El presente trabajo tuvo como objetivo determinar la prevalencia de tuberculosis bovina en el distrito de Végueta, provincia de Huaura para los años 2001 y 2002 teniendo como base el Reglamento para el Control y Erradicación de la Tuberculosis Bovina, DS-31-2000 AG. El monitoreo se realizó a un total de 3240 y 3230 bovinos para los años 2001 y 2002 respectivamente, en animales mayores de cuatro semanas de edad. Las pruebas utilizadas fueron la de intradermoreacción tuberculina (PPD), tanto la prueba caudal como la doble comparativa en la tabla del cuello para la confirmación . Los resultados obtenidos fueron de cuatro casos positivos a la prueba caudal, 0.1235%, de los cuales un caso resultó positivo a la prueba doble comparativa, en el año 2001. En el año 2002 resultaron dos casos positivos a la prueba ano caudal, 0.0619%, de los cuales ambos resultaron positivos a la prueba doble comparativa. / This paper had the goal of determining the prevalence of bovine tuberculosis in the district of Végueta, province of Huaura, in the years 2001 and 2002, having as a base the regulations for the bovine tuberculosis control and eradication, D.S.-31-2000 AG. The monitoring was made among a total of 3240 and 3230 bovines in the years 2001 and 2002, respectively, of all ages older than 4 week old. The testing for bovine tuberculosis wade made using the PPD skin test, both the caudal tuberculin test (CFT) and the comparative cervical tuberculin test (CCT) for confirmation. About the results, in the year 2001 the caudal tuberculin test showed 4 positive cases, 0.1235%.One of these cases was positive to the comparative cervical tuberculin test, too. In the year 2002, the caudal fold tuberculin test showed 2 positive cases, that were positive to the comparative cervical tuberculin test, too.

La Tuberculosis Multidrogorresistente es un problema de salud pública que afecta al país. El consumo de alcohol se asocia frecuentemente a fracaso o abandono pero existen pocas investigaciones entre consumo de alcohol y TBMDR. El presente estudio tuvo por objetivo determinar si el consumo excesivo de alcohol es un factor de riesgo de tuberculosis multidrogorresistente secundaria. Metodología: Se realizó un estudio caso – control, denominando caso al paciente con TBMDR secundaria según criterios. Los controles fueron pacientes con TB no MDR que acudían a los mismos establecimientos en el mismo periodo que los casos. Se seleccionaron mínimamente 2 controles por caso. En total se reclutaron 44 casos y 125 controles, la muestra calculada fue de 43 casos y 86 controles. Resultados: El consumo excesivo de alcohol fue detectado con la prueba de screening AUDIT (Alcohol Use Disorders Identification Test). Existe asociación entre consumo excesivo de alcohol y TBMDR (p=0,018). El 54,55% de los casos presenta consumo excesivo, mientras que solo el 34,40% de los controles presenta el mismo tipo de consumo. El consumo perjudicial de alcohol está asociado a TBMDR (p=0,02), el consumo de riesgo y la dependencia no estuvieron asociados a TBMDR. Existen diferencias estadísticamente significativas entre las medias del puntaje del AUDIT entre casos y controles (p=0,01). La variable abandono al tratamiento no es variable confusora. La probabilidad de TBMDR incrementa si el paciente presenta consumo excesivo de alcohol y además abandona el tratamiento de 0,35 a 0,99. Conclusiones: El consumo excesivo de alcohol es un factor asociado a TBMDR secundaria, al igual que el consumo perjudicial. EL consumo de riesgo y la dependencia no estuvieron asociados a TB-MDR secundaria. / Background: Multidrug-Resistant Tuberculosis is a problem of public health goes affect country. The alcohol consumption is frequently associated to failure or abandonment but exist a few investigations between alcohol consumption and TBMDR. The present study had by objective to determine if the excessive alcohol consumption is a risk factor of secondary multidrogorresistente tuberculosis. Methods: A case – control study was development, denominating case to the patient with secondary TBMDR according to criteria. The controls were patient with TB non MDR that went to the same health services in the same period that the cases. 2 controls by case were selected. Altogether 44 cases were recruited and 125 controls, the calculated sample was of 43 cases and 86 controls. The excessive alcohol consumption was detected with the test of screening AUDIT (Alcohol Use Disorders Identification Test). Results: There was association between excessive alcohol consumption and TBMDR (p=0,018), 54.55% of the cases had excessive consumption, while 34.40% of the controls only had the same type of consumption. The detrimental alcohol consumption is associate to TBMDR (p=0,02), the risk consumption and the dependency was not associate to TBMDR. There was statistically significant differences between the averages of AUDIT between cases and controls (p=0,01). The variable abandonment of treatment is not confusor variable. TBMDR probability increases if the patient had excessive alcohol consumption and in addition leaves the treatment from 0.35 to 0,99. Conclusion: Excessive consumption of alcohol and harmful consumptions are factors associated to secondary TBMDR. Risk consumption and dependence were not associated with secondary MDRTB.

La tuberculosis es una enfermedad de trascendencia social que plantea serios problemas de salud pública, con el modelo de desarrollo económico del país, las consecuencias negativas han recaído en las clases más reprimidas social y económicamente, trayendo como resultado desempleo, bajos ingresos y extrema pobreza, los cuales son factores que permiten la permanencia del foco infeccioso de la enfermedad y su propagación, aunado a un déficit de saneamiento ambiental, hacinamiento, deficiente nivel educativo para la salud, estrés social y deficiente alimentación. El Ministerio de Salud enfrenta esta realidad mediante la Estrategia Sanitaria Control de la Tuberculosis cuyo objetivo es brindar atención integral a la persona y familia en riesgo a enfermar y morir por tuberculosis. Dentro de la aplicación de estrategias innovadoras que garanticen el logro de sus objetivos, recobra importancia el rol del paciente en su propia recuperación y la conservación de la salud de los miembros de su familia; en tanto el enfermero dentro de la Estrategia Sanitaria Control de la Tuberculosis requiere generar cambios en el usuario a través de la información, educación y comunicación para modificar la respuesta al proceso salud – enfermedad. Sobre estos aspectos se concretiza el presente estudio acerca de la relación entre el nivel de conocimientos sobre tuberculosis pulmonar y las actitudes hacia el tratamiento que tienen los pacientes registrados en la Estrategia Sanitaria Control de la Tuberculosis del Centro de Salud “San Luis”. Tiene como propósito brindar información válida y confiable al enfermero que labora en la Estrategia Sanitaria Control de la Tuberculosis, la cual le permita generar ideas innovadoras de educación e información y favorecer un clima adecuado para la comunicación con el paciente. La hipótesis de la investigación plantea la existencia de relación entre el nivel de conocimientos sobre tuberculosis pulmonar y las actitudes hacia el tratamiento que tienen los pacientes. Se utilizó en el estudio de investigación el método descriptivo correlacional de corte transversal. La población considerada fue de 60 pacientes, quienes cumplieron con los criterios de inclusión. Para la recolección de datos se utilizó el cuestionario para medir los conocimientos y la escala tipo Lickert para las actitudes. Los resultados que se obtuvieron demuestran que la mayoría de los pacientes con tuberculosis pulmonar presentan un nivel de conocimientos de medio o bajo sobre el tratamiento farmacológico, cuidados en el hogar y medidas preventivas, predisponiendo al agravamiento de la enfermedad, incremento del contagio a los demás miembros de la familia y comunidad ,y el mayor riesgo de mortalidad, así mismo se halló que la mayoría de pacientes con tuberculosis pulmonar tienen una actitud de indiferencia hacia el tratamiento, lo cual indica que están en mayor riesgo de recaer o abandonar el tratamiento. Además se pudo comprobar la relación entre el nivel de conocimientos sobre tuberculosis pulmonar y las actitudes hacia el tratamiento que tienen los pacientes registrados en la Estrategia Sanitaria Control de la Tuberculosis del Centro de Salud “San Luis”. / The tuberculosis is a disease of social importance that creates serious problems of public health, with the generation of adjustments in the economy, the consequences have fallen to the repressed classes more social and economically, bringing like result unemployment, low income and carries far poverty, which is factors that allow to the permanence of the infectious center of the disease and its propagation, in addition produce deficit of environmental cleaning, accumalation, deficient educative level for the health, social stress and deficient feeding. The Ministry of Health faces this reality by means of the Component Control of the Tuberculosis whose objective is to offer to integral attention to the person and family in risk to become ill and to die by tuberculosis. Within the effort to look for strategies that guarantee the profit of their objectives, it recovers importance the roll of the patient in his own recovery and the conservation of the health of the members of his family. The nurse within the Component Control of the Tuberculosis requires to generate changes in the user through the information, education and communication, to modify the answer to the process health - disease. On these aspects to concrete the present study about the relation between the level of knowledge on pulmonary tuberculosis and the attitudes towards the treatment that have the patients registered in the Component Control of the Tuberculosis of the Center of Health "San Luis". The intention is to stimulate the nurse to transform itself into a change agent that generates ideas innovating of education and information and favors a climate adapted for the communication with the patient doing emphasis in the importance of the continuity of the treatment, the cares in the home and the preventive measures. The hypothesis of the investigation raises the existence of direct relation between the level of knowledge on pulmonary tuberculosis and the attitudes towards the treatment that have the patients. The used method was descriptive the corelational one of cross section. The considered population was of 60 patients, who fulfilled the inclusion criteria. For the data collection the survey was used to measure the knowledge and the scale Lickert type for the attitudes. The results demonstrate that most of the patients with pulmonary tuberculosis they present/display a level of low means knowledge or on the farmacology treatment, taken care of in the home and preventive measures, having to the wrong the disease, increase of I infect to the other members of the family and community, y the greater risk of mortality, also was that most of patients with pulmonary tuberculosis they have an indifference attitude towards the treatment, which indicates that they are in greater risk of falling or of leaving the treatment. In addition the relation between the level of knowledge on pulmonary tuberculosis and the attitudes could be verified towards the treatment that have the patients registered in the Component Control of the Tuberculosis.

Tuberculosis (TB) is a highly infectious disease that causes the second highest mortality rate in human worldwide. The emergence of multi-drug resistance tuberculosis (MDR-TB) leads to a major public health problem in controlling TB-caused mortality. Pyrazinamide (PZA) is an important first-line drug in the treatment of MDR-TB. However, since the challenge in performing susceptibility test on PZA, World Health Organization has not published any data on the prevalence of PZA resistance in Mycobacterium tuberculosis (M. tuberculosis). Since the occurrence of PZA resistance makes MDR-TB more difficult to treat with poor prognosis, rapid detection method in PZA resistance is urgently needed. Since pncA mutation is highly associated with up to 98% PZA resistant M. tuberculosis strains, it is worthwhile to develop rapid molecular method for detecting PZA resistance. This study aims to identify the mutations in PZA resistant M. tuberculosis strains. The first part of this study aims to characterize the pattern of pncA mutation among PZA-resistant and PZA-susceptible M. tuberculosis using Sanger sequencing method. Among all clinical isolates, 12 out of 29 cases of M. tuberculosis were resistant to PZA. All PZA-resistant M. tuberculosis strains harbored pncA mutation, whereas no known mutations were found among those PZA-susceptible strains, giving the positive predictive value to be 100%. Eight mutation patterns were found among 12 resistant isolates. Four of these pncA mutations have not been described previously by other studies. Study also characterizes the pattern of pncA mutation in 19 sputum specimens, with 2 mutation patterns found. Overall 10 mutation patterns were found in this study. Results show that the mutation of pncA gene is highly associated with PZA-resistant M. tuberculosis. Results also suggest the scattered and more extensive mutations in pncA gene that confer PZA resistance to M. tuberculosis. The second and the last part of this study aims to evaluate the possibility of using molecular method to detect PZA resistance in routine clinical laboratory. Results show that using molecular sequencing to detect PZA resistance can shorten the turnaround time to about 3-4 working days. Since mutation of pncA was scattered along the entire pncA gene, using DNA sequencing approach may be the best strategy for the rapid detection of PZA resistance in M. tuberculosis. / published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Tuberculosis (TB) is one of the most prevalent infectious diseases worldwide and causes high morbidity and mortality, despite the widespread availability of effective antibiotics against most strains of Mycobacterium tuberculosis, which is the causative agent of TB. One of the primary reasons that hinder TB control is that many cases of active disease go undetected or are discovered late. This is, in large part, due to the relative insensitivity and limited specificity, amongst other limitations, of the current TB diagnostics tests. Moreover, M. tuberculosis infection can be asymptomatic and latent, or cause active disease. Therefore, an ideal or effective TB diagnostic needs to distinguish between these two states. The aim of this study was to develop novel diagnostic reagents for M. tuberculosis using phage displayed peptides and nucleic acid aptamers with a view to discerning latent from active TB. Using a linear (X12) and constrained (CX7C) phage display libraries, five rounds of selection (biopanning) were performed. Ten phage displayed peptides that bind to the mycobacteria surface were selected. These phage clones were identified using both random clone picking and high throughput (HTP) sequencing. A phage clone displaying the CPLHARLPC peptide was identified by HTP sequencing as the most enriched, representing 82.49% of the selected CX7C phage population. Further characterization showed that it bound better to different mycobacteria species, including M. tuberculosis, than the unselected phage library. Moreover, using surface plasmon resonance (SPR) technology, the chemically synthesised CPLHARLPC peptide was shown to bind M. tuberculosis H37Rv whole cell lysate and not non-mycobacteria lysates. In addition, using the systematic evolution of ligands by exponential enrichment (SELEX) protocol and SPR technology, 2'-Fluoro-pyrimidine-RNA aptamers were selected against the mycobacteria ESX-3 secreted protein, ESX-G. At least five aptamers were identified after five rounds of selection. Two of these aptamers, GH43 and GH78, not only bound EsxG with high affinities, KD 8.04 ± 1.90 nM and KD 78.85 ±9.40 nM respectively, but also preferentially bound EsxG better than the EsxA homologue. Taken together, these findings suggest that a combination of phage display, SELEX and HTP sequencing can be a useful tool for the identification of specific detection reagents that can bind to mycobacteria and its associated targets. These reagents could be exploited to develop alternative molecular probes for TB diagnostics. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2013.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 5 uppsatser.

Thesis (M.S.P.H.)--University of Michigan, 1939.

Thesis (M.P.H.)--University of Michigan, 1942.

Thesis (M.S.P.H.)--University of Michigan, 1942.