Avaliação retrospectiva de sistema de pontuação pelo Ministério da Saúde do Brasil, no diagnóstico de tuberculose pulmonar na criança: estudo controle de casos

Based on a retrospective case-control study we evaluated the score system adopted by the Ministry of Health of Brazil (Ministério da Saúde - MS), to diagnose pulmonary tuberculosis (PTB) in childhood. This system is independent of bacteriological or histopathological data to define a very likely (>; or = 40 points), possible (30-35 points) or unlikely (;10mm (OR = 8.23). The best cut-off point to the diagnosis of PTB was 30 points, where the score system was more accurate, with sensitivity of 88.9% and specificity of 86.5%.Avaliou-se o sistema de pontuação adotado pelo Ministério da Saúde do Brasil para o diagnóstico de tuberculose pulmonar (TP) na infância através de estudo caso-controle retrospectivo. Tal sistema independe de dados bacteriológicos ou histopatológicos e define o diagnóstico de tuberculose como muito provável (>; ou = 40 pontos); possível (30 a 35 pontos) ou pouco provável (; 10 mm (OR = 8,23). O melhor ponto de corte para o diagnóstico de TP foi 30 pontos, no qual houve maior acurácia do sistema, com sensibilidade de 99,9% e especificidade de 86,5%

Radiologic findings of pulmonary tuberculosis in adolescents

AbstractObjectiveTo describe radiologic findings of pulmonary tuberculosis (TB) in adolescents.MethodsRetrospective, cross-sectional, observational study of 850 patients with TB, aged 10 to 19 years, and notified to the Brazilian Ministry of Health. Data were collected from the TB notification and medical records in the cities of Manaus, Amazonas State, and Salvador, Bahia State, in the 1996–2003 period. Data are shown in tables and analyzed using the chi-square and Mann-Whitney tests, with a 5% significance level.ResultsMean age was 15.6 years; 443 (52.1%) patients were males. The most common radiologic lesion was the upper pulmonary lobe infiltrate (53.3%), and isolated cavitation was found in 32.4% of the patients. Both lungs were affected in 29.2% of the patients. The finding of bilateral radiologic lesions was significantly associated with longer disease duration (p = 0.0005).ConclusionsPulmonary TB in adolescents has similar characteristics to TB in adults, evidencing the important role played by adolescents in community disease transmission

Tuberculose em adolescentes em duas capitais brasileiras

Analisamos o perfil clínico-radiológico da tuberculose (TB) em adolescentes de duas capitais brasileiras, segundo a revisão de 2010 das normas do Programa Nacional de Controle da Tuberculose; estudo descritivo, retrospectivo, transversal de casos notificados de TB em Manaus e Salvador, de 1996 a 2003, em dois grupos: 10 a 14 anos e &#8805; 15 a 19 anos com estatística descritiva. Havia 1.781 adolescentes [928 (52,1%) do sexo masculino]. A média de idade = 16 anos (mediana = 16; DP = 2,3). Encontramos 1.447 (82,9%) pacientes com TB pulmonar; 179 (10,3%) com TB pleural e 81 (4,6%) com ganglionar periférica. A tosse ocorreu mais no grupo &#8805; 15 anos (p < 0,001). A baciloscopia foi positiva em 150 (72,1%) com TB pulmonar no grupo de 10 a 14 anos, e em 870 (84,4%) no grupo de &#8805; 15 anos. Havia radiografias de tórax do tipo adulto em 1.088 (98.6%) no grupo de &#8805; 15 anos, e em 58 (98.1%) no grupo < 15 anos (p < 0.0001). Houve tendência à maior ocorrência de TB bacteriológica do tipo adulto na medida em que o paciente aumentava de idade

Pediatric tuberculosis in the metropolitan area of Rio de Janeiro

Aim: To evaluate the clinical characteristics, diagnostic approach, and treatment outcomes of tuberculosis (TB) in children living in a high-burden metropolitan area. Methods: This was a retrospective study, based on a medical chart review, involving children under 15 years old treated for TB between 2007 and 2016, in four primary health units (PHU) and three reference centers (RC) in five cities of Rio de Janeiro metropolitan area. Factors associated with TB treatment setting, microbiological diagnosis, and treatment outcomes were evaluated. Results: A total of 544 children were enrolled; 71% were treated in PHU, 36% were under 5 years old, and 72% had pulmonary TB (PTB). The HIV prevalence was 10% (31/322). Fifty-three percent had at least one microbiological test for TB, 68% of them (196/287) had TB confirmed. Among 222 children with previous TB contact, information on LTBI was available for 78 (35%), and only 17% (13/78) were treated. Extrapulmonary TB (56% vs 32%), microbiologically confirmed TB (77% vs 60%), and HIV positivity (18.5% vs 4.0%) were significantly more frequent in RC. Treatment in RC (odds ratio (OR) 3.08, 95% confidence interval (CI) 1.74–5.44) and PTB (OR 2.47, 95% CI 1.34–4.56) were independently associated with a microbiological diagnosis of TB. The treatment success rate was 85%. In the logistic regression analysis, HIV-infected children had a 2.5-fold higher risk of an unfavorable outcome (OR 2.53, 95% CI 1.0–6.38; p = 0.05). Conclusions: Opportunities for TB prevention and early TB treatment are missed due to suboptimal close contact screening. Microbiological diagnosis of TB and drug susceptibility testing in children should be made available through more sensitive and accessible tests

Tuberculose em adolescentes em duas capitais brasileiras Tuberculosis en adolescentes de dos capitales brasileñas Tuberculosis among adolescents in two Brazilian State capitals

Analisamos o perfil clínico-radiológico da tuberculose (TB) em adolescentes de duas capitais brasileiras, segundo a revisão de 2010 das normas do Programa Nacional de Controle da Tuberculose; estudo descritivo, retrospectivo, transversal de casos notificados de TB em Manaus e Salvador, de 1996 a 2003, em dois grupos: 10 a 14 anos e &#8805; 15 a 19 anos com estatística descritiva. Havia 1.781 adolescentes [928 (52,1%) do sexo masculino]. A média de idade = 16 anos (mediana = 16; DP = 2,3). Encontramos 1.447 (82,9%) pacientes com TB pulmonar; 179 (10,3%) com TB pleural e 81 (4,6%) com ganglionar periférica. A tosse ocorreu mais no grupo &#8805; 15 anos (p Analizamos el perfil clínico-radiológico de la tuberculosis (TB) en adolescentes de dos capitales brasileñas, según la revisión de 2010 de las normas del Programa Nacional de Control de la Tuberculosis, estudio descriptivo, retrospectivo, transversal de casos notificados de TB en Manaus y Salvador, de 1996 a 2003, en dos grupos: 10 a 14 años y &#8805; 15 a 19 años con estadística descriptiva. Había 1.781 adolescentes [928 (52,1%) del sexo masculino]. La media de edad = 16 años (mediana = 16; DP = 2,3). Encontramos 1.447 (82,9%) pacientes con TB pulmonar; 179 (10,3%) con TB pleural y 81 (4,6%) con ganglionar periférica. La tos ocurrió más en el grupo &#8805; 15 años (p The study analyzed clinical, laboratory, and radiological characteristics of tuberculosis (TB) among adolescents from two Brazilian State capitals, according to the 2010 Updated Guidelines of the National TB Control Program (NTPC) through a descriptive, retrospective cross-sectional study of reported TB cases from Manaus and Salvador from 1996 to 2003. Patients were divided into two groups: 10 to 14 years and 15 to 19 years of age. Variables were studied through descriptive statistics; 1,781 adolescents were included; 928 (52.1%) were males. Median age was 16 years (SD = 2.3). Pulmonary TB (PTB) occurred in 1,447 patients (82.9%), pleural TB in 179 (10.3%), and peripheral adenopathy in 81 (4.6%). Cough was more frequent in the &#8805; 15-year PTB group (p < 0.001). Chest x-rays were classified as: adult-type TB in 1,088 (98.6%) in the &#8805;-15 year group; 258 (98.1%) in the < 15-year group (p < 0.0001). Adult type bacteriological PTB increased in proportion to age