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

Hemócitos de Bradybaena similaris e Megalobulimus abbreviatus (Gastropoda, Stylommatophora)

Hemocytes act in the defense system against invading organisms, foreign particles aiding the recognition of what is own to the body of gastropods and what is not. Information and studies on the hemocytes in species of mollusks healthy (no infections), especially in Bradybaena similaris (Fèrussac, 1821) and Megalobulimus abbreviatus (Bequaert, 1948) are scarce. Therefore, this work aims at characterization and quantification of hemocytes present in the hemolymph of these two species. In this work three cell types were identified in the hemolymph of both species: round cells, hyalinocytes and granulocytes. The three types of hemocytes were measured, and the average of total diameter and the nucleus for each was calculated. On B. similaris, the average diameter of round cells was 10.7 μm, of hyalinocytes was 20 μm and of granulocytes was 25.4 μm. On M. abbreviatus, the average diameter of round cells was 11.7 μm, of hyalinocytes was 21.5 μm and of granulocytes was 30.5 μm. Although the hyalinocytes have similar averages between B. similaris and M. abbreviatus, the cells were demonstrated significant differences in their total diameter and size of the nucleus (p<0.0001). The average density of cells per ml without distinction of cellular type was 197,813 cells/ml for M. abbreviatus, and 416,333 cells/ml for B. similaris. The most frequent hemocytes in M. abbreviatus and B. similaris were hyalinocytes, unlike other gastropods.Os hemócitos atuam no sistema de defesa contra organismos invasores e partículas estranhas, auxiliando o reconhecimento do que é próprio do corpo dos grastrópodes e o que não é. São escassas as informações e estudos sobre os hemócitos em espécies de moluscos saudáveis (sem infecções), principalmente em Bradybaena similaris (Fèrussac, 1821) and Megalobulimus abbreviatus (Bequaert, 1948). Portanto, este trabalho tem como objetivos a caracterização e quantificação dos hemócitos presentes na hemolinfa destas duas espécies. Neste trabalho, foram identificados três tipos celulares na hemolinfa de ambas espécies: as células redondas, hialinócitos e granulócitos. Os três tipos de hemócitos foram medidos e foi calculada a média do diâmetro total e do núcleo para cada um deles. Para B. similaris, o diâmetro médio das células redondas foi de 10,7 μm, dos hialinócitos foi de 20 μm e dos granulócitos de 25,4 μm. Para M. abbreviatus, o diâmetro médio foi de 11,7 μm para as células redondas, de 21,5 μm para os hialinócitos e de 30,5 μm para os granulócitos. Embora os hialinócitos possuam médias parecidas entre B. similaris e M. abbreviatus, foram detectadas diferenças significativas do diâmetro celular total e diâmetro do núcleo (p<0,0001) dessas células entre as espécies estudadas. A densidade média de células por ml, sem distinção de tipo celular foi de 197.813 células/ml para M. abbreviatus, e de 416.333 células/ml para B. similaris. Diferentemente de outros gastrópodes, os hemócitos mais frequentes em M. abbreviatus e em B. similaris foram os hialinócitos