O crescimento da caprinocultura no Brasil e a necessidade de controle sanitário dessas criações justificam o estudo de avaliação do teste tuberculinico na espécie caprina. Utilizando os parâmetros de Silva et al. (2006) foram avaliados 600 caprinos procedentes dos Estados de Minas Gerais, Paraná, Pernambuco, Paraíba e São Paulo. Baseados nos valores do Teste Cervical Comparativo (TCC) 60 animais foram selecionados e submetidos a exame clínico, eutanásia e colheita de material para exames microbiológicos, histopatológicos e moleculares. Dos 36 caprinos positivos, 27 (72%) resultaram em isolamento de micobactérias tipificadas como sendo do complexo M. tuberculosis. Foram identificados focos de tuberculose em caprinos nos Estados de São Paulo, Minas Gerais e Paraíba. Além do isolamento de micobactérias do complexo M. tuberculosis, foram identificados em alguns animais outras bactérias como M. kansasii, M. flavescens, M. avium, complexo M. florentinum M. lentiflavum M. simiae, Corynebacterium pseudotuberculosis e C. bovis. Em um caso houve o isolamento de C. bovis concomitante com micobactéria do complexo M. tuberculosis. As lesões macroscópicas e histopatológicas não diferenciaram a infecção provocada por C. bovis. ou por micobactéria do complexo M. tuberculosis. Os resultados bacteriológicos, histopatológicos e de identificação genética validam a utilização do padrão de interpretação de Silva et al. (2006) no TCC para o diagnóstico da tuberculose em caprinos. / The development of farming goats in Brazil, and the need of sanitary control of these flocks, justify the study of tuberculin test evaluation in goats. Using cut-off points established by Silva et al. (2006), 600 goats from Minas Gerais, Paraná, Pernambuco, Paraíba and São Paulo states were evaluated. According to Comparative Cervical Test values, 60 goats were selected, and submitted to clinical exams, euthanized and materials collected for microbiologycal, histopathologycal and genetic typing. Out of the 36 positive goats, 27 (72%) had isolation of micobacteria classified like Mycobaterium tuberculosis complex. Focus of tuberculosis were identified in São Paulo, Minas Gerais and Paraíba states. Besides isolation of the M. tuberculosis complex micobacteria, other bacterias like M. kansasii, M. flavescens, M. avium, M. florentinum lentiflavum simiae complex, Corynebacterium pseudotuberculosis and C. bovis were identified in some animals. In one case, isolation of C. bovis occurred together with micobacteria of the M. tuberculosis complex. The macroscopic and histopathological lesions did not discriminate infection for C. bovis or of the M. tuberculosis complex micobateria. The bacteriological, histopathological and genetic typing results validate the use of cut-off points established by Silva et al. (2006), in the Cervical Comparative Test for diagnosis of tuberculosis in goats.

This study was conducted to confirm the presence of bovine tuberculosis (BTB) and determine its prevalence, based on skin test reactivity, in cattle reared under extensive farming conditions in the Govuro district, Inhambane province, Mozambique. The study was comprised of a primary screening test using the single intradermal test (SIT) in randomly selected animals from Colonato and Sede dip tanks in Govuro. Positive reactors to the SIT were tested again with bovine and avian tuberculin using the single intradermal comparative test (SICTT) 7 weeks after the SIT. The sample size was calculated using Win Episcope 2.0 based on 95% confidence to detect a 2% expected prevalence using the SIT, with a 1% accepted error and accounting for a total population size of 7208. The calculated sample size was 682 animals. To compensate for the probability of 20% default in reading, the sample size was increased to 853. During the testing process (SIT), it was evident from the first 3 reading days that the apparent prevalence (61, 94%) was higher than expected (2%), hence we decided to stop when the total number of cattle was 530. During the testing process (SIT), it was evident from the first 3 reading days that the apparent prevalence (61.94%) was far higher than expected (2%), hence we decided to stop when the total number of cattle was 530. This was due to the fact that, at such a high prevalence, it would not be necessary to achieve as high a precision as 1% accepted error. A sample size of 530 would be sufficient to achieve a precision of 4% accepted error, which was regarded as more than adequate. The 530 cattle, 3 or more years of age, were selected using systematic random sampling from the two dip tanks (Colonato 371 and Sede 159 animals). All animals were identified by numbers painted, dorsally on the sacral region. Out of 530 tested cattle by SIT, 268 were read, and 166/268 (61.94% with 95% confidence interval [CI]: 55.8 – 67.8%) were found positive, with visible swallow at the injection site. Apparent prevalence (AP) was found to be 61.94% while the true prevalence (TP) was 75.92%. The predictive value of a positive result (PV+) was found to be 87.9%. No significant difference in apparent prevalence between the two areas was detected by Fisher’s exact test (P = 0.11). By SICTT, out of 28 animals positive reactors to SIT, 21 were possible to read, and 13/21 (61.9%; 95% CI: 55.1 – 89.3%) were found positive. A three year old bull, positive reactor to the SIT, was slaughtered, and a detailed post mortem was carried out and organs with visible lesions were collected for further laboratory testing (histopathology, culture and isolation of M. Bovis and PCR). Later on, 30 more positive reactors to the SIT test were slaughtered: 25/30 (83.3%) showed visible lesions compatible with BTB, and total condemnation of carcass was made in 3/25 (12%) due to generalized lesions. The high prevalence rate of skin test positive animals as well as gross lesions and histopathology were confirmed to be BTB by the isolation and identification of M. Bovis by culture and PCR. Our results suggest that bovine tuberculosis is highly prevalent in Govuro district and may thus represent a potential health problem of zoonotic tuberculosis in humans. Our results suggest that BTB has reached the plateau phase of endemicity in cattle in Govuro district. In this context, the positive predictive value of the SIT is very high and thus the use of the SICTT as a confirmatory test has a limited value and should not be advocated. Our results further indicate that no other prevalence study of BTB should be conducted in the next few years in Govuro district, unless comprehensive control measures are implemented. The focus of further studies should be on the isolation and the molecular characterization of M. Bovis from cattle and humans in order to assess transmission routes and the role played by BTB in human TB cases in Govuro district. Copyright / Dissertation (MSc (Veterinary Tropical Diseases))--University of Pretoria, 2009. / Veterinary Tropical Diseases / unrestricted

Source: Masters Abstracts International, Volume: 47-06, page: 3552. Adviser: T. Robert Harris. Includes bibliographical references.

Disertacijos objektas: įvairių BCG skiepijimo režimų įtaka tuberkulino reakcijos išraiškai, vietinei BCG žymei, specifinei serologijai, alergijos klinikai vaikams iki 6 m. Tyrime dalyvavo 509 vaikai, vakcinuoti įprasta arba pusine BCG vakcinos doze naujagimio ar 3 mėn. amžiaus. Jiems 3 mėn. po BCG vakcinacijos, 1, 2 ir 6 m. atliktas tuberkulino mėginys, įvertintas BCG randelis, ištirti specifiniai antikūnai kraujo serume, įvertintos alerginės būklės. Disertacijos išvadose konstatuojama, kad 3 mėn. amžiaus BCG vakcinuotų vaikų tuberkulino reakcijos yra stipresnės bei susidariusi vietinė BCG žymė dažnesnė, nei įprasta BCG vakcinos doze naujagimio amžiaus skiepytųjų, tiriant juos 3 mėn. po BCG vakcinacijos ar 1 m. amžiaus. Specifinių antikūnų dėsningumų nepavyko aptikti. 3 mėn. amžiaus kūdikių BCG vakcinacija sumažino su maistu siejamų alerginių bėrimų riziką mergaitėms ikimokykliniu laikotarpiu. / Object of dissertation: The influence of different BCG vaccination schedules on the tuberculin reactivity, BCG scarring, specific serology and allergy. 509 children were included in this research, all of them received BCG vaccination with standard or half dosage as newborns or 3-months old. 3 months after BCG vaccination and at one, two, and six years of age they were tested with tuberculin, and examined for BCG scarring. Anti-tuberculosis antibodies were detected in sera and children were evaluated for allergy. In conclusions of the dissertation it is declared, that 3 months after BCG vaccination and at 1 year of age children, vaccinated as 3 months - old had stronger tuberculin reactions and better BCG scarring, in comparison to neonatal vaccination. Clear consistent patterns in anti-tuberculosis antibody levels were not established. BCG vaccination at 3 months of age reduced the risk of food –related allergic rash for girls in preschool period.

Object of dissertation: The influence of different BCG vaccination schedules on the tuberculin reactivity, BCG scarring, specific serology and allergy. 509 children were included in this research, all of them received BCG vaccination with standard or half dosage as newborns or 3-months old. 3 months after BCG vaccination and at one, two, and six years of age they were tested with tuberculin, and examined for BCG scarring. Anti-tuberculosis antibodies were detected in sera and children were evaluated for allergy. In conclusions of the dissertation it is declared, that 3 months after BCG vaccination and at 1 year of age children, vaccinated as 3 months - old had stronger tuberculin reactions and better BCG scarring, in comparison to neonatal vaccination. Clear consistent patterns in anti-tuberculosis antibody levels were not established. BCG vaccination at 3 months of age reduced the risk of food –related allergic rash for girls in preschool period. / Disertacijos objektas: įvairių BCG skiepijimo režimų įtaka tuberkulino reakcijos išraiškai, vietinei BCG žymei, specifinei serologijai, alergijos klinikai vaikams iki 6 m. Tyrime dalyvavo 509 vaikai, vakcinuoti įprasta arba pusine BCG vakcinos doze naujagimio ar 3 mėn. amžiaus. Jiems 3 mėn. po BCG vakcinacijos, 1, 2 ir 6 m. atliktas tuberkulino mėginys, įvertintas BCG randelis, ištirti prieštuberkulioziniai antikūnai kraujo serume, įvertintos alerginės būklės. Disertacijos išvadose konstatuojama, kad pusine BCG vakcina skiepytųjų tuberkulino reakcijos silpnesnės, o susidariusi vietinė žymė mažesnė, o 3 mėn. BCG vakcinuotų vaikų tuberkulino reakcijos yra stipresnės, o susidariusi vietinė BCG žymė dažnesnė, nei skiepijant įprasta BCG vakcina naujagimio amžiaus vaikus lyginant su įprasta BCG vakcina naujagimio amžiaus skiepytais vaikais 3 mėn. po BCG vakcinacijos ar 1 m. vaikams. Aiškių prieštuberkuliozinių antikūnų dėsningumų nepavyko aptikti. 3 mėn. amžiaus BCG vakcinacija sumažino su maistu siejamų alerginių bėrimų riziką ikimokyklinio amžiaus mergaitėms.

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

Foi investigado o valor diagnóstico da resposta alérgica cutânea à tuberculina e do ELISA indireto, com antígeno recombinante MPB 70, em leitões experimentalmente sensibilizados, pela via intramuscular, com suspensões oleosas de M. bovis ou M. avium inativados. Foram utilizados 91 animais divididos em quatro grupos. Os grupos A e B, cada um com 25 indivíduos, grupos C e D com 21 e 20 indivíduos respectivamente, balanceando-se as características de raça, linhagem, faixa etária e sexo. Aos 21 dias de idade, todos os animais foram submetidos a uma triagem com a aplicação de tuberculina PPD de M. bovis, pela via intradérmica na base da orelha e não houve qualquer tipo de reação. Decorridos 60 dias do teste tuberculínico de triagem, o grupo A, recebeu injeção intramuscular de 0,5 mL de uma suspensão oleosa de M. avium estirpe D4; o grupo B, recebeu 0,5 mL de uma suspensão oleosa de M. bovis estirpe AN5; o grupo C (controle I), recebeu 0,5 mL do adjuvante oleoso e o grupo D (controle II), recebeu 0,5 mL de solução fisiológica. Foi realizado o exame histopatológico de biopsias das reações cutâneas e a colheita de sangue para o teste de ELISA de captura. Após 30 dias da sensibilização, foi efetuada a prova de tuberculinização comparativa com reação medida pela variação da espessura da pele com paquímetro às 0h, 24h, 48h e 72h, após a aplicação das tuberculinas. No teste comparativo, lido às 72 horas, a reação foi considerada negativa quando a diferença das reações entre o PPD bovino e o PPD aviário foi menor que 6,7 mm; suspeito ou inconclusivo quando a diferença se situou na faixa de 6,7 a 7,5 mm; e positiva para o tipo de PPD, considerando-se tuberculose para PPD M. bovis e micobacteriose para PPD M. avium, quando a diferença da reação foi superior a 7,5 mm. Nos exames histopatológicos, foi observado intenso infiltrado inflamatório linfocitário no local das reações intradérmicas dos animais testados com o PPD homologo ao tipo de micobactéria utilizada na suspensão oleosa sensibilizante. O ensaio de ELISA com antígeno, MPB 70 recombinante, foi capaz de revelar a presença de anticorpos contra o M. bovis, porém não revelou anticorpos para M. avium. / The diagnostic value of the cutaneous allergic response to tuberculin and Indirect ELISA test was investigated using MPB 70 recombinant antigen, in piglets experimentally sensitized intramuscularly with the oily suspensions of inactivated M. bovis or M. avium. The ninety-one animals used were divided into four groups. The groups A and B were formed each with 25 individuals, and groups C and D, with 21 and 20 individuals, respectively, balancing the characteristics of race, ancestry, age and sex. At the age of 21 days, all the animals were submitted to the screening test with the use of M. bovis PPD, by the intradermal route at the base of the ear and no reaction was detected. Sixty days after the screening tuberculin test, animals of the group A were injected intramuscularly with 0.5 mL of oily suspension of M. avium D4 strain; animals of group B received 0.5 mL of an oily suspension of M. bovis, AN5 strain; and the members of group C (control I) received 0.5 mL of an oily adjuvant and the individuals of group D (control II) received 0.5 mL of saline solution. Histological examinations of biopsies of skin reactions were carried out and blood collections made for capture ELISA. Following 30 days of sensitization, comparative skin reactions were measured by the variation in skin thickness with a caliper at 0h, 24h, 48h an 72h after applications of tuberculins. In the comparative test measured at 72h, the reaction was considered negative when the difference of the reactions between bovine PPD and avian PPD was less than 6.7 mm; suspected or inconclusive, when the difference stood in the range of 6.7 to 7.5 mm; and positive according to the type of PPD, considering tuberculosis the M. bovis PPD and mycobacteriosis the M. avium PPD, when the difference of the reaction was greater than 7.5 mm. In histopathological examinations, intense lymphocytic inflammatory infiltrate were observed at the site of intradermal reactions of the animals tested with PPD homologous to the type of mycobacteria used in sensitizing oil suspension. The ELISA assay with MPB 70 recombinant antigen was able to reveal the presence of antibodies against M. bovis, but did not reveal antibodies to M. avium.

There are few reports on the impact of HIV-1 infection on tuberculosis in children. Microbiologic diagnosis of tuberculosis is difficult and much reliance is placed on the tuberculin skin test, as part of a scoring system, in diagnosing tuberculosis in children. A prospective study, enrolling 168 patients with clinical tuberculosis, was performed between July 1996 and January 1997 at the teaching hospitals attached to the Department of Paediatrics and Child Health, University of the Witwatersrand. Forty-two percent of children with tuberculosis were HIV-1 infected. Extrapulmonary tuberculosis was diagnosed more frequently in HIV uninfected children. Progressive pulmonary tuberculosis, based on radiographic findings, and mortality was higher in HIV-1 infected children with tuberculosis. HIV-1 infected children with pulmonary tuberculosis showed marked hyporeactivity to tuberculin skin testing. Both CD4+ lymphocyte counts and concurrent delayed type hypersensitivity testing, using the "CMI Multitest®”, offered little value in interpreting the tuberculin skin test in HIV-1 infected children with tuberculosis. The findings of the study suggest that aggressive microbiologic investigations coupled with a low threshold of clinical suspicion is essential in diagnosing tuberculosis in children, especially in HIV infected children.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 5 uppsatser.