Mayara L. Bastos

Cost-Effectiveness of Quantiferon®-TB Gold-In-Tube Versus Tuberculin Skin Testing for Contact Screening and Treatment of Latent Tuberculosis Infection in Brazil

Background Latent tuberculosis infection (LTBI) is a reservoir for new TB cases. Isoniazid preventive therapy (IPT) reduces the risk of active TB by as much as 90%, but LTBI screening has limitations. Unlike tuberculin skin testing (TST), interferon-gamma release assays are not affected by BCG vaccination, and have been reported to be cost-effective in low-burden countries. The goal of this study was to perform a cost-effectiveness analysis from the health system perspective, comparing three strategies for LTBI diagnosis in TB contacts: tuberculin skin testing (TST), QuantiFERON®-TB Gold-in-Tube (QFT-GIT) and TST confirmed by QFT-GIT if positive (TST/QFT-GIT) in Brazil, a middle-income, high-burden country with universal BCG coverage. Methodology/Principal Findings Costs for LTBI diagnosis and treatment of a hypothetical cohort of 1,000 adult immunocompetent close contacts were considered. The effectiveness measure employed was the number of averted TB cases in two years. Health system costs were US

Accuracy of polimerase chain reaction for the diagnosis of pleural tuberculosis.

105,096 for TST, US

Treatment of human disease due to Mycobacterium bovis: a systematic review

121,054 for QFT-GIT and US

Comparison of different treatments for isoniazid-resistant tuberculosis: an individual patient data meta-analysis

101,948 for TST/QFT-GIT; these strategies averted 6.56, 6.63 and 4.59 TB cases, respectively. The most cost-effective strategy was TST (US

The impact of the Brazilian family health on selected primary care sensitive conditions: A systematic review.

16,021/averted case). The incremental cost-effectiveness ratio was US

O papel das ligas acadêmicas na formação profissional

227,977/averted TB case for QFT-GIT. TST/QFT-GIT was dominated. Conclusions Unlike previous studies, TST was the most cost-effective strategy for averting new TB cases in the short term. QFT-GIT would be more cost-effective if its costs could be reduced to US

Cost and cost-effectiveness of tuberculosis treatment shortening: a model-based analysis.

26.95, considering a TST specificity of 59% and US

Reply to Wang and Zhang

18 considering a more realistic TST specificity of 80%. Nevertheless, with TST, 207.4 additional people per 1,000 will be prescribed IPT compared with QFT.

SÍFILIS E INFECÇÃO PELO HIV: EFEITO PROZONA EM UM PACIENTE COM NEUROSSÍFILIS

INTRODUCTION Polymerase chain reaction (PCR)-based techniques to detect Mycobacterium tuberculosis DNA in respiratory specimens have been increasingly used to diagnose pulmonary tuberculosis. Their use in non-respiratory specimens to diagnose extrapulmonary tuberculosis is, however, controversial. In this study, we estimated the accuracy of three in-country commercialized PCR-based diagnostic techniques in pleural fluid samples for the diagnosis of pleural tuberculosis. METHODS Patients underwent thoracenthesis for diagnosis purposes; pleural fluid aliquots were frozen and subsequently submitted to two real time PCR tests (COBAS(®)TAQMAN(®)MTB and Xpert(®)MTB/Rif) and one conventional PCR test (Detect-TB(®)). Two different reference standards were considered: probable tuberculosis (based on clinical grounds) and confirmed tuberculosis (bacteriologically or histologically). RESULTS Ninety-three patients were included, of whom 65 with pleural tuberculosis, 35 of them confirmed. Sensitivities were 29% for COBAS(®)TAQMAN(®)MTB, 3% for Xpert(®)MTB/Rif and 3% for Detect-TB(®); specificities were 86%, 100% and 97% respectively, considering confirmed tuberculosis. Considering all cases, sensitivities were 16%, 3% and 2%, and specificities, 86%, 100%, and 97%. DISCUSSION Compared to the 95% sensitivity of adenosine deaminase, the most sensitive test for pleural tuberculosis, the sensitivities of the three PCR-based tests were very low. We conclude that at present, there is no major place for such tests in routine clinical use.

Treatment Outcomes of Patients With Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis According to Drug Susceptibility Testing to First- and Second-line Drugs: An Individual Patient Data Meta-analysis

Mycobacterium bovis, a member of the Mycobacterium tuberculosis complex, is an important cause of disease in cattle, but it can also cause disease in humans [1]. Transmission to humans generally occurs after close contact with infected animals or consumption of unpasteurised contaminated dairy products [1, 2]. The symptoms of human disease due to M. bovis are similar to those of disease caused by M. tuberculosis, although M. bovis is more likely to cause extrapulmonary disease [3]. In clinical practice, M. bovis can only be differentiated from M. tuberculosis using biochemical or genetic tests [3, 4]. Only limited evidence exists to support current recommendations for the treatment of human disease due to M. bovis http://ow.ly/h92K3023fLu