Positive Bacilloscopy Research Articles

Adolescent Tuberculosis: 6 Years of Experience in a Tertiary Care Pediatric Hospital in Buenos Aires, Argentina.

Adolescence is a key risk period for tuberculosis disease and its adverse outcomes. This group commonly develops infectious forms of tuberculosis and has a wider range of social contacts outside the household. There are few specific data on the behavior of tuberculosis disease in this population. A total of 292 patients 10-19 years of age with tuberculosis between January 2016 and December 2021 were retrospectively analyzed in the Department of Phthisiology of the Children's Hospital "Dr. Ricardo Gutiérrez" of Buenos Aires, Argentina. The median patient age was 14 years (interquartile range 12-16). Most patients were previously healthy, and 55% were unaware of the source of the infection. However, 75% sought medical advice owing to the presence of symptoms, with hemoptysis and weight loss being most frequent in those older than 15 years. Lung imaging findings consistent with severe disease were significantly associated with an age of >15 years. Respiratory cultures were positive in 62% of the samples obtained. Half of the patients required hospitalization, while 45% showed extrapulmonary involvement. Evolution was as follows: 74% recovered from the illness, 13% were lost to follow-up, 11% were referred to a less complex facility, 1% experienced treatment failure, and 3 (1%) patients died. Pulmonary cavities and positive bacilloscopy were associated with the presence of pulmonary sequelae at the end of treatment. Tuberculosis in adolescents, particularly in those >15 years of age, may present characteristics similar to those of adults, with a higher frequency of severe pulmonary disease leading to pulmonary sequelae.

Factors associated with delayed diagnosis of pulmonary tuberculosis with positive bacilloscopy in Bangui, Central Africa

Background: A case of untreated bacteriologically confirmed pulmonary tuberculosis (BPT+) represents a reservoir for transmission of the disease. The objective of this study was to evaluate the delay and identify the determinants of the delay in the diagnosis of BPT+ in the diagnostic and treatment centers for tuberculosis (CDT) in Bangui. Methods: An analytical cross-sectional survey was conducted. It included all new TB patients aged 15 years and older (145) who presented a positive bascilloscopy. Exhaustive recruitment was performed during the study period. Multiple logistic regression with OR (95% CI) for p<0.05 was used to establish the relationship between delayed diagnosis and patient characteristics. Results: Patients ranged in age from 16 to 80 years with an average age of 33.81±12.18 years. The time to consultation and diagnosis >30 days after the onset of symptoms were 83.10% and 23.95%, respectively. In multivariate analysis, male patients [ORa=0.42 (0.19-0.93)]; patients residing in peri-urban areas [ORa=4.25 (2.10-9.02)]; patients using informal care facilities as first option [ORa=1.84 (1.47-3.38)] and not requesting acid-fast bacilli (AFB) test at first visit [ORa=6.09 (3.70-17.69)] were associated with risk of delayed diagnosis. Conclusions: Early diagnosis and treatment of BPT+, which is the spreading form of the disease, remains a public health concern in our context. Supervision and coaching of health workers coupled with increased public awareness of TB will contribute to better control of the disease.

ML Flow serological test: complementary tool in leprosy

BackgroundThe evaluation of household contacts of leprosy cases allows the early diagnosis of new cases. ObjectiveTo associate the results of the ML Flow test with the clinical characteristics of leprosy cases and to verify their positivity in household contacts, in addition to describing the epidemiological profile of both. MethodsProspective study with patients diagnosed over the course of one year (n = 26), without prior treatment, and their household contacts (n = 44) in six municipalities in northwestern São Paulo, Brazil. ResultsThere was a predominance of men among the leprosy cases, of 61.5% (16/26); 77% (20/26) were over 35 years old; 86.4% (22/26) were multibacillary; 61.5% (16/26) had a positive bacilloscopy; and 65.4% (17/26) had no physical disability. The ML Flow test was positive in 53.8% (14/26) of the leprosy cases and was associated with those who had a positive bacilloscopy and were diagnosed as multibacillary (p-value <0.05). Among the household contacts, 52.3% (23/44) were women and aged over 35 years; 81.8% (36/44) had been vaccinated with BCG ‒ Bacillus Calmette-Guérin. The ML Flow test was positive in 27.3% (12/44) of household contacts, all of whom lived with multibacillary cases; seven lived with positive bacilloscopy cases and six with consanguineous cases. Study limitationsDifficulty in convincing the contacts to undergo the evaluation and collection of the clinical sample. ConclusionThe ML Flow test, when positive in household contacts, can help the identification of cases that require more attention by the health team, as it indicates a predisposition to disease development, especially when they are household contacts of multibacillary cases, with positive bacilloscopy and consanguineous. The ML Flow test also helps in the correct clinical classification of the leprosy cases.

Epidemiologic-clinical, biological and radiological features of pulmonary tuberculosis in patients with diabetes in Antananarivo, Madagascar

La tuberculose pulmonaire est fréquemment associée au diabète sucré, avec parfois des présentations atypiques. Notre objectif était d´identifier les particularités épidémiologiques, cliniques, biologiques et radiologiques de la tuberculose pulmonaire chez les diabétiques par rapport aux non diabétiques. Ceci afin d´améliorer leur prise en charge. l´étude a été réalisée dans les services d´Endocrinologie et de Pneumologie du Centre Hospitalier Universitaire Joseph Raseta Befelatanana et le Service de Maladies Respiratoires du Centre Hospitalier de Soavinandriana à Antananarivo, Madagascar. Elle a concerné les cas de tuberculose pulmonaire à bacilloscopie positive enregistrés de janvier 2018 à janvier 2020 (25 mois). C´est une étude rétrospective transversale descriptive et analytique. Dans notre étude, la prévalence du diabète chez les tuberculeux était de 20,31%. Un âge plus avancé, une évolution clinique à bas bruit, un syndrome inflammatoire biologique important, moins de cavernes mais plus d´opacités systématisées, des lésions radiologiques à localisation basale ou diffuses, plutôt unilatérales droites, ont été constatés plus fréquemment chez les diabétiques comparés aux non diabétiques. La connaissance des particularités de la présentation de la tuberculose pulmonaire chez les diabétiques aidera les personnels de santé à ne pas passer à côté du diagnostic même devant une présentation atypique. Par ailleurs, comme la majorité des tuberculoses pulmonaires survient chez les diabétiques déséquilibrés, un bon équilibre glycémique permettra certainement de diminuer son incidence.

Magnitude of tuberculosis on the Bioceanic Route: an epidemiological description

This study aims to assess the epidemiological situation of five municipalities that are part of the bioceanic route in order to analyze the descriptors and general health aspect of the population through a retrospective, quantitative and cross-sectional descriptive study with a documentary approach, from secondary data reported to the National System of Notifiable Diseases in the municipalities of Guia Lopes da Laguna, Jardim, Nioaque, Porto Murtinho, Sidrolândia and Campo Grande, in the state of Mato Grosso do Sul, in the period from January 2015 to December 2020. The incidence rate ranged between 32.23 and 79.4 cases/100,000 inhabitants. There was a predominance of individuals aged between 30-39 years (26.05%) and males (67.5%). The most important injuries were alcoholism (19.15%) and smoking (18%). In the exams, 52.3% had positive bacilloscopy and 32.03% had a positive culture. The incidence of tuberculosis in the evaluated municipalities was higher than the Brazilian average and that of the state of Mato Grosso do Sul. These evaluated municipalities do not have a favorable epidemiological situation with regard to tuberculosis and the construction of the biocenic route may further aggravate the situation.

Epidemiological characteristics and trends of leprosy in children and adolescents under 15 years old in a low-endemic State in Southern Brazil.

ABSTRACTLeprosy is an infectious and contagious disease affecting skin and nerves. The number of cases in individuals under 15 years old is one of the parameters used in Brazil as an indicator of endemic permanence of the disease and its continuous transmission. Rio Grande do Sul State, in Southern Brazil, is low-endemic to leprosy. However, the disease remains a public health problem. This is a retrospective, observational and analytical study of a historical series of new cases of leprosy in children under 15 years old diagnosed in the period from 2000 to 2019, in all health units in Rio Grande do Sul State. Seventy-seven new cases were notified. The male gender was predominant in 53.2% of the cases (n=41). The average age was 10.4 years (standard deviation of 2.9), with predominance of the age group between 10 and 15 incomplete years old. The most frequent operational classification was multibacillary, in 62.3% of cases (n=48), and the most common clinical form was borderline, in 38.9% of cases (n=28). The predominant disability degree in the sample was grade zero, in 80.0% of the cases (n=60), but in 4.0% (n=3) the grade assessed was 2. In 54.0% of cases (n=27), bacilloscopy was performed, with positive results in 36.0% (n=9) of the exams. Multibacillary cases, with physical disability and/or positive bacilloscopy, draws attention that that the diagnosis is frequently not made in early stages.

Efectividad del Programa de Control de Tuberculosis en las entidades estatales. Departamento de Córdoba -Colombia 2015.

Objective. To measure the effectiveness of the Tuberculosis Control Program in the different entities of the department of Córdoba. Materials and methods. This is a descriptive and retrospective study. The researchers used data from the secondary sources relating to social, demographic, epidemiological, clinical, laboratory, treatment, final evolution, and diagnosis to analyze the behavior of the attention and the degree of therapeutic adherence to tuberculosis. Results. In 2015, the prevalence of disease was 17 cases per 1000 inhabitants. In four of the six geographic target areas, the prevalence exceeded the national average. The regions with the highest incidence were the Alto Sinú and Alto San Jorge. The lowest was the coastal and savanna areas. 79.2% of the cases were incidents, 18.8%, relapses, and 2.1%, treatment withdrawal. In 68.7% of the reviewed histories of the cases attended in the public network, no institutional evidence of activities performed to contacts was found. Patients go for the initial consultation after a period between 31 to 60 days of symptoms. 12.5% of the cases were diagnosed after 15 days of the initial consultation. In 14.6% of the cases, the tuberculosis treatment started after 16 days of the patient’s initial meeting. In 41.7%, negative sputum smear microscopy was achieved. 37.5% of those who completed their treatment but did not undergo BK at the end. 2.1% of the cases failed, and 14.6% died. The process ended with positive bacilloscopy. Conclusions. There are program management factors that delay in identifying the probable instances and initiate treatment promptly.

Molecular, immunological and neurophysiological evaluations for early diagnosis of neural impairment in seropositive leprosy household contacts.

BackgroundHousehold contacts constitute the highest risk group for leprosy development, and despite significant progress in the disease control, early diagnosis remains the primary goals for leprosy management programs.MethodsWe have recruited 175 seropositive and 35 seronegative household contacts from 2014 to 2016, who were subjected to an extensive protocol that included clinical, molecular (peripheral blood qPCR, slit-skin smear qPCR, skin biopsy qPCR) and electroneuromyographic evaluations.Results/Principal findingsThe positivity of peripheral blood qPCR of seropositive contacts was 40.6% (71/175) whereas only 8.6% (3/35) were qPCR positive in seronegative contacts (p = 0.0003). For the slit-skin smear, only 4% (7/175) of seropositive contacts presented positive bacilloscopy, whereas the qPCR detected 47.4% (83/175) positivity in this group compared with only 17.1% (6/35) in seronegative contacts (p = 0.0009). In the ENMG evaluation of contacts, 31.4% (55/175) of seropositives presented some neural impairment, and 13.3% (4/35) in seronegatives (p = 0.0163). The presence of neural thickening conferred a 2.94-fold higher chance of ENMG abnormality (p = 0.0031). Seropositive contacts presented a 4.04-fold higher chance of neural impairment (p = 0.0206). The peripheral blood qPCR positivity presented odds 2.08-fold higher towards neural impairment (OR, 2.08; p = 0.028). Contrarily, the presence of at least one BCG vaccine scar demonstrated 2.44-fold greater protection against neural impairment (OR = 0.41; p = 0.044).Conclusions/SignificanceELISA anti-PGL-I is the most important test in determining the increased chance of neural impairment in asymptomatic leprosy household contacts. The combination of the two assays (ELISA anti-PGL-I and peripheral blood qPCR) and the presence of BCG scar may identify individuals with higher chances of developing leprosy neuropathy, corroborating with the early diagnosis and treatment.

Leprosy: clinical and epidemiological study in patients above 60 years in Espirito Santo State - Brazil

AbstractBackground: Leprosy is a chronic infectious disease that is endemic in Brazil and little studied in patients over 60 years old.Objective: The aim of this study was the epidemiological and clinical description of cases of leprosy in individuals older than 60 years, notified in the State of Espirito Santo - Brazil.Methods: It was an observational, descriptive and retrospective study of leprosy patients notified between 2001 and 2011.Results: Out of 16,025 notifications, 2,510 (15.6%) were of patients over 60 years of age; the distribution among the period was egalitarian except in the last 2 years, when there was a mild reduction of cases; the average was 70 years of age (±7 years); 46% were women, being 62% of those paucibacillary cases; 1,145 (50.5%) were dark-skined people in particular among paucibacillary cases; 1,638 (72.9%) were illiterates or poorly instructed n particular among multibacillary cases (P=0.022); 59.9% patients were clinically multibacillary cases and 37.4% had positive bacilloscopy; 37.9% patients had clinical alterations on peripheral nerves, 36.7% of all the multibacillary cases were classified as grade I and 15.3% as grade in assessment of disability.Study limitations: This was a retrospective study, which used secondary data generated by physicians and notified by other professionals, whar could have enabled possible errors on original data.Conclusions: Leprosy in this age group suggests a long incubation period with reactivation of latent focus or late infection. Men were more affected, as well as the afro descendent race was statistically significant in the paucibacillary cases (P=0.000) and illiterate/poor education in multibacillary cases (P=0.022). Nearly 40% of patients had positive bacilloscopy and grade I/ II disability, demonstrating a late diagnosis.

Relationship between bacilloscopy and operational classification of Hansen’s disease in patients with reactions

Leprosy can be classified according to its operational form as paucibacillary or multibacillary. Bacilloscopy integrates its diagnostic armamentarium. Patients with the disease may present leprosy reactions. This study describes the association of bacilloscopy results and the type of operational classification of leprosy in patients with leprosy reactions. Medical records were analyzed at a reference center between 2010 and 2015. Reactions occurred in almost half of the patients, making their identification important. The bacilloscopic and operational characterization indicates a greater occurrence of leprosy reactions in patients with positive bacilloscopy and also in multibacillary.

Tuberculose pulmonar entre usuários de uma unidade de atenção básica

Objective: To evaluate the prevalence of positive bacterial sputum cases of pulmonary tuberculosis among users of a primary healthcare unit. Methods: Cross-sectional, observational study, conducted between February and August 2011 with 1,873 individuals aged above 18 years seen at a Basic Healthcare Unit (BHU) in the city of Rio de Janeiro, Brazil, selected through convenience non-probabilistic sampling. A tool for the presumptive diagnosis of pulmonary tuberculosis was initially applied. The individuals with positive score were submitted to bacilloscopy. Descriptive statistics was performed, with absolute and percentage frequencies, as well as Fisher’s exact test to assess the association between gender, age, and the results of bacterial sputum microscopy. Results: Of the users seen at the studied BHU, 157 individuals were tested positive for the presumptive diagnosis of tuberculosis. Their most frequent symptoms were cough (76.5%, n=13) and chest pain (70.6%, n=12). There was no significant association between positive bacilloscopy, sex (p=0.477), and age (p=0.186). Conclusion: The frequency of positive bacilloscopy cases of pulmonary tuberculosis among individuals with positive score for presumption of that disease was high in the studied health unit.

Active search for leprosy cases in Midwestern Brazil: a serological evaluation of asymptomatic household contacts before and after prophylaxis with bacillus Calmette-Guérin

Leprosy is a disease caused by Mycobacterium leprae that carries a high risk of disability, making early diagnosis mandatory. This study aimed to determine the applicability of anti-PGL-1 IgM antibody detection, using the ML FLOW technique, as an assistant tool for the detection of leprosy infection in asymptomatic household contacts (AHHC) of multibacillary leprosy index cases from Midwest Brazil. Serological changes induced by the prophylaxis of these household contacts with Bacillus Calmette-Guérin (BCG) were also verified. A total of 91 AHHC were assessed, among which, 18.68% (n = 17) presented both positive bacilloscopy and positive anti-PGL-1 IgM serology. Positivity concordance between these two laboratorial exams (Kappa Index = 1; p < 0.001) was indicated, however, one case did not demonstrate concordance between the semiquantitative assessment of anti-PGL-1 IgM and the bacilloscopy index (Kappa Index = 0.96; p < 0.001). Among the 17 AHHC with positive bacilloscopy, eight were reassessed after prophylaxis with BCG and two of them presented negative anti-PGL-1 IgM serology, being these patients who had presented a bacilloscopy index of < 2[+] in the initial assessment. This study shows that anti-PGL-1 IgM detection may be used as a tool to determine the bacillary load in AHHC and to detect immune changes related to prophylaxis by nonspecific vaccination.

Estudo retrospectivo de recidiva da hanseníase no Estado do Espírito Santo

Leprosy relapse is the reappearance of the disease after regular treatment with current regimens and discharge due to cure. In this retrospective and descriptive cohort study, the aim was to evaluate the characteristics of cases of leprosy relapse in the State of Espírito Santo between 2000 and 2005. The investigation strategies consisted of monitoring the SINAN entries, with file analysis and case discussions at the State Reference Center. One hundred and four cases of relapse were studied, representing 1.12% of the new cases detected over this period. The greatest frequency was between 21 and 60 years of age; 59.6% were men; 44.2% presented relapse more than five years after discharge; 66.4% were multibacillary; and 42.2% presented positive bacilloscopy (complete bacilli) and therefore were relapse cases. Negatives bacilloscopy was observed in 57.8%. Prospective studies should be conducted to establish the real relapse rate.

Incidência de tuberculose e taxa de cura, Brasil, 2000 a 2004

To describe the geographical distribution of tuberculosis incidence rates based on a set of epidemiological and operational indicators from information system database. Data from the Sistema de Informação de Agravos de Notificação (Brazilian Information System for Tuberculosis Notification) were collected after removal of improper repeat records and record linkage. Tuberculosis incidence rates were estimated according to geographical unit, age group, sex, clinical manifestation and treatment schedule and standardized for population age group distribution based on 2000 Population Census. In 2004, in Brazil, tuberculosis incidence rate was 41 per 100,000 inhabitants and 74,540 new cases were notified. Of these, 52.8% were pulmonary tuberculosis with positive bacilloscopy, 24.1% were under supervised treatment, 63.5% were from state capitals or metropolitan areas, and 54.9% were cured cases (complete treatment). After records with missing outcome data were excluded, cure rates were 72.4% for new cases, 47% for new HIV-positive cases, 64.9% for relapses, 64.5% for transfers in/out, and 40% for returns after default. Cure rate for new cases under supervised treatment was 77.1%. A higher proportion of records with missing outcome information was seen in recent years. Different incidence rates and treatment outcomes were found in different Brazilian states. To reach the 85% cure goal for new cases and to increase cure in HIV-positive and defaults cases additional efforts are needed by the Brazilian National Tuberculosis Program, including scaling up the Directly Observed Therapy Strategy.