Situación de la tuberculosis en Colombia, 2002
TL;DR: Of 11,376 cases, 7,787 were new pulmonary smear-positive cases; most of them were males aged 25 to 34 years, with the highest incidence in age group 65 or older, and a decrease was observed in respiratory symptomatic patients aged 15 years or older.
Abstract: Tuberculosis (TB) remains an important public health problem in Colombia. Therefore, in 2002, the epidemiological behavior of TB was described in order to identify priority interventions for its control. Data were analyzed from the 2002 ?Quarterly Report of Cases and Activities? collected by the National TB Program. TB demonstrated a fluctuating behavior during the past decade, particularly until 1997, when regularly increasing trend began. Two thirds of the 32 departments of Colombia had incidence rates above the national average (>26 per 100,000); six departments were classified as being at very high risk (incidence >50 per 100,000). Of 11,376 cases, 7,787 were new pulmonary smear-positive cases; most of them were males aged 25 to 34 years, with the highest incidence in age group 65 or older. A decrease was observed in respiratory symptomatic patients aged 15 years or older. Smear positivity from all patients was 3.8% and the smear average was 1.6 per patient. Follow up indicators are still under the desirable levels.The application of health care guidelines to TB patients by health care institutions, as well as the development of monitoring activities, the report feedback are essential elements in an effective TB control program. However, successful implementation also requires careful supervision at each level of application and political will at local and department levels to adhere to DOTS.
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TL;DR: The results indicate that a polymorphism in the NOS2A gene influences the susceptibility to TB and suggest a role for Nos2A in the pathogenesis of mycobacterial infection.
58 citations
TL;DR: The most frequent extrapulmonary forms were pleural tuberculosis, meningeal tuberculosis and lymphadenitis, and a prolonged hospital stay was associated with a delay in diagnosis and AIDS infection.
Abstract: Introduccion. La tuberculosis continua siendo un problema de salud publica en el mundo. Es necesario conocer su magnitud en cada institucion, la oportunidad en el diagnostico y la utilizacion de recursos. Objetivo. Determinar las localizaciones y caracterizar la tuberculosis extrapulmonar desde el punto de vista epidemiologico, clinico, microbiologico, de diagnostico y de costos hospitalarios de los pacientes egresados en un hospital estatal de III nivel. Materiales y metodos. Estudio descriptivo retrospectivo realizado entre el 2000 y el 2004 mediante la revision de historias clinicas y archivos de laboratorio de pacientes egresados con diagnostico de tuberculosis extrapulmonar del Hospital Universitario San Jorge de Pereira, Colombia. Resultados. Se encontraron 102 casos, con promedio de edad de 31,6 anos, de los cuales el 62,7% correspondia a hombres. El 70,6% procedia del area urbana y el 59,6% presento sintomas clinicos mayores a los 15 dias de evolucion. La forma mas frecuente de presentacion fue la pleural, con 47 casos, seguida de la meningea con 19, la ganglionar con 13, la peritoneal con 5, la miliar con 4, la genitourinaria con 4, la faringea con 4, la articular con 3, la osea con 2 y la pericardica con 1 caso. Los metodos de diagnostico mas utilizados fueron la biopsia en 68 casos (66,6%), el clinico en 28 (27,4%). Por medio de baciloscopia con coloracion de Zielh Neelsen, se diagnostico el 3,9%, y con el cultivo de Mycobacterium tuberculosis, el 5,8%. El tiempo de estancia hospitalaria promedio fue de 13 dias y el costo promedio fue de $5'784.603 por caso. Fallecieron 15 pacientes, de los cuales el 60% se asocio con sida, y 53,3% con meningitis. Conclusion. Las localizaciones mas frecuentes fueron la pleural, la meningea y la ganglionar. El principal metodo de diagnostico fue la biopsia. La estancia prolongada se relaciono con demora en el diagnostico y sida. La mortalidad fue mayor en los casos de sida y localizacion meningea.
31 citations
TL;DR: The data recommend the following strategies for improving compliance with antituberculosis treatment: (1) early diagnosis, (2) opportune treatment, (3) improved family support and (4) immediate intervention if a treatment is missed -especially in patients with HIV/AIDS, from low socioeconomic strata, or with record of incarceration.
Abstract: Introduction. Tuberculosis is a public health problem. Non-compliance with treatment regimes increases morbidity-mortality, perpetuates transmission and generates bacterial resistance. It is necessary to know incidence and associated factors to non-compliance for performance interventions. Objective. The incidence of and associated factors associated with non-compliance to antituberculous treatment were investigated. Materials and methods. A follow-up study was conducted in an adult cohort with tuberculosis, living in an urban area. Non-compliance was defined as treatment default of 30 days or more. Patients were interviewed at the initiation of treatment and and re-interviewed in subsequent intervals. Outcome was defined as the period of time until treatment abandonment. Noncompliance rates were calculated, as well as survival curves; the Cox regression model was used to adjust for associated variables. Results. Of the 261 patients who were interviewed, 39 (14.9%) had abandoned treatment (rate 0.4 episodes/1,000 days-person, 95%CI 0.2-0.8). Factors associated with compliance were family support (HR=0.4, 95%CI 0.2-0.9), secondary drug effects (HR=0.2, 95%CI 0.1-0.6) and opportunity to receive treatment at the clinic where tuberculosis was diagnosed (HR=0.3, 95%CI 0.1-0.6). Risk factors for non-compliance were as follows: treatment requiring >2 months (HR=14.3, 95%CI 1.8-112.7), low socioeconomic status (HR=3.90, 95%CI 2.1-9.3), age between 21-30 years (HR=20.6, 95%CI 2.4-175.4), history of incarceration (HR=2.2, 95%CI 1.0-5.4), skipping treatments more that twice (HR=6.6, 95%CI 2.8-15.6) and co-infection with HIV/AIDS (HR=2.9, 95%CI 1.6-5.4). Conclusion. Non-compliance rate is higher than previously reported. The data recommend the following strategies for improving compliance with antituberculosis treatment: (1) early diagnosis, (2) opportune treatment, (3) improved family support and (4) immediate intervention if a treatment is missed -especially in patients with HIV/AIDS, from low socioeconomic strata, or with record of incarceration.
29 citations
TL;DR: A prevalencia de infeccao tuberculosa e doenca ativa nessa populacao foi elevada, e as estrategias de controle tiveram resultados positivos, com reducao na incidencia em tempos recentes.
Abstract: OBJETIVO: Descrever as caracteristicas sociodemograficas e clinico-epidemiologicas dos casos de tuberculose notificados na populacao indigena do Municipio de Sao Gabriel de Cachoeira, Estado do Amazonas, Brasil, e identificar fatores associados ao obito durante o tratamento; e estimar a prevalencia de infeccao latente por tuberculose (ILTB) e fatores associados e obter informacoes sobre o itinerario terapeutico e a percepcao acerca do adoecimento dos indigenas do Distrito de Iauarete. METODOS: Primeiramente, realizou-se um estudo epidemiologico retrospectivo (1997 a 2007) com base nos dados do Sistema de Informacao de Agravos de Notificacao. Posteriormente, realizou-se um estudo transversal (2010) em sintomaticos respiratorios e contatos no Distrito Indigena de Iauarete. RESULTADOS: Registraram-se 723 casos novos, com incidencia de 273,4/100 000 e mortalidade de 13,2/100 000. Houve predominio em homens (57%), idade > 45 anos (37,6%), pessoas sem escolaridade (42,7%) e na area rural (76,9%). Doentes de 0 a 20 anos apresentaram menor chance de obito quando comparados a idade > 45 anos (OR = 0,3; IC95%: 0,1 a 0,9). Em Iauarete, que concentrou 15,3% das notificacoes, foram entrevistados 184 indigenas. Revelou-se prevalencia de ILTB de 76,1%. Prova tuberculinica > 5 mm associou-se com idade > 15 anos, historia de tuberculose ativa e alteracoes radiologicas. Tuberculose anterior foi citada por 54 indigenas (29,3%). A principal explicacao para o adoecimento foi sopro/envenenamento (24,1%). O itinerario terapeutico incluiu medicamentos industrializados (42,6%), plantas medicinais/raizes, pajelanca/xamanismo e reza (42,7%). CONCLUSOES: A prevalencia de infeccao tuberculosa e doenca ativa nessa populacao foi elevada. As estrategias de controle tiveram resultados positivos, com reducao na incidencia em tempos recentes. Entretanto, para controlar a tuberculose e necessario intensificar a vigilância dos contatos e aperfeicoar as estrategias de comunicacao das equipes com a populacao indigena.
27 citations
References
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01 Jan 2003
TL;DR: The Organización Panamericana de la Salud (OPS) as discussed by the authors is an organismo especializado de salud del sistema interamericano, encabezado by the Organizacion de los Estados Americanos (OEA), desde 1949.
Abstract: La Organizacion Panamericana de la Salud (OPS) es el organismo especializado de salud del sistema interamericano, encabezado por la Organizacion de los Estados Americanos (OEA), y tambien esta afiliada a la Organizacion Mundial de la Salud, desde 1949,de manera que forma parte igualmente del sistema de las Naciones Unidas. Tiene su sede en Washington y esta dedicada a controlar y coordinar politicas que promuevan la salud y el bienestar en los paises americanos. La secretaria de la OPS es la Oficina Sanitaria Panamericana, que funciona a la vez como Oficina Regional de la OMS para las Americas.
676 citations
TL;DR: An elevated rate of decline suggests that 27% of cases and 70% of deaths among smear-positive patients were averted between 1991 and 2000, the first demonstration that a significant number of TB cases can be prevented through intensive short-course chemotherapy in a high-burden country.
Abstract: Improved tuberculosis (TB) case detection and cure rates are expected to accelerate the decline in incidence of TB and to reduce TB-associated deaths. Time series analyses of case reports in Peru showed that the per capita TB incidence rate was probably steady before 1991. Case reports increased between 1990 and 1992 as a result of improved case detection. Although diagnostic efforts have continued to increase since 1993, the incidence of new pulmonary TB cases has declined in every department of the country, with a national rate of decline > or =5.8% per year (range, 1.9%-9.7%). This elevated rate of decline suggests that 27% (19%-34%) of cases (158,000) and 70% (63%-77%) of deaths (91,000) among smear-positive patients were averted between 1991 and 2000. This is the first demonstration that a significant number of TB cases can be prevented through intensive short-course chemotherapy in a high-burden country.
164 citations
TL;DR: Para la salud publica el TAES demostro ser la actividad mas importante en el control oficial de the tuberculosis, al elevar las tasas de curacion y disminuir, por lo tanto, las fuentes de transmision of the enfermedad.
Abstract: Objetivo. Evaluar la posibilidad de aplicar el tratamiento acortado estrictamente supervisado (TAES) en el Programa de Control de la Tuberculosis en Chiapas, Mexico. Material y metodos. Se evaluo la eficacia y la eficiencia del tratamiento en una cohorte de pacientes con tuberculosis pulmonar confirmada por baciloscopia, que ingresaron a tratamiento con esquemas de autoadministracion semisupervision y estricta supervision, de enero a junio de 1996. Resultados. La eficacia fue de 90.9. 97.7 y 100% para los esquemas de tratamiento autoadministrado, semisupervisado y TAES, respectivamente, mientras que la eficiencia fue de 68.1. 77.6 y 88.5% en el mismo orden. Conclusiones. Para la salud publica el TAES demostro ser la actividad mas importante en el control de la tuberculosis, al elevar las tasas de curacion y disminuir, por lo tanto, las fuentes de transmision de la enfermedad.
25 citations
"Situación de la tuberculosis en Col..." refers background in this paper
...Se sabe que el tratamiento de la tuberculosis es más eficiente cuando se observa diariamente, por lo general, en la institución prestadora de servicios y es de lejos la medida con mayor impacto (17)....
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TL;DR: McLean described life on a British World War II cruiser on convoy duty in the North Atlantic in his novel HMS Ulysses as discussed by the authors. But these two images pretty much describe the state of the world's population today and most humans on this planet clearly belong to the have-nots.
Abstract: “ Everything interacts with everything else: each single factor conspires with the others to crush a man, break him physically and mentally, and lay him wide open to disease…. Pack men together like herring in a barrel, deprive ’em of every last ounce of resistance, batten ’em below decks for days at a time, and what do you get? T.B. It's inevitable.”
This is how the novelist Alistair McLean described life on a British World War II cruiser on convoy duty in the North Atlantic in his novel HMS Ulysses . Compare this picture with the life of a passenger on board a luxury cruiseliner—well fed, enjoying the cruise, pampered by the stewards and being taken care of by the first‐class health care on board. These two images pretty much describe the state of the world's population today—the ‘haves’ and the ‘have‐nots’. And most humans on this planet clearly belong to the have‐nots, which brings us back to tuberculosis (TB). The poor will remain a breeding ground for the ‘white plague’ until we realize that it is not only the microbe Mycobacterium tuberculosis that is causing the disease, but also the abominable conditions under which hundreds of millions of people on this planet are forced to live.
M. tuberculosis was not a serious threat to humans when they were hunter–gatherers and lived in small groups. As they formed settlements and started growing crops, their population increased, as did contact between groups, and new opportunities for human pathogens emerged. An ancestral mycobacterial species occupied this new niche, and either infected humans first, to become M. tuberculosis , then possibly crossing the species barrier into bovids to evolve into M. bovis , or vice versa. Which of these scenarios accurately reflects history is disputed at present, but what is indisputable is the …
16 citations