RESUMO
Patients with autoimmune rheumatic diseases are at increased risk for developing infections and these are associated with increased morbidity and mortality from these diseases, especially in patients with systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis and autoimmune inflammatory myopathies. The objective of this paper is to address the challenges in detecting latent tuberculosis in immunosuppressed patients and the initiation of prophylactic treatment because currently there are no well-defined guidelines indicating what action to take for detection and treatment; so far the available scientific evidence is scarce and some methodological shortcomings.
Los pacientes con enfermedades reumáticas autoinmunes tienen un elevado riesgo para el desarrollo de infecciones, y estas se asocian al incremento de la morbimortalidad de estas enfermedades, principalmente en pacientes con lupus eritematoso sistémico, artritis reumatoide, esclerosis sistémica y con miopatías inflamatorias autoinmunes. El objetivo de este trabajo es abordar los retos en la detección de tuberculosis latente en pacientes inmunosuprimidos y el inicio del tratamiento profiláctico ya que en la actualidad no existen lineamientos bien definidos que indiquen la conducta a seguir para su detección y tratamiento; por el momento la evidencia científica disponible es escasa y con algunas deficiencias metodológicas.
Assuntos
Tuberculose Miliar/diagnóstico , Doenças do Tecido Conjuntivo Indiferenciado/complicações , Adulto , Feminino , Humanos , Tuberculose Latente/diagnóstico , Tuberculose Latente/imunologia , Tuberculose Miliar/complicações , Tuberculose Miliar/imunologia , Tuberculose Miliar/prevenção & controle , Doenças do Tecido Conjuntivo Indiferenciado/diagnósticoRESUMO
BACKGROUND: In Colombia, epidemiological and clinical information related to pediatric tuberculosis (TB) is scarce. Data are needed to define the impact of the disease and to strengthen measures for detection and treatment. It is proposed to analyze the pediatric population diagnosed with pulmonary TB in a national reference institution. METHODS: Retrospective observational study including pediatric patients with pulmonary and miliary TB, and pulmonary and extrapulmonary involvement, treated between January 1, 2008 and December 31, 2016. A descriptive analysis of the selected variables was done. RESULTS: A total of 93 cases of diagnosed TB were identified, of which 61 cases were classified as pulmonary (65.6%). The location of TB occurred only in lungs in 51 patients (83.6%), was miliar in 3 (4.9%), pulmonary and extrapulmonary involvement in 7 patients (11.5%). The mean age was 7.5 years (0.5-18 years). Clinical criteria used for diagnosis was related to 98.3% of the cases, whereas radiological criteria in 90.2%. Bacteriological criterion was met in 42.6% of the cases. The most frequent symptoms were coughing (83.6%), fever (63.9%), and weight loss (26.2%); human immunodeficiency virus co-infection occurred in 3 cases (4.9%). During treatment, 5 mortality cases were recorded, although they were not attributable to TB. CONCLUSIONS: The epidemiological characterization of pediatric patients with pulmonary TB helps to achieve a better diagnostic approach in this population. Improving monitoring and follow-up activities in children with pulmonary TB, as well as promoting actions for adequate prevention and treatment is highly necessary.
Assuntos
Hospitais Pediátricos/estatística & dados numéricos , Tuberculose Pulmonar/epidemiologia , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Adolescente , Criança , Pré-Escolar , Coinfecção/epidemiologia , Colômbia/epidemiologia , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Lactente , Masculino , Estudos Retrospectivos , Tuberculose/microbiologia , Tuberculose/prevenção & controle , Tuberculose Miliar/epidemiologia , Tuberculose Miliar/microbiologia , Tuberculose Miliar/prevenção & controle , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/prevenção & controleRESUMO
OBJECTIVES: To review the protective efficacy of the first and second doses of BCG vaccine and to assess its major indications and contraindications. SOURCES OF DATA: A systematic review of the literature was made by searching PubMed and selecting studies carried out in the last 50 years. The studies were grouped according to their design (clinical trials, case-control studies, and meta-analyses) and the results were presented separately for each type of study. Other relevant topics such as BCG and HIV/AIDS, use of tuberculin skin test, issues related to vaccine scars and to the development of new vaccines were also reviewed. SUMMARY OF THE FINDINGS: BCG vaccine has been used since 1921. However, the data concerning its use are variable and inconsistent. The protective efficacy of the first dose of BCG vaccine against miliary tuberculosis or tuberculous meningitis is remarkably important. Nevertheless, results regarding pulmonary tuberculosis have been inconsistent, either showing no efficacy or a protective efficacy rate around 80%. There is some evidence that a second dose of BCG vaccine does not increase its protective efficacy. Studies have shown that BCG vaccine protects against leprosy. The development of new vaccines to replace BCG in the future has been investigated. CONCLUSIONS: Despite the hope that a new vaccine against tuberculosis will be available in the future, BCG vaccine, in spite of its deficiencies, is today and will be for many years to come an important tool in controlling the harmful effects of tuberculosis, especially in countries where this disease has moderate to high levels of incidence.
Assuntos
Vacina BCG/uso terapêutico , Tuberculose Pulmonar/terapia , Vacinação/normas , Animais , Vacina BCG/administração & dosagem , Vacina BCG/normas , Brasil , Pessoal de Saúde , Humanos , Programas de Imunização , Imunização Secundária , Avaliação de Programas e Projetos de Saúde , Teste Tuberculínico , Tuberculose Meníngea/prevenção & controle , Tuberculose Miliar/prevenção & controle , Tuberculose Pulmonar/imunologiaRESUMO
OBJETIVOS: Revisar aspectos relacionados ao efeito protetor da primeira e segunda doses da vacina BCG e discutir as suas principais indicações e contra-indicações. FONTES DOS DADOS: Utilizando o PubMed, foi realizada uma revisão sistemática da literatura abrangendo um período de, aproximadamente, 50 anos. Os estudos foram agrupados por tipo de desenho, apresentando-se separadamente os principais resultados de ensaios clínicos, estudos de caso-controle e meta-análises. Outros tópicos relevantes, como a BCG e HIV/AIDS, o uso do teste tuberculínico, aspectos relacionados à cicatriz vacinal e ao desenvolvimento de novas vacinas, dentre outros, foram também revistos. SíNTESE DOS DADOS: A vacina BCG é utilizada desde 1921. Apesar disso, ainda apresenta controvérsias e aspectos não esclarecidos. O efeito protetor da primeira dose da vacina BCG contra a tuberculose na forma miliar ou na meningite é bastante significativa. No entanto, em relação à forma pulmonar, os resultados são discordantes, variando de ausência de efeito a níveis próximos a 80 por cento. Há evidências de que uma segunda dose da BCG não aumenta o seu efeito protetor. Estudos demonstram proteção da vacina contra a hanseníase. Pesquisas sobre novas vacinas que, no futuro, poderão vir a substituir a BCG estão sendo realizadas. CONCLUSÕES:Apesar da expectativa de que, no futuro, venhamos a ter uma nova vacina para a tuberculose, no presente e ainda por muitos anos, a vacina BCG, apesar de suas deficiências, mantém-se como um importante instrumento nos esforços para controle dos efeitos danosos da tuberculose, sobretudo em países em que essa doença ocorre em médias e elevadas taxas de incidência.
Assuntos
Humanos , Animais , Vacina BCG/uso terapêutico , Tuberculose Pulmonar/terapia , Vacinação/normas , Vacina BCG/administração & dosagem , Vacina BCG/normas , Brasil , Pessoal de Saúde , Programas de Imunização , Imunização Secundária , Avaliação de Programas e Projetos de Saúde , Teste Tuberculínico , Tuberculose Meníngea/prevenção & controle , Tuberculose Miliar/prevenção & controle , Tuberculose Pulmonar/imunologiaRESUMO
The authors reviewed the histories of 133 patients with abdominal tuberculosis in Instituto Nacional de Salud del Niño (Children's Hospital), Lima, Perú, between 1989 and 1991. We found morbidity higher in scholars (67.4%). Weight lost were present in all cases and malaise in 95.3%, abdominal distension in 83.72% and abdominal pain in 79.06%. Anaemia in 76.06%, ratio albumin/globulin were altered in 74.41% leukocytosis in 67.44%. Evidence of tuberculosis on chest X-ray were detected only in 62.5%.
Assuntos
Peritonite Tuberculosa/epidemiologia , Tuberculose Gastrointestinal/epidemiologia , Tuberculose Miliar/epidemiologia , Distribuição por Idade , Vacina BCG/imunologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Peritonite Tuberculosa/complicações , Peritonite Tuberculosa/prevenção & controle , Peru/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Tuberculose Gastrointestinal/complicações , Tuberculose Gastrointestinal/prevenção & controle , Tuberculose Miliar/complicações , Tuberculose Miliar/prevenção & controleRESUMO
A retrospective case-control study was conducted in Argentina to determine the protection conferred by BCG vaccination against tuberculosis in children under six years of age, in an area where coverage is about 55%. A total of 175 tuberculosis patients were included. Five controls selected from patients treated at the same hospital as those under study for reasons other than tuberculosis were matched to each case on the basis of age, socioeconomic origin, nutritional status and place of residence. Information on BCG vaccination status was collected by an independent examiner. Tuberculosis localizations were as follows: 152 pulmonary, pleural and/or miliary; 18 meningitis; 2 lymphadenitis; 2 osteoarticular; and 1 otic. The diagnosis was based on bacteriological and histopathological tests, computerized tomography, radiology, clinical examination, endoscopy, and proved source of infection. The protective effect of BCG among those who were vaccinated was 73.0% with 95% confidence limits of 82% and 62%. According to these results BCG vaccination given early in life is very effective in preventing tuberculosis.
Assuntos
Vacina BCG , Tuberculose/prevenção & controle , Vacinação , Argentina , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Fatores Socioeconômicos , Tuberculose/epidemiologia , Tuberculose Meníngea/prevenção & controle , Tuberculose Miliar/prevenção & controle , Tuberculose Pulmonar/prevenção & controle , População UrbanaRESUMO
In the course of 3 1/2 years, 27 children with miliary tuberculosis were seen at the Hospital Infantil Lorencita Villegas de Santos in Bogotá, Columbia. Twenty-six percent of cases were infants under 12 months of age. Typical clinical cases were malnourished patients with impairment of their general condition, light respiratory stress or neurologic meningoencephalic involvement and febrile syndrome having a high contact index with tuberculous relatives. Some of them were undergoing measles or whooping cough convalescence. The chest X-ray showed micronodular infiltration and some cases, with hiliar adenomegaly, effusion or caverns. The liver percutaneous biopsy was of great help. The isolation of the bacillus from exudates was difficult to achieve. Tuberculin test was positive only in 30%. Cause of death: infiltration of central nervous system.