Diagnóstico da tuberculose em indígenas menores de quinze anos por meio de um sistema de pontuação em Mato Grosso do Sul

Abstract

OBJECTIVE: To evaluate the process of diagnosing pulmonary tuberculosis in smear-negative indigenous children and adolescents under 15 years of age with the modified Brazilian National Ministry of Health Scoring System (mBNMH-SS). METHODS: This was a retrospective descriptive study involving 49 indigenous patients under 15 years of age with tuberculosis, treated between 2007 and 2010 in the state of Mato Grosso do Sul, Brazil. RESULTS: Of the 49 patients, 27 (56%) were under 5 years of age, 33 (67%) had symptoms suggestive of tuberculosis, 24 (49%) were underweight, and 36 (73.5%) had been BCG vaccinated. The tuberculin skin test was positive in 28 patients (57%), 18 (64%) of whom had an induration ≥ 10 mm. Chest X-rays were performed in 37 (76%) of the patients, 31 (84%) of whom had only one chest X-ray taken. Among those 37 patients, the radiological findings were suggestive of tuberculosis in 16 (43%), infiltration/condensation in 10 (27%), and normal in 4 (11%). The Indigenous Health Care Teams made the diagnosis in 31 (63%) of the cases, using the original BNMH-SS in only 14 (45%). We calculated the mBNMH-SS scores for 30 (61%) of the 49 patients. Among the 30 cases scored, a diagnosis of tuberculosis was found to be highly likely, possible, and unlikely in 16 (53%), 11 (37%), and 3 (10%), respectively. CONCLUSIONS: The proportion of highly likely and possible diagnoses was consistent with the standard proportion of cases diagnosed by the teams (90%), demonstrating the epidemiological applicability of the mBNMH-SS for the diagnosis of pulmonary tuberculosis in the indigenous population, within the scenario of the health care provided.

Situação epidemiológica da tuberculose no Rio Grande do Sul: uma análise com base nos dados do Sinan entre 2003 e 2012 com foco nos povos indígenas

“…Concerning specifically the situation of tuberculosis in the indigenous populations and its comparative dimension, the situation in Rio Grande do Sul is similar to that described in other studies conducted in the country, both addressing indigenous peoples, specifically, or including data about race/color in the analyses. However, this set of studies has pointed out to even more severe situations, when the indigenous segment systematically presents higher incidence rates than those registered in the other segments [4][5][6][7][8][9][10][11][12][13][14][15][16][21][22][23][24][25][26] .…”

Prevalence of nutritional deficiency in patients with pulmonary tuberculosis

“…( 15 , 16 ) Likewise, underweight was present in 49% of 49 indigenous subjects under 15 years of age diagnosed with tuberculosis in Mato Grosso do Sul between 2007 and 2010. ( 17 ) …”

“…( 15 , 16 ) Do mesmo modo, o baixo peso estava presente em 49% de 49 indígenas menores de 15 anos com diagnóstico de tuberculose no Mato Grosso do Sul entre 2007 e 2010. ( 17 ) …”

Incidence and transmission patterns of tuberculosis among indigenous populations in Brazil

“…Interestingly, the non-indigenous TB patients had 4.5 times higher mortality than the indigenous TB patients. Furthermore, Marques et al (2010) and Santos et al (2013) showed that the incidence of new TB cases in children less than 10 years of age decreased by approximately 40% between 2000-2006.…”