Jamocyr Moura Marinho

Increased risk of tuberculosis with human T-lymphotropic virus-1 infection : A case-control study

Objectives:To investigate whether infection with human T-lymphotropic virus type 1 (HTLV-1) increases the risk of tuberculosis. Design:A case-control study. Setting:City of Salvador, Brazil. Participants:A total of 375 patients with tuberculosis (cases) and 378 individuals without tuberculosis (controls), matched by age and sex. Main Outcome Measure:Tuberculosis of lung or lymph node. Main Exposure:Human HTLV-1 infection. Results:The prevalence of HTLV-1 infection was 4.27% (16/375) in patients with tuberculosis and 1.32% (5/378) in controls, resulting in a crude odds ratio of 3.31 (95% CI, 1.20-9.13) and an adjusted odds ratio of 3.01 (95% CI, 1.06-8.58). Conclusion:HTLV-1 infection is associated with a first diagnosis of tuberculosis. This may have implications for tuberculosis control in places with high prevalence of HTLV-1.

Características dos serviços de saúde associadas à adesão ao tratamento da tuberculose

OBJECTIVE To analyze characteristics related to adherence to tuberculosis treatment in tuberculosis outpatient clinics. METHODS An ecological study was conducted in outpatient clinics for the treatment of tuberculosis cases in the sanitary districts of Salvador, Northeastern Brazil, in 2006. The sample was composed of the municipal health units that assisted 67.2% of the 2,283 tuberculosis cases that were reported during the year. The following variables were analyzed: cure, dropout, tests, health team and benefits offered to the patients. Chi-square test or Fishers exact test was used to verify the association between variables, and associations with p<0.05 were considered to be statistically significant. RESULTS Of the studied cases, 78.4% resulted in cure, 8.6% in dropout, 2.2% in death and 8.1% in transference. Adherence rates per health unit varied between 66.7% and 98.1%. The variables cure and dropout showed a statistically significant association with adherence in the comparison of proportions. All the units with high adherence rates had complete health teams. CONCLUSIONS Adherence was an important factor for the outcomes cure and dropout, but the index of units that achieved the cure goals was low. The presence of a complete multidisciplinary team in the tuberculosis program may help the patient understand his/her illness and contribute to adherence to treatment.OBJETIVO: Analizar caracteristicas relacionadas a la adhesion al tratamiento de los casos de tuberculosis en servicios de referencia para tuberculosis. METODOS: Se trata de estudio ecologico en las unidades de referencia en el tratamiento de los casos de tuberculosis de los distritos sanitarios de Salvador, Noreste de Brasil, en 2006. La muestra fue compuesta por las unidades de salud municipales que atendieron 67,2% de los 2.283 casos notificados de tuberculosis en el ano. Fueron analizadas las variables: cura, abandono, examenes realizados, equipo de salud y beneficios a los pacientes. Para verificar asociacion entre las variables, fue utilizada la prueba chi-cuadrado o exacto de Fisher, siendo consideradas estadisticamente significativas las asociaciones con p<0,05. RESULTADOS: De los casos estudiados, 78,4% resultaron en cura, 8,6% en abandono, 2,2% en obito y 8,1% en transferencia. Las tasas de adhesion por unidad de salud presentaron variabilidad entre 66,7% a 98,1%. Las variables cura y abandono mostraron asociacion estadisticamente significativa con la adhesion en la comparacion de proporciones. Todas las unidades con alta adhesion poseian equipo de salud completo. CONCLUSIONES: La adhesion fue factor importante para el resultado cura y abandono, pero fue bajo el indice de unidades que alcanzaron las metas de cura. La presencia de equipo multidisciplinar completo en el programa de tuberculosis puede contribuir para la comprension por el paciente sobre su enfermedad y la adhesion al tratamiento para la cura.

N-acetyl-cysteine exhibits potent anti-mycobacterial activity in addition to its known anti-oxidative functions

BackgroundMycobacterium tuberculosis infection is thought to induce oxidative stress. N-acetyl-cysteine (NAC) is widely used in patients with chronic pulmonary diseases including tuberculosis due to its mucolytic and anti-oxidant activities. Here, we tested whether NAC exerts a direct antibiotic activity against mycobacteria.MethodsOxidative stress status in plasma was compared between pulmonary TB (PTB) patients and those with latent M. tuberculosis infection (LTBI) or healthy uninfected individuals. Lipid peroxidation, DNA oxidation and cell death, as well as accumulation of reactive oxygen species (ROS) were measured in cultures of primary human monocyte-derived macrophages infected with M. tuberculosis and treated or not with NAC. M. tuberculosis, M. avium and M. bovis BCG cultures were also exposed to different doses of NAC with or without medium pH adjustment to control for acidity. The anti-mycobacterial effect of NAC was assessed in M. tuberculosis infected human THP-1 cells and bone marrow-derived macrophages from mice lacking a fully functional NADPH oxidase system. The capacity of NAC to control M. tuberculosis infection was further tested in vivo in a mouse (C57BL/6) model.ResultsPTB patients exhibited elevated levels of oxidation products and a reduction of anti-oxidants compared with LTBI cases or uninfected controls. NAC treatment in M. tuberculosis-infected human macrophages resulted in a decrease of oxidative stress and cell death evoked by mycobacteria. Importantly, we observed a dose-dependent reduction in metabolic activity and in vitro growth of NAC treated M. tuberculosis, M. avium and M. bovis BCG. Furthermore, anti-mycobacterial activity in infected macrophages was shown to be independent of the effects of NAC on the host NADPH oxidase system in vitro. Short-term NAC treatment of M. tuberculosis infected mice in vivo resulted in a significant reduction of mycobacterial loads in the lungs.ConclusionsNAC exhibits potent anti-mycobacterial effects and may limit M. tuberculosis infection and disease both through suppression of the host oxidative response and through direct antimicrobial activity.

Characteristics of healthcare services associated with adherence to tuberculosis treatment

OBJECTIVE To analyze characteristics related to adherence to tuberculosis treatment in tuberculosis outpatient clinics. METHODS An ecological study was conducted in outpatient clinics for the treatment of tuberculosis cases in the sanitary districts of Salvador, Northeastern Brazil, in 2006. The sample was composed of the municipal health units that assisted 67.2% of the 2,283 tuberculosis cases that were reported during the year. The following variables were analyzed: cure, dropout, tests, health team and benefits offered to the patients. Chi-square test or Fishers exact test was used to verify the association between variables, and associations with p<0.05 were considered to be statistically significant. RESULTS Of the studied cases, 78.4% resulted in cure, 8.6% in dropout, 2.2% in death and 8.1% in transference. Adherence rates per health unit varied between 66.7% and 98.1%. The variables cure and dropout showed a statistically significant association with adherence in the comparison of proportions. All the units with high adherence rates had complete health teams. CONCLUSIONS Adherence was an important factor for the outcomes cure and dropout, but the index of units that achieved the cure goals was low. The presence of a complete multidisciplinary team in the tuberculosis program may help the patient understand his/her illness and contribute to adherence to treatment.OBJETIVO: Analizar caracteristicas relacionadas a la adhesion al tratamiento de los casos de tuberculosis en servicios de referencia para tuberculosis. METODOS: Se trata de estudio ecologico en las unidades de referencia en el tratamiento de los casos de tuberculosis de los distritos sanitarios de Salvador, Noreste de Brasil, en 2006. La muestra fue compuesta por las unidades de salud municipales que atendieron 67,2% de los 2.283 casos notificados de tuberculosis en el ano. Fueron analizadas las variables: cura, abandono, examenes realizados, equipo de salud y beneficios a los pacientes. Para verificar asociacion entre las variables, fue utilizada la prueba chi-cuadrado o exacto de Fisher, siendo consideradas estadisticamente significativas las asociaciones con p<0,05. RESULTADOS: De los casos estudiados, 78,4% resultaron en cura, 8,6% en abandono, 2,2% en obito y 8,1% en transferencia. Las tasas de adhesion por unidad de salud presentaron variabilidad entre 66,7% a 98,1%. Las variables cura y abandono mostraron asociacion estadisticamente significativa con la adhesion en la comparacion de proporciones. Todas las unidades con alta adhesion poseian equipo de salud completo. CONCLUSIONES: La adhesion fue factor importante para el resultado cura y abandono, pero fue bajo el indice de unidades que alcanzaron las metas de cura. La presencia de equipo multidisciplinar completo en el programa de tuberculosis puede contribuir para la comprension por el paciente sobre su enfermedad y la adhesion al tratamiento para la cura.

Interferon-gamma production by mononuclear cells in Bacille Calmette-Guérin-revaccinated healthy volunteers predicted long-term antimycobacterial responses in a randomized controlled trial

The Bacille Calmette-Guérin (BCG) vaccine is the only vaccine currently available for tuberculosis, and it demonstrates variable efficacy against the disease. The assessment of new vaccine strategies is hindered by the small annual probability that an infected individual will develop tuberculosis, and the lack of simple and reliable surrogate markers of protection. The frequency of cytokine-producing T cells as well as the production of IFN-γ have been disputed as surrogate markers of protection. We evaluated the evolution of these immune parameters in a population from a high burden city where BCG revaccination has been shown to result in mild protection. We found that individuals whose in vitro IFN-γ responses to mycobacterial antigens had increased by more than 3.3-fold were more likely to maintain higher responses after 1 year and to show increased expansion of IFN-γ-producing T lymphocytes than those with lower or null increase of IFN-γ.

Common Mental Disorders Associated with Tuberculosis: A Matched Case-Control Study

Introduction Despite the availability of treatment and a vaccine, tuberculosis continues to be a public health problem worldwide. Mental disorders might contribute to the burden of the disease. Objective The objective of this study was to investigate the association between common mental disorders and tuberculosis. Methods A matched case-control study was conducted. The study population included symptomatic respiratory patients who attended three referral hospitals and six community clinics in the city of Salvador, Brazil. A doctor’s diagnosis defined potential cases and controls. Cases were newly diagnosed tuberculosis cases, and controls were symptomatic respiratory patients for whom tuberculosis was excluded as a diagnosis by the attending physician. Cases and controls were ascertained in the same clinic. Data collection occurred between August 2008 and April 2010. The study instruments included a structured interview, a self-reporting questionnaire for the identification of common mental disorders, and a questionnaire for alcoholism. An univariate analysis included descriptive procedures (with chi-square statistics), and a multivariate analysis used conditional logistic regression. Results The mean age of the cases was 38 years, and 61% of the cases were males. After adjusting for potential confounders, the odds of tuberculosis were significantly higher in patients dignosed with a common mental disorder (OR: 1.34; 95% CI 1.05–1.70). Conclusion There appears to be a positive and independent association between common mental disorders and tuberculosis; further epidemiological studies are required to increase our understanding of the possible biological and social mechanisms responsible for this association. Independent of the direction of the association, this finding has implications for the provision of care for mental disorders and for tuberculosis.

Revisiting the Heterogeneous IFN-γ Response of Bacille of Calmette-Guérin (BCG)-Revaccinated Healthy Volunteers in a Randomized Controlled Trial: Effect of the Body Mass Index and of the IFNG+874 A/T Polymorphism

In trials evaluating the immune responses to Bacille of Calmette-Guérin (BCG), the genetic background and the nutritional status are host-related factors that could affect the heterogeneity in these parameters. The IFNG+874 A/T (rs 62559044) polymorphism has been reported to influence the IFN-γ production by BCG-vaccinated individuals challenged in vitro with mycobacterial antigens. The body mass index (BMI) is a proxy for the nutritional status and has been associated both with the susceptibility to tuberculosis and with the IFN-γ response. We show that although the IFNG+874 A/T polymorphism was not associated with the heterogeneity of IFN-γ production in a randomized controlled trial that evaluated long-term immune responses to BCG revaccination previously conducted in Salvador, Bahia, Brazil, the effect of this polymorphism on the observed increase in IFN-γ production among revaccinated subjects was adjusted in individuals with a low BMI.

Non-compliance with health surveillance is a matter of Biosafety: a survey of latent tuberculosis infection in a highly endemic setting

Objective This study aimed at identifying demographic, socio-economic and tuberculosis (TB) exposure factors associated with non-compliance with the tuberculin skin test, the management and prevention of non-compliance to the test. It was carried out in the context of a survey of latent TB infection among undergraduate students taking healthcare courses in two universities in Salvador, Brazil, a city highly endemic for TB. Methods This is a cross-sectional study of 1164 volunteers carried out between October 2004 and June 2008. Bivariate analysis followed by logistic regression was used to measure the association between non-compliance and potential risk factors through non-biased estimates of the adjusted OR for confounding variables. A parallel evaluation of occupational risk perception and of knowledge of Biosafety measures was also conducted. Results The non-compliance rate was above 40% even among individuals potentially at higher risk of disease, which included those who had not been vaccinated (OR 3.33; 95% CI 1.50 to 7.93; p=0.0018), those reporting having had contact with TB patients among close relatives or household contacts (p=0.3673), or those whose tuberculin skin test status was shown within the survey to have recently converted (17.3% of those completing the study). In spite of the observed homogeneity in the degree of Biosafety knowledge, and the awareness campaigns developed within the study focussing on TB prevention, the analysis has shown that different groups have different behaviours in relation to the test. Family income was found to have opposite effects in groups studying different courses as well as attending public versus private universities. Conclusions Although the data presented may not be directly generalisable to other situations and cultural settings, this study highlights the need to evaluate factors associated with non-compliance with routine testing, as they may affect the efficacy of Biosafety programs.

Características de los servicios de salud asociadas a la adhesión al tratamiento de la tuberculosis

OBJECTIVE To analyze characteristics related to adherence to tuberculosis treatment in tuberculosis outpatient clinics. METHODS An ecological study was conducted in outpatient clinics for the treatment of tuberculosis cases in the sanitary districts of Salvador, Northeastern Brazil, in 2006. The sample was composed of the municipal health units that assisted 67.2% of the 2,283 tuberculosis cases that were reported during the year. The following variables were analyzed: cure, dropout, tests, health team and benefits offered to the patients. Chi-square test or Fishers exact test was used to verify the association between variables, and associations with p<0.05 were considered to be statistically significant. RESULTS Of the studied cases, 78.4% resulted in cure, 8.6% in dropout, 2.2% in death and 8.1% in transference. Adherence rates per health unit varied between 66.7% and 98.1%. The variables cure and dropout showed a statistically significant association with adherence in the comparison of proportions. All the units with high adherence rates had complete health teams. CONCLUSIONS Adherence was an important factor for the outcomes cure and dropout, but the index of units that achieved the cure goals was low. The presence of a complete multidisciplinary team in the tuberculosis program may help the patient understand his/her illness and contribute to adherence to treatment.OBJETIVO: Analizar caracteristicas relacionadas a la adhesion al tratamiento de los casos de tuberculosis en servicios de referencia para tuberculosis. METODOS: Se trata de estudio ecologico en las unidades de referencia en el tratamiento de los casos de tuberculosis de los distritos sanitarios de Salvador, Noreste de Brasil, en 2006. La muestra fue compuesta por las unidades de salud municipales que atendieron 67,2% de los 2.283 casos notificados de tuberculosis en el ano. Fueron analizadas las variables: cura, abandono, examenes realizados, equipo de salud y beneficios a los pacientes. Para verificar asociacion entre las variables, fue utilizada la prueba chi-cuadrado o exacto de Fisher, siendo consideradas estadisticamente significativas las asociaciones con p<0,05. RESULTADOS: De los casos estudiados, 78,4% resultaron en cura, 8,6% en abandono, 2,2% en obito y 8,1% en transferencia. Las tasas de adhesion por unidad de salud presentaron variabilidad entre 66,7% a 98,1%. Las variables cura y abandono mostraron asociacion estadisticamente significativa con la adhesion en la comparacion de proporciones. Todas las unidades con alta adhesion poseian equipo de salud completo. CONCLUSIONES: La adhesion fue factor importante para el resultado cura y abandono, pero fue bajo el indice de unidades que alcanzaron las metas de cura. La presencia de equipo multidisciplinar completo en el programa de tuberculosis puede contribuir para la comprension por el paciente sobre su enfermedad y la adhesion al tratamiento para la cura.