Low antimycobacterial drug concentrations have been observed in tuberculosis (TB) patients under treatment. The lactulose/mannitol urinary excretion test (L/M), normally used to measure intestinal permeability, may be useful to assess drug absorption. The objective of this research was to study intestinal absorptive function and bioavailability of rifampin and isoniazid in TB patients. A cross sectional study was done with 41 patients and 28 healthy controls, using the L/M test. The bioavailabilities of rifampin (R) and isoniazid (H) were evaluated in 18 patients receiving full doses. Urinary excretion of mannitol and lactulose, measured by HPLC, was significantly lower in TB patients. The serum concentrations of the drugs were below the expected range for R (8-24 mcg/mL) or H (3-6 mcg/mL) in 16/18 patients. Analyzing the drugs individually, 12/18 patients had low serum concentrations of R, 13/18 for H and 8/18 for both drugs. We suggest that there is a decrease in the functional absorptive area of the intestine in TB patients, which would explain the reduced serum concentrations of antituberculosis drugs. There is a need for new approaches to improve drug bioavailability in TB patients.

Diarrhea is still an important cause of morbidity and mortality among children under five years old. It is not mandatory to report diarrheal diseases, and the statistics are not accurate. The objective of this study was to describe follow-up of acute diarrhea in Fortaleza, the capital of Ceará State, Brazil. From 1994 to 2001, cases of acute diarrhea were reported by 100 health care units using a standardized form, keyed-in and analyzed by month, age group, treatment plan, place of treatment, and place of residence. There were 489,069 cases reported, with an annual average of 81,511. February and March had the highest monthly rates. Incidence in infants (< 1 year) was 538.8, three times that of children from 1 to 4 years and 13 times the rate in the 5-to-9-year bracket. All areas in the city reported cases of diarrhea. Diarrhea shows a persistently high incidence, mainly among infants, and merits attention as a major public health problem.

O Plano Nacional de Controle da Tuberculose tem como meta diagnosticar pelo menos 92% dos casos esperados, e tratar com sucesso no mínimo 85% deles. O acompanhamento dessas metas depende da informação dos casos diagnosticados e de sua evolução. O objetivo deste estudo é verificar se existe subnotificação de casos de tuberculose que evoluíram para o óbito. Este é um estudo descritivo de dados secundários em que foi feita busca no Sistema de Informação de Agravos de Notificação (Sinan) dos óbitos ocorridos entre 1999 e 2003, que tiveram tuberculose como uma das causas múltiplas e estavam registrados no Sistema de Informação em Mortalidade (SIM), tendo como variáveis de referência o nome, data do nascimento e nome da mãe. Dos óbitos registrados, 610 tiveram tuberculose como uma das causas associadas, 204 (33,4%) deles notificados no Sinan. Em 438 (71,8%), a tuberculose foi causa básica. A média de notificações entre 1999 e 2002 foi de 37%, reduzindo-se para 19,3% em 2003 (p=0,03). Em cinco hospitais ocorreram 324 (53,1%) dos óbitos e tiveram origem 114 (55,9%) notificações. O Sinan registrou 153 evoluções para o óbito. O acréscimo da notificação dos 406 casos de tuberculose que evoluíram para o óbito acarretará incremento de 5,9% no total de casos notificados no período e de 265,4% nas evoluções para o óbito. Os casos graves de tuberculose encontram-se subnotificados, sendo o SIM uma importante fonte de resgate desses casos, que pode ser utilizada de forma rotineira e preferencialmente informatizada.

Training and sensitization of FHP professionals were effective in promoting an increase in the number of TB cases detected in a low-income community.

This study evaluates the serum concentrations of rifampin (RMP), isoniazid (INH), and intestinal barrier function in patients with multidrug-resistant tuberculosis (MDR-TB), drug susceptible tuberculosis (DS-TB), and health volunteers (HC; controls). Peak serum concentrations of RMP were significantly lower in MDR-TB and DS-TB as compared with HC (odds ratio [OR] = 3.125, confidence interval [CI] [1.037-9.418] and OR = 4.025, CI [1.207-13.418], respectively). The INH peak serum concentration was not significantly different between MDR-TB versus DS-TB or DS-TB versus HC. The percent of mannitol excretion was significantly lower in the MDR-TB group compared with DS-TB (13.18 versus 16.03, analysis of covariance [ANCOVA], P = 0.0369) and compared with HC (13.18 versus 16.61, ANCOVA, P = 0.0291) the other study groups. These data suggested a lower peak serum concentration of RMP for both MDR-TB and DS-TB as compared with the HC group. The data also showed a lower intestinal area of absorption in patients with tuberculosis and even worse in MDR-TB.