RESUMO
The combination of molecular and conventional epidemiological methods has improved the knowledge about the transmission of tuberculosis in urban populations. To examine transmission of tuberculosis in Havana, Cuba, with DNA fingerprinting, we studied 51 out of 92 Mycobacterium tuberculosis strains isolated from tuberculosis patients who resided in Havana and whose infection was culture-confirmed in the period from September 1997 to March 1998. Isolates from 28 patients (55%) had unique IS6110 restriction fragment length polymorphism (RFLP) patterns, while isolates from 23 others (45%) had identical patterns and belonged to 7 clusters. Three clusters consisting of six, five and two cases were each related to small outbreaks that occurred in a closed setting. Three other clustered cases were linked to a large outbreak that occurred in another institution. Younger patients were more correlated to clustering than older ones. The finding that 45% of the isolates had clustered RFLP patterns suggests that recent transmission is a key factor in the tuberculosis cases in Havana. The IS6110 RFLP typing made it possible to define the occurrence of outbreaks in two closed institutions.
Assuntos
DNA Bacteriano , Mycobacterium tuberculosis/genética , Polimorfismo de Fragmento de Restrição , Tuberculose/transmissão , Adulto , Idoso , Cuba/epidemiologia , Impressões Digitais de DNA , Surtos de Doenças , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose/epidemiologia , Tuberculose/genéticaRESUMO
The combination of molecular and conventional epidemiological methods has improved the knowledge about the transmission of tuberculosis in urban populations. To examine transmission of tuberculosis in Havana, Cuba, with DNA fingerprinting, we studied 51 out of 92 Mycobacterium tuberculosis strains isolated from tuberculosis patients who resided in Havana and whose infection was culture-confirmed in the period from September 1997 to March 1998. Isolates from 28 patients (55 percent) had unique IS6110 restriction fragment length polymorphism (RFLP) patterns, while isolates from 23 others (45 percent) had identical patterns and belonged to 7 clusters. Three clusters consisting of six, five and two cases were each related to small outbreaks that occurred in a closed setting. Three other clustered cases were linked to a large outbreak that occurred in another institution. Younger patients were more correlated to clustering than older ones. The finding that 45 percent of the isolates had clustered RFLP patterns suggests that recent transmission is a key factor in the tuberculosis cases in Havana. The IS6110 RFLP typing made it possible to define the occurrence of outbreaks in two closed institutions
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , DNA Bacteriano , Mycobacterium tuberculosis/genética , Polimorfismo de Fragmento de Restrição , Tuberculose/transmissão , Cuba/epidemiologia , Surtos de Doenças , Impressões Digitais de DNA , Incidência , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose/epidemiologia , Tuberculose/genéticaRESUMO
BACKGROUND: The province of Havana City, the capital and most densely populated city in Cuba, totals around 27% of the new cases of tuberculosis. This article is for the purpose of describing the distribution and trend of the tuberculosis cases rates from 1986 to 1998, by municipalities and age groups in this province. METHOD: A calculation was made of the rates and of the total percentage of deviation of these rates, in addition to the annual average deviation both throughout two time periods and between the two (1986-1993 and 1994-1998). The trends were calculated by simple linear regression. RESULTS: Throughout the 1986-1993 period, the case rate for this province underwent a 6% increase. Throughout the 1994-1998 period, it dropped by 7.3%. The three most densely-populated cities showed a higher rate increase. Of the 15 municipalities, only La Lisa showed a drop in the rates throughout the entire period in question. The rates by ages were similar throughout all of the municipalities, being higher for individuals > 65 years of age. Six tenths (0.6%) of the cases reported involved people under 15 years of age. The infantile tuberculosis rates were very low for the time period under analysis. CONCLUSIONS: The differences among the municipalities in question make it necessary for different measures to be taken to achieve a greater impact and repercussion in Cuba. The drop in the rates detected over the last three years is indicative of the epidemic being brought under control and the national tuberculosis control program being reinstated.
Assuntos
Tuberculose/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Criança , Pré-Escolar , Cuba/epidemiologia , Humanos , Incidência , Lactente , Pessoa de Meia-Idade , População UrbanaRESUMO
Se expuso el resultado del seguimiento de 94 casos de tuberculosis pulmonar en dos áreas de verificación del Programa Nacional de Control. En este grupo de pacientes no hubo pérdidas en el tratamiento. La proporción de cepas resistentes en 37 casos investigados, alcanzó el 43 por ciento aunque no pueden establecerse concluciones definitivas al respecto. La conversión de los esputos alcanzó el 84 por ciento. En el grupo de pacientes resistentes fue el 62 por ciento. Se exponen planteamientos alrededor de estos hallazgos y se señala que tal ves la modificación de la fase inicial de tratamiento, añadiendo la thiocetazona y prolongando la administración diaria hasta 8 semanas, se obtengan ersultados aún más favorables(AU)
Assuntos
Humanos , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/prevenção & controle , Tuberculose Pulmonar/terapia , Escarro/microbiologiaRESUMO
Se expuso el resultado del seguimiento de 94 casos de tuberculosis pulmonar en dos áreas de verificación del Programa Nacional de Control. En este grupo de pacientes no hubo pérdidas aunque no pueden establecerse conclusiones definitivas al respecto. La conversión de los esputos alcanzó el 84(por ciento). En el grupo de pacientes resistentes fue el 62(por ciento). Se exponen planteamientos alrededor de estos hallazgos y se señala que tal vez la modificación de la fase inicial de tratamiento, añadiendo la thioacetazona y prolongando la administración diaria hasta 8 semanas, se obtengan resultados aun más favorables(AU)
Assuntos
Animais , Ratos , Tuberculose/epidemiologiaRESUMO
Se presenta el resultado de las actividades realizadas durante dos años de ejecución del Programa de Control de la Tuberculosis integrado a los Servicios Generales de salud, también denominado programa horizontal, y que segùn el criterio del Comité de Expertos de la OMS es el más aconsejable. Se verifica, en la Provincial Oriente-Norte, el rendimiento elevado que se obtiene en el diagnóstico, tratamiento y curación de los nuevos casos de tuberculosis pulmonar y en el examen y protección de sus contactos. Se plantea que la extensión del programa a toda la nación y su enrequecimiento por el aporte de la experiencia nacional en internacional nos llevará al muy cercano control de la tuberculosis y más adelante a su erradicación(AU)