Impact of Latent Infection Treatment in Indigenous Populations

The aims of the present study were to identify risk factors associated with latent tuberculosis (TB), examine the development of active disease among contacts, and assess the effectiveness of treating latent infection in indigenous Brazilians from January 2006 to December 2011. This was a retrospective study consisting of 1,371 tuberculosis contacts, 392 of whom underwent treatment for latent infection. Morbidity-from-TB data were obtained from the Information System for Disease Notification (SINAN) database, and the contacts’ data were collected from the clinical records using forms employed by Special Department of Indigenous Health (SESAI) multidisciplinary teams, according to SESAI’s instructions. The variables that were associated with latent infection among the contacts were age (odds ratio [OR]: 1.03; 95% confidence interval [CI]: 1.02–1.04) and close contact with a smear-positive index case (OR: 2.26, 95% CI: 1.59–3.22). The variables associated with the development of active TB among the contacts were a tuberculin skin test (TST) ≥10 mm (relative risk [RR]: 1.12, 95% CI: 1.07–1.17), age (RR: 1.01, 95% CI: 1.00–1.03), and treatment of latent infection (RR: 0.03, 95% CI: 0.01–0.27). The estimated number of latent infection treatments needed to prevent one case of active TB among the contacts was 51 treatments (95% CI: 33–182). In contacts with TST ≥10 mm, 10 (95% CI: 6–19) latent infection treatments were necessary to prevent one case of active TB. Age and close contact with a smear-positive index case were associated with latent TB. Screening with TST is a high priority among individuals contacting smear-positive index cases. Age and TST are associated with the development of active TB among contacts, and treatment of latent infection is an effective measure to control TB in indigenous communities.     

Outbreak of tuberculosis after minimal exposure to infection.

The identification of a case of respiratory tuberculosis in a swimming-baths attendant whose sputum was smear positive was followed by intensive contact tracing of children aged 8-11 years who had visited the baths. An outbreak was discovered that otherwise might not have been detected. Out of 3764 children, 108 (2.9%) had evidence of infection: there were 16 cases of tuberculosis, of which 11 were symptomless but showed lesions on chest radiography, and a further 92 with tine test grade 3 or 4 without clinical or radiological signs. The contact of these children with the index case was apparently minimal. Early detection, isolation, and treatment of infectious cases of respiratory tuberculosis and vigorous contact tracing should be given more priority in tuberculosis control.     

High Incidence of Tuberculosis in the Absence of Isoniazid and Cotrimoxazole Preventive Therapy in Children Living with HIV in Northern Ethiopia: A Retrospective Follow-Up Study

ObjectiveTo identify the incidence of and predictors for tuberculosis in children living with HIV in Northern Ethiopia.DesignObservational, retrospective follow-up study.MethodsA total of 645 HIV-infected children were observed between September 2009 and September 2014. Cox regression analysis was used to identify predictors for developing TB.ResultsThe incidence rate of tuberculosis was 4.2 per 100 child-years. Incidence of tuberculosis was higher for subjects who were not on cotrimoxazole preventive therapy, were not on isoniazid preventive therapy, had delayed motor development, had a CD4 cell count below the threshold, had hemoglobin level less than 10 mg/dl and were assessed as World Health Organization (WHO) clinical stage III or IV.ConclusionIncidence of TB in children living with HIV was high. This study reaffirmed that isoniazid preventive therapy is one of the best strategy to reduce incidence of TB in children living with HIV. All children living with HIV should be screened for TB but for children with delayed motor development, advanced WHO clinical stage, anemia or immune suppression, intensified screening is highly recommended.     

TUBERCULOSIS IN CHILDHOOD

Those physicians who deal with children have much to contribute toward case finding in tuberculosis among these patients as well as adults. The tuberculin test is the most accurate weapon at hand. Contacts other than the parents should be looked for. Symptoms, beside fever, to be noted are eye and skin complaints. In the physical examination the chest is relatively unimportant as compared to the eye, the skin, the lymphatic and skeletal systems. In the roentgenographic examination, epituberculosis and atelectasis should be differentiated. When stomach washings are necessary for the diagnosis, the tuberculin test on the guinea-pig should not be forgotten. Careful laboratory studies will clear up roentgenographic confusion.In the treatment, removal of contact is essential, and often all that is necessary, but other factors should be considered. Of the more common complications, atelectasis, bronchiectasis, and cavitation or reinfection, may be treated surgically with all the accepted methods except thoracoplasty. Heliotherapy should not be forgotten in bone and joint tuberculosis. It is to be hoped that BCG will prove efficacious in vaccination, but published reports are not scientifically convincing. It destroys the value of the tuberculin test where used, and it should never be substituted for removal of contact as a prophylactic measure.     

Tuberculosis in childhood

Those physicians who deal with children have much to contribute toward case finding in tuberculosis among these patients as well as adults. The tuberculin test is the most accurate weapon at hand. Contacts other than the parents should be looked for. Symptoms, beside fever, to be noted are eye and skin complaints. In the physical examination the chest is relatively unimportant as compared to the eye, the skin, the lymphatic and skeletal systems. In the roentgenographic examination, epituberculosis and atelectasis should be differentiated. When stomach washings are necessary for the diagnosis, the tuberculin test on the guinea-pig should not be forgotten. Careful laboratory studies will clear up roentgenographic confusion. In the treatment, removal of contact is essential, and often all that is necessary, but other factors should be considered. Of the more common complications, atelectasis, bronchiectasis, and cavitation or reinfection, may be treated surgically with all the accepted methods except thoracoplasty. Heliotherapy should not be forgotten in bone and joint tuberculosis. It is to be hoped that BCG will prove efficacious in vaccination, but published reports are not scientifically convincing. It destroys the value of the tuberculin test where used, and it should never be substituted for removal of contact as a prophylactic measure.     

Longitudinal study of tuberculosis outcomes among immunologically naive Aché natives of Paraguay

This study documents the course of a tuberculosis epidemic in an immunologically naive group of South American Indians within fewer than 20 years after first sustained contact with outsiders. Groups of Northern Aché (ah-CHAY) of eastern Paraguay were contacted and settled on reservations between 1971-1979. Not surprisingly, the Aché are very susceptible to tuberculosis, and the epidemiological characteristics of the disease are quite different from those of populations that have had tuberculosis for centuries. Within 6 years of the first detected case of tuberculosis among the Aché, the prevalence rate of active tuberculosis cases reached 18.2%, and of infected cases among adults, 64.6%, some of the highest rates ever reported for any human group. Remarkably, males and females are equally likely to have been diagnosed with active tuberculosis, Aché children between birth and 5 years of age are least vulnerable to tuberculosis, high nutritional and socioeconomic status do not decrease the risk of disease or infection, and children immunized with BCG are less responsive to tuberculin challenge than are other children. Moreover, similar to the Yanomam?, but unlike populations of European or African descent, a high percentage of Aché with active disease test negative on tuberculin challenge tests (purified protein derivative; PPD). These differences may be due to a high prevalence of diminished cell-mediated immunity, and T-helper 2 dominance. We also hypothesize that these immunological characteristics, low genetic diversity, hostile intergroup interactions, and behavioral noncompliance to treatment protocols together contribute to the high rates of active disease observed. Existing tuberculosis control programs are poorly equipped to handle the impact of these causal complexities on the course of recent tuberculosis epidemics that have quickly spread throughout native communities of Latin America during the last decade.     

TREATMENT OF MILIARY AND MENINGEAL TUBERCULOSIS IN INFANTS AND CHILDREN

Streptomycin and combined streptomycin-promizole treatment of miliary and meningeal tuberculosis in infants and children at the Los Angeles Children''s Hospital has resulted in clear-cut arrests in seven patients, two of whom had meningitis. A much longer period of observation will be necessary before these patients may be considered cured. These results are incomparably better than the universally fatal outcome of both diseases in a large and unselected group of untreated cases which has been studied. Promizole, and possibly also para-aminosalicylic acid, should be given concurrently with streptomycin. As they are relatively harmless drugs, they should be given to ambulatory patients for a long period of time after arrest of the disease to decrease the likelihood of recurrence. If necessary, streptomycin may be given for longer than 90 days, or in second courses, since combined chemotherapy apparently delays the appearance of streptomycin-resistant strains of tubercle bacilli. The current pessimism with which many pediatricians view miliary and meningeal tuberculosis is unwarranted. Optimism will be rewarded with many more recoveries in the future.     

Isoniazid Chemoprophylaxis of Tuberculosis

A major step toward the eradication of tuberculosis in the United States has been the use of isoniazid for chemoprophylaxis in certain persons who have positive tuberculin skin tests but no other evidence of active infection. Chemical trials have demonstrated the effectiveness of chemoprophylaxis in groups where there is a relatively high risk of active tuberculosis. However, only the practicing physician can identify and offer chemoprophylaxis to many other susceptible persons. Even if the patient is a candidate for isoniazid, the risk of developing tuberculosis must be weighed against the cost and possible adverse effects of the drug. If isoniazid is given, the physician must be alert to the signs of possible drug toxicity. If isoniazid is not given, he must anticipate the development of active tuberculosis in susceptible persons.     

Control and prevention of tuberculosis in Britain: an updated code of practice. Subcommittee of the Joint Tuberculosis Committee of the British Thoracic Society.

A subcommitte was appointed by the Joint Tuberculosis Committee of the British Thoracic Society to review and bring up to date guidelines on control measures for tuberculosis. The updated code of practice emphasises that all cases of tuberculosis must be notified. A minority of patients need admission, and those with positive sputum smears should be regarded as infectious until they have received two weeks of chemotherapy. NHS staff at risk should be protected, and evidence of infectious tuberculosis should be sought as routine among certain prospective NHS employees, schoolteachers, and others. Contact tracing should be vigorously pursued, and all entrants to Britain from countries where tuberculosis is common should be screened. BCG vaccination should be offered in selected instances, and local organisation of tuberculosis services should be extended.     

Epidemiological patterns of tuberculosis in Croatia in the period 1996-2005

The last comprehensive publication on tuberculosis in Croatia and the earliest impact of war, besides the yearly routine reports, was done in 1996 in Croatian. We were, therefore, interested to explore incidence trends and to highlight the early post-war tuberculosis epidemiological patterns in the next ten years period (1996-2005). A retrospective analysis of epidemiological data on all registered tuberculosis cases in Croatia searching the databases of 21 Croatian Public Health Institutes and the National Tuberculosis Registry was made. During the study period, the total tuberculosis incidence rates in Croatia dropped from 45 to 25.8/100 000 inhabitants. The average highest age-specific rates were recorded in the age group > or = 65 years being in decrease in all age groups. Paediatric cases (0-14 years) represented 4.5% of all cases. Tuberculosis cases among males were recorded in 64% cases, and 83.6% were indigenous population. Tuberculosis was bacteriologically confirmed in 67.7% cases. A low proportion of drug resistance (3.3%) was recorded. During 1985-2005, 56 tuberculosis cases among 242 AIDS cases were reported. Tuberculosis mortality showed a decreasing trend (p < 0.001). However, tuberculosis has still had the highest mortality rates among infectious diseases in Croatia. Despite the War chain of events and tuberculosis programmatic changes, tuberculosis incidence rates in Croatia have been decreasing but they are still far away from national target, incidence rate of 10/100 000 declared in 1998 and much higher than in European Union and Western Europe. Tuberculosis among children, resistance to tuberculosis drugs and HIV prevalence, significant problems in many European countries, have not caused problems in tuberculosis control in Croatia. This favourable epidemiological situation must be kept and improved through strengthened tuberculosis control measures.     

Effectiveness of antibiotics in preventing meningococcal disease after a case: systematic review

Objective To summarise the evidence for the role of antibiotics in preventing further cases of meningococcal disease through chemoprophylaxis given to the index patient, household contacts, and children in day care settings after a single case.Design Systematic review.Methods Studies were identified by searching Embase (1983-2003), Medline (1965-2003), and CAB Health (1973-2003) and by contacting the World Health Organization and the European meningococcal disease surveillance network and examining references of identified papers. The review included all studies with at least 10 cases in which outcomes were compared between treated and untreated groups.Main outcome measure Subsequent cases of meningococcal disease 1-30 days after onset of disease in the index patient.Results Four observational studies and one small trial met the inclusion criteria. Meta-analysis of studies on chemoprophylaxis given to household contacts showed a significant reduction in risk (risk ratio 0.11, 95% confidence interval 0.02 to 0.58). The number needed to treat to prevent a case was estimated as 218 (121 to 1135). Primary outcome data were not available in studies of chemoprophylaxis given to the index patient: when prophylaxis had not been given, rate of carriage after discharge from hospital was estimated as 3% (0 to 6), probably an underestimate of the true rate. No studies of chemoprophylaxis in day care settings were identified that met the inclusion criteria.Conclusion There have been no high quality experimental trials looking at control policies for meningococcal disease. The best available evidence is from retrospective studies. The risk of meningococcal disease in household contacts of a patient can be reduced by an estimated 89% if they take antibiotics known to eradicate meningococcal carriage. Chemoprophylaxis should be recommended for the index patient and all household contacts.     

PULMONARY RESECTION IN TUBERCULOSIS

Newer surgical and anesthetic techniques and the use of streptomycin and para-aminosalicylic acid (PAS) have made possible increased success in pulmonary resection for tuberculosis. Especially in early cases, however, bed rest and pneumothorax or pneumoperitoneum should be given adequate trial before resection is decided upon. In all cases a thorough bronchoscopic examination should be made first and the findings carefully evaluated.Pulmonary resection may be advisable for lesions of certain kinds which do not respond well to thoracotomy; for lesions which have not responded to trial of other methods; for a lung destroyed by tuberculosis; and in cases of active disease in an unexpanded lung.The experience of the author and of others emphasizes the importance of correct postoperative care. Since tuberculosis is rarely limited to the resected area, at least six months'' rest in bed under medical supervision is necessary to permit cure of residual disease. Streptomycin with PAS is particularly valuable in the postoperative period; therefore indiscriminate use of it in earlier treatment should be avoided lest resistance develop.     

The Basic Principles of Collapse Therapy

Collapse therapy has a definite objective of resting and healing tuberculous lesions. It should be used, not so much as an independent means, but as a supplement to other established practices in the treatment of tuberculosis.The indications for each measure have changed over the years and are still changing, so that proper treatment can be given only by those having a knowledge of the changing trends, as well as of the disease and principles of treatment. Each case should be handled on its merits and the choice of procedure should depend generally upon the circumstances, such as the skill of the physician carrying it out, the facilities for the care of the patient, and the equipment for working. Above all, it should be recognized that knowledge, experience, and especially wisdom will go far towards achieving good results.     

Biological age in children who practise swimming.

In the estimation of the developmental regularity among children it is important to know the relation between the developmental and the calendar age. It is particularly important in the estimation of the level of development among children with an increased level of guided motor activity. It takes place, for instance, in the case of children practising swimming. In auxology there are many morphological, physiological and motor features which are regarded as the measure of the developmental age. For several years researches have been conducted on the EMN index as the determinant of the biological age. The EMN index shows continuous changes during ontogeny, proves the existence of stages in the developmental age and is also considerably correlated with the calendar age. This is an ecosensitive factor. The EMN index differentiates individuals from another as well as groups isolated with regard to the effect of the environmental factors, for instance, the different levels of motor activity. The aim of this investigation is to estimate the standard of biological maturity (the body height and mass, the EMN index) among children, who went through a guided swimming training. Morphological features are most often used as the measures of development. However, they can become unreliable when they themselves establish the criterion of selection to a sports discipline or when some ranges of values are optimal on some given standards. The EMN index is not burdened with these features. The children who go through training show the higher level of the EMN index values than the children who do not go. The effect of this is the fact that young swimmers are biologically older than their peers. However, the shape of the curve of development of the EMN index in swimmers goes at a different level depending on the seniority of training.     

定西市2007—2010年外出务工人员肺结核线索调査情况分析

目的为了了解外出务工人群的结核病疫情状况,进一步加强对这部分人群结核病的控制工作。方法利用大多外出务工人员春节前集中返乡与家人团聚的时机,对有咳嗽、咳痰超过3周等可疑肺结核病症状者进行摸底调查和造册登记,并由县(区)疾控中心组织免费检查,对确诊患者进行免费抗结核治疗。结果 4年中调查返乡务工人员102万余人次,有可疑肺结核症状者占2.56%,共确诊活动性肺结核患者346例,其中涂阳108例,初治涂阴238例,男女之比为2.15∶1,以青壮年人群为主,20～39岁占73.99%;年均涂阳和活动性肺结核登记率分别为10.59/10万和33.92/10万,涂阳比例为31.21%,其中初治涂阳比例为95.37%。结论外出务工人员是结核病的高发人群,应加强外出务工人员的结核病防治工作,利用外出务工人员春节集中返乡的有利时机开展肺结核病线索调查是主动发现病人的有效方法。     

Importation of poliomyelitis to industrialised nations between 1975 and 1984: evaluation and conclusions for vaccination recommendations.

World Health Organisation and public health authority records show that 175 cases of paralytic poliomyelitis were imported to industrialised countries between 1975 and 1984. Detailed case reports were therefore analysed to identify characteristic features associated with acquisition of the infection. Of the 175 cases, 96 (55%) were diagnosed in foreign workers or their families, 47 (27%) in nationals travelling on holiday or business, 11 (6%) in immigrants, and 21 (12%) either in contacts who had not travelled or in unclassified groups. Poliomyelitis principally affected children under 5, but travellers aged 41-65 had the highest case fatality rate. The main serotype isolated was poliovirus type 1. The findings suggest that though fewer than one in every 100,000 travellers may be infected by poliomyelitis, all travellers and all immigrants, refugees, and foreign workers should be given full protection against all three polioviruses by routine vaccination.     

Nutritional status of under-five children in Bangladesh: a multilevel analysis

The nutritional status of under-five children is a sensitive sign of a country's health status as well as economic condition. This study investigated the differential impact of some demographic, socioeconomic, environmental and health-related factors on the nutritional status among under-five children in Bangladesh using Bangladesh Demographic and Health Survey 2007 data. Two-level random intercept binary logistic regression models were used to identify the determinants of under-five malnutrition. The analyses revealed that 16% of the children were severely stunted and 25% were moderately stunted. Among the children under five years of age 3% were severely wasted and 14% were moderately wasted. Furthermore, 11% of the children were severely underweight and 28% were moderately underweight. The main contributing factors for under-five malnutrition were found to be child's age, mother's education, father's education, father's occupation, family wealth index, currently breast-feeding, place of delivery and division. Significant community-level variations were found in the analyses.     

An initial strategy for comparing proteins at the domain architecture level

MOTIVATION: Ideally, only proteins that exhibit highly similar domain architectures should be compared with one another as homologues or be classified into a single family. By combining three different indices, the Jaccard index, the Goodman-Kruskal gamma function and the domain duplicate index, into a single similarity measure, we propose a method for comparing proteins based on their domain architectures. RESULTS: Evaluation of the method using the eukaryotic orthologous groups of proteins (KOGs) database indicated that it allows the automatic and efficient comparison of multiple-domain proteins, which are usually refractory to classic approaches based on sequence similarity measures. As a case study, the PDZ and LRR_1 domains are used to demonstrate how proteins containing promiscuous domains can be clearly compared using our method. For the convenience of users, a web server was set up where three different query interfaces were implemented to compare different domain architectures or proteins with domain(s), and to identify the relationships among domain architectures within a given KOG from the Clusters of Orthologous Groups of Proteins database. Conclusion: The approach we propose is suitable for estimating the similarity of domain architectures of proteins, especially those of multidomain proteins. AVAILABILITY: http://cmb.bnu.edu.cn/pdart/.     

Tubercular involvement of the thyroid gland: a report of two cases

Thyroid tuberculosis is rare. In the last decade, however, the incidence of extrapulmonary forms of tuberculosis has increased. We report on 2 cases of thyroid tuberculosis. In case 1, a tubercular abscess mimicking acute thyroiditis was found which was correctly diagnosed by fine-needle aspiration biopsy (FNAb). No evidence of active disease was noticed. Pleural thickening on chest X-ray was the only sign compatible with a previous infection. In case 2, tubercular thyroiditis with lymph node enlargement was also diagnosed by FNAb in a reevaluation setting. In both cases treatment with antitubercular drugs resulted in complete recovery. Thyroid tuberculosis should be kept in mind in the differential diagnosis of thyroid nodules, notably in patients with a history of tuberculous disease. FNAb represents the main approach to making the diagnosis.