D M Pelissari1, D C Kuhleis1, P Bartholomay1, D Barreira2, C L P Oliveira3, R S de Jesus3, L A Possa3, C A Jarczewski4, L T Nemeth5, N D de Araujo6, P B L Alves7, R de Souza1, D Arakaki1, D B Dal Molin8, P Werlang1, M Brouwer9. 1. National Tuberculosis Programme, Ministry of Health, Brasilia, Distrito Federal (DF), Brazil. 2. Unitaid, Vernier, Switzerland. 3. Health Prison Team, Central Prison of Porto Alegre, Porto Alegre, Rio Grande do Sul. 4. State Tuberculosis Programme, State Health Secretary, Porto Alegre, Rio Grande do Sul, Brazil. 5. EDGE Funders Alliance, Brussels, Belgium. 6. Fundação Oswaldo Cruz, Brasilia DF, Brazil, United Nations Office of Drugs and Crime Health Development Programme, Vienna, Austria. 7. United Nations Office of Drugs and Crime Health Development Programme, Vienna, Austria, Secretaria de Estado da Segurança Pública e da Paz Social do Distrito Federal, Brasilia DF. 8. Associação Hospitalar Vila Nova, Porto Alegre, Rio Grande do Sul, Brazil. 9. PHTB Consult, Tilburg, The Netherlands.
Abstract
SETTING: Tuberculosis (TB) remains a challenge in Brazil, particularly among prison inmates. OBJECTIVE: To assess TB prevalence by active case finding in a public prison in southern Brazil. DESIGN: Prison inmates were screened for TB using the presence of cough and chest X-ray (CXR) from October 2014 to August 2016. Presence of cough, irrespective of duration, and abnormal CXRs were further investigated using laboratory tests. RESULTS: Of 10 326 inmates screened, 196 had confirmed TB (1898/100 000 inmates screened). At the first screening, 1759 inmates presented with cough only, 16 of whom had TB; among those with only abnormal CXR (n = 1273), 92 had TB. Xpert was positive in 155 patients, and negative in 15; these results were confirmed using culture. The remaining 26 patients did not undergo Xpert testing and were confirmed using microscopy (27%), culture (42%) or both (31%). CONCLUSION: The combined use of symptom screening (cough) and CXR was much more effective in maximising TB yield than using either method alone. If patients presenting with cough alone had not been investigated, 10% of TB patients would have been missed; if those with abnormal CXR but no cough had not been investigated, 51% of TB patients would have been missed. We detected high TB prevalence in this prison by using active case finding.
SETTING:Tuberculosis (TB) remains a challenge in Brazil, particularly among prison inmates. OBJECTIVE: To assess TB prevalence by active case finding in a public prison in southern Brazil. DESIGN: Prison inmates were screened for TB using the presence of cough and chest X-ray (CXR) from October 2014 to August 2016. Presence of cough, irrespective of duration, and abnormal CXRs were further investigated using laboratory tests. RESULTS: Of 10 326 inmates screened, 196 had confirmed TB (1898/100 000 inmates screened). At the first screening, 1759 inmates presented with cough only, 16 of whom had TB; among those with only abnormal CXR (n = 1273), 92 had TB. Xpert was positive in 155 patients, and negative in 15; these results were confirmed using culture. The remaining 26 patients did not undergo Xpert testing and were confirmed using microscopy (27%), culture (42%) or both (31%). CONCLUSION: The combined use of symptom screening (cough) and CXR was much more effective in maximising TB yield than using either method alone. If patients presenting with cough alone had not been investigated, 10% of TB patients would have been missed; if those with abnormal CXR but no cough had not been investigated, 51% of TB patients would have been missed. We detected high TB prevalence in this prison by using active case finding.
Authors: Paulo César Pereira Dos Santos; Andrea da Silva Santos; Roberto Dias de Oliveira; Bruna Oliveira da Silva; Thiego Ramon Soares; Leonardo Martinez; Renu Verma; Jason R Andrews; Julio Croda Journal: Clin Infect Dis Date: 2022-07-06 Impact factor: 20.999
Authors: Andrea da Silva Santos; Roberto Dias de Oliveira; Everton Ferreira Lemos; Fabiano Lima; Ted Cohen; Olivia Cords; Leonardo Martinez; Crhistinne Gonçalves; Albert Ko; Jason R Andrews; Julio Croda Journal: Clin Infect Dis Date: 2021-03-01 Impact factor: 9.079