Brazilian Journal of Pulmonology

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


Publication continuous and bimonthly

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Guided sputum sample collection and culture contamination rates in the diagnosis of pulmonary TB

Associação entre coleta de escarro guiada e taxas de contaminação de culturas para o diagnóstico de TB pulmonar

Ethel Leonor Noia Maciel, Thiago Nascimento do Prado, Renata Lyrio Peres, Moises Palaci, John L. Johnson, Reynaldo Dietze

J Bras Pneumol.2009;35(5):460-463

Abstract PDF PT PDF EN Portuguese Text

A comparative study to evaluate contamination in cultures of morning sputum samples, comparing those collected at home under currently recommended conditions and those collected under supervision after patient orientation and education. The home and supervised collection groups produced 43 and 76 sputum samples, respectively. The contamination rate was nearly 3-times higher among samples collected at home than among those collected under supervision (37% vs. 13%, p < 0.05; OR = 0.25). The simple educational and hygiene measures described can decrease the contamination rate among sputum samples collected for diagnostic culture.


Keywords: Tuberculosis/diagnosis; Sputum/microbiology; Culture techniques.


Juvenile household contacts aged 15 or younger of patients with pulmonary TB in the greater metropolitan area of Vitória, Brazil: a cohort study

Comunicantes domiciliares jovens de pacientes com TB pulmonar na região da grande Vitória (ES): um estudo de coorte

Ethel Leonor Noia Maciel, Luiza Werner Heringer Vieira, Lucília Pereira Dutra Molina, Rosana Alves, Thiago Nascimento do Prado, Reynaldo Dietze

J Bras Pneumol.2009;35(4):359-366

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Objective: To compare clinical, radiological and laboratory aspects of household contacts, aged 15 or younger, of patients presenting a positive culture for Mycobacterium tuberculosis. Methods: This was a cohort study comparing children and adolescents (≤ 15 years of age) who were household contacts of TB cases presenting positive sputum smear and positive culture results (exposed group, n = 100) or negative sputum smear and positive culture results (unexposed group, n = 55). All of the contacts were evaluated via the TB control program of a university hospital in the city of Vitória, Brazil, between July of 2003 and December of 2006. Results: Of the 155 minors evaluated, 87 (56.1%) were female and 68 (43.9%) were male. Of those 155, 28 (18%) were aged 5 or younger, 62 (40%) were aged 5-9, and 65 (42%) were aged 10-15. Symptoms of the disease were found in 17 (17%) of the 100 contacts in the exposed group and in 9 (16%) of the 55 in the unexposed group (p = 0.86). Chest X-rays showed alterations in 20 (21%) and 2 (4%) of the contacts in the exposed and unexposed groups, respectively (RR = 6.9; p = 0.004). In the exposed and unexposed groups, respectively, 35 (38%) and 10 (18%) of the contacts presented positive results on the tuberculin skin test (RR = 2.8; p = 0.01). Of the 100 contacts in the exposed group, 5 (5%) were diagnosed with TB, which was not diagnosed in any of those in the unexposed group (p = 0.08). Conclusions: Although no significant difference was found between the two groups regarding the incidence of TB, it is of note that there is a greater risk of becoming infected with M. tuberculosis if the bacterial load of the index case is high.


Keywords: Tuberculosis; Mycobacterium tuberculosis; Tuberculosis, pulmonary; Child; Adolescent.


Factors associated with nonadherence to TB chemoprophylaxis in Vitória, Brazil: a historical cohort study

Fatores associados ao abandono da quimioprofilaxia de TB no município de Vitória (ES): um estudo de coorte histórica

Ethel Leonor Noia Maciel, Ana Paula Brioschi, Letícia Molino Guidoni, Anne Caroline Barbosa Cerqueira, Thiago Nascimento do Prado, Geisa Fregona, Reynaldo Dietze

J Bras Pneumol.2009;35(9):884-891

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Objective: To describe the factors associated with nonadherence to TB chemoprophylaxis in patients older than 15 years of age treated via referral TB control programs. Methods: A historical cohort study was carried out based on medical charts related to cases treated via referral TB control programs in the city of Vitória, Brazil, between 2002 and 2007. Cases of infection with Mycobacterium tuberculosis were stratified into two groups: health care workers (HCW group); and individuals who were not health care workers (NHCW group). Results: A total of 395 patients were included in the study: 35 in the HCW group and 360 in the NHCW group. The mean age in the HCW and NHCW groups was 34.8 and 32.4 years, respectively (p = 0.36). Of the 35 patients in the HCW group, 29 (82.9%) were female, compared with 180 (50.0%) of the 360 patients in the NHCW group. In the HCW and NHCW groups, respectively, 15 (42.9%) and 169 (46.9%) of the patients were contacts of TB cases. In addition, 9 (25.7%) and 157 (78.5%) the HCW and NHCW group patients, respectively, were HIV-infected. Nonadherence to chemoprophylaxis was 37.1% and 21.9% in the HCW and NHCW groups, respectively (p = 0.045). In the multivariate analysis, the factors associated with nonadherence were being a health care worker (OR = 8.60; 95% CI: 2.09-35.41), being HIV-infected (OR = 4.57; 95% CI: 1.2-17.5) and having had contact with a TB patient (OR = 2.65; 95% CI: 1.15-6.12). Conclusions: In order to improve adherence to TB chemoprophylaxis, new TB control program strategies are needed, especially for health care workers and HIV-infected patients.


Keywords: Tuberculosis; Chemoprevention; Isoniazid.


Tuberculosis infection among primary health care workers

Infecção por tuberculose entre profissionais de saúde da atenção básica

Thamy Carvalho Lacerda1,2,3, Fernanda Mattos de Souza1, Thiago Nascimento do Prado1,2,4,5, Rodrigo Leite Locatelli1,2, Geisa Fregona1,3, Rita de Cássia Duarte Lima2,5, Ethel Leonor Maciel1,2,5

J Bras Pneumol.2017;43(6):416-423

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Objective: To estimate the prevalence of and determine the risk factors associated with latent Mycobacterium tuberculosis infection (LTBI) among primary health care workers in the city of Vitória, Brazil. Methods: This was a cross-sectional study with data collected through a survey regarding socio-demographic, occupational, clinical, and exposure characteristics, as well as knowledge about tuberculosis, conducted between 2011 and 2012. All participants underwent a tuberculin skin test (TST), and TSTs were read at 72 h by a trained professional. Results: A total of 218 primary health care workers participated in the study. The prevalence of TST positivity at the ≥ 10-mm and ≥ 5-mm cut-off points was, respectively, 39.4% (95% CI: 32.9-45.9) and 54.1% (95% CI: 47.4-60.7). Regarding occupational categories, community health agents had the highest proportion of TST positivity, regardless of the cut-off point (≥ 10 mm: 47.5%; and ≥ 5 mm: 60.5%). Regarding factors associated with TST results, "having had a previous TST" showed a statistically significant association with TST positivity at the ≥ 10-mm and ≥ 5-mm cut-off points (OR = 2.5 [95% CI: 1.17-5.30] and OR = 2.18 [95% CI: 1.23-3.87], respectively). Conclusions: The prevalence of LTBI was found to be high among the primary health care workers in this sample. Therefore, we recommend the establishment of a periodic screening program for LTBI and implementation of effective biosafety policies for the prevention of this infection among primary health care workers.


Keywords: Health personnel; Tuberculin test; Latent tuberculosis; Primary health care.


Epidemiological profile of adult patients with tuberculosis and AIDS in the state of Espírito Santo, Brazil: Cross-referencing tuberculosis and AIDS databases

Perfil epidemiológico de pacientes adultos com tuberculose e AIDS no estado do Espírito Santo, Brasil: Relacionamento dos bancos de dados de tuberculose e AIDS

Thiago Nascimento do Prado, Antonio Luiz Caus, Murilo Marques, Ethel Leonor Maciel, Jonathan E. Golub, Angélica Espinosa Miranda

J Bras Pneumol.2011;37(1):93-99

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Objective: To evaluate the epidemiological profile of patients with tuberculosis (TB) only and that of patients with TB/AIDS in the state of Espírito Santo, Brazil, between 2000 and 2006. Methods: For the patients of interest, we collected demographic and clinical data from the Epidemiological Surveillance Center (TB database), Brazilian Case Registry Database, and Brazilian National Mortality Database, as well as the Brazilian National CD4+/CD8+ T Lymphocyte Count and Viral Load Network Laboratory Test Control System and the Logistic Medication Monitoring System (HIV/AIDS databases). All of the compiled data were cross-referenced. Results: During the study period, we identified 9,543 TB patients > 15 years of age, 437 of whom (4.6%) had AIDS. The median age did not differ between TB/AIDS and TB-only patients (35 years vs. 38 years). Of the 437 TB/AIDS patients, 298 (68.2%) were male, and 156 (35.8%) were in the 30-39 age bracket. In terms of TB treatment outcome, 79.0% were cured, 9.7% were referred to other facilities, 6.0% died, 5.2% abandoned treatment, and 0.2% developed multidrug-resistant TB. Death was 4.75 times more common in patients with TB/AIDS than in those with TB only. Pulmonary TB accounted for 82.4% of the cases. The combination of pulmonary and extrapulmonary TB was 8.2 times more common in the TB/AIDS patients than in the TB-only patients (95% CI: 6.2-10.8). Conclusions: Our results emphasize the significance of AIDS among TB patients in Brazil, as well as the importance of evaluating secondary data in order to improve their quality and develop public health interventions.


Keywords: Tuberculosis; Acquired immunodeficiency syndrome; Brazil.


Epidemiological profile of tuberculosis cases reported among health care workers at the University Hospital in Vitoria, Brazil

Perfil epidemiológico dos casos notificados de tuberculose entre os profissionais de saúde no Hospital Universitário em Vitória (ES) Brasil

Thiago Nascimento do Prado, Heleticia Scabelo Galavote, Ana Paula Brioshi, Thamy Lacerda, Geisa Fregona, Valdério do Valle Detoni, Rita de Cássia Duarte Lima, Reynaldo Dietze, Ethel Leonor Noia Maciel

J Bras Pneumol.2008;34(8):607-613

Abstract PDF PT PDF EN Portuguese Text

Objective: To describe the epidemiological profile of tuberculosis cases reported among health care workers in the Tuberculosis Control Program of the Cassiano Antonio of Moraes University Hospital in Vitoria, Brazil. Methods: A retrospective descriptive study of secondary data was conducted between 2002 and 2006. Results: Twenty-five cases of health care workers with tuberculosis were reported: 8 in nursing technicians (32%); 4 in doctors (16%); 3 in nurses (12%); 2 in radiology technicians (8%) and 8 in professionals from other categories (32%). Of those 25 health care workers, 14 (56%) were male and 11 (44%) were female. The incidence of the disease was highest among those from 35 to 39 years of age. The predominant clinical presentation was extrapulmonary (12 cases, 48%), followed by pulmonary (11 cases, 44%) and a combination of the two (2 cases, 8%). Regarding comorbidities, AIDS, alcoholism and smoking, respectively, were present in 33.3% of the study population. Outcomes were as follows: 22 cases of cure (88%); 2 transfers (8%); and 1 death (4%). The proportion of health care workers diagnosed with tuberculosis in the period studied was 2.53%. Conclusions: The results show the need for heath care workers who work in the tuberculosis control program to fill out the field "professional occupation" on the tuberculosis case registry database reporting forms. In addition, this situation draws attention to the need to implement an occupational tuberculosis control program.


Keywords: Health profile; Tuberculosis/epidemiology; Health personnel; Prevalence.


Tuberculosis in health professionals: a new perspective on an old problem

Tuberculose em profissionais de saúde: um novo olhar sobre um antigo problema

Ethel Leonor Noia Maciel, Thiago Nascimento do Prado, Juliana Lopes Fávero, Tiago Ricardo Moreira, Reynaldo Dietze

J Bras Pneumol.2009;35(1):83-90

Abstract PDF PT PDF EN Portuguese Text

The objective of this review was to contribute to the debate on the nosocomial transmission of TB among health professionals in a country where TB is endemic. Prior to 1900, there was no reason to believe that health professionals interacting with TB patients were more susceptible to becoming infected with the bacillus than was the general population. Between 1920 and 1930, various studies showed significant findings regarding the rates of positive tuberculin skin tests among students in the area of health care. However, most clinicians remained skeptical about the susceptibility of health professionals to becoming infected with TB. In the various locales where the treatment of patients with TB has been implemented, health professionals have been described as an especially predisposed population to becoming infected with and developing active TB. It is urgent that the scientific community and health professionals become mobilized, recognizing themselves as a population at risk of developing TB, and that actions be taken in order to minimize the potential risks of acquiring the disease at locales where patients with TB are treated.


Keywords: Tuberculosis; Cross infection; Health personnel.




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