Brazilian Journal of Pulmonology

ISSN (on-line): 1806-3756 | ISSN (printed): 1806-3713

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Epidemiological aspects, clinical manifestations, and prevention of pediatric tuberculosis from the perspective of the End TB Strategy

Aspectos epidemiológicos, manifestações clínicas e prevenção da tuberculose pediátrica sob a perspectiva da Estratégia End TB

Anna Cristina Calçada Carvalho1,a, Claudete Aparecida Araújo Cardoso2,b, Terezinha Miceli Martire3,c, Giovanni Battista Migliori4,d, Clemax Couto Sant'Anna5,e

J Bras Pneumol.2018;44(2):134-144

Abstract PDF PT PDF EN Portuguese Text

Tuberculosis continues to be a public health priority in many countries. In 2015, tuberculosis killed 1.4 million people, including 210,000 children. Despite the recent progress made in the control of tuberculosis in Brazil, it is still one of the countries with the highest tuberculosis burdens. In 2015, there were 69,000 reported cases of tuberculosis in Brazil and tuberculosis was the cause of 4,500 deaths in the country. In 2014, the World Health Organization approved the End TB Strategy, which set a target date of 2035 for meeting its goals of reducing the tuberculosis incidence by 90% and reducing the number of tuberculosis deaths by 95%. However, to achieve those goals in Brazil, there is a need for collaboration among the various sectors involved in tuberculosis control and for the prioritization of activities, including control measures targeting the most vulnerable populations. Children are highly vulnerable to tuberculosis, and there are particularities specific to pediatric patients regarding tuberculosis development (rapid progression from infection to active disease), prevention (low effectiveness of vaccination against the pulmonary forms and limited availability of preventive treatment of latent tuberculosis infection), diagnosis (a low rate of bacteriologically confirmed diagnosis), and treatment (poor availability of child-friendly anti-tuberculosis drugs). In this review, we discuss the epidemiology, clinical manifestations, and prevention of tuberculosis in childhood and adolescence, highlighting the peculiarities of active and latent tuberculosis in those age groups, in order to prompt reflection on new approaches to the management of pediatric tuberculosis within the framework of the End TB Strategy.

 


Keywords: Tuberculosis, pulmonary/prevention & control; Mycobacterium tuberculosis; Lung diseases/etiology; Child; Adolescent.

 


Predictors of mortality among intensive care unit patients coinfected with tuberculosis and HIV

Preditores de mortalidade em pacientes da unidade de terapia intensiva coinfectados por tuberculose e HIV

Marcia Danielle Ferreira1,2,a, Cynthia Pessoa das Neves1,3,b, Alexandra Brito de Souza3,c, Francisco Beraldi-Magalhães1,3,d, Giovanni Battista Migliori4,e, Afrânio Lineu Kritski5,f, Marcelo Cordeiro-Santos1,3,g

J Bras Pneumol.2018;44(2):118-124

Abstract PDF PT PDF EN Portuguese Text

Objective: To identify factors predictive of mortality in patients admitted to the ICU with tuberculosis (TB)/HIV coinfection in the Manaus, Amazon Region. Methods: This was a retrospective cohort study of TB/HIV coinfected patients over 18 years of age who were admitted to an ICU in the city of Manaus, Brazil, between January of 2011 and December of 2014. Sociodemographic, clinical, and laboratory variables were assessed. To identify factors predictive of mortality, we employed a Cox proportional hazards model. Results: During the study period, 120 patients with TB/HIV coinfection were admitted to the ICU. The mean age was 37.0 ± 11.7 years. Of the 120 patients evaluated, 94 (78.3%) died and 62 (66.0%) of those deaths having occurred within the first week after admission. Data on invasive mechanical ventilation (IMV) and ARDS were available for 86 and 67 patients, respectively Of those 86, 75 (87.2%) underwent IMV, and, of those 67, 48 (71.6%) presented with ARDS. The factors found to be independently associated with mortality were IMV (p = 0.002), hypoalbuminemia (p = 0.013), and CD4 count < 200 cells/mm3 (p = 0.002). Conclusions: A high early mortality rate was observed among TB/HIV coinfected ICU patients. The factors predictive of mortality in this population were IMV, hypoalbuminemia, and severe immunosuppression.

 


Keywords: Mycobacterium tuberculosis; Critical care; Respiration, artificial; Acquired immunodeficiency syndrome.

 


Managing severe tuberculosis and its sequelae: from intensive care to surgery and rehabilitation

Tratamento da tuberculose grave e suas sequelas: da terapia intensiva à cirurgia e reabilitação

Simon Tiberi1,2,a, Marcela Muñoz Torrico3,b, Ananna Rahman1,c, Maria Krutikov1,d, Dina Visca4,e, Denise Rossato Silva5,f, Heinke Kunst2,g, Giovanni Battista Migliori4,h

J Bras Pneumol.2019;45(2):e20180324-e20180324

Abstract PDF PT PDF EN Portuguese Text

Multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) continue to challenge physicians and public health specialists. Global treatment outcomes continue to be unsatisfactory, positive outcomes being achieved in only 54% of patients. Overall outcomes are even worse in patients infected with highly resistant strains. Treating MDR-/XDR-TB is difficult because of frequent adverse events, the long duration of drug regimens, the high costs of second-line drugs, chronic post-infectious sequelae, and loss of organ function. Ongoing research efforts (studies and trials) have various aims: increasing the rates of treatment success; understanding the potentialities of new and repurposed drugs; shortening the treatment duration; and reducing the rates of adverse events. It is hoped that better access to rapid diagnostics, increased awareness, and treatments that are more effective will reduce the rate of complications and of lung function impairment. This article aims to discuss the management of severe tuberculosis (defined as that which is potentially life threatening, requiring higher levels of care) and its sequelae, from intensive care to the postoperative period, rehabilitation, and recovery. We also discuss the nonpharmacological interventions available to manage chronic sequelae and improve patient quality of life. Because the majority of MDR-/XDR-TB cases evolve to lung function impairment (typically obstructive but occasionally restrictive), impaired quality of life, and low performance status (as measured by walk tests or other metrics), other interventions (e.g., smoking cessation, pulmonary rehabilitation, vaccination/prevention of secondary bacterial infections/exacerbations, complemented by psychological and nutritional support) are required.

 


Keywords: Extensively drug-resistant tuberculosis; Tuberculosis, multidrug-resistant; Critical care; Smoking cessation.

 


 

 


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