Recent studies have provided conflicting results in regards to equine intradermal skin testing and its use in defining causative antigens in IgE mediated diseases such as equine recurrent airway obstruction (RAO). This study was divided into two experiments. In the first experiment of this study, the hypothesis tested was normal horses would have minimal variability in the wheals formed by intradermal injection of positive control stimulants. This was evaluated by examining the repeatability of skin test wheals created by 5 concentrations of histamine, compound 48/80, and phaseolus vulgaris (PHA) within a normal horse and between 12 normal horses at 0.5 hours, 4 hours, and 24 hours post injection. Minimal variability was detected within individual horses and between 12 horses for histamine and compound 48/80 at 0.5 hours and for PHA at 4 hours. This information suggests that the intradermal injection of positive control substances is a repeatable test in normal horses. In the second experiment of this study, the hypothesis tested was normal horses react differently to intradermal injection of positive control stimulants (histamine, compound 48/80, PHA) and/or an environmental antigen (Aspergillus) in comparison to horses affected with RAO. This was evaluated by identifying differences in wheal responses between normal horses and RAO affected horses. Concentration response curves were created in normal and RAO affected horses to the aforementioned stimulants at 0.5 hours, 4 hours, and 24 hours post injection. No statistically significant differences were noted in concentration response between normal and ROA affected horses when compound 48/80 and PHA were evaluated. RAO affected horses demonstrated a greater slope at the 0.5 hour time when compared to normal horses suggesting that RAO affected horses are hypersensitive to intradermal injection of histamine. Injection of Aspergillus mix at 4000 protein nitrogen units/ml caused an intradermal wheal reaction at the 24-hour time in 4/5 RAO horses. This reaction was not noted in normal horses. This information suggests that there may be a positive relationship between causative antigens (i.e. Aspergillus) that may induce clinical RAO and positive intradermal skin test results. An additional aspect that was evaluated in both experiments involved histologic examination of skin biopsies taken from wheals created by intadermal injection of histamine, compound 48/80, PHA, and Aspergillus at various times post injection. In the first experiment, intradermal injection of histamine caused severe dermal edema and margination of neutrophils and eosinophils at 0.5 hours. Compound 48/80 demonstrated mild to modest dermal edema at 0.5 hours while PHA demonstrated severe dermal edema, hemorrhage, and lymphactic ectasia at 4 and 24 hours. PHA also demonstrated a neutophilic inflammation at 4 hours that progressed to a mixed lymphohistiocytic and neutrophilic inflammation at 24 hours. In the second experiment, no edema and modest to moderate neutrophilic inflammation was noted in normal horses after intradermal injection of Aspergillus at 24 hours. In contrast, RAO affected horses demonstrated mild to modest edema and a mild to moderate mixed inflammatory response (lympho-histocytic, neutrophilic, eosinophilic) after intradermal injection of Aspergillus at 24 hours suggesting a delayed type response. / Master of Science

Background: Migrant farmworkers are among the highest-risk populations for latent TB infection (LTBI) in the United States with numerous barriers to healthcare access and increased vulnerability to infectious diseases. LTBI is usually diagnosed on the border using the tuberculin skin test (TST). QuantiFERON-TB Gold In-Tube (QFT-GIT) also measures immune response against specific Mycobacterium tuberculosis antigens. The objective of this study is to assess the comparability of TST and QFT-GIT to detect LTBI among migrant farmworkers on the border, as well as to examine the effects of various demographic and clinical factors on test positivity. Methods: Participants were recruited using mobile clinics on the San Luis US-Mexico border and tested with QFT-GIT and TST. Demographic profiles and clinical histories were collected. Kappa coefficients assessed agreement between TST and QFT-GIT using various assay cutoffs. Logistic regression examined factors associated with positive TST or QFT-GIT results. Results: Of 109 participants, 59 of 108 (55 %) were either TST (24/71, 34 %) or QFT-GIT (52/106, 50 %) positive. Concordance between TST and QFT-GIT was fair (71 % agreement,kappa= 0.38, 95 % CI: 0.15, 0.61). Factors associated with LTBI positivity included smoking (OR = 1.26, 95 % CI-1.01-1.58) and diabetes/high blood sugar (OR = 0.70, 95 % CI = 0.51-0.98). Discussion: Test concordance between the two tests was fair, with numerous discordant results observed. Greater proportion of positives detected using QFT-GIT may help avoid LTBI under-diagnosis. Assessment of LTBI status on the border provides evidence whether QFT-GIT should replace the TST in routine practice, as well as identifies risk factors for LTBI among migrant populations.

Introdução- A busca ativa de indivíduos infectados pelo Mycobacterium tuberculosis, com o auxílio do teste tuberculínico, principalmente em populações de detentos, moradores de rua, infectados pelo vírus do HIV entre outras, tem como objetivo prevenir a evolução da infecção para a doença tuberculose e auxiliar o conhecimento de novos casos da doença. O teste tuberculínico é uma importante ferramenta, para identificar os indivíduos reatores (infectados) e não reatores (não infectados). Ele pode ser aplicado a partir de várias técnicas, mas a que permite a padronização e a comparação dos resultados é a técnica intradérmica de Mantoux, a mais usada atualmente. No Brasil, a leitura do resultado do teste tuberculínico é realizada, por recomendação do Ministério de Saúde, com régua milimetrada. Para seu uso é necessário um treinamento rigoroso, o que tem contribuído para a diminuição de leitores do teste tuberculínico na rotina dos serviços de saúde. Como alternativa temos outro instrumento, paquímetro, ainda não padronizado no Brasil. Outros países o utilizam nas rotinas dos serviços de saúde para busca de indivíduos reatores ou não ao teste tuberculínico, ele não cabe para aferição ou inquéritos epidemiológicos. Objetivo- Comparar os instrumentos de leitura dos resultados do teste tuberculínico obtidos através da leitura padronizada, feita por régua milimetrada, e a leitura, não padronizada, feita por paquímetro. Métodos- Estudo descritivo realizado numa população prisional de uma Penitenciária e de um Centro de Detenção Provisória, da cidade de Guarulhos, Grande São Paulo, entre os meses de março a junho de 2008. Foi realizada a leitura do teste tuberculínico de forma dupla cega, por dois leitores, com instrumentos diferentes, paquímetro e régua milimetrada. Resultados- Foram administrados testes tuberculínicos em 1954 indivíduos; destes 111 foram excluídos por não terem comparecido à leitura do teste, resultando em uma amostra de 1843 indivíduos divididos em 1059 (57,5 por cento ) na Penitenciária e 784 (42,5 por cento ) no Centro de Detenção Provisória. Os resultados comparativos entre os dois instrumentos, quando avaliados os reatores com os não reatores, foram altos e equivalentes, pois a sensibilidade (93 por cento ) e a especificidade (97 por cento ) foram praticamente as mesmas. A média da concordância foi alta entre os dois instrumentos (95,5 por cento ) e a discordância foi baixa (4,5 por cento ). O Ministério da Saúde preconiza uma concordância acima de 80 por cento para aferição de novos leitores. Conclusões- Com este estudo observamos que o paquímetro pode ser considerado equivalente à régua milimetrada e poderá ser uma alternativa à régua para a leitura do teste tuberculínico no Brasil, principalmente para a busca de casos de tuberculose latente na rotina dos serviços de saúde, por ser um bom instrumento de separação dos indivíduos e não é suficiente para aferir um novo leitor. Entretanto, a régua deverá ser mantida, especialmente para inquéritos epidemiológicos / Introduction- The active search of individuals infected with Mycobacterium tuberculosis aims to prevent the development of infection to the disease tuberculosis and ancillary knowledge of new cases of the disease. The tuberculin test is an important tool to identify individuals (infected) and non-reactors reactors (noninfected). It can be applied from various techniques. Nowadays Mantoux intradermal technique is the most widely used and allows the standardization and comparability of results. In Brazil, the reading of the tuberculin test result is performed with a ruler, by recommendation of the Ministry of health. For its use is required a rigorous training, which has contributed to the decline of tuberculin test readers in routine health services. Alternatively, caliper rule is a technique that can be used, but it is not standardized in Brazil. Objective- Compare the reading instruments of tuberculin skin test results obtained through the standardized reading, made by a millimeter ruler, and reading, not standardized, made with a caliper rule. Method- It was a descriptive study in a prison population of a Penitentiary and a Provisional Detention Centre in the city of Guarulhos, São Paulo, between the months of March to June 2008. Tuberculin test reading was done in a double blind, tuberculin test by two readers, with different instruments, ruler and caliper rule. Results- Tuberculin skin tests were administered to 1,954 individuals; of these 111 was excluded for failing to appear for the reading test, resulting in a sample of 1,843 individuals divided in 1,059 (57.5 per cent ) in Penitentiary and 784 (42.5 per cent ) in the Provisional Detention Center. The comparative results between the two instruments were high and equivalent (sensitivity=93 per cent and specificity=97 per cent ). The average correlation was high among the two instruments (95.5 per cent ) and the disagreement was low (4.5 per cent ). The Ministry of Health recommends a concordance above 80 per cent for benchmarking new readers. Conclusions- We observed that the caliper rule can be considered equivalent to the rule and may be an alternative for reading the tuberculin test in Brazil, especially to search for latent TB cases. However, the rule should be maintained, especially toepidemiological investigations

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Salvador, BA, Brasil / Introdução: As leishmanioses representam um grande problema de saúde pública sendo consideradas como doença emergente e sem controle - doença de categoria 1 - e que o foco das pesquisas deve ser a aquisição de novos conhecimentos e medidas eficazes de controle. Sob o ponto de vista clínico, a leishmaniose tegumentar (LT) nas Américas apresenta as seguintes modalidades: infecção inaparente, ganglionar, cutânea localizada (LCL), cutânea disseminada (LD), cutânea difusa (LCD), recidiva cútis (LRC) e mucosa. A primeira descrição sobre LRC ocorreu na leishmaniose no Oriente com o nome “chronic lúpus-like”, definidas como lesões de aparecimento tardio e refratariedade aos tratamentos ou como uma reação peculiar do sistema imune do hospedeiro ao parasito. A LRC é uma variante da LT convencional, uma forma de cicatrização, sendo importante entender aspectos relacionados à resposta imune do hospedeiro. Objetivo: Avaliar aspectos clínico-imunológicos e terapêuticos da LRC em pacientes da região do Vale de Jiquiriçá, Bahia, Brasil. Metodologia: O estudo foi realizado no Município de Jiquiriçá, pertencente à região Sudoeste da Bahia. Os pacientes foram atendidos no ambulatório de Doenças infecciosas e Parasitárias do Centro de Referência em Doenças Endêmicas do Vale do Jiquiriçá (CERDEJJC). Realizou-se um estudo descritivo retrospectivo e prospectivo com tempo de avaliação de 13 anos, tendo início em 2001. Na 1ª fase do estudo, foi realizada revisão dos prontuários dos pacientes com LRC curados ou com lesões parcialmente cicatrizadas (melhora clínica); na 2ª fase, casos novos de LRC foram cadastrados, tratados, acompanhados e a intradermorreação de Montenegro (IDRM) foi realizada em 43% (n=28) da casuística total (65 pacientes). Os esquemas terapêuticos definidos para nosso estudo foram: 1a escolha, com a associação das drogas Antimoniato-N-metilgucamina (405mg/Sb5+) + Azitromicina (500mg) + Pentoxifilina (400mg), sendo que nos casos de falha terapêutica instituiu-se o uso de Anfotericina B como terapia de 2a escolha. Resultados: A análise da série de 65 casos de LRC adultos jovens, portadores de lesões únicas e de tamanho mediano (de 1a 6 cm) acometendo vários segmentos corporais (face, tronco MMSS e MMII). Os casos tiveram maior concentração no gênero masculino (53,8%). Em 98% dos casos (n=63) evoluíram com refratariedade ao tratamento com posterior cura clínica (lesões totalmente cicatrizadas). A resposta terapêutica com a associação de (Sb5+ + Azitromicina + Pentoxifilina) e nos casos de falha terapêutica, com Anfotericina B foram satisfatórias para cicatrização total das lesões ao final do tratamento. O tempo médio de cicatrização total após terapia variou entre 2 a 5 meses. Na apresentação clínica das lesões observamos: placas, nódulos infiltrados, descamação, eritema, lesões satélites ao redor das cicatrizes e relatos de prurido no local. Conclusão: a LRC constitui-se como uma forma hiperérgica da LT, pouco diagnosticada pela raridade e por baixa suspeição clínica e resposta terapêutica satisfatória com associação de Sb5+, Azitromicina 500 e Pentoxifilina 400mg como 1ª escolha, representando 21% dos pacientes curados com tempo de cura de 2,6 meses e nos casos de falha terapêutica 18,5% obtiveram cicatrização total após terapia com Anfotericina B. Como subsídios evolutivos no surgimento da LRC, tivemos: idade adulta, diferença insignificante entre os gêneros, lesões com surgimento em indivíduos com cicatrizes anteriores de LT, localizadas em vários segmentos corporais e IDRM fortemente positva (>10mm) pós-cura total. / Introduction: Leishmaniasis represent a major public health problem being considered as emerging and uncontrolled disease - disease of category 1 - and the focus of research should be new knowledge and effective control measures. In relation clinical modalities, cutaneous leishmaniasis (CL) in the Americas presents the following forms: inapparent infection, lymphnode and localized cutaneous leishmaniasis (LCL), disseminated cutaneous leishmaniasis (DL), diffuse cutaneous leishmaniasis (DCL), cutis recidivans leishmaniasis (CRL) and mucosal form. The first description of CRL occurred in Orient leishmaniasis called "chronic lupus-like lesions” defined as a late compromise and refractory to treatment or as a peculiar reaction of the immune response of the host to the parasite. The CRL is a variant of the conventional TL, a form of wound healing. Objective: To evaluate clinical, immunological and therapeutic aspects of the CRL in patients of the Jiquiriçá Valley region, Bahia, Brazil. Methodology: The study was conducted in Jiquiriçá municipality, belonging to southwest Bahia state. The patients were enrolled at the outpatient Infectious and Parasitic Diseases of the Reference Center for Endemic Diseases Jiquiriçá Valley (CERDEJJC). We conducted a retrospective and prospective descriptive study with evaluation time of 13 years, beginning in 2001. In the 1st phase of the study, review of patient charts was performed with CRL healed or partially healed lesions (clinical improvement); in the 2nd stage, new cases of CRL were registered, treated, monitored and the Montenegro skin test (MST) was performed in 43% (n=28) of the total sample (65 patients).Therapeutic regimens were defined for this study: first choice, drugs association as meglumine anthimoniate (405mg) + Azithromycin (500mg) + Pentoxifylline (400mg), in cases of failure, instituted Amphotericin B as second-line therapy. Results: The analysis of the series of 65 cases of RCL young adults, persons with single lesions and median size (the first 6cm) affecting several body parts (face, upper and lower limbs, trunk). The cases had a higher concentration in males (53.8%). In 98% of cases (n=63) developed resistance to treatment with subsequent clinical cure (completely healed lesions). Therapeutic responses with drugs associations (meglumine anthimoniate + Azithromycin + Pentoxifylline), in cases of failure with amphotericin B were satisfactory for complete healing of lesions after the treatment. The median time to complete healing after therapy ranged from 2-5 months. The clinical presentation of the lesions observed: plates, infiltrated nodules, scaling, erythema, satellites lesions around the scars and pruritus. Conclusion: CRL is considered as a hyperergic form of TL underdiagnosed by the rarity and low clinical suspicion and satisfactory therapeutic response with Sb5+ association + Azithromycin 500 and pentoxifylline 400mg as 1st choice, representing 21% of patients cured with time of healing of 2.6 months and in cases of treatment failure 18.5% had complete healing after treatment with amphotericin B. As evolutionary subsidies in the emergence of CRL, we had: adulthood, insignificant difference between the genders, lesions and the onset in individuals with previous scars of TL, located in several body segments and MST strongly positve (>10mm) after total healing.

Introdução- A busca ativa de indivíduos infectados pelo Mycobacterium tuberculosis, com o auxílio do teste tuberculínico, principalmente em populações de detentos, moradores de rua, infectados pelo vírus do HIV entre outras, tem como objetivo prevenir a evolução da infecção para a doença tuberculose e auxiliar o conhecimento de novos casos da doença. O teste tuberculínico é uma importante ferramenta, para identificar os indivíduos reatores (infectados) e não reatores (não infectados). Ele pode ser aplicado a partir de várias técnicas, mas a que permite a padronização e a comparação dos resultados é a técnica intradérmica de Mantoux, a mais usada atualmente. No Brasil, a leitura do resultado do teste tuberculínico é realizada, por recomendação do Ministério de Saúde, com régua milimetrada. Para seu uso é necessário um treinamento rigoroso, o que tem contribuído para a diminuição de leitores do teste tuberculínico na rotina dos serviços de saúde. Como alternativa temos outro instrumento, paquímetro, ainda não padronizado no Brasil. Outros países o utilizam nas rotinas dos serviços de saúde para busca de indivíduos reatores ou não ao teste tuberculínico, ele não cabe para aferição ou inquéritos epidemiológicos. Objetivo- Comparar os instrumentos de leitura dos resultados do teste tuberculínico obtidos através da leitura padronizada, feita por régua milimetrada, e a leitura, não padronizada, feita por paquímetro. Métodos- Estudo descritivo realizado numa população prisional de uma Penitenciária e de um Centro de Detenção Provisória, da cidade de Guarulhos, Grande São Paulo, entre os meses de março a junho de 2008. Foi realizada a leitura do teste tuberculínico de forma dupla cega, por dois leitores, com instrumentos diferentes, paquímetro e régua milimetrada. Resultados- Foram administrados testes tuberculínicos em 1954 indivíduos; destes 111 foram excluídos por não terem comparecido à leitura do teste, resultando em uma amostra de 1843 indivíduos divididos em 1059 (57,5 por cento ) na Penitenciária e 784 (42,5 por cento ) no Centro de Detenção Provisória. Os resultados comparativos entre os dois instrumentos, quando avaliados os reatores com os não reatores, foram altos e equivalentes, pois a sensibilidade (93 por cento ) e a especificidade (97 por cento ) foram praticamente as mesmas. A média da concordância foi alta entre os dois instrumentos (95,5 por cento ) e a discordância foi baixa (4,5 por cento ). O Ministério da Saúde preconiza uma concordância acima de 80 por cento para aferição de novos leitores. Conclusões- Com este estudo observamos que o paquímetro pode ser considerado equivalente à régua milimetrada e poderá ser uma alternativa à régua para a leitura do teste tuberculínico no Brasil, principalmente para a busca de casos de tuberculose latente na rotina dos serviços de saúde, por ser um bom instrumento de separação dos indivíduos e não é suficiente para aferir um novo leitor. Entretanto, a régua deverá ser mantida, especialmente para inquéritos epidemiológicos / Introduction- The active search of individuals infected with Mycobacterium tuberculosis aims to prevent the development of infection to the disease tuberculosis and ancillary knowledge of new cases of the disease. The tuberculin test is an important tool to identify individuals (infected) and non-reactors reactors (noninfected). It can be applied from various techniques. Nowadays Mantoux intradermal technique is the most widely used and allows the standardization and comparability of results. In Brazil, the reading of the tuberculin test result is performed with a ruler, by recommendation of the Ministry of health. For its use is required a rigorous training, which has contributed to the decline of tuberculin test readers in routine health services. Alternatively, caliper rule is a technique that can be used, but it is not standardized in Brazil. Objective- Compare the reading instruments of tuberculin skin test results obtained through the standardized reading, made by a millimeter ruler, and reading, not standardized, made with a caliper rule. Method- It was a descriptive study in a prison population of a Penitentiary and a Provisional Detention Centre in the city of Guarulhos, São Paulo, between the months of March to June 2008. Tuberculin test reading was done in a double blind, tuberculin test by two readers, with different instruments, ruler and caliper rule. Results- Tuberculin skin tests were administered to 1,954 individuals; of these 111 was excluded for failing to appear for the reading test, resulting in a sample of 1,843 individuals divided in 1,059 (57.5 per cent ) in Penitentiary and 784 (42.5 per cent ) in the Provisional Detention Center. The comparative results between the two instruments were high and equivalent (sensitivity=93 per cent and specificity=97 per cent ). The average correlation was high among the two instruments (95.5 per cent ) and the disagreement was low (4.5 per cent ). The Ministry of Health recommends a concordance above 80 per cent for benchmarking new readers. Conclusions- We observed that the caliper rule can be considered equivalent to the rule and may be an alternative for reading the tuberculin test in Brazil, especially to search for latent TB cases. However, the rule should be maintained, especially toepidemiological investigations

Objetivo: A prevalência e incidência da tuberculose na população prisional é muito maior que na população geral. Conhecer a prevalência de infectados, doentes e características físicas, sociais e criminais dos presos, foram objetos deste estudo. Método: Realizou-se uma busca ativa de casos de tuberculose nos 1.052 detentos de 9 Distritos Policiais da Zona Oeste da Cidade de São Paulo, entre 2000-2001. Após a aplicação de um inquérito e da prova tuberculínica, foram realizados os exames de baciloscopia, cultura, identificação e teste de sensibilidade às drogas antituberculose. Resultados: Do total de 1.052 detentos 99,7 por cento eram homens; 71,3 por cento tinham entre 18 e 29 anos; 82,4 por cento eram solteiros ou amasiados; 51,4 por cento eram pretos ou pardos; 64,5 por cento não completaram o 1º grau; 40 por cento praticaram o roubo como principal delito; 3,7 por cento tiveram tuberculose no passado e 32,8 por cento eram sintomáticos respiratórios. Dos 932 que fizeram a prova tuberculínica, 64,5 por cento estavam infectados. Dos 1.017 escarros analisados, 8 (0,8 por cento) foram positivos na baciloscopia e 54 (5,3 por cento) na cultura. Das 54 cepas isoladas, 38,9 por cento eram M. tuberculosis e 61,1 por cento eram micobactérias não tuberculosas. Das 21 cepas de M. tuberculosis, 85,7 por cento eram sensíveis, 9,5 por cento eram resistentes à isoniazida e rifampicina e 4,8 por cento à isoniazida, rifampicina e pirazinamida. Conclusões: Pela baciloscopia, o coeficiente de prevalência de tuberculose (por 100.000 detentos) foi de 787, e pela cultura de 5.310, cerca de 30 e 203 vezes mais que o da população da cidade de São Paulo, respectivamente. O fato de haver 3 detentos com cepas multirresistentes às drogas antituberculose é uma ameaça à saúde pública / Purpose: The prevalence and incidence of tuberculosis in inmates population is much larger than in the general population. The purpose of this study was acquiring good knowledge of the prevalence of infected person and tuberculosis patients, as well as the physical, social and criminal characteristics of inmates. Method: An active search of tuberculosis cases was conducted among the 1,052 inmates of 9 County Jails of the West Section of the São Paulo City between 2000-2001. After application of an inquiry and the tuberculin skin test, laboratory investigations were also conducted such as sputum bacilloscopy, culture, identification and the test of sensitivity to anti-TB drugs. Results: Out of the total number of 1,052 inmates, 99.7 per cent were males; 71.3 per cent were in the group of ages 18 and 29 years old; 82.4 per cent were single or had sexual mates; 51.4 per cent were negroes or mulattos; 64.5 per cent had low education level; 40 per cent had been engaged in thefts/robberies; 3.7 per cent had tuberculosis episodes in the past and 32.8 per cent displayed respiratory symptoms. Out of the 932 which underwent the tuberculin skin test, 64.5 per cent were infected. Out of the 1,017 sputum samples analyzed, 8 (0.8 per cent) had positive bacilloscopy and 54 (5.3 per cent) positive culture. Of the 54 strains isolated, 38.9 per cent were M. tuberculosis and 61.1 per cent were non-tuberculosis mycobacteria. Of the 21 M. tuberculosis strains 85.7 per cent were sensitive, 9.5 per cent were resistant to isoniazide and rifampicin and 4.8 per cent to isoniazide, rifampicin and pyrazinamide. Conclusions: Based on the bacilloscopy, the tuberculosis prevalence rate (per 100,000 inmates) was 787 and based on the culture was 5,310 inmates, around 30 and 203 times higher than that of the São Paulo city population, respectively. The fact that 3 inmates had strains multi-resistant to anti-TB drugs can be deemed a threat to the public health

Introduksjon: QuantiFERON®TB Gold (QFT) er en ny blodtest for påvisning av tuberkulosesmitte, men med få data så langt fra undersøkelse av immigranter. Målet med studien var å sammenligne resultat av QFT og tuberkulin hudtest blant nyankomne asylsøkere i Norge og å vurdere hvilken rolle QFT bør ha i screening for latent tuberkulose. Metode: Alle asylsøkere, 18 år eller eldre, som ankom Tanum asylmottak fra september 2005 ble invitert til å delta og ble inkludert etter informert samtykke. Inkludering pågikk inntil et forhåndsbestemt antall på 1000 inkluderte ble nådd. Siste deltager ble inkludert i juni 2006. Deltagelse innebar en QFT test og standardiserte spørsmål, i tillegg til den lovpålagte tuberkulintesten og lungerøntgen. Resultat: Totalt 2813 asylsøkere ankom Tanum asylmottak i inkluderingsperioden (sept 05-juni 06).  Blant de 1000 deltagerne hadde 912 gyldige testresultater og ble inkludert i analysen, 29 % (264) hadde positiv QFT, mens 50 % (460) hadde positiv tuberkulintest (indurasjon &gt; 6mm). Det indikerer en høy andel smittede personer i denne gruppen. Blant deltagere med positiv tuberkulintest hadde 50 % negativ QFT, mens 7 % av dem med negativ tuberkulintest hadde positiv QFT. Det var en signifikant sammenheng mellom økning i tuberkulinutslag og sannsynligheten for å ha positiv QFT. Samsvar mellom testene var 71-79%, avhengig av grenseverdi for tuberkulin. Det var bedre samsvar mellom testene for ikke-vaksinerte personer. Konklusjon: Ved å implementere QFT som rutine kan videre oppfølging avsluttes for 42% av dem som ville ha blitt henvist basert kun på tuberkulinresultat (&gt; 6mm). Andelen som henvises vil være den samme enten QFT implementeres som erstatning for eller som supplement for å bekrefte en positiv tuberkulinreaksjon, men antallet som testes vil variere mye. Ulike tilnærminger vil identifisere samme andel (88-89%) av asylsøkere med positiv QFT og/eller sterkt positiv tuberkulinutslag (&gt;15mm), men ulike grupper vil mistes. / Introduction: QuantiFERON®TB Gold (QFT), a new blood test that detects tuberculosis infection, currently provides few data from immigrant screening. This study aimed to compare results of QFT and tuberculin skin tests (TST) among newly arrived asylum seekers in Norway and also assess the role of QFT in screening for latent tuberculosis. Methods: All asylum seekers, 18 years or older, who arrived at Tanum reception center from September 2005 were invited to participate and included after informed consent. Enrollment was continued until a fixed sample size of 1000 participants was reached. The last participant was included in June 2006. In addition to mandatory TST and chest X-ray, study participants underwent a QFT test and answered standardized questions. Results: A total of 2813 asylum seekers arrived at Tanum reception center during the inclusion period. Among the 1000 study participants, 912 showed valid test results and were included in analysis; 29% (264) had a positive QFT test and 50% (460) tested positive with TST (indurations &gt;6 mm), indicating a high proportion of latent infection within this population. Among the TST-positive participants, 50% were QFT-negative, whereas 7% of the TST-negative participants were QFT-positive. A significant association occurred between increase in size of TST induration and positive QFT result. Test agreement (71%–79%) depended on the chosen TST cut-off and was higher for nonvaccinated individuals. Conclusions: By implementing QFT as a routine screening test further follow up can be avoided for 42% of asylum seekers who would have been referred based only on a positive TST (&gt;6 mm). The proportion of individuals referred remained the same whether QFT replaced TST or confirmed a positive TST; however, the number of individuals tested varied greatly. Different approaches would identify the same proportion (88%-89%) of asylum seekers with either a positive QFT or a strongly positive TST (&gt;15 mm), but different groups will be missed. / <p>ISBN 978-91-85721-53-5</p>

Despite Africa accounting for ~20% of the global cattle population, prevalence estimates and related risk factors of bovine tuberculosis (bTB), caused by Mycobacterium bovis, are still poorly quantified in many countries across the continent. Control of bTB in Africa is difficult due to poor monitoring of cattle movements and limited abattoir surveillance. Also M. bovis is zoonotic and risk factors for transmission include living in close contact with cattle and consumption of unpasteurised milk. Cattle keeping is integral to some rural populations in Cameroon and understanding the epidemiology of bTB in cattle populations is important both to bovine and public health. Detection of bTB in cattle is difficult due to variability of immune responses to M. bovis infection. The interferon-γ (IFN-γ) assay maybe useful to estimate bTB prevalence and identify bTB risk factors in Cameroon. However its performance can vary at different stages of bTB pathogenesis and in different cattle populations. Recently Fasciola hepatica co-infections have been reported to suppress IFN-γ responses in M. bovis infected cattle but the potential effect with F. gigantica co-infections on bTB prevalence estimates in Cameroon is unknown. An abattoir study was conducted in Cameroon to assess the performance of the IFN-γ assay. In 2012-13; 2064 slaughtered cattle were sampled from Bamenda abattoir (North West Region; NWR) and Ngaoundere abattoir (Vina Division; VD). Individual animal data was collected from routine meat inspection including identification of bTB and Fasciola pathology. Cattle were also tested for bTB using the IFN-γ assay and an M. bovis antibody ELISA. In the absence of a gold-standard diagnostic, the IFN-γ assay was compared to other diagnostic tests to assess agreement and identify factors that affected performance of the assay. Agreement between IFN-γ assay, TB lesion identification and an M. bovis antibody ELISA was poor-moderate, probably partly related to differences in immune response detected. A presence of Fasciola gigantica also increased the odds of false negative IFN-γ assay results. On further investigation co-infected cattle had increased odds of TB lesions and reduced IFN-γ responses that potentially could lead to ~20% reduction in test sensitivity. In an attempt to take into account the potential impact of F. gigantica, when estimating bTB prevalence, an antibody ELISA was developed to detect the exposure in live cattle. To highlight the awareness of disease in cattle-rearing communities, estimate prevalence and identify risk factors of bTB in cattle populations; two cross-sectional studies were conducted in 2013. A stratified clustered cross-sectional study of pastoral cattle herds, in the NWR and the VD, sampled 1448 pastoral cattle reared by 100 pastoralists. A smaller cross-sectional study sampled 60 dairy cattle from 46 small-holder co-operative dairy farmers. Individual animal data and herd-level data were collected and animals were screened by both the single comparative intradermal skin test (SCITT) and IFN-γ assay. Awareness of zoonotic TB was low yet consumption of raw milk was high in cattle-keeping communities highlighting the need for accurate bTB prevalence estimates. Despite the high awareness of the clinical presentation of bTB, clinical signs identified by pastoral herdsmen were not associated with cattle being bTB positive. The SCITT was used to compare two manufacturers cut offs for the IFN-γ assay, ≥0.05 and ≥0.1, and highlighted that these two diagnostics may detect different populations of bTB positive cattle. Using the IFN-γ assay at ≥0.1, bTB prevalence was highest in dairy cattle (21.67%) and was also present in pastoral cattle in the NWR and VD (11.33% and 6.55% respectively). Importantly, as F. gigantica is endemic in Cameroon and its influence could mean the true prevalence of bTB could be higher. Female pastoral cattle were at lower odds of being IFN-γ assay positive potentially due to immunosuppressive factors had lower odds of disease. Husbandry practices also decreased the odds of being IFN-γ assay positive such as drinking from streams, antelope and contact with herds at grazing. Age increased the odds of pastoral cattle being IFN- assay positive potentially being a confounder to chronicity of bTB and other co-infections may influence IFN-γ responses. Dairy cattle herds had different risk factors for being IFN- positive likely due to differences in husbandry practices. Considering the potential risk to public health of M. bovis this thesis highlights the extent of bTB across two major cattle keeping regions in Cameroon and the public health risk in cattle-rearing communities. Furthermore the relationship between Fasciola co-infection and IFN- responses to M. bovis described has potential implications for bTB diagnosis in cattle populations where the parasite is present across the globe.

Objetivo: A prevalência e incidência da tuberculose na população prisional é muito maior que na população geral. Conhecer a prevalência de infectados, doentes e características físicas, sociais e criminais dos presos, foram objetos deste estudo. Método: Realizou-se uma busca ativa de casos de tuberculose nos 1.052 detentos de 9 Distritos Policiais da Zona Oeste da Cidade de São Paulo, entre 2000-2001. Após a aplicação de um inquérito e da prova tuberculínica, foram realizados os exames de baciloscopia, cultura, identificação e teste de sensibilidade às drogas antituberculose. Resultados: Do total de 1.052 detentos 99,7 por cento eram homens; 71,3 por cento tinham entre 18 e 29 anos; 82,4 por cento eram solteiros ou amasiados; 51,4 por cento eram pretos ou pardos; 64,5 por cento não completaram o 1º grau; 40 por cento praticaram o roubo como principal delito; 3,7 por cento tiveram tuberculose no passado e 32,8 por cento eram sintomáticos respiratórios. Dos 932 que fizeram a prova tuberculínica, 64,5 por cento estavam infectados. Dos 1.017 escarros analisados, 8 (0,8 por cento) foram positivos na baciloscopia e 54 (5,3 por cento) na cultura. Das 54 cepas isoladas, 38,9 por cento eram M. tuberculosis e 61,1 por cento eram micobactérias não tuberculosas. Das 21 cepas de M. tuberculosis, 85,7 por cento eram sensíveis, 9,5 por cento eram resistentes à isoniazida e rifampicina e 4,8 por cento à isoniazida, rifampicina e pirazinamida. Conclusões: Pela baciloscopia, o coeficiente de prevalência de tuberculose (por 100.000 detentos) foi de 787, e pela cultura de 5.310, cerca de 30 e 203 vezes mais que o da população da cidade de São Paulo, respectivamente. O fato de haver 3 detentos com cepas multirresistentes às drogas antituberculose é uma ameaça à saúde pública / Purpose: The prevalence and incidence of tuberculosis in inmates population is much larger than in the general population. The purpose of this study was acquiring good knowledge of the prevalence of infected person and tuberculosis patients, as well as the physical, social and criminal characteristics of inmates. Method: An active search of tuberculosis cases was conducted among the 1,052 inmates of 9 County Jails of the West Section of the São Paulo City between 2000-2001. After application of an inquiry and the tuberculin skin test, laboratory investigations were also conducted such as sputum bacilloscopy, culture, identification and the test of sensitivity to anti-TB drugs. Results: Out of the total number of 1,052 inmates, 99.7 per cent were males; 71.3 per cent were in the group of ages 18 and 29 years old; 82.4 per cent were single or had sexual mates; 51.4 per cent were negroes or mulattos; 64.5 per cent had low education level; 40 per cent had been engaged in thefts/robberies; 3.7 per cent had tuberculosis episodes in the past and 32.8 per cent displayed respiratory symptoms. Out of the 932 which underwent the tuberculin skin test, 64.5 per cent were infected. Out of the 1,017 sputum samples analyzed, 8 (0.8 per cent) had positive bacilloscopy and 54 (5.3 per cent) positive culture. Of the 54 strains isolated, 38.9 per cent were M. tuberculosis and 61.1 per cent were non-tuberculosis mycobacteria. Of the 21 M. tuberculosis strains 85.7 per cent were sensitive, 9.5 per cent were resistant to isoniazide and rifampicin and 4.8 per cent to isoniazide, rifampicin and pyrazinamide. Conclusions: Based on the bacilloscopy, the tuberculosis prevalence rate (per 100,000 inmates) was 787 and based on the culture was 5,310 inmates, around 30 and 203 times higher than that of the São Paulo city population, respectively. The fact that 3 inmates had strains multi-resistant to anti-TB drugs can be deemed a threat to the public health

As pessoas vivendo com HIV tÃm probabilidade aumentada de desenvolver, apresentar formar graves, ter cepas multirresistentes e morrer por tuberculose. A profilaxia para infecÃÃo latente por Mycobacteium tuberculosis (ILTB) diminui a chance de ativaÃÃo de tuberculose (TB) numa mÃdia de 62% nessa populaÃÃo. Entretanto, o diagnÃstico da TB na sua forma latente à controverso. O teste tuberculÃnico (TT) à o Ãnico exame aprovado no Brasil para avaliaÃÃo dessa infecÃÃo, embora existam problemas tanto na sua realizaÃÃo quanto na sua interpretaÃÃo. Exames de liberaÃÃo de interferon-gama foram criados recentemente com o objetivo de aumentar a especificidade e a praticidade da investigaÃÃo da ILTB. Esse estudo se propÃs a avaliar como vem sendo feita a investigaÃÃo da ILTB e o desempenho do TT e do QuantiFERON-TB Gold In-Tube (QTF-GIT) em portadores de HIV. Foram selecionados ao todo 351 pacientes portadores de HIV e sem evidÃncia de TB ativa, admitidos em dois centros de referÃncia de Fortaleza-CE, no perÃodo de 2007-2010. Na admissÃo, 41,8% dos pacientes realizaram TT, 36,3% foram avaliados quanto a contato com TB e 28,4% tiveram radiografia de tÃrax. A profilaxia foi realizada para 73,3% dos pacientes com TT positivo. Houve diagnÃstico de ILTB em 25,3% dos pacientes de acordo com o TT e em 6,7% pelo QTF-GIT (p<0,001). A correlaÃÃo entre os resultados dos dois testes foi considerada fraca (k= -0,037). Resultado positivo do TT esteve associado com drogadiÃÃo (OR 7 CI: 1,53-32,11; p=0,01), contato com TB bacilÃfera (OR 13 CI: 2,7-62,83; p=0,001), profilaxia para ILTB prÃvia (OR 17,5 CI: 3,4-90,4; p<0,001), procedÃncia do interior do estado (OR 2,74 CI:1,04-7,22; p= 0,04). NÃo houve associaÃÃo entre QTF-GIT positivo e fatores de risco para TB. A mÃdia de contagem de linfÃcitos T CD4+ nos indivÃduos com TT positivo foi superior à mÃdia dos com TT negativo (535,8 vs. 373,4 cÃl/mm3; p=0,006), enquanto o inverso ocorreu em relaÃÃo ao QTF-GIT (277 vs. 438,3 cÃl/mm3; p= 0,055). A mÃdia do logaritmo da carga viral foi superior naqueles com QTF-GIT positivo (4,81 vs. 2,11 log10 cÃp/ml; p= 0,005). Mais da metade dos pacientes nÃo realizou TT, apesar da alta prevalÃncia de ILTB. O TT contou com maior nÃmero de testes positivos. O QTF-GIT mostrou-se superior para pacientes com elevada viremia e imunossupressÃo. Sugere-se o uso de ambos os testes de forma complementar para aumentar a chance de diagnÃstico de ILTB e diminuir os riscos de progressÃo da doenÃa. / People living with HIV have an enhanced chance to develop and to die of tuberculosis (TB). Many studies demonstrate that chemoprophylaxis for latent tuberculosis infection (LTBI) reduces the progression to active TB. Indeed, the diagnosis of LTBI is controversial. In Brazil, the only test approved for use is the tuberculin skin test (TST), however, this test is complicated by several problems due to application and interpretation of the exam. Recently developed interferon-gamma release assays (IGRA) using Mycobacterium tuberculosis-specific antigens have the advantage of decreased cross-reactivity and, therefore, increased specificity. The purpose of this study is to evaluate the adherence of LTBI diagnosis and to compare the results of the QuantiFERON-TB Gold In-Tube test (QTF-GIT) and TST in a population of HIV-positive individuals from a country with high prevalence of TB. A cross-sectional study was carried out with 351 HIV patients without active tuberculosis, attending outpatient in two reference centers, from November 2007- 2010. At admission, 41.8% had realized TST, 36.3% had been interrogated about TB exposure and 28.4% had performed a chest X-ray. Chemoprophylaxis was offered to 73.3% of TST positive patients. The TST and QTF-GIT results were positive in 25.3% and 6.7% (p<0.001) of the individuals, respectively. The agreement between the two tests was poor (k= -0.037). Drug use (OR 7, 95% CI 1.5-32.1; p=0.01), TB exposure (OR 13, 95% CI 2.7-62.83; p=0.001), previous LTBI prophylaxis (OR 17.5, 95% CI 3.4-90.4; p<0.001), and living outside the state capÃtal (OR 2.7, 95% CI 1-7.2; p= 0.04) were associated with a positive TST result. There is no association between QTF-GIT positive result and risk factors for TB. TST positive individuals had a higher mean CD4+ cell count than those with TST negative result (535.8 cell/mm3 vs. 373.4 cell/mm3; p=0.006), in contrast to QTF-GIT positive result (277 cell/mm3 vs. 438.3 cell/mm3; p= 0.055). Higher viral load was associated with QTF-GIT positive result (4.8 log10 cop/ml vs. 2.1 log10 cop/ml; p= 0.005). Despite of Brazil being a country with a high burden of TB, more than half the patients have not realized TST, which appears to be more sensitive than QTF-GIT for diagnosis of LTBI. Otherwise, QTF-GIT shows better results in patients with advanced immunosuppression and high viral load. We suggest the use of both tests to increase LTBI diagnosis and decrease the risk of disease progression.