巴西里约热内卢一所教学医院的抗结核治疗不合作情况调查

背景：少数研究已经调查了医院内抗结核治疗不合作的有关因素。目的：确定巴西里约热内卢市住院病人不合作治疗的有关因素。设计：病例对照研究。方法：所有选入研究的病例均在一所教学医院开始抗结核治疗。不合作病例定义为病人中断治疗60天仍未返回治疗。经过培训的卫生保健人员采用标准表格对病例组和对照组病人进行随访调查。结果：从1997年1月1日至12月31日共登记结核病人228例。经过查阅病历，剔除了其中的39例。对其余189例病人进行家庭访视；46例被确定为病例组，117例为对照组。在家庭访视以前观察到的抗结核治疗不合作者66(28．9％)例，家庭妨视后不合作治疗者46例(20．2％)。多元分析结果显示，治疗不合作的最主要预测指标是：1)没有提供返回治疗卡(OR=0．099；95％CI：0．008-1．2，P=0．07)，2)病人感觉医生服务不周(OR=0．16；95％CI：0．33-0．015，P=0．001)，3)未测血压(OR=0．072；95％CI：0．036-0．79，P=0．024)。、结论：该医院的抗结核治疗不合作相关因素表明，非常需要系统的结核病控制规划。预计实施此类规划，采取特殊方法，将有助于强化抗结核治疗的完成率和治愈率。     

Defaulting from anti-tuberculosis treatment in a teaching hospital in Rio de Janeiro, Brazil.

SETTING: Few studies have investigated factors associated with defaulting from anti-tuberculosis (TB) therapy in hospital settings. OBJECTIVE: To identify the factors associated with defaulting from treatment among TB in-patients in Rio de Janeiro city, Brazil. DESIGN: Case-control study. METHODS: All study participants initiated anti-tuberculosis treatment in a teaching hospital. A defaulting case was defined as a person who did not return for anti-tuberculosis medications after 60 days. Cases and controls were interviewed by a trained health care worker using a standardized form. RESULTS: From 1 January to 31 December 1997, 228 TB cases were registered. After a review of the medical records, 39 were excluded. Household visits were performed in 189 patients; 46 subjects were identified as cases and 117 as controls. Defaulting from anti-tuberculosis treatment was observed in 66 cases (28.9%) before and in 46 (20.2%) after a home visit. After multivariate analysis, the strongest predictors of defaulting from treatment were: 1) returning card not provided (OR 0.099; 95%CI 0.008-1.2; P = 0.07), 2) not feeling comfortable with a doctor (OR 0.16; 95%CI 0.33-0.015; P = 0.001), and 3) blood pressure not measured (OR 0.072; 95%CI 0.036-0.79; P = 0.024). CONCLUSIONS: In this hospital, the factors associated with defaulting from anti-tuberculosis treatment highlight the necessity for a structured TB Control Program. It is expected that the implementation of such a program, pursuing specific approaches, should enhance completion of anti-tuberculosis treatment and cure.     

Jarisch-Herxheimer reaction among syphilis patients in Rio de Janeiro, Brazil

The Jarisch-Herxheimer reaction (JHR) is a syndrome observed after antimicrobial treatment of some infectious diseases. The syndrome has clinical characteristics of an inflammatory reaction to antibiotic treatment. A prospective study of patients with a clinical and laboratory diagnosis of syphilis was conducted at a sexually transmitted diseases clinic in Rio de Janeiro, Brazil. Patients were treated with benzathine penicillin and observed for the JHR. A total of 115 patients were included in this study. Fifty-one patients (44%) had secondary syphilis; 37 (32%), primary; 26 (23%), latent; and one (1%), tertiary syphilis. Ten patients (9%) developed the JHR. All JHRs occurred in patients with secondary and latent syphilis. No patients experienced an allergic reaction to penicillin. The JHR occurred less frequently than in previous studies. It is important that health-care professionals recognize the clinical characteristics of the JHR so that it is not misinterpreted as an allergic reaction to penicillin.     

Paleoparasitological results from XVIII century human remains from Rio de Janeiro,Brazil

Paleoparasitological studies of the Brazilian colonial period are scarce. A paleoparasitological analysis was performed on human remains from the archeological site Praça XV Cemetery in Rio de Janeiro, dating from the early 18th to 19th Centuries. The samples were obtained from the Institute of the Brazilian Archaeology collection, and showed evidence of washing and brushing. Sediments were extracted from sacral foramina by scraping. Sediments from skulls were used as negative paleoparasitological controls. Spontaneous sedimentation method was performed prior to microscopic analysis. The results revealed that 8 of 10 individuals were infected with intestinal helminths and/or protozoa. Eggs of the nematodes Trichuris sp. and Ascaris sp. as well as a single taeniid egg were found. Protozoa cysts suggestive of Entamoeba sp. were also observed. Trichuris sp. was the most frequent and abundant parasite, found in 70% of individuals (26 eggs). The study showed the importance of analysis of sediment from human remains preserved in museum or scientific collections, even those subjected to a curating procedure. The levels of infection revealed here should be considered underestimations. This is the first paleoparasitological study from Rio de Janeiro city for the Brazilian colonial period and the first report of human Taenia sp. in the New World.     

Ectopic dirofilariosis in two dogs from Rio de Janeiro state, Brazil

Report of two canine dirofilariosis cases of ectopic location in the state of Rio de Janeiro. This is the first report of erratic migration for this parasitosis in dogs in the state, calling attention to the short period of time between the two cases. The fact that the area is endemic for this parasite, its zoonotic potential and the report of human cases in the state, demonstrates that authorities should be alerted to the control programs of dirofilariosis along with the pathogenic profile of the infections.     

Vertical transmission of HIV in Rio de Janeiro,Brazil

A cohort of 297 HIV-infected pregnant women was followed from January 1996 to December 2001. The overall transmission rate was 3.57% and remained constant over time. Low birth-weight was independently associated with a higher risk of vertical transmission (P=0.0072), whereas a longer duration of antiretroviral drugs during pregnancy was independently associated with a lower risk of transmission (P=0.0084). Further decreases in transmission should be obtained by initiating prophylaxis earlier in pregnancy.     

Gender differences in tuberculosis in Rio de Janeiro, Brazil.

As the leading infectious killer of youths and adults, tuberculosis (TB) kills more women than all other causes of maternal mortality combined. The aim of this study is to investigate gender differences in the reported cases in Rio de Janeiro from January 1995 to December 1999. There were 18,428 females and 36,830 males, with a female:male ratio of 0.5; 30.8% (5676) of the female cases reported had had previous close contact with a tuberculosis case compared to 23.1% (8510) of the males. Extra-pulmonary tuberculosis occurred in 3966 (21.5%) and 6521 (17.7%) women and men, respectively. Genitourinary tuberculosis had the highest female:male ratio.     

Tuberculosis as primary cause of death among AIDS cases in Rio de Janeiro, Brazil

SETTING: Data from the mortality database, Rio de Janeiro City (RJC) Health Department, Rio de Janeiro, Brazil. OBJECTIVES: To determine the role played by tuberculosis (TB) in Brazil's human immunodeficiency virus (HIV) positive population, we investigated the frequency of TB as the primary cause of death among HIV-positive subjects in RJC. DESIGN: Information about acquired immune-deficiency syndrome (AIDS) deaths from 1996 to 2005 in individuals aged >12 years was obtained from the Mortality Information System (SIM), and the cause of death was classified according to the International Classification of Diseases (ICD-10), through primary causes coded in Chapter I--B20 to B24 (HIV disease). RESULTS: There were 8601 AIDS-related deaths in RJC between 1996 and 2005. TB was the primary cause of death in 9.0% of all AIDS-related deaths, while Pneumocystis carinii pneumonia (PCP) accounted for 4.7%. TB cases erroneously classified under other infectious diseases may have contributed to an underestimation of the number of TB deaths among HIV-positive patients. CONCLUSION: Our study showed that TB is the leading cause of AIDS-related deaths and is responsible for twice as many deaths as PCP, in a scenario of free access to antiretrovirals. The potential benefits of TB preventive treatment and of the availability of highly active antiretroviral treatment could not be established by this analysis.     

Safe sexual behaviour among female partners of HIV-infected men in Rio de Janeiro, Brazil

A cross-sectional study was designed to assess safe sexual behaviour among heterosexual couples after the woman learned of her partner's infection with HIV. Female partners who had known their partners' serostatus for at least 4 weeks were eligible for participation. Couples were interviewed separately and independent predictors of safe sexual behaviour were identified using multiple logistic regression. Safe sexual behaviour was defined as no unprotected vaginal, oral, or anal intercourse. Of 328 women, 197 (60%) reported safe sexual behaviour since learning of their partners' infection. Significant independent predictors of safe sexual behaviour included older women (>30 years old) (odds ratio [OR]=1.89; 95% confidence intervals [CI]=1.01-3.51), current negative HIV serostatus (OR=2.72; 95% CI=1.50-4.94), advanced clinical stage of the index case (OR=1.96; 95% CI=1.07-3.59), longer duration of relationship (10+ years) (OR= 2.35; 95% CI=1.15-4.82), fewer sex contacts (<100) (OR=2.01; 95% CI=1.14-3.56), only one lifetime partner (OR=2.29; 95% CI=1.26-4.17), non-smoking (OR=2.67; 95% CI=1.43-4.99), not practising oral sex (OR=3.35; 95% CI=1.82-6.19) and previous HIV testing (OR=2.11; 95% CI=1.09-4.07). In addition, women who had known their partner's infection for longer were less likely to report safe sexual behaviour (P < 0.001). Our results indicate that among female partners of HIV-positive Brazilian men, learning of their partner's infection does not uniformly result in safe sexual behaviour. Counselling must emphasize disclosure of serostatus to female partners and target couples with short-term relationships, as well as those where the woman has known about her male partner's infection for a long time, because these are the least likely to maintain safe sexual behaviour.     

Latent tuberculosis infection among undergraduate medical students in Rio de Janeiro State, Brazil.

SETTING: Five medical schools in three cities with different tuberculosis (TB) incidence rates in Rio de Janeiro State, Brazil. OBJECTIVE: To estimate prevalence of and associated factors for latent tuberculosis infection (LTBI) among medical students. DESIGN: A cross-sectional survey was conducted among undergraduate students in pre-clinical, early and late clinical years from schools in cities with low (28/100,000), intermediate (63/100,000) and high (114/100,000) TB incidence rates. Information on socio-demographic profile, previous BCG vaccination, potential TB exposure, co-morbidity and use of respiratory protective masks was obtained. A tuberculin skin test (TST) was performed using the Mantoux technique by an experienced professional. A positive TST, defined as induration > or = 10 mm, was considered LTBI. RESULTS: LTBI prevalence was 6.9% (95%CI 5.4-8.6). In multivariate analysis, male sex (adjusted odds ratio [aOR] 1.8; 95% CI 1.1-3.0), late clinical years (aOR 1.9; 95% CI 1.01-3.5), intermediate TB incidence (aOR 4.3; 95% CI 1.3-14.6) and high TB incidence in the city of medical school (aOR 5.1; 95% CI 1.6-16.8) were significantly associated with LTBI. CONCLUSIONS: The higher prevalence of LTBI in late clinical years suggests that medical students are at increased risk for nosocomial Mycobacterium tuberculosis infection. The implementation of a TB control program may be necessary in medical schools, particularly in cities with higher TB incidence.     

The prevalence of antibody to human parvovirus B19 in Rio de Janeiro, Brazil

During 1985 and 1986 serum samples were collected from the Rio de Janeiro population and examined for the presence of IgG antibody to human parvovirus B19. No difference in prevalence was found between males and females. Antibody prevalence rose from 35% in children less than five years old to almost 80% in children aged eleven to fifteen years. The antibody prevalence in individuals over 50 years old was over 90%.     

Trypanosoma cruzi transmission in a captive primate unit, Rio de Janeiro, Brazil

A breeding in captivity program of neotropical primates for subsequent reintroduction in nature is in progress at the Primatology Center of Rio de Janeiro (CPRJ). Almost 200 animals of 20 species that include both wild captured animals and specimens born in captivity are maintained in CPRJ. Here, we examined 198 primates of CPRJ for infection with the protozoan parasite Trypanosoma cruzi. The animals included 18 species of eight genera. We also performed an "ad lib" search for triatomines that could be incriminated as putative transmitters of the protozoan in this scenario. Anti-T. cruzi antibodies were observed (by indirect immunofluorescence assay-IFA) in 40 monkeys (26.5%). Four Panstrongylus megistus were collected in the monkey's food storage room near the cages and in human dwellings in the proximity to CPRJ. T. cruzi were isolated from nine primates of two genera (Leontopithecus and Saguinus) and from two individuals of the vector P. megistus. The transmission inside the cages could be attested by the isolation of the T. cruzi from primates born in captivity. Multi-locus enzyme electrophoresis (MLEE) demonstrated that the two isolates from Saguinus bicolor bicolor displayed a zymodeme 1 profile in four out of five tested enzymes, while all isolates derived from Leontopithecus showed zymodeme 2 for four out of the five tested enzymes. Mini-exon gene analysis genotyped all isolates as T. cruzi II, which is associated with human disease in Brazil. A wild primate unit such as CPRJ, located inside the forest and near to human dwellings and with T. cruzi II infected animals, deserves a careful surveillance in order to prevent expansion of the infection.