Heloisa da Silveira Paro Pedro

Isolamento de micobactérias não-tuberculosas em São José do Rio Preto entre 1996 e 2005

OBJECTIVE To study the incidence of nontuberculous mycobacteria and the range of species isolated between 1996 and 2005 at a regional branch of the Adolfo Lutz Institute-located in the city of São José do Rio Preto, Brazil-and to show the importance of laboratory testing. METHODS Mycobacteria were isolated from pulmonary and extrapulmonary specimens and identified through phenotyping and molecular methods (polymerase chain reaction-restriction enzyme analysis). RESULTS We isolated 317 nontuberculous mycobacterium strains: Mycobacterium avium complex, 182 (57.4%); M. gordonae, 33 (10.4%); M. fortuitum, 25 (7.9%); M. chelonae, 8 (2.5%); M. terrae complex, 8(2.5%); M.kansasii, 7 (2.2%); and less frequent species, 54 (17%). During this period, 72 cases (33.3%) were characterized as mycobacteriosis, according to bacteriological criteria established by the American Thoracic Society in 2007. Of those 72 cases, 56 were attributed to M.avium complex. Of those 56, 29 (51.8%) were characterized as disseminated disease. Six cases were attributed to M. fortuitum, 3 to M. gordonae, 2 to M. chelonae, 1 to M. abscessus, 1 to M. kansasii, 1 to M. intracellulare, 1 to M. malmoense and 1 to Mycobacterium ssp. CONCLUSIONS These results show the importance of the bacteriological diagnosis, since identification of the species enables early and appropriate treatment.

Escala salsa e grau de incapacidades da Organização Mundial de Saúde: avaliação da limitação de atividades e deficiência na hanseníase

Verificar o grau de incapacidades da OMS (GI-OMS) e a limitacao de atividades avaliada pela escala Screening of Activity Limitation and Safety Awareness (SALSA) pos-alta medicamentosa dos pacientes que tiveram hanseniase. Estudo transversal que incluiu pacientes tratados entre 2007 a 2009, em Sao Jose do Rio Preto-SP, Brasil. Utilizouse protocolo proprio para coletar dados gerais e clinicos, construido com base no Check List da Classificacao Internacional Funcionalidade, Incapacidade e Saude. A deficiencia foi medida pelo GI-OMS e a limitacao de atividades pelo SALSA que tem variacao de 10 a 80 e ponto de corte ≥25. De 84 pessoas tratadas no periodo, 54(64,3%) foram entrevistadas, sendo 31(57,4%) homens, idade 53,8(dp16,3) e 33(61,2 %) possuia ate 6 anos de educacao formal. A forma clinica dimorfa predominou 17(32,1%), 21(38,9%) considerou sua saude fisica “boa”. A analise dos escores SALSA e variaveis estudadas resultou em significância aos que relataram lesao significante (valor-p=0,04), baixa renda familiar (valor-p=0,04), baixa escolaridade (valor-p=0,00), formas clinicas multibacilares (valor-p=0,01) e deficiencias avaliadas pelo GI-OMS (valor-p=0,01). As limitacoes de atividades sao frequentes (57,4%), assim como as deficiencias medidas pelo GI-OMS (68,5%), atingem as formas multibacilares, pessoas que relataram lesao significante, de baixa renda e escolaridade.1 Terapeuta Ocupacional, Instituto de Psiquiatria do Hospital da Clinicas da Faculdade de Medicina da Universidade de Sao Paulo. 2 Terapeuta Ocupacional, Instituto Lauro de Souza Lima, Centro de Laboratorios Regionais Instituto Adolfo Lutz, Sao Jose do Rio Preto. 3 Terapeuta Ocupacional, Docente da Universidade Federal de Sao Carlos-UFSCar. 4 Centro de Laboratorios Regionais Instituto Adolfo Lutz, Sao Jose do Rio Preto. 5 Doutora, Departamento de Enfermagem e Saude Coletiva. Faculdade de Medicina de Sao Jose do Rio Preto. Verificar o grau de incapacidades da OMS (GI-OMS) e a limitacao de atividades avaliada pela escala Screening of Activity Limitation and Safety Awareness (SALSA) pos-alta medicamentosa dos pacientes que tiveram hanseniase. Estudo transversal que incluiu pacientes tratados entre 2007 a 2009, em Sao Jose do Rio Preto-SP, Brasil. Utilizouse protocolo proprio para coletar dados gerais e clinicos, construido com base no Check List da Classificacao Internacional Funcionalidade, Incapacidade e Saude. A deficiencia foi medida pelo GI-OMS e a limitacao de atividades pelo SALSA que tem variacao de 10 a 80 e ponto de corte ≥25. De 84 pessoas tratadas no periodo, 54(64,3%) foram entrevistadas, sendo 31(57,4%) homens, idade 53,8(dp16,3) e 33(61,2 %) possuia ate 6 anos de educacao formal. A forma clinica dimorfa predominou 17(32,1%), 21(38,9%) considerou sua saude fisica “boa”. A analise dos escores SALSA e variaveis estudadas resultou em significância aos que relataram lesao significante (valor-p=0,04), baixa renda familiar (valor-p=0,04), baixa escolaridade (valor-p=0,00), formas clinicas multibacilares (valor-p=0,01) e deficiencias avaliadas pelo GI-OMS (valor-p=0,01). As limitacoes de atividades sao frequentes (57,4%), assim como as deficiencias medidas pelo GI-OMS (68,5%), atingem as formas multibacilares, pessoas que relataram lesao significante, de baixa renda e escolaridade.

Detection of Mycobacterium tuberculosis complex by nested polymerase chain reaction in pulmonary and extrapulmonary specimens

OBJECTIVE: To compare the performance of nested polymerase chain reaction (NPCR) with that of cultures in the detection of the Mycobacterium tuberculosis complex in pulmonary and extrapulmonary specimens. METHODS: We analyzed 20 and 78 pulmonary and extrapulmonary specimens, respectively, of 67 hospitalized patients suspected of having tuberculosis. An automated microbial system was used for the identification of Mycobacterium spp. cultures, and M. tuberculosis IS6110 was used as the target sequence in the NPCR. The kappa statistic was used in order to assess the level of agreement among the results. RESULTS: Among the 67 patients, 6 and 5, respectively, were diagnosed with pulmonary and extrapulmonary tuberculosis, and the NPCR was positive in all of the cases. Among the 98 clinical specimens, smear microscopy, culture, and NPCR were positive in 6.00%, 8.16%, and 13.26%, respectively. Comparing the results of NPCR with those of cultures (the gold standard), we found that NPCR had a sensitivity and specificity of 100% and 83%, respectively, in pulmonary specimens, compared with 83% and 96%, respectively, in extrapulmonary specimens, with good concordance between the tests (kappa, 0.50 and 0.6867, respectively). CONCLUSIONS: Although NPCR proved to be a very useful tool for the detection of M. tuberculosis complex, clinical, epidemiological, and other laboratory data should also be considered in the diagnosis and treatment of pulmonary and extrapulmonary tuberculosis.

Mycobacterium tuberculosis in a HIV-1-infected population from Southeastern Brazil in the HAART era

Objective  To evaluate retrospectively the microbiological profile of Mycobacterium species isolated from HIV‐infected patients attending the HIV/TB reference health care units in São José do Rio Preto, Brazil.

Epidemiological and laboratorial profile of patients with isolation of nontuberculous mycobacteria

Background: An increase in NTM diseases in the international scenario has been observed in recent years. Aims: To analyze the epidemiological and laboratory profiles of patients with isolation of nontuberculous mycobacteria (NTM) over one decade. A retrospective analysis of records of a mycobacterial reference laboratory found 135 cases with isolation of NTM. Methods: Clinical and epidemiological data were collected from the records of government health clinics and from the State notification system (TBWEB). The cases were geocoded by location based on the street address in the Mercator Transverse Universal projection, Datum SAD/69 and MapInfo software. Results: Most patients were male (66.7%), older than 50 years (40%) and had only completed elementary schooling (38.5%). Associated health problems were found in 71.8% of the subjects, with 43.7% being HIV positive and 25.9% having had tuberculosis in the past. Hospitals were the most able institutions to diagnose cases (45.2%). Sputum was the most common material tested (63.0%) with the bacilloscopy being positive in 33.3% of cases. The most common mycobacteria species in the region were Mycobacterium avium and M. abscessus/M. massiliense/M. bolletii. When the regional reference municipality was analyzed, M. avium and M. fortuitum were the most common species isolated in the urban area. Conclusions: In the study region, mycobacteriosis most affected adult males with low schooling. Most patients presented comorbidities in particular co-infection with the HIV virus. M. avium is the most prevalent species in the region with the M. abscessus/M. massiliense/M. bolletii species being the main cause of nosocomial infections.

PROFISSIONAIS DE UM LABORATÓRIO DE SAÚDE PÚBLICA ESTIMULAM ESTUDANTES NA PREVENÇÃO DE DOENÇAS TRANSMITIDAS POR ALIMENTOS

Introduction: Educational activities focused on prevention are important tools to reduce outbreaks of foodborne illness. Objective: To verify whether, after educational lectures, students changed their habits to prevent foodborne diseases. Patients and Methods: Over four years, the staff and students of the Institute Adolfo Lutz, through the project “Itinerant Circuit of Lectures”, presented 41 talks and distributed a folder detailing the etiological agents, symptoms, and measures of prevention, conservation and handling of food to 1906 students in 12 private schools. Two months after the lectures an assessment tool comprising ten statements was applied to the students to see if they had changed their daily habits. Results: A total of 1555 students answered the questionnaire, with 81.5% having changed their habits, in particular students of the 6th, 7th and 8th grades of elementary school compared to students of the 9th grade, and 1st and 3rd grade of high school (p-value <0.05). The mean number of changes in habits related to the four personal hygiene items was 2.42 (SD 1.07), and for the six items on food care the mean number was 3.37 (SD 1.41). Conclusion: Popularization of science with educative actions proved to be effective, as 81.5% of young people changed their daily habits of personal hygiene and food care. Descriptors: Foodborne Diseases; Health Education; Food Contamination.

HISTÓRIA EM QUADRINHOS PARA ENSINO E PREVENÇÃO DAS DOENÇAS TRANSMITIDAS POR ALIMENTOS

Doencas transmitidas por alimentos (DTA) representam um problema de saude publica, contudo, sao passiveis de prevencao. Os surtos alimentares ocorrem em grande parte nas residencias, devido manipulacao ou armazenagem inadequada dos alimentos; assim, estrategias de educacao em saude voltadas a populacao podem colaborar na diminuicao dos riscos relacionados. Considera-se que a criacao de um material impresso voltado para o publico infanto-juvenil pode colaborar para o interesse e facil disseminacao do conhecimento.