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Background: The risk of death due to tuberculosis (TB) in Brazil is high and strongly related to living conditions (LC). However, epidemiological studies investigating changes in LC and their impact on TB are lacking., Objectives: To evaluate the impact of LC on TB mortality in Brazil., Design and Setting: This ecological study, using panel data on spatial and temporal aggregates, was conducted in 1,614 municipalities between 2002 and 2015., Methods: Data were collected from the Mortality Information System and the Brazilian Institute of Geography and Statistics. The proxy variable used for LC was the Urban Health Index (UHI). Negative binomial regression models were used to estimate the effect of the UHI on TB mortality rate. Attributable risk (AR) was used as an impact measure., Results: From 2002 to 2015, TB mortality rate decreased by 23.5%, and LC improved. The continuous model analysis resulted in an RR = 0.89 (95%CI = 0.82-0.96), so the AR was -12.3%. The categorized model showed an effect of 0.92 (95%CI = 0.83-0.95) in municipalities with intermediate LC and of 0.83 (95%CI = 0.82-0.91) in those with low LC, representing an AR for TB mortality of -8.7% and -20.5%, respectively., Conclusions: Improved LC impacted TB mortality, even when adjusted for other determinants. This impact was greater in the strata of low-LC municipalities.

Tuberculosis (TB) is the leading cause of death among infectious diseases worldwide. Among the estimated cases of drug-resistant TB, approximately 60% occur in the BRICS countries (Brazil, Russia, India, China and South Africa). Among Brazilian states, primary and acquired multidrug-resistant TB (MDR-TB) rates were the highest in Rio Grande do Sul (RS). This study aimed to perform molecular characterisation of MDR-TB in the State of RS, a high-burden Brazilian state. We performed molecular characterisation of MDR-TB cases in RS, defined by drug susceptibility testing, using 131 Mycobacterium tuberculosis (M.tb) DNA samples from the Central Laboratory. We carried out MIRU-VNTR 24loci, spoligotyping, sequencing of the katG, inhA and rpoB genes and RDRio sublineage identification. The most frequent families found were LAM (65.6%) and Haarlem (22.1%). RDRio deletion was observed in 42 (32%) of the M.tb isolates. Among MDR-TB cases, eight (6.1%) did not present mutations in the studied genes. In 116 (88.5%) M.tb isolates, we found mutations associated with rifampicin (RIF) resistance in rpoB gene, and in 112 isolates (85.5%), we observed mutations related to isoniazid resistance in katG and inhA genes. An insertion of 12 nucleotides (CCAGAACAACCC) at the 516 codon in the rpoB gene, possibly responsible for a decreased interaction of RIF and RNA polymerase, was found in 19/131 of the isolates, belonging mostly to LAM and Haarlem families. These results enable a better understanding of the dynamics of transmission and evolution of MDR-TB in the region.

Objective: To determine the prevalence of latent tuberculosis infection (LTBI) and the risk of infection in patients with chronic kidney disease treated at a hemodialysis center., Methods: We included 307 patients with chronic kidney disease undergoing hemodialysis at the Mineiro Institute of Nephrology, located in the city of Belo Horizonte, Brazil. All of the patients were submitted to tuberculin skin tests (TSTs). We investigated the booster effect and TST conversion. If the initial TST (TST1) was negative, a second TST (TST2) was performed 1-3 weeks later in order to investigate the booster effect. If TST2 was also negative, a third TST (TST3) was performed one year after TST2 in order to determine whether there was TST conversion., Results: When we adopted a cut-off induration of 5 mm, the prevalence of LTBI was 22.2% on TST1, increasing by 11.2% on TST2. When we adopted a cut-off induration of 10 mm, the prevalence of LTBI was 28.5% on TST1, increasing by 9.4% on TST2. The prevalence of LTBI increased significantly from TST1 to TST2 (booster effect), as well as from TST2 to TST3 (p < 0.01 for both). In our sample, the mean annual risk of infection was 1.19%., Conclusions: In the population studied, the prevalence of LTBI was high, and the mean annual risk of infection was similar to that reported for the general population of Brazil, which suggests recent infection.

Background: Occupational Tuberculosis (TB) can lead to work absenteeism and a negative professional impact. Knowing the reactivity of the tuberculin test and the risk of M. tuberculosis infection among healthcare professionals is essential for the revision and reinforcement of control measures against TB transmission., Aim: To assess the reactivity of tuberculin test and risk of M. tuberculosis infection among healthcare professionals working in an upright building, in which a TB Reference Clinic is placed., Subjects and Methods: A tuberculosis Skin Test (TST) was done to 251 staff members of a TB clinic that did not have a previous history or suspicion of TB and that did not have a previous TST done. Among subjects with absence of reaction, repeated tests were carried out to assess booster reaction., Results: Fifty one percent of studied subjects (129) had a positive tuberculin test. The booster phenomenon was evidenced in 35.7% (68/190). The seroconversion among non-reactive subjects, subjected to a new TST after one year, was 5.1%. The infection risk was 1.4., Conclusions: This study indicates an important occupational risk of infection in healthcare settings exposed to high TB incidence, and should be used to better allocate resources for infection control.

Objective: To describe the occurrence of tuberculous uveitis (TBU) at a referral center in the state of Minas Gerais, Brazil., Methods: A total of 16 consecutive patients (>15 years of age) who underwent diagnostic evaluation of uveitis between January of 2001 and July of 2004 at the Minas Gerais State Referral Center were selected for study. Demographic and clinical data, as well as data related to screening for toxoplasmosis, syphilis, and rheumatologic diseases, together with the results of tuberculin skin testing and HIV testing, were collected., Results: Of the16 patients evaluated, 11 (69%) were found to have TBU. A history of contact with pulmonary tuberculosis was reported by 8 (72%) of the 11 patients with TBU and by 1 (20%) of the 5 with non-TBU. Although the odds ratio for this association was 10.67 (95% CI: 0.59-398.66), the p value was borderline significant (p = 0.078). There was no difference between the patients with TBU and those with non-TBU in terms of the status of ocular inflammation or the tuberculin skin testing results. All of the patients were HIV negative and were monitored for two years., Conclusion: In this study, a history of contact with pulmonary tuberculosis proved to be useful in diagnosing TBU.

Objectives: The human leucocyte antigen (HLA) has been related to susceptibility factors in several diseases. This study aimed to determine the potential genetic susceptibility of patients with pityriasis rosea (PR) through HLA molecular typing analysis., Methods: The method of choice was polymerase chain reaction with sequence-specific primers (PCR-SSP) using low-resolution typing kits, with determination of the alleles class I (HLA-A, HLA-B and HLA-C) and class II (HLA-DRB1, DRB3, DRB4, DRB5 and DQB1) performed in 30 Afro-Brazilian PR-diagnosed patients and 45 healthy individuals as the control group (PR-C)., Results: Analysis of the HLA typing results showed that the relative risk (RR) of 4.00 [95% confidence interval (95% CI) 1.20-13.28, two-tailed P = 0.018] for allele HLA-DQB1*04 class II, detected in 33.3% of PR patients, was significant. By contrast, in the control group only 11.1% of subjects had that allele. Three out of six B*51 alleles and three out of six B*53 alleles detected in PR patients were found, together with the allele DQB1*04., Conclusion: We suggest that alleles DQB1*04 may be involved in the genetic susceptibility of PR based on the significant predominance of those alleles observed in the black PR patients. We also recommend that more studies are conducted on populations of other ethnic origins, preferentially with higher resolution techniques of DNA typing.

The intergenerational transmission of violence and the tendency for abused and neglected children to become abusers, delinquents, and violent offenders in their adult life is an important field to be understood. It is also important to understand these backgrounds to guide future preventative interventions. Through a cross-sectional study, the occurrence of abuse during childhood and adolescence of adult women incarcerated in a female state prison at Recife in northeast Brazil was investigated. Among 219 prisoners, 190 accepted to join the research; 149 were young women (23-27 years) with severe educational deficiency. Living in poor socioeconomical conditions with problematic and violent familiar relations, 116 (61 per cent) left home at the end of their adolescence and the same number reported having been abused (p < 0.000015). There was a statistical significance between the abuses suffered and witnessed by the subjects and the perpetration of abuse against children and adolescents by themselves (p < 0.0022 and p < 0.0000049). Parents were the most frequent perpetrators (37.4 per cent). Sexual activity and use of legal and illegal drugs occurred early in adolescence. The group also had a family history of violence. Based on the analysed data of this studied group, the authors assumed that the abuse suffered in childhood and adolescence of these women drove them to be abusers in adult life and could have been a predictive marker for their conduct disorders and subsequent criminal behavior.

We evaluated the mutations in a 193bp of the rpoB gene by automated sequencing of rifampicin (RMP)-resistant and susceptible Mycobacterium tuberculosis strains isolated from Brazil (25 strains) and France (37 strains). In RMP-resistant strains, mutations were identified in 100% (16/16) from France and 89% (16/18) from Brazil. No mutation was detected in the 28 RMP-susceptible strains. Among RMP-resistant or RMP-susceptible strains deletion was observed. A double point mutation which had not been reported before was detected in one strain from France. Among French resistant strains mutations were found in codons 531 (31.2%), 526, 513 and 533 (18.7% each). In Brazilian strains the most common mutations were in codons 531 (72.2%), 526 (11.1%) and 513 (5.5%). The heterogeneity found in French strains may be related to the fact that most of those strains were from African or Asian patients.

Objective: To investigate whether clinical criteria could differentiate between women with vulvovaginitis who were culture positive or negative for vaginal Candida species., Methods: Vulvovaginal specimens were obtained from 501 women with a vaginal discharge and/or pruritus. Clinical information and wet mount microscopy findings were obtained. All specimens were sent to a central laboratory for species identification., Results: A positive culture for Candida species was obtained from 364 (72.7%) of the specimens. C. albicans was identified in 86.4% of the positive cultures, followed by C. glabrata in 4.5%, C parapsilosis in 3.9%, C. tropicalis in 2.7% and other Candida species in 1.4%. Women with a positive Candida culture had an increased utilization of oral contraceptives (26.1% vs. 16.8%, p = 0.02) and antibiotics (8.2% vs. 0.7%, p = 0.001), and were more likely to be pregnant (9.1% vs. 3.6%, p = 0.04) than the culture-negative women. Dyspareunia was more frequent in women without Candida (38.0% vs. 28.3%, p = 0.03) while vaginal erythema (p = 0.01) was more common in women with a positive Candida culture., Conclusions: Although quantitative differences were observed, the presence of vaginal Candida vulvovaginitis cannot be definitively identified by clinical criteria.

Genomic DNA from two Brazilian hemoglobin (Hb) Lepore heterozygotes of Italian ancestry have been studied in order to identify the Hb Lepore type and to sequence the breakpoint region. The two genes were sequenced after PCR amplification and had the delta globin sequence up to exon 2 codon 68 while the first specific base for the beta globin gene was at codon 86 of the second exon; between the two ends, they had 51 base pairs in common with the delta and beta globin genes. These data indicate that the mutation was of the Hb Lepore Baltimore type. The Lepore chromosome haplotype was different from that previously described in members of a Spanish family with Hb Lepore Baltimore. These data suggest that independent mutations have given rise to Hb Lepore Baltimore in different regions of the world.