Learning from the Italian experience in coping with COVID-19

Introduction: In March 2020, the rapid increase in COVID-19 cases overburdened the Italian health system, with the country becoming the pandemic’s epicenter. Methods: We present a narrative review based on manuscripts, official documents, and newspaper articles regarding COVID-19 in Italy. Results: Characteristics of the epidemic, possible causes for its worsening, and the measures adopted across Italian regions are presented. Conclusions: In the early stages of an epidemic, effective decision-making is essential to contain the number of cases. Medical support for patients and social isolation measures are the most appropriate strategies currently available to reduce the spread and lethality of COVID-19

Barriers faced by patients in the diagnosis of multidrug-resistant tuberculosis in Brazil

OBJECTIVE To understand patients’ narratives about the barriers they faced in the diagnosis and treatment of multidrug-resistant tuberculosis, and their consequences in Rio de Janeiro State, Brazil. METHODS This is a qualitative cross-sectional study with non-probabilistic sampling. A theoretical saturation criterion was considered for composing the number of interviewees. Semi-structured interviews were conducted from August to December 2019 with 31 patients undergoing treatment for multidrug-resistant tuberculosis at an outpatient referral center in Rio de Janeiro. Data were transcribed and processed with the aid of the NVIVO software. Interviews were evaluated by content analysis, and their themes, cross-referenced with participants’ characterization data. RESULTS Our main findings were: a) participants show a high proportion of primary drug resistance, b) patients experience delays in the diagnosis and effective treatment of multidrug-resistant tuberculosis ; c) healthcare providers fail to value or seek the diagnosis of drug-resistant tuberculosis, thus beginning the inadequate treatment for drug-susceptible tuberculosis, d) primary health units show low report rates of active case-finding and contact monitoring, and e) patients show poor knowledge about the disease. CONCLUSIONS We need to improve referral systems, and access to the diagnosis and effective treatment of multidrug-resistant tuberculosis; conduct an active investigation of contacts; intensify the training of healthcare providers, in collaboration with medical and nursing schools, in both public and private systems; and promote campaigns to educate the population on tuberculosis signs and symptoms

Clinical presentation and survival of smear-positive pulmonary tuberculosis patients of a University General Hospital in a developing country

From January 1995 to August 1997 we evaluated prospectively the clinical presentation, laboratory findings and short-term survival of smear-positive pulmonary tuberculosis (TB) patients who sought care at our hospital. After providing informed, written consent, the patients were interviewed and laboratory tests were performed. Information about survivorship and death was collected through September 1998. Eighty-six smear-positive pulmonary TB patients were enrolled; 26.7% were HIV-seropositive. Seventeen HIV-seronegative pulmonary TB patients (19.8%) presented chronic diseases in addition to TB. In the multiple logistic regression analysis a CD4+ cell count or = 50 years were independently associated with decreased survival. Among HIV-seronegative persons, the presence of an additional disease increased the risk of death of almost six-fold. Use of antiretroviral drugs was associated with a lower risk of death among HIV-seropositive smear-positive pulmonary TB patients (RH = 0.32, 95% CI 0.10-0.92). In our study smear-positive pulmonary TB patients had a low short-term survival rate that was strongly associated with HIV infection, age and co-morbidities. Therapy with antiretroviral drugs reduced the short-term risk of death among HIV-seropositive patients after TB diagnosis

DAILY OF THE ENROLLED CARRIERS OF TUBERCULOSIS IN PROGRAM OF TREATMENT OF A UNIVERSITY HOSPITAL IN THE CITY OF RIO DE JANEIRO

Objective: To analyze the existential daily life of the patient in treatment in pulmonary tuberculosis, taking like base his history of life. Method: Qualitative study. There was used the phenomenology of Heidegger. There were interviewed eleven patients registered in the Program of Control of Tuberculosis Hospital of a university hospital of the Rio of January. Results: The analysis hermeneutic was revealed what the patient shows off in the way of being of the daily life with fear and anguish of infecting his relatives and one feels marked by the stigma in his community. Conclusion: We end that in the perspective of the treatment of pulmonary tuberculosis the presence of the team of the program develops the emergence of the being with other in the movement ex-sistencial and that this way of being favors during the validity of the treatment, the overcoming of the difficulties of the daily life of the patients who live in his time and own space, the expectation of being cured. DESCRIPTORS: Pulmonary Tuberculosis – Qualitative Research – Phenomenology – Daily routine of the Treatment of TuberculosisObjetivo - Analisar o cotidiano existencial do paciente em tratamento em tuberculose pulmonar, tomando como base sua historia de vida. Método: Estudo qualitativo. Utilizou-se o referencia da fenomenologia de Heidegger. Foram entrevistados onze pacientes inscritos no Programa de Controle de Tuberculose Hospitalar de um hospital universitário do Rio de Janeiro. Resultados: A análise hermenêutica desvelou que o paciente mostra-se no modo de ser da cotidianidade com temor e angústia de contagiar seus familiares e se sente marcado pelo estigma em sua comunidade. Conclusão: Concluímos que na perspectiva do tratamento de tuberculose pulmonar a assistência da equipe do programa desenvolve a emergência do ser-com o outro no movimento ex-sistencial e que este modo de ser favorece durante a vigência do tratamento, a superação das dificuldades do cotidiano dos pacientes que vivem no seu tempo e espaço próprio, a expectativa de se verem curados. DESCRITORES: Tuberculose Pulmonar – Pesquisa Qualitativa – Fenomenologia – Cotidiano do Tratamento

Association between Human T-Cell Lymphotropic Virus Type 1 and 2 (HTLV 1/2) infection and tuberculosis: systematic review and meta-analysis

Background HTLV-1 infection alters the immune function and increases the risk of several infectious diseases. In this meta-analysis, we assess the association between HTLV- 1/2 and active tuberculosis (TB). Methods Four databases were searched for relevant articles that describe the frequency of HTLV- 1/2 infection among TB patients and control groups of healthy individuals or patients without a history of TB. Data were analyzed using the EasyMA software. Results The search yielded two hundred and eight articles. Six met the inclusion criteria and were included in the meta-analysis. The estimated relative risk of HTLV- 1/2 infection in TB patients was 3.25 times higher than in the population based control groups. Conclusion Patients with active TB have a higher risk of HTLV- 1/2 infection. Prospective studies involving latent tuberculosis infection (LTBI) in HTLV-1-infected individuals are necessary to evaluate the potential benefit of TB chemoprophylaxis

Usefulness of the polymerase chain reaction dot-blot assay, used with Ziehl-Neelsen staining, for the rapid and conveni­ent diagnosis of pulmonary tuberculosis in human immuno­deficiency virus-seropositive and -seronegative individuals

There are scarce data regarding the value of molecular tests, when used in parallel with classical tools, for the diagnosis of tuberculosis (TB) under field conditions, especially in regions with a high burden of TB-human immunodeficiency virus (HIV) co-infection. We evaluated the usefulness of the polymerase chain reaction dot-blot assay (PCR) used in parallel with Ziehl-Neelsen staining (ZN) for pulmonary tuberculosis (PTB) diagnosis, in a TB-HIV reference hospital. All sputum samples from 277 patients were tested by ZN, culture, and PCR. Performances were assessed individually, in parallel, for HIV status, history of anti-TB treatment, and in different simulated TB prevalence rates. Overall, the PTB prevalence was 46% (128/277); in HIV-seropositive (HIV+) individuals, PTB prevalence was 54% (40/74); the ZN technique had a lower sensitivity (SE) in the HIV+ group than in the HIV-seronegative (HIV–) group (43% vs. 68%; Fisher test, P<0.05); and the SE of PCR was not affected by HIV status (Fisher test; P=0.46). ZN, in parallel with PCR, presented the following results: i) among all PTB suspects, SE of 90%, specificity (SP) of 84%, likelihood ratio (LR)+ of 5.65 and LR– of 0.12; ii) in HIV– subjects: SE of 92%, LR– of 0.10; iii) in not previously treated cases: SE of 90%, LR– of 0.11; iv) in TB, prevalence rates of 5-20%; negative predictive values (NPV) of 98-99%. ZN used in parallel with PCR showed an improvement in SE, LR–, and NPV, and may offer a novel approach in ruling out PTB cases, especially in not previously treated HIV– individuals, attended in hospitals in developing nations

Gene-Xpert Ultra for the diagnosis of extrapulmonary tuberculosis in children and adolescents

This prospective study describes the use of Gene-Xpert Ultra for the diagnosis of extrapulmonary tuberculosis (EPTB) in children and adolescents, in Rio de Janeiro, Brazil. Eighteen patients were studied; the final diagnosis of EPTB was established in 13 (72%). Gene-Xpert Ultra results showed detection in 10/13 (77%) of EPTB cases (7 of these 10 with trace-positive results). Gene-Xpert Ultra proved to be a promising method for the diagnosis of childhood EPTB

Duas décadas de pesquisa em tuberculose no Brasil: estado da arte das publicações científicas

The trends of scientific articles about tuberculosis in Brazil published between 1986 and 2006 were analyzed. This analysis included Capes database-indexed dissertations and theses and papers indexed in Medline and SciELO. Papers containing the word "tuberculosis" and authors affiliated to Brazilian institutions were included in the assessment. The analysis showed initially case report and review publications, and later it shifted to original articles on science, technology and innovation. These changes may reflect the strengthening of scientific research activities and new attitudes regarding tuberculosis research objectives in academic institutions in recent years. Although many theses used qualitative methodology, few qualitative publications were found, possibly because of the quantitative orientation of many journals. Qualitative versus quantitative research and education versus research-oriented publications are discussed, together with public policies and strategies to include research as a tool to control diseases. The use of the same methodology is suggested to assess the trends in research on other neglected diseases.A tendência das publicações brasileiras em tuberculose referente ao período de foi analisada no período 1986 a 2006. Esta análise incluiu dissertações e teses registradas da Capes e artigos indexados na base de dados Medline e no SciELO. A seleção das publicações foi realizada por busca pela palavra "tuberculose" e instituições brasileiras a que se afiliavam os autores. A análise mostrou inicialmente publicações do tipo relatos de caso e revisões, e posteriormente artigos originais em ciência, tecnologia e inovação científica. Estas mudanças podem refletir o incremento das atividades de pesquisa nas instituições acadêmicas e novas atitudes relativas aos objetivos da pesquisa em tuberculose nos últimos anos. Embora muitas teses tenham utilizado metodologia qualitativa, poucos artigos nessa modalidade foram encontrados, possivelmente refletindo a orientação quantitativa das revistas. Discutem-se pesquisa quantitativa versus qualitativa e educação versus pesquisa, assim como políticas públicas e estratégias para incluir a pesquisa como instrumento de controle das doenças. Sugere-se a utilização da mesma metodologia para analisar as tendências da pesquisa em outras doenças negligenciadas

Evaluation of the commercial kit SIRE Nitratase for detecting resistant Mycobacterium tuberculosis in Brazil

This study was supported by the Minas Gerais State Research Support Foundation (FAPEMIG) protocol number 65/10 and the National Council for Scientific and Technological Development [Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)] protocol number 310174/2014-7-CNPQ.Universidade Federal de Minas Gerais. Faculdade de Medicina. Grupo de Pesquisa em Micobactérias. Belo Horizonte, MG, Brasil.Universidade Federal de Minas Gerais. Faculdade de Medicina Grupo de Pesquisa em Micobactérias. Belo Horizonte, MG, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Universidade Federal de Minas Gerais. Faculdade de Medicina Grupo de Pesquisa em Micobactérias. Belo Horizonte, MG, Brasil.Universidade Federal de Minas Gerais. Faculdade de Medicina Grupo de Pesquisa em Micobactérias. Belo Horizonte, MG, Brasil.Universidade Federal do Rio de Janeiro. Programa Acadêmico de Tuberculose. Rio de Janeiro, RJ, Brasil.Universidade Federal de Minas Gerais. Faculdade de Farmácia. Belo Horizonte, MG, Brasil.Universidade Federal de Minas Gerais. Consultoria e Apoio Técnico. Belo Horizonte, MG, Brasil.Introduction: This study aimed to evaluate a new commercial kit, Kit SIRE Nitratase-PlastLabor, for testing the drug susceptibility of clinical Mycobacterium tuberculosis isolates. Methods: The accuracy of the Kit SIRE Nitratase was evaluated by examining the susceptibility (streptomycin, isoniazid, rifampicin, and ethambutol) of 40 M. tuberculosis isolates, using the proportion method with Lowenstein-Jensen medium or the BACTEC MGIT 960 system. Results: The detection accuracy for streptomycin, isoniazid, rifampicin, and ethambutol was 95%, 97.5%, 100%, and 80%, respectively. Conclusions: The exceptional accuracy demonstrated by Kit SIRE Nitratase for isoniazid and rifampicin makes the kit an attractive option for screening M. tuberculosis strain resistance