Molecular genotyping has shown Mycobacterium tuberculosis lineages to be geographically restricted and associated with distinct ethnic populations. Whether tuberculosis (TB) caused by some M. tuberculosis lineages can present with a differential clinical spectrum is controversial because of very limited clinical data. We recently reported on the discovery of RD Rio M. tuberculosis, a Latin American-Mediterranean sublineage that is the predominant cause of TB in Rio de Janeiro, Brazil. To investigate the clinical attributes of TB caused by RD Rio strains, we studied a cohort of TB cases from Belo Horizonte, Brazil, in which clinical information recorded on a standardized questionnaire was collected at the time of microbiological testing. These patients were referred for culture and drug susceptibility testing because of the clinical suspicion of "complicated" TB, as demonstrated by high rates of multidrug resistance (12%) and cavitary TB (80%). We performed spoligotyping and RD Rio genotyping on the M. tuberculosis strains and analyzed the clinical data from these patients. RD Rio M. tuberculosis accounted for 37% of the total TB burden. Multivariate analysis found a significant association between TB caused by RD Rio strains and pulmonary cavitation and residence in Belo Horizonte. Since cavitary TB is associated with higher sputum bacillary load, our findings support the hypothesis that RD Rio M. tuberculosis is associated with a more "severe" disease as a strategy to increase transmission. Future studies are needed to confirm these observations and to better define the contribution of RD Rio M. tuberculosis to the global TB epidemic.Mycobacterium tuberculosis, the etiologic agent of tuberculosis (TB), is estimated to have infected one-third of the world's population and annually causes ϳ8 million new TB cases and Ͼ2 million deaths (16, 58). The challenges posed by TB have been further worsened by the emergence of multi-drugresistant and extensively drug-resistant M. tuberculosis strains.Molecular typing, based on genetic markers, permits the rapid detection and species level identification of mycobacteria within the M. tuberculosis complex (MTC), as well as provides useful tools for examining the transmission and evolution of these microorganisms (7,17,30,53). Genome-wide single nucleotide polymorphism (SNP) and deletion analyses have been used to organize the global M. tuberculosis population structure into overlapping phylogenies with major lineages that show distinct geographic distribution and that may be associated with specific host adaptation (1,21,23,24,27,28,50). Similar results have also been obtained with spoligotyping and IS6110-RFLP fingerprint analysis (18). The W/Beijing lineage, for example, is the predominant family in major SNP cluster II, accounts for ϳ10% of strains causing TB globally, and is localized mainly to Asia but has spread internationally. W/Beijing has been associated with outbreaks and multiple drug resistance (MDR) (4, 32) and also contributed significantly to the resurgence of...

BackgroundDevelopments in molecular detection and strain differentiation of members of Mycobacterium tuberculosis complex have proved to be useful. The DNA extraction method influences the amplification efficiency, causing interference on the sensitivity and respective inhibitors. The aim of this study was to standardize a simple and fast DNA extraction method, providing DNA amplification by IS6110-PCR effectively free from undue interferences.FindingsThe efficiency of the six different protocols tested in M. tuberculosis cultures has varied from 75% to 92.5%. This preliminary study evaluating the IS6110 PCR sensitivity and specificity was developed in DNA extracted from microscope slides, and achieved 100% of efficiency.ConclusionsDNA extraction by Chelex + NP-40 method from both, cultures of M. tuberculosis and smear slides, resulted in good quantity of interference free DNA, especially in samples with low concentrations of genetic material; therefore, such technique may be used for the molecular diagnosis of tuberculosis.

Trata-se de estudo de corte transversal, realizado mediante a aplicação de questionário em uma amostra aleatória e representativa de 489 agentes comunitários de saúde (ACS) a respeito da tuberculose (TB), suas medidas de controle e o tratamento diretamente observado (TDO), em Belo Horizonte, Minas Gerais, Brasil. A proporção média de itens acertados foi de 74,6%. A proporção média de acertos no domínio TB foi 81%; no domínio medidas de controle, 84,1%; e sobre TDO, 59,4%. Verificou-se uma lacuna no conhecimento sobre a identificação de pacientes com TB pulmonar, o público-alvo do TDO, e a técnica adequada para supervisão do tratamento. Foi observada associação entre maior conhecimento e tempo de atuação igual ou superior a três anos (RC = 2,3) e acompanhamento de casos nos 12 meses anteriores à entrevista (RC = 1,7). Este trabalho apresentou informações inéditas na literatura científica sobre o nível de conhecimento dos ACS sobre TDO, e poderá subsidiar estratégias destinadas ao aperfeiçoamento das atividades de controle da tuberculose.

OBJECTIVE: To analyze the profile of tuberculosis cases reported between 2002 and 2009 in the state of Minas Gerais, Brazil, according to sociodemographic, clinical, and laboratory characteristics, as well as to comorbidities and mortality. METHODS: This was a descriptive, epidemiological study based on data obtained from the Brazilian Case Registry Database and the Brazilian Mortality Database for the 2002-2009 period. RESULTS: There were 47,285 reported cases of tuberculosis, corresponding to a mean incidence of 22.3/100,000 population. The individuals diagnosed with tuberculosis were predominantly in the 20- to 49-year age bracket and male (62.4% and 67.0%, respectively). Individuals with a low level of education accounted for 18.5% of the cases. New cases, cases of recurrence, and cases of retreatment accounted for 83.7%, 5.7%, 5.7%, respectively. The rates of cure and treatment noncompliance were 66.2% and 11.2%, respectively; multidrug-resistant tuberculosis was identified in 0.2% of the cases; and the mortality rate was 12.9%. The directly observed treatment, short-course (DOTS) strategy was applied in 21.8% of the cases. Sputum smear microscopy and culture were performed in only 73.9% and 12.9% of the cases, respectively. Chest X-rays were performed in 90.5% of the cases. Pulmonary tuberculosis was the predominant form (in 83.9%). Comorbidity with alcoholism, HIV infection, and diabetes mellitus were identified in 17.2%, 8.3%, and 3.8%, respectively. CONCLUSIONS: During the study period, the numbers of new cases, cases of treatment noncompliance, and deaths were high, comorbidities were common, and there was a failure to perform adequately basic tests for the diagnosis of tuberculosis. Multidisciplinary approaches, expanded use of the DOTS strategy, better knowledge of the distribution of tuberculosis, and improvements in the databases are needed in order to achieve better control of the disease in the state of Minas Gerais.

This present observational, longitudinal, and non-concurrent study was developed with the purposes of evaluate the profile of patients attended by a pharmacotherapeutic follow-up service and describe the Drug-Related Problems (DRPs) found over there; determine the proportion of DRPs between the health problems presented by the studied population, classifying them and identifying the situations related with their appearance. The study was developed at the School Pharmacy of Newton Paiva University Center, Belo Horizonte, MG, during the period from 2001 November up to 2003 November. Ninety seven patients have been evaluated, the majority of female sex (66.0%), with up to 8 years of scholarship (45.4%), mean age of 56.7 ± 13.0 years; mean of 4 ± 2 diagnosed diseases; 7 ± 6 complaints and 4 ± 2 medications per patient. Nine hundred and twelve health problems have been identified: 56.5% uncontrolled. From the uncontrolled problems, 380 (73.6%) were DRPs and between these, 81 (21.3%) were risks for DRP. From the 97 followed-up patients, 89 (91.7%) have presented at least one DRP during the follow-up. The more frequent DRPs were related to effectiveness (53.2%), to necessity (25.2%) and to safety (21.6%). A great number of uncontrolled problems was observed, as well as the possibility to resolve them by means of pharmaceutical care, indicating so the resolutive potential of this practice. Uniterms: Pharmaceutical care. Pharmacotherapeutic follow-up. Drug Related Problem (DRP).O presente estudo observacional, longitudinal, não concorrente teve por objetivos avaliar o perfil dos pacientes atendidos por um serviço de acompanhamento farmacoterapêutico e descrever os 'problemas relacionados com medicamento' (PRM) encontrados; determinar a proporção de PRM dentre os problemas de saúde apresentados pela população estudada, classificá-los e identificar situações relacionadas com seu surgimento. O estudo foi realizado na Farmácia Escola do Centro Universitário Newton Paiva, em Belo Horizonte, MG, durante o período de novembro de 2001 a novembro de 2003. Foram avaliados 97 pacientes, maioria mulheres (66,0%), com até 8 anos de escolaridade (45,4%), média de idade de 56,7 ± 13,0 anos; média de 4 ± 2 doenças com diagnóstico; 7 ± 6 queixas e 4 ± 2 medicamentos por paciente. Foram identificados 912 problemas de saúde: 56,5% não controlados. Dos problemas não controlados, 380 (73,6%) eram PRM e desses 81 (21,3%) eram riscos de PRM. Dos 97 pacientes acompanhados 89 (91,7%) apresentaram pelo menos um PRM durante o acompanhamento. Os PRMs mais freqüentes foram relacionados à efetividade (53,2%), à necessidade (25,2%) e à segurança (21,6%). Observou-se grande número de problemas não controlados e a possibilidade de resolvê-los por meio da atenção farmacêutica, demonstrando o potencial resolutivo dessa prática.