiles for determining specific regional needs of surveillance and containment.
Collapse
|
2
|
Tomographic Aspects of Advanced Active Pulmonary Tuberculosis and Evaluation of Sequelae following Treatment. Pulm Med 2017; 2017:9876768. [PMID: 28261498 PMCID: PMC5316448 DOI: 10.1155/2017/9876768] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/19/2016] [Accepted: 01/15/2017] [Indexed: 01/15/2023] Open
Abstract
Objectives. To evaluate tomographic changes in pulmonary tuberculosis (TB), degree of agreement among three radiologists regarding tomographic diagnoses, and sequelae following treatment. Methods. Cross-sectional and descriptive study of 74 TB patients confirmed by sputum culture and chest computed tomography before (CT1) and 6 months after (CT2) drug therapy. Results were performed by three radiologists blinded to clinical and laboratory results. Results. Main findings in CT1 included nodules indicating the presence of a tree-in-bud pattern in 93% of cases, ill-defined nodules in 84% of cases, consolidation in 77% of cases, architectural distortion in 71% of cases, cavitary lesions in 62% of cases, and ground glass opacities in 37% of cases. Airway involvement, characterized by increased thickness and dilatation of the bronchial walls, occurred in 93% of cases. Pleural involvement occurred in 54%. There was an agreement on active TB among the three radiologists in 85% of cases. The results in CT2 indicated the presence of architectural distortion in 91% of cases and cylindrical bronchiectasis in 86%. Conclusions. The study established a tomographic pattern for diagnosis of active TB characterized by the presence of airway nodules, consolidation, architectural distortion, and cavitary lesions, and an almost complete degree of agreement (Kappa) was observed among the radiologists (0.85). CT after treatment assists in defining the cure.
Collapse
|
3
|
Yamamura M, de Freitas IM, Santo M, Chiaravalloti F, Popolin MAP, Arroyo LH, Rodrigues LBB, Crispim JA, Arcêncio RA. Spatial analysis of avoidable hospitalizations due to tuberculosis in Ribeirao Preto, SP, Brazil (2006-2012). Rev Saude Publica 2016; 50:20. [PMID: 27191156 PMCID: PMC4902087 DOI: 10.1590/s1518-8787.2016050006049] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 06/09/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe the spatial distribution of avoidable hospitalizations due to tuberculosis in the municipality of Ribeirao Preto, SP, Brazil, and to identify spatial and space-time clusters for the risk of occurrence of these events. METHODS This is a descriptive, ecological study that considered the hospitalizations records of the Hospital Information System of residents of Ribeirao Preto, SP, Southeastern Brazil, from 2006 to 2012. Only the cases with recorded addresses were considered for the spatial analyses, and they were also geocoded. We resorted to Kernel density estimation to identify the densest areas, local empirical Bayes rate as the method for smoothing the incidence rates of hospital admissions, and scan statistic for identifying clusters of risk. Softwares ArcGis 10.2, TerraView 4.2.2, and SaTScan™ were used in the analysis. RESULTS We identified 169 hospitalizations due to tuberculosis. Most were of men (n = 134; 79.2%), averagely aged 48 years (SD = 16.2). The predominant clinical form was the pulmonary one, which was confirmed through a microscopic examination of expectorated sputum (n = 66; 39.0%). We geocoded 159 cases (94.0%). We observed a non-random spatial distribution of avoidable hospitalizations due to tuberculosis concentrated in the northern and western regions of the municipality. Through the scan statistic, three spatial clusters for risk of hospitalizations due to tuberculosis were identified, one of them in the northern region of the municipality (relative risk [RR] = 3.4; 95%CI 2.7-4,4); the second in the central region, where there is a prison unit (RR = 28.6; 95%CI 22.4-36.6); and the last one in the southern region, and area of protection for hospitalizations (RR = 0.2; 95%CI 0.2-0.3). We did not identify any space-time clusters. CONCLUSIONS The investigation showed priority areas for the control and surveillance of tuberculosis, as well as the profile of the affected population, which shows important aspects to be considered in terms of management and organization of health care services targeting effectiveness in primary health care.
Collapse
Affiliation(s)
- Mellina Yamamura
- Programa de Pós-Graduação em Saúde Pública. Escola de Enfermagem de Ribeirão Preto. Universidade de São Paulo. Ribeirão Preto, SP, Brasil
| | - Isabela Moreira de Freitas
- Programa de Pós-Graduação em Saúde Pública. Escola de Enfermagem de Ribeirão Preto. Universidade de São Paulo. Ribeirão Preto, SP, Brasil
| | - Marcelino Santo
- Departamento de Enfermagem. Universidade Federal do Maranhão. Imperatriz, MA, Brasil
| | - Francisco Chiaravalloti
- Departamento de Epidemiologia. Faculdade de Saúde Pública. Universidade de São Paulo. São Paulo, SP, Brasil
| | - Marcela Antunes Paschoal Popolin
- Programa de Pós-Graduação em Saúde Pública. Escola de Enfermagem de Ribeirão Preto. Universidade de São Paulo. Ribeirão Preto, SP, Brasil
| | - Luiz Henrique Arroyo
- Programa de Pós-Graduação em Saúde Pública. Escola de Enfermagem de Ribeirão Preto. Universidade de São Paulo. Ribeirão Preto, SP, Brasil
| | | | - Juliane Almeida Crispim
- Programa de Pós-Graduação em Saúde Pública. Escola de Enfermagem de Ribeirão Preto. Universidade de São Paulo. Ribeirão Preto, SP, Brasil
| | - Ricardo Alexandre Arcêncio
- Departamento de Enfermagem Materno Infantil e Saúde Pública. Escola de Enfermagem de Ribeirão Preto. Universidade de São Paulo. Ribeirão Preto, SP, Brasil
| |
Collapse
|
4
|
Nabi Koul A, Ahmad Wagay H, Bashir Rather A, Nabi Dhobi G, Ahmad Bhat F, Rafiq Bhat M. Demography and clinical outcome of pulmonary tuberculosis in Kashmir; 2 year prospective study. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2016. [DOI: 10.1016/j.ejcdt.2015.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
5
|
Muller BLA, Ramalho DMDP, Santos PFGD, Mesquita EDD, Kritski AL, Oliveira MM. Inflammatory and immunogenetic markers in correlation with pulmonary tuberculosis. J Bras Pneumol 2014; 39:719-27. [PMID: 24473766 PMCID: PMC4075896 DOI: 10.1590/s1806-37132013000600011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 10/10/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE: To describe serum levels of the cytokines IL-10, TNF-α, and IFN-γ, as well
as polymorphisms in the genes involved in their transcription, and their
association with markers of the acute inflammatory response in patients with
pulmonary tuberculosis. METHODS: This was a descriptive, longitudinal study involving 81 patients with
pulmonary tuberculosis treated at two referral hospitals. We collected data
on sociodemographic variables and evaluated bacteriological conversion at
the eighth week of antituberculosis treatment, gene polymorphisms related to
the cytokines studied, and serum levels of those cytokines, as well as those
of C-reactive protein (CRP). We also determined the ESR and CD4+ counts.
RESULTS: The median age of the patients was 43 years; 67 patients (82.7%) were male;
and 8 patients (9.9%) were infected with HIV. The ESR was highest in the
patients with high IFN-γ levels and low IL-10 levels. IFN-γ and TNF-α gene
polymorphisms at positions +874 and −238, respectively, showed no
correlations with the corresponding cytokine serum levels. Low IL-10 levels
were associated with IL-10 gene polymorphisms at positions −592 and −819
(but not −1082). There was a negative association between bacteriological
conversion at the eighth week of treatment and CRP levels. CONCLUSIONS: Our results suggest that genetic markers and markers of acute inflammatory
response are useful in predicting the response to antituberculosis
treatment.
Collapse
Affiliation(s)
- Beatriz Lima Alezio Muller
- Federal University of Rio de Janeiro, School of Medicine Clementino Fraga Filho, University Hospital, Rio de Janeiro, Brazil
| | - Daniela Maria de Paula Ramalho
- Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Rio de Janeiro, Brazil
| | | | - Eliene Denites Duarte Mesquita
- Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Rio de Janeiro, Brazil
| | - Afranio Lineu Kritski
- Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital
| | - Martha Maria Oliveira
- Federal University of Rio de Janeiro, School of Medicine, Clementino Fraga Filho University Hospital, Rio de Janeiro, Brazil
| |
Collapse
|
6
|
Moraes MLD, Ramalho DMDP, Delogo KN, Miranda PFC, Mesquita EDD, de Melo Guedes de Oliveira HM, Netto AR, Dos Anjos MJ, Kritski AL, de Oliveira MM. Association of serum levels of iron, copper, and zinc, and inflammatory markers with bacteriological sputum conversion during tuberculosis treatment. Biol Trace Elem Res 2014; 160:176-84. [PMID: 24958018 DOI: 10.1007/s12011-014-0046-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 06/11/2014] [Indexed: 10/25/2022]
Abstract
Iron, copper, and zinc are key micronutrients that play an important role in the immune response to Mycobacterium tuberculosis. The present study aimed to evaluate the association between serum levels of those micronutrients, inflammatory markers, and the smear and culture conversion of M. tuberculosis during 60 days of tuberculosis treatment. Seventy-five male patients with pulmonary tuberculosis (mean age, 40.0 ± 10.7 years) were evaluated at baseline and again at 30 and 60 days of tuberculosis treatment. Serum levels of iron, copper, zinc, albumin, globulin, C-reactive protein, and hemoglobin, and smear and cultures for M. tuberculosis in sputum samples were analyzed. Compared to healthy subjects, at baseline, patients with PTB had lower serum iron levels, higher copper levels and copper/zinc ratio, and similar zinc levels. During the tuberculosis treatment, no significant changes in the serum levels of iron, zinc, and copper/zinc were observed. Lower serum copper levels were associated with bacteriological conversion in tuberculosis treatment (tuberculosis-negative) at 30 days but not at 60 days (tuberculosis-positive). C-reactive protein levels and the C-reactive protein/albumin ratio were lower in tuberculosis-negative patients than in tuberculosis-positive patients at 30 and 60 days after treatment. Albumin and hemoglobin levels and the albumin/globulin ratio in patients with pulmonary tuberculosis increased during the study period, regardless of the bacteriological results. High serum globulin levels did not change among pulmonary tuberculosis patients during the study. Serum copper levels and the C-reactive protein/albumin ratio may be important parameters to evaluate the persistence of non-conversion after 60 days of tuberculosis treatment, and they may serve as predictors for relapse after successful treatment.
Collapse
|
7
|
Gonçalves MJF, Ferreira AA. Factors associated with length of hospital stay among HIV positive and HIV negative patients with tuberculosis in Brazil. PLoS One 2013; 8:e60487. [PMID: 23593227 PMCID: PMC3625177 DOI: 10.1371/journal.pone.0060487] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Accepted: 02/26/2013] [Indexed: 11/18/2022] Open
Abstract
Objective Identify and analyze the factors associated to length of hospital stay among HIV positive and HIV negative patients with tuberculosis in Manaus city, state of Amazonas, Brazil, in 2010. Methods Epidemiological study with primary data obtained from monitoring of hospitalized patients with tuberculosis in Manaus. Data were collected by interviewing patients and analyzing medical records, according to the following study variables age, sex, co-morbidities, education, race, income, lifestyle, history of previous treatment or hospitalization due to tuberculosis, treatment regimen, adverse reactions, smear test, clinical form, type of discharge, and length of hospital stay. The associated factors were identified through chi-square or t-Student test at a 5% significance level. Results Income from 1 to 3 minimum wages (P = 0.028), pulmonary tuberculosis form (P = 0.011), negative smear test or no information in this regard (P = 0.014), initial 6-month treatment scheme (P = 0.029), and adverse drug reactions (P = 0.021) were associated to prolonged hospital stay in HIV positive patients. Conclusion We found out that although there were no significant differences in the length of hospital stay in HIV positive patients, all factors significantly associated to prolonged hospital stay occurred in this group of patients. This finding corroborates other studies indicating the severity of tuberculosis in HIV patients, which may also contribute to lengthen their hospital stay.
Collapse
Affiliation(s)
- Maria Jacirema Ferreira Gonçalves
- Post-Graduate Program in Health, Society, and Endemic Diseases in the Amazon, Amazonas Federal University/Para Federal University/Leonidas & Maria Deane Institute (Fiocruz Foundation), Manaus, Amazonas, Brazil.
| | | |
Collapse
|
8
|
Patel KK, Caramelli B, Silva MRE. Original research articles on the cardiopulmonary system recently appeared in Brazilian clinical and surgical journals. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1590/s0104-42302011000600022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
9
|
Original research articles on the cardiopulmonary system recently appeared in Brazilian clinical and surgical journals. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1016/s0104-4230(11)70140-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
10
|
Lopes T, Gomes C, Diogo N. [Tuberculosis unit: case study of 10 years of activity (1999-2009)]. REVISTA PORTUGUESA DE PNEUMOLOGIA 2011; 17:266-71. [PMID: 21782379 DOI: 10.1016/j.rppneu.2011.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Accepted: 05/30/2011] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION The Pulmonology Service of a Central Hospital in Lisbon created a Unit dedicated to the treatment of tuberculosis (TB). OBJECTIVES Casuistic analysis and assessment of the predictive factors for in-hospital mortality, over a 10-years period. MATERIAL/METHODS Retrospective study, from April 1999 to September 2009, through the Statistical Package for the Social Sciences application for binary logistic regression. RESULTS In a total of 1917 patients, most were male (n=1450; 76%), Caucasian (76.6%), with an average age of 43±15.2 years, and 19.8% were immigrants. The retreatments were responsible for 26% of the hospitalizations. The presence of comorbidities was detected in 85.7%, particularly HIV infection (34.7%). The multidrug-resistant (MDR) and the extensively drug resistant (XDR) TB occurred in 6.6% and 6.8%, respectively. The average delay was 28.5±54.8 days, with the mortality rate at 8.6%. The mortality risk was more significant amongst men (OR 1.8; 95%CI 1.16-2.90; p<0.01), in patients with HIV infection (OR 3.7; 95%CI 2.47-5.49; p<0.001), and amongst those who presented MDR TB (OR 2.5; 95%CI 1.24-5.15; p<0.01) and XDR TB (OR 5.5; 95%CI 3.14-9.58; p<0.001). CONCLUSIONS A high percentage of patients presented comorbidities, namely HIV infection. The main factors associated with mortality were HIV infection, XDR TB and MDR TB.
Collapse
Affiliation(s)
- T Lopes
- Serviço de Pneumologia, Unidade de Tuberculose, Hospital Pulido Valente (Centro Hospitalar de Lisboa Norte, EPE), Lisbon, Portugal
| | | | | |
Collapse
|