Original Article

Descriptive study of the frequency of nontuberculous mycobacteria in the Baixada Santista region of the state of São Paulo, Brazil

Estudo descritivo da freqüência de micobactérias não tuberculosas na Baixada Santista

Liliana Aparecida Zamarioli, Andréa Gobetti Vieira Coelho, Clemira Martins Pereira, Ana Carolina Chiou Nascimento, Suely Yoko Mizuka Ueki, Erica Chimara

J Bras Pneumol.2008;34(8):590-594

Restriction enzyme analysis of the hsp65 gene in clinical isolates from patients suspected of having pulmonary tuberculosis in Teresina, Brazil

Análise de restrição enzimática do gene hsp65 de isolados clínicos de pacientes com suspeita de tuberculose pulmonar em Teresina, Piauí

Maria das Graças Motta e Bona, Maria José Soares Leal, Liline Maria Soares Martins, Raimundo Nonato da Silva, José Adail Fonseca de Castro, Semiramis Jamil Hadad do Monte

J Bras Pneumol.2011;37(5):628-635

Objective: To identify mycobacterial species in the sputum of patients suspected of having pulmonary tuberculosis and to determine the impact that the acquisition of this knowledge has on the therapeutic approach. Methods: We evaluated 106 patients suspected of having pulmonary tuberculosis and referred to the pulmonology department of a public hospital in the city of Teresina, Brazil. Morning sputum specimens were evaluated for the presence of mycobacteria by sputum smear microscopy and culture. We used PCR and restriction enzyme analysis of the hsp65 gene (PRA-hsp65) to identify the strains of mycobacteria isolated in culture. Results: A total of 206 sputum samples were analyzed. Patient ages ranged from 15 to 87 years, and 67% were male. There was cough in 100% of the cases. The predominant radiographic pattern was moderate disease, observed in 70%. Smear positivity was 76%, and isolation in culture occurred in 91% of the cultures. Traditional tests identified nontuberculous mycobacteria (NTM) in 9% of the isolates. The PRA-hsp65 method confirmed these data, showing seven band patterns that were able to identify the isolated species of NTM: Mycobacterium kansasii; M. abscessus 1; M. abscessus 2; M. smegmatis; M. flavescens 1; M. gordonae 5; and M. gordonae 7. All of the patients with NTM were over 60 years of age, and bronchiectasis was seen in 88% of the X-rays. There were two cases of reinfection, initially attributed to M. abscessus and M. kansasii. Conclusions: In immunocompetent patients, NTM can infect the lungs. It is important to identify the specific NTM in order to establish the correct diagnosis and choose the most appropriate therapeutic regimen. The PRA-hsp65 method is useful in identifying NTM species and can be implemented in molecular biology laboratories that do not specialize in the identification of mycobacteria. Keywords:

Keywords: Tuberculosis; Mycobacteria, atypical; Polymerase chain reaction; Brazil.

Nontuberculous mycobacteria in patients with suspected tuberculosis and the genetic diversity of Mycobacterium avium in the extreme south of Brazil

Micobactérias não tuberculosas em pacientes com suspeita de tuberculose e a diversidade genética de Mycobacterium avium no extremo sul do Brasil

Caroline Busatto1, Júlia Silveira Vianna1, Ana Barbara Scholante Silva1, Rossana Basso2, Jussara Silveira2, Andrea Von Groll1, Ivy Bastos Ramis1, Pedro Eduardo Almeida da Silva1

J Bras Pneumol.2020;46(2):e20190184

Pulmonary nontuberculous mycobacterial infections: presumptive diagnosis based on the international microbiological criteria adopted in the state of São Paulo, Brazil, 2011-2014

Micobacterioses pulmonares: diagnóstico presuntivo pelos critérios microbiológicos internacionais adotados no estado de São Paulo, Brasil, 2011-2014

Lilian Regina Macelloni Marques1,a, Lucilaine Ferrazoli2,b, Érica Chimara2,c

J Bras Pneumol.2019;45(2):e20180278

Smoking among physicians in a specific region of the greater metropolitan area of São Paulo

Tabagismo entre médicos da Região do ABC Paulista

Adriano Cesar Guazzelli, Mário Terra Filho, Elie Fiss

J Bras Pneumol.2005;31(6):516-522

Identification of nontuberculous mycobacteria isolated from clinical sterile sites in patients at a university hospital in the city of Rio de Janeiro, Brazil

Identificação de micobactérias não tuberculosas isoladas de sítios estéreis em pacientes em um hospital universitário na cidade do Rio de Janeiro

Simone Gonçalves Senna, Ana Grazia Marsico, Gisele Betzler de Oliveira Vieira, Luciana Fonseca Sobral, Philip Noel Suffys, Leila de Souza Fonseca

J Bras Pneumol.2011;37(4):521-526

Epidemiological aspects of pleural tuberculosis in the state of São Paulo, Brazil (1998-2005)

Aspectos epidemiológicos da tuberculose pleural no estado de São Paulo (1998-2005)

Márcia Seiscento, Francisco Suso Vargas, Maria Josefa Penon Rujula, Sidney Bombarda, David Everson Uip, Vera Maria Nedes Galesi

J Bras Pneumol.2009;35(6):548-554

Silicosis among PIT diggers in the region of Ibiapaba, State of Ceará, Brazil: from detection to control

Silicose em cavadores de poços da região de Ibiapaba (CE): da descoberta ao controle

Márcia Alcântara Holanda, Ana Carolina Peixoto do Rego Barros, Alexandre Alcântara Holanda, Cristina Gomes do Monte, Elias Bezerra Leite, Luiz Ximenes Junior, Maria Zélia Maia Holanda, Pedro Henrique Felismino

J Bras Pneumol.1999;25(1):1-11

Tuberculosis recurrence in a priority city in the state of São Paulo, Brazil

Recorrência de tuberculose em município prioritário do estado de São Paulo

Amadeu Antonio Vieira1,2, Danila Torres Leite3, Solange Adreoni2

J Bras Pneumol.2017;43(2):106-112

Lung donor profile in the state of São Paulo, Brazil, in 2006

Perfil do doador de pulmão disponibilizado no estado de São Paulo, Brasil, em 2006

Paulo Manuel Pêgo Fernandes, Marcos Naoyuki Samano, Jader Joel Machado Junqueira,Daniel Reis Waisberg, Gustavo Sousa Noleto, Fabio Biscegli Jatene

J Bras Pneumol.2008;34(7):497-505

Letters to the Editor

Nontuberculous mycobacteria in respiratory specimens: clinical significance at a tertiary care hospital in the north of Portugal

Micobactérias não tuberculosas em espécimes respiratórios: significado clínico em um hospital terciário no norte de Portugal

Hans Dabó1, Vanessa Santos1, Anabela Marinho2, Angélica Ramos3, Teresa Carvalho3, Manuela Ribeiro3, Adelina Amorim2

J Bras Pneumol.2015;41(3):292-294

Original Article

The relative frequency of hypomagnesemia in outpatients with chronic airflow limitation treated at a referral center in the north of the state of Paraná, Brazil

Freqüência relativa de hipomagnesemia em pacientes com limitação crônica do fluxo aéreo atendidos em ambulatório de referência do norte do Paraná

Alcindo Cerci Neto, Olavo Franco Ferreira Filho, Johnathan de Sousa Parreira

J Bras Pneumol.2006;32(4):294-300

PLATINO, a nine-year follow-up study of COPD in the city of São Paulo, Brazil: the problem of underdiagnosis

PLATINO, estudo de seguimento de nove anos sobre DPOC na cidade de São Paulo: o problema do subdiagnóstico

J Bras Pneumol.2014;40(1):30-37

Objective: To determine the underdiagnosis rate in new COPD cases at the end of a nine-year follow-up period-in the study designated "Projeto Latino-Americano de Investigação em Obstrução Pulmonar" (PLATINO, Latin-American Pulmonary Obstruction Investigation Project)-and compare that with the underdiagnosis rate during the initial phase of the study, as well as to identify the clinical features exhibited by the subjects who were not diagnosed until the end of the follow-up phase. Methods: The study population comprised the 1,000 residents of the city of São Paulo, Brazil, who took part in the PLATINO study. Of those, 613 participated in the follow-up phase, during which the subjects were assessed with the same instruments and equipment employed in the initial phase of the study. We used the chi-square test or the independent sample t-test to analyze the underdiagnosis rate and to identify the characteristics of the subjects who were not diagnosed until the end of the follow-up phase. Results: The underdiagnosis rate for new COPD cases at the end of the nine-year follow-up period was 70.0%. The underdiagnosis rate during the follow-up phase was 17.5% lower than that reported for the initial phase of the study. The subjects who were not diagnosed until the end of the follow-up phase presented with fewer respiratory symptoms, better pulmonary function, and less severe disease than did those previously diagnosed with COPD. Conclusions: The underdiagnosis rate for new COPD cases was lower in the follow-up phase of the study than in the initial phase. The subjects who were not diagnosed until the end of the follow-up phase of the PLATINO study presented with the same clinical profile as did those who were not diagnosed in the initial phase. These findings underscore the need for spirometry in order to confirm the diagnosis of COPD and provide early intervention.

Keywords: Pulmonary disease, chronic obstructive/diagnosis; Pulmonary disease, chronic obstructive/epidemiology; Spirometry.

Analysis of treatment outcomes related to the tuberculosis control program in the city of Campinas, in the state of São Paulo, Brazil

Análise do programa de controle da tuberculose em relação ao tratamento, em Campinas - SP

Helenice Bosco de Oliveira, Leticia Marin-León, Jovana Gardinali

J Bras Pneumol.2005;31(2):133-138

Background: Tuberculosis cure is dependent upon treatment adherence. Objective: To analyze the results of tuberculosis treatment in public health clinics in the city of Campinas, in the state of São Paulo, Brazil, during 2002. Method: From a cohort of 484 patients diagnosed with tuberculosis, we evaluated 436. Treatment outcomes were described for all patients, whether new patients or patients in retreatment, including those presenting the pulmonary form, with or without acquired immunodeficiency syndrome (AIDS) comorbidity. Results: The success rate was 68.6% (72.3% among non-AIDS patients and 57.6% among AIDS patients). Among new cases, the non-AIDS group presented a 2.2-times greater chance of presenting favorable results. In the AIDS group, no differences were observed between new patients and those in retreatment. Among the unfavorable outcomes, only lethality presented a difference (18.9% among AIDS patients and 8.0% among non-AIDS patients). In patients presenting the pulmonary form, the success rate was similar between those who were initially acid-fast bacilli positive and those who were not. Conclusion: The tuberculosis control program in Campinas presented low effectiveness. In comparison to the 2001 national cohort, success rates were higher for non-AIDS patients but lower for AIDS patients. The higher success rate among cases of tuberculosis without AIDS was primarily derived from the treatment of new cases. The unfavorable profile of tuberculosis patients co-infected with AIDS, characterized by the (18.9%) lethality and the (15.3%) noncompliance, were partially responsible for the lower success rate seen among such patients. It is notable that such high proportions of noncompliant patients were seen in a city providing easy access to treatment. In order to improve the program, medical teams should receive further training in supervised treatment, health education and techniques for interacting with patients, all of which will require considerable investment.

Keywords: Key words: Tuberculosis. Treatment Refusal. Retreatment. Acquired Immunodeficiency Syndrome. Comorbidity

Reasons for the admission, length of stay and type of discharge in tuberculosis hospitals in the State of São Paulo, Brazil - 1981 to 1995

Motivos e tempo de internação e o tipo de saída em hospitais de tuberculose do Estado de São Paulo, Brasil - 1981 a 1995

Péricles Alves Nogueira

J Bras Pneumol.2001;27(3):123-129

Case Report

The challenge of managing extensively drug-resistant tuberculosis at a referral hospital in the state of São Paulo, Brazil: a report of three cases

O desafio do tratamento da tuberculose extensivamente resistente em um hospital de referência no estado de São Paulo: um relato de três casos

Marcos Abdo Arbex1,2, Hélio Ribeiro de Siqueira3,4, Lia D'Ambrosio5,6, Giovanni Battista Migliori5

J Bras Pneumol.2015;41(6):554-559

Original Article

Who are the patients with tuberculosis who are diagnosed in emergency facilities? An analysis of treatment outcomes in the state of São Paulo, Brazil

Quem são os pacientes com tuberculose diagnosticados no pronto-socorro? Uma análise dos desfechos do tratamento no Estado de São Paulo, Brasil

Otavio Tavares Ranzani1,2,a, Laura Cunha Rodrigues2,b, Eliseu Alves Waldman3,c, Elena Prina1,d, Carlos Roberto Ribeiro Carvalho1,e

J Bras Pneumol.2018;44(2):125-133

Objective: Early tuberculosis diagnosis and treatment are determinants of better outcomes and effective disease control. Although tuberculosis should ideally be managed in a primary care setting, a proportion of patients are diagnosed in emergency facilities (EFs). We sought to describe patient characteristics by place of tuberculosis diagnosis and determine whether the place of diagnosis is associated with treatment outcomes. A secondary objective was to determine whether municipal indicators are associated with the probability of tuberculosis diagnosis in EFs. Methods: We analyzed data from the São Paulo State Tuberculosis Control Program database for the period between January of 2010 and December of 2013. Newly diagnosed patients over 15 years of age with pulmonary, extrapulmonary, or disseminated tuberculosis were included in the study. Multiple logistic regression models adjusted for potential confounders were used in order to evaluate the association between place of diagnosis and treatment outcomes. Results: Of a total of 50,295 patients, 12,696 (25%) were found to have been diagnosed in EFs. In comparison with the patients who had been diagnosed in an outpatient setting, those who had been diagnosed in EFs were younger and more socially vulnerable. Patients diagnosed in EFs were more likely to have unsuccessful treatment outcomes (adjusted OR: 1.54; 95% CI: 1.42-1.66), including loss to follow-up and death. At the municipal level, the probability of tuberculosis diagnosis in EFs was associated with low primary care coverage, inequality, and social vulnerability. In some municipalities, more than 50% of the tuberculosis cases were diagnosed in EFs. Conclusions: In the state of São Paulo, one in every four tuberculosis patients is diagnosed in EFs, a diagnosis of tuberculosis in EFs being associated with poor treatment outcomes. At the municipal level, an EF diagnosis of tuberculosis is associated with structural and socioeconomic indicators, indicating areas for improvement.

Keywords: Tuberculosis/diagnosis; Emergency treatment; Treatment outcome; Delivery of health care.

Spatial analysis of hospitalizations for pneumonia in the Vale do Paraíba region of Brazil

Análise espacial das internações por pneumonia na região do Vale do Paraíba (SP)

Adriana de Oliveira Mukai, Kátia de Souza Costa Alves, Luiz Fernando Costa Nascimento

J Bras Pneumol.2009;35(8):753-758

Descriptive study of the implementation and impact of the directly observed treatment, short-course strategy in the São José do Rio Preto municipal tuberculosis control program (1998-2003)

Estudo descritivo sobre a implantação da estratégia de tratamento de curta duração diretamente observado no controle da tuberculose em São José do Rio Preto e seus impactos (1998-2003)

Cláudia Eli Gazetta, Silvia Helena Fiqueiredo Vendramini, Antônio Ruffino-Netto, Maria Rita de Cássia Oliveira, Tereza Cristina Scatena Villa

J Bras Pneumol.2007;33(2):192-198

Prevalence of and factors related to tuberculosis in seropositive human immunodeficiency virus patients at a reference center for treatment of human immunodeficiency virus in the southern region of the state of Rio Grande do Sul, Brazil

Prevalência e fatores associados à tuberculose em pacientes soropositivos para o vírus da imunodeficiência humana em centro de referência para tratamento da síndrome da imunodeficiência adquirida na região sul do Rio Grande do Sul

Jussara Maria Silveira, Raúl Andrés Mendoza Sassi, Isabel Cristina de Oliveira Netto, Jorge Lima Hetzel

J Bras Pneumol.2006;32(1):48-55

Objective: In view of the relevance of co-infection with tuberculosis and human immunodeficiency virus, this study was designed to determine tuberculosis prevalence and identify factors related to tuberculosis in patients residing in a region in which both infections are highly prevalent. Methods: All patients treated during 1999 at the HIV/AIDS Clinic of the Universidade Federal do Rio Grande (Rio Grande Federal University) University Hospital were evaluated retrospectively, from the time of human immunodeficiency virus diagnosis, in terms of the incidence of tuberculosis and its relationship to sociodemographic, behavioral and immunological factors. Results: The sample included 204 patients, and tuberculosis prevalence was found to be 27%. The multivariate analysis showed a significant correlation between the development of tuberculosis and being of African descent (odds ratio: 4.76; 95% confidence interval: 1.93-11.72) and an inverse correlation between the development of tuberculosis and the TCD4+ lymphocyte count at the time of human immunodeficiency virus diagnosis (odds ratio: 0.995; 95% confidence interval: 0.993-0.997). When analyzed separately, other variables were found to be potential risk factors: being of the male gender (odds ratio: 2.49; 95% confidence interval: 1.15-5.39); and using illicit drugs (odds ratio: 2.1; 95% confidence interval: 1.02-4.31). Conclusion: The factors responsible for the development of tuberculosis among patients who are human immunodeficiency virus seropositive include immunological, socioeconomic and demographic factors. The high rate of tuberculosis prevalence among the seropositive patients underscores the urgent need to implement strategies that combine rapid identification and prompt treatment of individuals with active or latent infection, as well as of those with whom they have been in contact.

Keywords: HIV Infections/complications; AIDS-related opportunistic infections/complications; Tuberculosis/etiology; Tuberculosis/epidemiology

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