RESUMO
El compromiso ocular es una forma extrapulmonar de tuberculosis. Puede comprometer cualquier componente del sistema visual. Las manifestaciones oculares pueden ser causadas por una infección activa que invade el ojo o por una reacción inmunológica de hipersensibilidad retardada. Las presentaciones clínicas más comunes son uveítis anterior crónica, coroiditis y esclero-queratitis. A pesar de la existencia de herramientas moleculares altamente sensibles, arribar al diagnóstico de formas poco frecuentes o no pensadas como la TB ocular en un niño sigue siendo un gran reto y se basa en la presentación clínica, evaluación sistémica y la respuesta terapéutica. El tratamiento implica el uso de antifímicos y, muchas veces, esteroides. El objetivo fue presentar una forma de tuberculosis endoftálmica, pulmonar miliar y meníngea, en el marco de la drogorresistencia.
Eye engagement is an extrapulmonary form of tuberculosis. It can compromise any component of the visual system. Eye manifestations can be caused by an active infection that invades the eye or by a delayed hypersensitivity immune reaction. The most com mon clinical presentations are: chronic anterior uveitis, choroiditis and sclero-keratitis. Despite the existence of highly sensitive molecular tools, arriving at diagnosis in rare or undeceived ways with eye tuberculosis in a child remains a major challenge, based on clinical presentation, systemic evaluation and therapeutic response. Treatment involves the use of antiphymics and often steroids. The objective was to present a form of endophthalmic tuberculosis, miliary pulmonary and meningeal, in the framework of drug resistance.
Assuntos
Pré-Escolar , PediatriaRESUMO
Abstract INTRODUCTION: Laboratory and clinical features of childhood tuberculosis (TB) are non-specific and establishing an accurate diagnosis remains a challenge. This study evaluated a Single tube nested-PCR (STNPCR) to detect genomic DNA of Mycobacterium tuberculosis complex in blood and urine. METHODS: Biological samples were obtained from children (<15 years old) with clinical suspicion of pulmonary and extrapulmonary TB at public hospitals in Recife-Pernambuco, Brazil. Cultures yielded negative results in a majority of childhood TB cases, which are generally paucibacillary. A set of clinical, epidemiological, radiological, and laboratory criteria with evident clinical improvement after anti-TB treatment were frequently used to define childhood TB cases. RESULTS: Ninety children with clinical suspicion were enrolled in this study (44 with TB and 46 without TB). The pulmonary TB group had 20 confirmed cases and 46 negative controls, while the extrapulmonary TB group had 24 confirmed cases. The STNPCR showed sensitivities to pulmonary and extrapulmonary TB of 47.4% and 52.2% (blood) and 38.8% and 20% (urine), respectively. Considering the low performance of STNPCR on separate samples, we decided to perform a combined analysis (parallel sensitivity analysis) of the results from blood and urine samples. The parallel sensitivity increased to 65% in blood and 62.5% in urine. The specificity in both samples ranged from 93.5-97.8%. CONCLUSIONS: Although STNPCR showed moderate sensitivity, the specificity is high; therefore, the test can be used as an auxiliary tool to diagnose TB in children. It is a rapid test that demonstrated better performance than other diagnostic tests in paucibacillary samples as it does in childhood tuberculosis.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Tuberculose Pulmonar/diagnóstico , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Pulmonar/urina , Tuberculose Pulmonar/sangue , Brasil , Estudos de Casos e Controles , Reação em Cadeia da Polimerase , Estudos Prospectivos , Testes Diagnósticos de Rotina , Mycobacterium tuberculosis/genéticaRESUMO
La prevención, el diagnóstico y el tratamiento de la Tuberculosis Infantil (TBI), no ha sido suficientemente reconocida como causa importante de enfermedad y muerte entre los 0 a 14 años. El objetivo del presente trabajo fue analizar la situación epidemiológica de la TBI en la Región Sanitaria V (RSV), provincia de Buenos Aires. Es un estudio observacional longitudinal, realizado entre el 1º de enero del 2000 y el 31 de diciembre de 2014. Se efectuó un análisis de tendencia sobre un total de 2.142 casos de Tuberculosis Infantil, calculada por regresión lineal simple y expresada como variación anual promedio (VAP). Se analizó el número de casos notificados y tasas de incidencia(TI) por 100.000 habitantes de todas las formas de TBI, TBI pulmonar (TBIP) y TBIP confirmada por bacteriología. La TBP se estudió desagregada en dos grupos de edad: 0 a 4 y 5 a 14 años. Resultados: La tasa de incidencia de TBI y la tasa de incidencia de la TBIP presentaron una tendencia neta al descenso, con una declinación mayor al 5% y similar a la TBIP entre los 0 a 4 años y entre los 5 a 14 años. En cambio, la tasa de incidencia de la TBIP confirmada del total de los casos y en los dos subgrupos, la tendencia al descenso fue mínima y no resultó estadísticamente significativa. La TB se mantiene como un riesgo de salud en la RSV, con la mayor afectación en edades jóvenes, hecho que refleja la tendencia de una transmisión reciente y que se asocia cuando no se ha logrado controlar la enfermedad (AU)
Prevention, diagnosis, and treatment of childhood tuberculosis (childhood TB) is underrecognized as an important cause of disease and death between 0 and 14 years of age. The aim of this study was to analyze the epidemiological situation of childhood TB in the Public Health Region V (PHRV), the province of Buenos Aires. In a longitudinal, observational study conducted between January 1, 2000 and December, 2014.A trend analysis was performed in a total of 2,142 cases of childhood TB, calculated by simple linear regression and expressed as average annual rate (AAR). The number of reported cases and incidence rate (IR) were calculated per 100,000 inhabitants of all forms of childhood TB, childhood lung TB, and childhood lung TB confirmed by bacteriological tests. Lung TB was assessed according to age group: 0 to 4 and 5 to 14 years. Results: IR of childhood TB and IR of childhood lung TB showed a net downward trend, with a greater than 5% decrease and similar to childhood lung TB between children between 0 and 4 years and those between 5 and 14 years of age. However, the IR of confirmed childhood lung TB of the total of cases and in the two subgroups showed a minimal downward trend and was not statistically significant. TB remains a health risk in PHRV, with a higher incidence in children, reflecting a trend of recent transmission and associated with a lack of disease control (AU)
Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Argentina/epidemiologia , Incidência , Tuberculose Resistente a Múltiplos Medicamentos , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Estudo ObservacionalRESUMO
BACKGROUND: Globally, >30 000 children fall sick with multidrug-resistant (MDR) tuberculosis every year. Without robust pediatric data, clinical management follows international guidelines that are based on studies in adults and expert opinion. We aimed to identify baseline predictors of death, treatment failure, and loss to follow-up among children with MDR tuberculosis disease treated with regimens tailored to their drug susceptibility test (DST) result or to the DST result of a source case. METHODS: This retrospective cohort study included all children ≤15 years old with confirmed and probable MDR tuberculosis disease who began tailored regimens in Lima, Peru, between 2005 and 2009. Using logistic regression, we examined associations between baseline patient and treatment characteristics and (1) death or treatment failure and (2) loss to follow-up. RESULTS: Two hundred eleven of 232 (90.9%) children had known treatment outcomes, of whom 163 (77.2%) achieved cure or probable cure, 29 (13.7%) were lost to follow-up, 10 (4.7%) experienced treatment failure, and 9 (4.3%) died. Independent baseline predictors of death or treatment failure were the presence of severe disease (adjusted odds ratio [aOR], 4.96; 95% confidence interval [CI], 1.61-15.26) and z score ≤-1 (aOR, 3.39; 95% CI, 1.20-9.54). We did not identify any independent predictors of loss to follow-up. CONCLUSIONS: High cure rates can be achieved in children with MDR tuberculosis using tailored regimens containing second-line drugs. However, children faced significantly higher risk of death or treatment failure if they had severe disease or were underweight. These findings highlight the need for early interventions that can improve treatment outcomes for children with MDR tuberculosis.
Assuntos
Antituberculosos/uso terapêutico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adolescente , Fatores Etários , Antituberculosos/farmacologia , Criança , Pré-Escolar , Feminino , Genótipo , Humanos , Lactente , Recém-Nascido , Perda de Seguimento , Masculino , Testes de Sensibilidade Microbiana , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/genética , Peru , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Falha de Tratamento , Resultado do Tratamento , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia , Tuberculose Resistente a Múltiplos Medicamentos/mortalidadeRESUMO
BACKGROUND: There is a lack of uniform criteria for the diagnosis and management of tuberculosis (TB) in children in Cali, Colombia. Addressing TB in children is a challenge in this setting, under both programmatic and research conditions. OBJECTIVES: To facilitate the diagnostic assessment of TB in a paediatric cohort of TB household contacts. METHODS: A diagnostic and management algorithm (DMA) was used to assess children exposed to adult TB cases, according to clinical and epidemiological findings and under programmatic conditions. On the basis of diagnostic tests, cases were classified as TB exposure, TB infection, suspected TB, possible TB or confirmed TB and then submitted to a management plan. This was a prospective pilot study nested within a national cohort study of the transmission dynamics of Mycobacterium tuberculosis, undertaken in Colombia during 2005-2008. RESULTS: During 24 months of follow-up, 54 of 217 children met the criteria for assessment by DMA, 18 of whom (33%) were considered to be TB incident cases (new TB cases among household contacts). The main clinical findings were failure to thrive and cough lasting >21 days. Only one case was smear-positive and culture-confirmed TB. TB treatment was given to 16 children and they demonstrated clinical and radiographic resolution at follow-up. Conducting the study under programmatic conditions demonstrated barriers to accessing competent radiological evaluation, correct interpretation of the tuberculin skin test, and proper specimen collection. CONCLUSION: Structured assessment using DMA facilitated the detection of incident TB cases. The study identified potential barriers to addressing childhood TB in Cali.
Assuntos
Antituberculosos/uso terapêutico , Atenção à Saúde/organização & administração , Saúde da Família , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico , Adolescente , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Colômbia , Humanos , Recém-Nascido , Estudos Prospectivos , Tuberculose Pulmonar/transmissãoRESUMO
INTRODUCCIÓN: los niños se infectan de tuberculosis a partir del contacto con un adulto enfermo, casi siempre en el hogar. OBJETIVO: evaluar la calidad de las acciones de control de foco en niños expuestos. MÉTODOS: estudio retrospectivo, descriptivo de los controles de focos de tuberculosis realizados a 143 menores de 15 años que estuvieron en contacto con 95 enfermos, en el municipio habanero de "10 de Octubre". Se clasificaron en 3 categorías: 1) expuestos: niños sin elementos clínicos, radiológicos ni microbiológicos de enfermedad activa y anergia tuberculínica; 2) con infección latente: niños reactores a la tuberculina (lecturas de 5 o más mm), pero sin elementos de enfermedad activa; y 3) enfermos: niños con criterios clínicos y/o radiológicos de tuberculosis activa, independientemente del resultado de la prueba de Mantoux y los estudios microbiológicos. RESULTADOS: se estudió una media de 1,5 menores de 15 años por cada caso índice, con una edad media de 6,7 años, con predominio de los prescolares (63= 44,1 %) y el sexo masculino (87= 60,8 %). La mayoría se consideraron expuestos (124= 86,9 %); la cuarta parte de los niños con exposición intradomiciliaria se infectaron o enfermaron (16/62= 25,8 %), resultado muy superior a la extradomiciliaria (3/81= 3,7 %). Se diagnosticaron 3 enfermos: 2 formas pulmonares primarias, y una adenitis (entre 1 y 5 años), que representan el 60 % de los casos infantiles diagnosticados en el municipio en ese quinquenio. Se identificaron errores: no registro de la quimioprofilaxis primaria (55= 38,4 %), inicio tardío del control de foco (39= 27,3 %), y la no realización de la prueba de Mantoux o radiografía torácica al inicio (24= 16,7 %), entre otros. CONCLUSIONES: es necesario fortalecer la capacitación del personal de salud y el cumplimiento de los procedimientos establecidos en el Programa, para garantizar la calidad de los controles de foco, y contribuir a la eliminación de la tuberculosis como problema de salud.
INTRODUCTION: the children become infected with tuberculosis from contact with sick adults, most often at home. OBJECTIVE: to evaluate the quality of tuberculosis foci control actions in exposed children. METHODS: retrospective and descriptive study of tuberculosis foci control actions conducted in 143 children aged less than 15 years, who had been in contact with 95 sick persons in 10 de Octubre municipality in Havana. They were classified into 3 categories: 1) exposed: children with no clinical, radiological or microbiological elements of active disease and tuberculin anergy; 2) latent infective: children reacting to tuberculin (5 mm or more readings), but with no active disease elements, and 3) ill: children with clinical and/or radiological criteria of active tuberculosis regardless of the Mantoux's test results and the microbiological studies. RESULTS: a mean of 1.5 children under 15 years of age per index case, average age of 6.7 years, predominating preschoolers (63= 44.1 %) and males (87= 60.8 %). Most of them were considered exposed (124= 86.9 %); a quarter of the children exposed at home became infected or sick (16 out of 62= 25.8 %), and this result was much higher than the outdoor exposure (3 out of 81= 3.7 %). Three sick children were diagnosed-two had primary pulmonary forms and one had adenitis (one to 5 years-old). They accounted for 60% of the pediatric cases diagnosed in the municipality in this 5-year period. The identified errors were non-registration of primary chemoprophylaxis (55= 38.4%), late starting of focus control (39= 27.3 %) and non-performance of Mantoux's test or thorax X-ray at the very beginning (24= 16.7 %) among others. CONCLUSIONS: it is necessary to strengthen the training of the health staff and the compliance with the procedures set by the National Program, in order to assure the quality of focus controls and to contribute to the eradication of tuberculosis as a health problem.
Assuntos
Humanos , Adolescente , Tuberculose Pulmonar , CriançaRESUMO
Introducción: la adolescencia constituye una edad de riesgo para la tuberculosis. Objetivo: caracterizar la tuberculosis en adolescentes de entre 15 y 18 años en La Habana, en el período 2001-2010. Métodos: se realizó un estudio observacional, descriptivo y transversal, en el universo de adolescentes de 15 a 18 años afectados de tuberculosis, de la provincia La Habana, desde el 1º de enero de 2001 hasta el 31 de diciembre de 2010. De las encuestas epidemiológicas se revisaron: variables demográficas, categoría epidemiológica, topografía de la lesión, estudios realizados y resultados del tratamiento. Resultados: se reportó una incidencia de 32 casos, con 8 casos en 2001 y 6 en 2010, y tasas de 8,6 y 4,9 × 100 mil habitantes de 15-18 años respectivamente. Predominó el sexo masculino y la edad de 18 años, sin relación con el color de la piel. Los municipios más afectados fueron 10 de Octubre, Habana Vieja y Centro Habana. Predominaron los estudiantes (17-53,1 %), de ellos 5 en escuelas internas; 9 eran desocupados (28,1 %), incluyendo 1 recluso. En la mayoría (20 casos, 62 %) no se encontró el contacto infectante. Predominó la forma pulmonar (27-84,4 %), con 44,4 % de baciloscopias positivas. No se reportó coinfección con el virus de la inmunodeficiencia humana. Todos recibieron el tratamiento estrictamente supervisado y curaron, con excepción de un fallecido en la segunda semana de tratamiento. Conclusiones: es necesario profundizar en los factores que inciden en la tuberculosis en este grupo de edad, así como garantizar un mayor aislamiento microbiológico y búsqueda exhaustiva de la fuente de infección.
Introduction: adolescence is a risky age for tuberculosis. Objective: to characterize tuberculosis in 15-16 years old adolescents in Havana from 2001-2010. Methods: a cross-sectional, observational and descriptive study was conducted in a universe of 15-18 years-old adolescents with tuberculosis from Havana in the period of January 1st, 2001 to December 31st, 2010. Demographic variables, epidemiological category, lesion topography, performed studies and treatment results were reviewed in the epidemiological surveys. Results: there was reported an incidence of 32 cases, with 8 and 6 cases in 2001 and 2010 respectively and rates of 8.6 and 4.9 per one hundred thousand 15-18 years old respectively. Males and age of 18 years prevailed, no association with race. The most affected municipalities were 10 de Octubre, Habana Vieja y Centro Habana. The students predominated (17-53.1 %), 5 of them in boarding schools; 9 were unemployed (28.1 %) including 1 prisoner. The infecting contact was not found in most of the cases (20 cases, 62 %). Pulmonary form predominated (27 cases-84.4 %) showing 44.4% of positive bacilloscopy. There was no co-infection with human immunodeficiency virus. All the patients received the strictly supervised treatment and they recovered, except for one death during the second week of treatment. Conclusions: it is necessary to delve into the factors having an effect on tuberculosis within this age group, as well as to assure more microbiological isolation and extensive search for the source of infection.
RESUMO
INTRODUÇÃO: A tuberculose infantil é responsável por 15 por cento das notificações dos casos. O foco do Programa Nacional de Controle da Tuberculose é a identificação da tuberculose em adultos, deixando os menores de 15 anos à margem dos estudos, diagnóstico e tratamento. A análise espacial quantifica a exposição à doença e expõe as principais causas relacionadas ao espaço geográfico. O objetivo deste estudo é analisar a distribuição espacial da tuberculose infantil no Espírito Santo, de 2000 a 2007, segundo município de notificação MÉTODOS: Realizou-se um estudo ecológico dos 515 casos de tuberculose infantil, entre 2000 e 2007. Utilizou-se o Método Bayesiano Empírico Local para estimação do risco. O Índice de Moram Local foi calculado para avaliação da autocorrelação entre as incidências de bairros limítrofes RESULTADOS: Altas taxas de incidência foram encontradas na Região Metropolitana de Vitória e região nordeste, e baixas taxas na região serrana; dados semelhantes foram observados no estudo da endemia de tuberculose em adultos no Espírito Santo, o que pode possivelmente estar relacionada aos contatos intradomiciliares CONCLUSÕES: Este estudo identifica possíveis áreas de transmissão recente da doença. É importante ressaltar que o conhecimento dos locais prioritários para o controle, pode auxiliar a gestão publica na diminuição das iniquidades em saúde e permitir uma otimização dos recursos e das equipes no controle da tuberculose infantil.
INTRODUCTION: Childhood tuberculosis is responsible for 15 percent of case notifications. The focus of Tuberculosis Control National Program is on identifying tuberculosis in adults, while leaving children under 15 years of age on the margins of studies, diagnoses and treatment. Spatial analysis quantifies the exposition to the illness and displays the main causes relating to geographical space. The objective of this study was to analyze the spatial distribution of childhood tuberculosis in Espírito Santo, between 2000 and 2007, according to the municipality of notification METHODS: An ecological study was conducted on 515 cases of childhood tuberculosis that occurred between 2000 and 2007. The Local Empirical Bayesian Method was used to measure the risk. The Moran Local Index was calculated in order to evaluate autocorrelations between threshold districts RESULTS: High incidence rates were found in the Metropolitan Region of Vitória and the northeastern region, and lower rates were found in the southeastern region. Similar data were observed in a study on endemic tuberculosis among adults in Espírito Santo. This is possibly related to contacts within the home CONCLUSIONS: This study identified possible areas of recent transmission of the disease. It is important to emphasize that knowledge of the high priority areas for tuberculosis control may help public administrators to diminish healthcare iniquities and enable improvement of resources and teams for controlling childhood tuberculosis.