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

Diagnosis of pulmonary tuberculosis in children and adolescents: comparison of two versions of the Brazilian Ministry of Health scoring system

The aim of this study was to evaluate the concordance between two versions of the scoring system (2011 and 2019), recommended by the Brazilian Ministry of Health, for the diagnosis of pulmonary tuberculosis (PTB) in children and adolescents. A retrospective descriptive study was performed to assess the medical records of children and adolescents with PTB, in TB units from Brazilian cities located in Rio de Janeiro, Minas Gerais, and Parana States, from January 1st, 2004, to December 1st, 2018. Patients aged 0 to 18 years old with a diagnosis of PTB were included. The comparison between the two scoring systems showed a moderate concordance according to the κ coefficient value = 0.625. Fourteen patients showed a reduction in the TB score, going from 30 points in the 2011, to 25 points or less in the 2019 one. Seventy one percent of these 14 patients had radiological changes suggestive of PTB and 86% had tuberculin skin tests greater than 10 mm. The study concluded that a moderate agreement was observed between the 2011 and 2019 scoring systems, with an increase in the number of patients scoring 25 points or less in 2019, which can eventually hinder the diagnosis of PTB

Biomarcadores séricos: ferramenta para o diagnóstico diferencial entre tuberculose latente e tuberculose pulmonar em crianças e adolescentes

As crianças representam 10% dos casos de tuberculose (TB) no mundo e a confirmação bacteriológica nesse grupo continua um desafio, pois desenvolvem formas paucibacilares de TB pulmonar (TBP). Diferenciar casos de infecção latente da TB (ILTB) e TBP nem sempre é fácil. A prova tuberculínica (PT) e a dosagem de interferon gama (Igras) apresentam limitações e não diferenciam ILTB da TB ativa. Os biomarcadores despertam o interesse pelo potencial de uso em testes rápidos como os point of care (POC) testes. A parede celular do Mycobacterium tuberculosis é complexa, com lipídeos e proteínas capazes de estimular a síntese de anticorpos no hospedeiro. Esse estudo de corte transversal, com inclusões prospectivas, realizado de agosto de 2014 a junho de 2017, teve como objetivo avaliar se os níveis séricos das imunoglobulinas IgM anti- cardiolipina, - sulfatide, - ácido micólico, -proteína Mce 1A e IgG anti- proteína Mce 1A são capazes de diferenciar a ILTB de TBP em crianças e adolescentes. Os participantes foram divididos em 3 grupos: controle - contatos de TB, assintomáticos, radiografia de torax normal e PT negativa; ILTB - contatos de TB, assintomáticos, com radiografia de tórax normal e PT positiva e TBP - pacientes com sinais, sintomas, alterações laboratoriais e radiológicas sugestivas de doença ativa, selecionados em unidades de saúde de seis municípios do estado do RJ, Brasil. Realizou-se a dosagem dos biomarcadores pelo teste Elisa no soro. A análise estatística foi realizada através do programa The Graphprism (version 5.0). Para a comparação dos níveis dos biomarcadores utilizou-se o teste de Kruskal-Wallis, seguido de pós teste Dunn ou teste de Mann - Whitney e o teste T quando indicado. As variáveis categóricas foram analisadas pelo teste do qui-quadrado. O nível de significância foi estabelecido em p< 0,05. Com a análise da curva ROC avaliou-se a sensibilidade e a especificidade. Foram incluídos 107 pacientes entre zero e 19 anos, distribuídos nos grupos controle (n=20), ILTB (n=44) e TBP (n=43). A mediana de idade foi de 7 anos (intervalo interquartil=IIQ: 4,3 – 9) no grupo controle, 8,5 anos no ILTB (IIQ: 4 -11) e 11 anos no TBP (IIQ: 1,9 -15), com p= 0,47,sem diferença entre os gêneros. Na amostra geral, o título de IgG Mce 1A foi maior naqueles com TBP comparados àqueles com ILTB. A análise através da curva ROC evidenciou AUC= 0,73 com p= 0,0002. Para o cut-off de 0,26 DO (IC 95%= 0,628 – 0,836) a sensibilidade foi de 72,09% e a especifidade de 63,64%. Ao compararmos o grupo TBP BACT+ (algum teste bacteriológico +) com ILTB, a sensibilidade foi de 73,7% e a especificidade de 63,7% e para TBP BACT+ vs controle, 73,7% e 70% respectivamente. Os anticorpos IgM anti cardiolipina, sulfatide, ácido micólico e proteína Mce 1A não discriminaram ILTB de TBP e seus níveis foram mais elevados no grupo controle. Os níveis de IgG Mce 1A foram mais elevados nas crianças e adolescentes com TBP se comparadas àquelas com ILTB, mostrando o potencial uso desse biomarcador como ferramenta inicial no diagnóstico de TB em pediatriaChildren are estimated to account for 10% of tuberculosis (TB) cases worldwide.However, bacteriological confirmation in this group remains a challenge, as they most often develop paucibacillary forms of pulmonary TB (PTB). Additionally, the tuberculin skin test (TST) and interferon gamma release assays (IGRAs) present diagnostic limitations and do not differentiate LTBI from active TB. Serum biomarkers have been proposed as a potential alternative for use in rapid tests such as point of care (POC) tests. The cell wall of Mycobacterium tuberculosis is composed of lipids and proteins capable of stimulating the synthesis of antibodies in the host. This cross-sectional study, with prospective inclusions from August 2014 to June 2017, had the objective of evaluating whether serum levels of the biomarkers are capable of differentiating LTBI from pulmonary TB in children and adolescents. The participants were included at health units of six municipalities in the state of Rio de Janeiro, Brazil and divided into 3 groups: control -TB contacts, asymptomatic, with normal chest radiography and negative TST; LTBI - TB contacts, asymptomatic, with normal chest radiography and positive TST; and pulmonary TB - patients with signs, symptoms, laboratory and radiological findings suggestive of active disease. Serum anti-cardiolipin, -sulfatide, -mycolic acid, and -Mce1A IgM, and anti-Mce1A IgGwere assayed by the ELISA method. Statistical analysis was performed using GraphPadPrism (version 5.0). The Kruskal-Wallis test was used to compare biomarkers levels, followed by the Dunn test or the Mann-Whitney test and the T test when indicated. Categorical variables were analyzed using chi-square tests. The level of significance was set at p <0.05. Sensitivity and specificity were assessed by analysis of the ROC curve. Of the 107 participants, 20 were classified as control, 44 as LTBI and 43 as PTB. The median age was 7 years (interquartile range = IQR: 4.3 - 9) in the control group, 8.5 years in the LTBI (IQR: 4 - 11) and 11 years in the PTB (IQR: 1.9 - 15), with p= 0.47. There was no difference between genders. In all age groups, the anti-Mce1A IgG titer was higher in those with PTB compared to those with LTBI. Analysis across the curve showed the AUC = 0.73 with p= 0.0002. For the cut-off of 0.26 OD (95% CI = 0.628-0.88), sensitivity was 72.09% and specificity was 63.64%. When comparing the BACT+ PTB group with LTBI, sensitivity was 73.7% and specificity was 63.7% (cut-off = 0.26) and for the comparison of BACT+ PTB vs control, 73.7% and 70 % respectively. Anti-cardiolipin, sulfatide, mycolic acid and Mce1A IgM did not discriminate LTBI and PTB,and their levels were higher in the control group. Anti-Mce 1A IgG levels were higher in children and adolescents with PTB compared to those with LTBI, showing the potential use of these biomarkers as a tool for the diagnosis of TB in the pediatric group121f

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

Tuberculosis among adolescents in two Brazilian State capitals

Barreto, Mauricio Lima. “Documento produzido em parceria ou por autor vinculado à Fiocruz, mas não consta à informação no documento”.Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2018-04-03T12:49:48Z No. of bitstreams: 1 Sant Anna CC Tuberculose em adolescentes em duas capitais...pdf: 67313 bytes, checksum: acb804ba8fe4aab30c20242ea9b44246 (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2018-04-03T13:06:15Z (GMT) No. of bitstreams: 1 Sant Anna CC Tuberculose em adolescentes em duas capitais...pdf: 67313 bytes, checksum: acb804ba8fe4aab30c20242ea9b44246 (MD5)Made available in DSpace on 2018-04-03T13:06:15Z (GMT). No. of bitstreams: 1 Sant Anna CC Tuberculose em adolescentes em duas capitais...pdf: 67313 bytes, checksum: acb804ba8fe4aab30c20242ea9b44246 (MD5) Previous issue date: 2013Universidade Federal do Rio de Janeiro. Instituto de Puericultura e Pediatria Martagão Gesteira. Rio de Janeiro, RJ, BrasilUniversidade Federal Fluminense. Hospital Universitário Antônio Pedro. Niterói, RJ, BrasilUniversidade Federal do Rio de Janeiro. Instituto de Puericultura e Pediatria Martagão Gesteira. Rio de Janeiro, RJ, Brasil / Universidade Federal Fluminense. Hospital Universitário Antônio Pedro. Niterói, RJ, BrasilUniversidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, BrasilUniversidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, BrasilAnalisamos 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 ≥ 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 ≥ 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 ≥ 15 anos. Havia radiografias de tórax do tipo adulto em 1.088 (98.6%) no grupo de ≥ 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.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 ≥ 15-year PTB group (p < 0.001). Chest x-rays were classified as: adulttype TB in 1,088 (98.6%) in the ≥-15 year group; 258 (98.1%) in the < 15-year group (p < 0.0001). Adult type bacteriological PTB increased in proportion to age.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 ≥ 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 ≥ 15 años (p < 0,001). La baciloscopia fue positiva en 150 (72,1%) con TB pulmonar, en el grupo de 10 a 14 años, y en 870 (84,4%) en el grupo de ≥ 15 años. Había radiografías de tórax del tipo adulto en 1.088 (98.6%) en el grupo de ≥ 15 años, y en 58 (98.1%) en el grupo < 15 años (p < 0.0001). Hubo tendencia a una mayor ocurrencia de TB bacteriológica de tipo adulto, a medida que el paciente aumentaba de edad

Rare manifestations of tuberculosis in children: a case series

Tuberculose (TB) é uma doença infectocontagiosa que impõe um desafio na prática pediátrica, uma vez que crianças podem apresentar manifestações raras, o que dificulta o seu diagnóstico. São apresentados cinco casos de manifestações pouco comuns de TB em crianças vacinadas com BCG ao nascer e sem história de contato prévio com adulto bacilífero. Ressalta-se a dificuldade e a importância da suspeição diagnóstica da TB em quadros raros da doença em crianças.SimTuberculosis (TB) is an infectious and contagious disease that poses a challenge in pediatric practice, since children can present rare manifestations, which makes their diagnosis difficult. Five cases of uncommon manifestations of TB are presented in children vaccinated with BCG at birth and with no history of previous contact with bacilliferous adults. The difficulty and importance of the diagnostic suspicion of TB in rare cases of the disease in children is emphasized