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Diuana FA, Diuana V, Constantino P, Larouzé B, Sanchez A. COVID-19 in prisons: what telejournalism (not) showed - a study on the criteria for newsworthiness during the pandemic. Ciênc saúde coletiva 2022. [DOI: 10.1590/1413-81232022279.08112022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract To analyze the news coverage of the COVID-19 pandemic in Brazilian prisons and its visibility, 213 articles broadcast between March and December 2020 were examined, found in the search service of the digital streaming video platform Globoplay. Most aired in March, April and July, with the theme almost disappearing in subsequent months. The reports, on numbers of deaths or infections, prevention measures and house arrest or freedom for groups at risk of COVID-19 were mainly published in local telejournals. Health agencies were barely heard. Of the 19 news items presented nationally, 12 address “famous prisoners” and the legibility of house arrest or freedom for groups at risk of COVID-19 unfavorable outcome. The health guidelines and the guarantee of the right to health of persons deprived of liberty were limited to the difficulties in implementing protection measures in prisons and to sustaining the need for restrictive measures to move inside prisons and in exchanges with the outside, to limit the circulation of the virus. In general, the form and visibility given to the topic do not contribute to broadening the viewers’ perception of the sanitary conditions in prisons and the fact that health is a right for all, without any distinction.
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Diuana FA, Diuana V, Constantino P, Larouzé B, Sanchez A. COVID-19 in prisons: what telejournalism (not) showed - a study on the criteria for newsworthiness during the pandemic. Cien Saude Colet 2022; 27:3559-3570. [PMID: 36000644 DOI: 10.1590/1413-81232022279.08112022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 05/26/2022] [Indexed: 11/22/2022] Open
Abstract
To analyze the news coverage of the COVID-19 pandemic in Brazilian prisons and its visibility, 213 articles broadcast between March and December 2020 were examined, found in the search service of the digital streaming video platform Globoplay. Most aired in March, April and July, with the theme almost disappearing in subsequent months. The reports, on numbers of deaths or infections, prevention measures and house arrest or freedom for groups at risk of COVID-19 were mainly published in local telejournals. Health agencies were barely heard. Of the 19 news items presented nationally, 12 address "famous prisoners" and the legibility of house arrest or freedom for groups at risk of COVID-19 unfavorable outcome. The health guidelines and the guarantee of the right to health of persons deprived of liberty were limited to the difficulties in implementing protection measures in prisons and to sustaining the need for restrictive measures to move inside prisons and in exchanges with the outside, to limit the circulation of the virus. In general, the form and visibility given to the topic do not contribute to broadening the viewers' perception of the sanitary conditions in prisons and the fact that health is a right for all, without any distinction.
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Affiliation(s)
- Felipe A Diuana
- Grupo de Pesquisa CNPq "Saúde nas Prisões", Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz. Av. Brasil 4036, sala 914, Manguinhos. 21041-361 Rio de Janeiro RJ Brasil.
| | - Vilma Diuana
- Grupo de Pesquisa CNPq "Saúde nas Prisões", Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz. Av. Brasil 4036, sala 914, Manguinhos. 21041-361 Rio de Janeiro RJ Brasil.
| | - Patricia Constantino
- Departamento de Estudos sobre Violência e Saúde Jorge Careli (CLAVES), Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | - Bernard Larouzé
- Grupo de Pesquisa CNPq "Saúde nas Prisões", Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz. Av. Brasil 4036, sala 914, Manguinhos. 21041-361 Rio de Janeiro RJ Brasil.
| | - Alexandra Sanchez
- Grupo de Pesquisa "Saúde nas Prisões" ENSP/CNPq, Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
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Leal MDC, Ayres BVDS, Esteves-Pereira AP, Sánchez AR, Larouzé B. Birth in prison: pregnancy and birth behind bars in Brazil. Cien Saude Colet 2018; 21:2061-70. [PMID: 27383340 DOI: 10.1590/1413-81232015217.02592016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 04/07/2016] [Indexed: 11/22/2022] Open
Abstract
The high vulnerability of incarcerated women is worsened when they are pregnant and give birth during imprisonment. This article traces the profile of incarcerated women living with their children in female prison units of the capitals and metropolitan regions of Brazil and describes pregnancy and childbirth conditions and healthcare practices while in incarceration. This study is an analysis of a series of cases resultant from a national census conducted between August 2012 and January 2014. This analysis included 241 mothers. Of these, 45% were younger than 25 years old, 57% were dark skinned, 53% had studied less than eight years and 83% were multiparous. At the time of incarceration, 89% were already pregnant and two thirds did not want the current pregnancy. Access to prenatal care was inadequate for 36% of the women. During their hospital stay, 15% referred to having suffered some type of violence (verbal, psychological, or physical). Only 15% of the mothers rated the care received during their hospital stay as excellent. They had low social/familial support and more than one third reported the use of handcuffs during their hospital stay. Incarcerated mothers received poorer healthcare during pregnancy and birth when compared with non-incarcerated users of the public sector. This study also found violations of human rights, especially during birth.
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Affiliation(s)
- Maria do Carmo Leal
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz. 21041-210 Rio de Janeiro RJ Brasil.
| | - Barbara Vasques da Silva Ayres
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz. 21041-210 Rio de Janeiro RJ Brasil.
| | - Ana Paula Esteves-Pereira
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz. 21041-210 Rio de Janeiro RJ Brasil.
| | - Alexandra Roma Sánchez
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz. 21041-210 Rio de Janeiro RJ Brasil.
| | - Bernard Larouzé
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, IPLESP UMRS 1136, Equipe de Recherche en Epidémiologie Sociale, F75012. Paris, France
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Domingues RMSM, Leal MDC, Pereira APE, Ayres B, Sánchez AR, Larouzé B. Prevalence of syphilis and HIV infection during pregnancy in incarcerated women and the incidence of congenital syphilis in births in prison in Brazil. CAD SAUDE PUBLICA 2017; 33:e00183616. [PMID: 29166489 DOI: 10.1590/0102-311x00183616] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/01/2017] [Indexed: 11/21/2022] Open
Abstract
This study aimed to estimate the prevalence of syphilis and HIV infection during pregnancy, the mother to child transmission of syphilis and the incidence of congenital syphilis in incarcerated women in Brazil; to compare these rates to those observed in pregnant women outside of jail; and to verify the maternal factors associated with syphilis infection during pregnancy in free and incarcerated women. We used data from two nationwide studies conducted during the period 2011-2014. The Birth in Brazil study included 23,894 free women cared for in 266 hospitals. The Maternal and Infant Health in Prisons study included 495 incarcerated pregnant women or mothers living with their children, according to a census conducted in 33 female prisons. The same case definitions and data collection methods were used in both studies. The chi-square test was used to compare the characteristics of incarcerated and free women with a significance of 0.05. For incarcerated women, the estimated prevalence of syphilis during pregnancy was 8.7% (95%CI: 5.7-13.1) and for HIV infection 3.3% (95%CI: 1.7-6.6); the estimated mother to child transmission of syphilis was 66.7% (95%CI: 44.7-83.2) and the incidence of congenital syphilis was 58.1 per 1,000 living newborns (95%CI: 40.4-82.8). Incarcerated women had a greater prevalence of syphilis and HIV infection during pregnancy, lower quality of antenatal care and higher levels of social vulnerability. Syphilis infection showed to be an indicator of social vulnerability in free women, but not in incarcerated women. Health initiatives in prison are necessary to reduce healthcare inequalities and should include adequate antenatal and birth care.
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Affiliation(s)
| | - Maria do Carmo Leal
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Barbara Ayres
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Alexandra Roma Sánchez
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Bernard Larouzé
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, IPLESP UMRS 1132, F75012 Paris, France
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Larouzé B. Saúde penitenciária no Brasil: plano e política. Ciênc saúde coletiva 2016; 21:2317. [DOI: 10.1590/1413-81232015217.08762014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Sánchez A, Larouzé B. Controle da tuberculose nas prisões, da pesquisa à ação: a experiência do Rio de Janeiro, Brasil. Ciênc saúde coletiva 2016; 21:2071-80. [DOI: 10.1590/1413-81232015217.08182016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 04/13/2016] [Indexed: 01/28/2023] Open
Abstract
Resumo As altas taxas de tuberculose (TB) observadas na população carcerária brasileira evidenciam a necessidade, de medidas mais efetivas para o controle da doença nesta população, especialmente no Estado de Rio de Janeiro, onde as taxas de detecção de casos nas prisões são 30 vezes superiores as da população geral. Apresentamos resultados de pesquisas realizadas neste estado no campo da epidemiologia, modelagem matemática, biologia molecular, psicossociologia, arquitetura e direito, a fim de avaliar a situação e desenvolver estratégias de controle da TB adaptadas às especificidades do contexto carcerário. A implementação dessas estratégias implica em considerar o dia a dia da vida na prisão e tornar mais efetiva a fiscalização do sistea de saúde prisional por entidades encarregadas do acompanhamento do cumprimento da pena, de modo a garantir o acesso dos presos à saúde de acordo com leis internacionais e nacionais.
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Diuana V, Ventura M, Simas L, Larouzé B, Correa M. Direitos reprodutivos das mulheres no sistema penitenciário: tensões e desafios na transformação da realidade. Ciênc saúde coletiva 2016; 21:2041-50. [DOI: 10.1590/1413-81232015217.21632015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 12/19/2015] [Indexed: 11/21/2022] Open
Abstract
Resumo Neste artigo buscou-se identificar e discutir violações e desafios à efetivação dos direitos reprodutivos das mulheres em situação de privação de liberdade, com ênfase na saúde sexual e reprodutiva. Foram considerados como referenciais de análise os parâmetros normativos que sustentam estes direitos, identificados por levantamento bibliográfico, e os discursos e práticas relativos à sua efetivação no dia a dia das prisões, colhidos em entrevistas com mulheres gestantes e com filhos nas prisões e profissionais cujas práticas interferem no exercício destes direitos. Verificou-se que as violações destes direitos sustentam-se em discursos que deslegitimam a maternidade destas mulheres. Considera-se o recurso aos direitos como estratégico nas lutas pela transformação desta situação.
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Affiliation(s)
- Vilma Diuana
- Universidade do Estado do Rio de Janeiro, Brasil
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Larouzé B, Ventura M, Sánchez AR, Diuana V. Tuberculose nos presídios brasileiros: entre a responsabilização estatal e a dupla penalização dos detentos. CAD SAUDE PUBLICA 2015. [DOI: 10.1590/0102-311xpe010615] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | - Vilma Diuana
- Secretaria de Estado de Administração Penitenciária do Rio de Janeiro, Brasil
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Ventura M, Simas L, Larouzé B. Maternidade atrás das grades: em busca da cidadania e da saúde. Um estudo sobre a legislação brasileira. CAD SAUDE PUBLICA 2015; 31:607-19. [DOI: 10.1590/0102-311x00092914] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 09/29/2014] [Indexed: 11/22/2022] Open
Abstract
Este estudo analisa as conexões entre saúde, direitos, legislação e políticas públicas a partir da pesquisa documental realizada no âmbito federal e nos estados do Rio Grande do Sul, Mato Grosso, Paraná e São Paulo, acerca das garantias legais das mulheres e seus filhos que vivem no cárcere. Busca instrumentalizar uma atuação garantista dos agentes públicos e dar visibilidade à problemática, diante das extremas vulnerabilidades e invisibilidade jurídica e administrativa da questão. Foram identificadas 33 normas legais, com pontos de tensão, como a possibilidade de prisão domiciliar e as disparidades quanto a prazos e condições de permanência das crianças no sistema penitenciário. A garantia legal constitucional do direito à amamentação é refletida nas regulamentações identificadas. Mas constatam-se ausências de outros aspectos relativos à maternidade na prisão, que se traduzem em dupla penalidade às mulheres, arbitrariamente estendida aos seus filhos. É necessária a ampliação e efetivação da regulamentação existente para prevenir e coibir as violações de direitos apontadas.
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Affiliation(s)
| | | | - Bernard Larouzé
- Institut Pierre Louis d'Epidémiologie et Santé Publique, France
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Le Pont F, Hatungimana V, Guiguet M, Ndayiragije A, Ndoricimpa J, Niyongabo T, Larouzé B. Assessment of Occupational Exposure to Human Immunodeficiency Virus and Hepatitis C Virus in a Referral Hospital in Burundi, Central Africa. Infect Control Hosp Epidemiol 2015; 24:717-8. [PMID: 14587928 DOI: 10.1086/502908] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Huber FD, Sánchez A, Gomes HM, Vasconcellos S, Massari V, Barreto A, Cesconi V, de Almeida Machado SM, Gomgnimbou MK, Sola C, Larouzé B, Suffys PN, Saad MHF. Insights into the population structure of Mycobacterium tuberculosis using spoligotyping and RDRio in a southeastern Brazilian prison unit. Infect Genet Evol 2014; 26:194-202. [PMID: 24907670 DOI: 10.1016/j.meegid.2014.05.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 05/26/2014] [Accepted: 05/27/2014] [Indexed: 11/28/2022]
Abstract
Tuberculosis (TB) is still a serious public health problem, continuing to be an important threat for confined populations. We used spoligotyping to estimate the genotypic clades of Mycobacterium tuberculosis isolates from inmates in two blocks in a southeastern Brazilian prison unit, with TB incidence rate of 8185/100.000. The Latin American Mediterranean (LAM) clade is well represented in the country, and the LAM specific molecular markers, RD(Rio) large sequence polymorphism and the SNP on the Rv3062 [ligB(1212)], were used to characterize spoligotype signatures from prison isolates. Typing of RD(Rio) and ligB increase LAM clade from 66.7% (n=72/108) to 69.4% (n=75). The LAM2 SIT17 (n=23) and SIT179 (n=12) signatures comprised one third of all isolates, followed by Haarlem (11.5%, n=12), T (8.7%, n=9) and X (5.7%, n=6) clades. Strains with unknown signatures represented 5.5% (n=6), and four (3.7%) did not match any lineage. We observed RD(Rio) among 64 (59.2%) isolates, and 54 (50%) were of the LAM clade. In particular, the LAM2/RD(Rio) sub-lineage was significantly associated with clustering (p=0.02) and its frequency was higher (32%) when compared to that of the previous general TB cases in RJ (4.29%). Overall cluster frequency defined by spoligotyping/IS6110-RFLP was 62%. The two evolutionary markers helped to evaluate some LAM signature misconceptions and demonstrate that LAM2/RD(Rio) was found with high frequency, hitherto being unnoticed. All these data, allied to high clustering, imply that public health measures to minimize the escalation of TB in prison is essential, and both spoligotyping as well as RD(Rio) would be useful tools to monitor the effects of the measures with respect to M. tuberculosis lineage variation.
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Affiliation(s)
- Fé Dagmar Huber
- Laboratory of Cellular Microbiology, Oswaldo Cruz Institute (IOC), Fiocruz, Rio de Janeiro, Brazil
| | - Alexandra Sánchez
- Tuberculosis Control Program and Coordination Management in Prison Health, State Department of Corrections, Rio de Janeiro, Brazil
| | | | - Sidra Vasconcellos
- Laboratory of Molecular Biology Applied to Mycobacteria, IOC, Fiocruz, Brazil
| | - Véronique Massari
- INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, France; Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, France
| | | | - Vanderci Cesconi
- Tuberculosis Control Program and Coordination Management in Prison Health, State Department of Corrections, Rio de Janeiro, Brazil
| | | | - Michel K Gomgnimbou
- Univ Paris-Sud, UMR8621, Orsay F-91405, France; CNRS, Orsay F-91405, France; Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Christophe Sola
- Univ Paris-Sud, UMR8621, Orsay F-91405, France; CNRS, Orsay F-91405, France
| | - Bernard Larouzé
- INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, France; Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, France; Department of Epidemiology and Quantitative Methods, ENSP/Fiocruz, Rio de Janeiro, Brazil
| | - Philip Noel Suffys
- Laboratory of Molecular Biology Applied to Mycobacteria, IOC, Fiocruz, Brazil
| | - Maria Helena Féres Saad
- Laboratory of Cellular Microbiology, Oswaldo Cruz Institute (IOC), Fiocruz, Rio de Janeiro, Brazil.
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Sanchez A, Massari V, Gerhardt G, Espinola AB, Siriwardana M, Camacho LAB, Larouzé B. X ray screening at entry and systematic screening for the control of tuberculosis in a highly endemic prison. BMC Public Health 2013; 13:983. [PMID: 24139204 PMCID: PMC4015746 DOI: 10.1186/1471-2458-13-983] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 10/11/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is a major issue in prisons of low and middle income countries where TB incidence rates are much higher in prison populations as compared with the general population. In the Rio de Janeiro (RJ) State prison system, the TB control program is limited to passive case-finding and supervised short duration treatment. The aim of this study was to measure the impact of X-ray screening at entry associated with systematic screening on the prevalence and incidence of active TB. METHODS We followed up for 2 years a RJ State prison for adult males (1429 inmates at the beginning of the study) and performed, in addition to passive case-finding, 1) two "cross-sectional" X-ray systematic screenings: the first at the beginning of the study period and the second 13 months later; 2) X-ray screening of inmates entering the prison during the 2 year study period. Bacteriological examinations were performed in inmates presenting any pulmonary, pleural or mediastinal X-ray abnormality or spontaneously attending the prison clinic for symptoms suggestive of TB. RESULTS Overall, 4326 X-rays were performed and 246 TB cases were identified. Prevalence among entering inmates remained similar during 1st and the 2nd year of the study: 2.8% (21/754) and 2.9% (28/954) respectively, whereas prevalence decreased from 6.0% (83/1374) to 2.8% (35/1244) between 1st and 2nd systematic screenings (p < 0.0001). Incidence rates of cases identified by passive case-finding decreased from 42 to 19 per 1000 person-years between the 1st and the 2nd year (p < 0.0001). Cases identified by screenings were less likely to be bacteriologically confirmed as compared with cases identified by passive-case finding. CONCLUSIONS The strategy investigated, which seems highly effective, should be considered in highly endemic confined settings such as prisons.
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Affiliation(s)
- Alexandra Sanchez
- Programa de Controle de Tuberculose e, Coordenação de Gestão em Saúde Penitenciária, Secretaria de Estado de Administração Penitenciária, Rio de Janeiro, Brasil
| | - Veronique Massari
- INSERM U707, F-75012, Paris, France
- UPMC UMR-S707, F-75012, Paris, France
| | | | - Ana Beatriz Espinola
- Programa de Controle de Tuberculose e, Coordenação de Gestão em Saúde Penitenciária, Secretaria de Estado de Administração Penitenciária, Rio de Janeiro, Brasil
| | | | - Luiz Antonio B Camacho
- Departamento de Epidemiologia e Metodos Quantitativos em Saúde, Escola Nacional de Saude Publica, Fiocruz, Rio de Janeiro, Brasil
| | - Bernard Larouzé
- INSERM U707, F-75012, Paris, France
- UPMC UMR-S707, F-75012, Paris, France
- Departamento de Epidemiologia e Metodos Quantitativos em Saúde, Escola Nacional de Saude Publica, Fiocruz, Rio de Janeiro, Brasil
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Larouzé B, Sanchez A. Le tabac, facteur de risque de tuberculose en milieu carcéral, État de Rio de Janeiro, Brésil. Rev Epidemiol Sante Publique 2013. [DOI: 10.1016/j.respe.2013.07.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Prellwitz IM, Alves BM, Ikeda MLR, Kuhleis D, Picon PD, Jarczewski CA, Osório MR, Sánchez A, Seuánez HN, Larouzé B, Soares MA, Soares EA. HIV behind bars: human immunodeficiency virus cluster analysis and drug resistance in a reference correctional unit from southern Brazil. PLoS One 2013; 8:e69033. [PMID: 23874857 PMCID: PMC3706441 DOI: 10.1371/journal.pone.0069033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 06/05/2013] [Indexed: 02/06/2023] Open
Abstract
People deprived of liberty in prisons are at higher risk of infection by the human immunodeficiency virus (HIV) due to their increased exposure through intravenous drug use, unprotected sexual activity, tattooing in prison and blood exposure in fights and rebellions. Yet, the contribution of intramural HIV transmission to the epidemic is scarcely known, especially in low- and middle-income settings. In this study, we surveyed 1,667 inmates incarcerated at Presídio Central de Porto Alegre, located in southern Brazil, for HIV infection and molecular characterization. The HIV seroprevalence was 6.6% (110/1,667). Further analyses were carried out on 40 HIV-seropositive inmates to assess HIV transmission clusters and drug resistance within the facility with the use of molecular and phylogenetic techniques. The molecular epidemiology of HIV-1 subtypes observed was similar to the one reported for the general population in southern Brazil, with the predominance of HIV-1 subtypes C, B, CRF31_BC and unique BC recombinants. In particular, the high rate (24%) of URF_BC found here may reflect multiple exposures of the population investigated to HIV infection. We failed to find HIV-infected inmates sharing transmission clusters with each other. Importantly, the analysis of HIV-1 pol genomic fragments evidenced high rates of HIV primary and secondary (acquired) drug resistance and an alarming proportion of virologic failure among patients under treatment, unveiling suboptimal access to antiretroviral therapy (ARV), low ARV adherence and dissemination of drug resistant HIV strains in primary infections. Our results call for immediate actions of public authority to implement preventive measures, serological screening and, for HIV-seropositive subjects, clinical and treatment follow-up in order to control HIV infection and limit the spread of drug resistance strains in Brazilian prisons.
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Affiliation(s)
| | - Brunna M. Alves
- Programa de Genética, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Maria Letícia R. Ikeda
- Secretaria de Saúde de Viamão, Prefeitura de Viamão, Viamão, Brazil
- Departamento de Ensino e Pesquisa, Hospital Sanatório Partenon, Porto Alegre, Brazil
| | - Daniele Kuhleis
- Secretaria de Segurança Pública, Governo do Estado do Rio Grande do Sul, Porto Alegre, Brazil
| | - Pedro D. Picon
- Secretaria de Segurança Pública, Governo do Estado do Rio Grande do Sul, Porto Alegre, Brazil
| | - Carla A. Jarczewski
- Departamento de Ensino e Pesquisa, Hospital Sanatório Partenon, Porto Alegre, Brazil
| | - Marta R. Osório
- Fundação Estadual de Produção e Pesquisa em Saúde, Governo do Estado do Rio Grande do Sul, Porto Alegre, Brazil
| | - Alexandra Sánchez
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
- Secretaria de Estado de Administração Penitenciária, Governo do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Héctor N. Seuánez
- Programa de Genética, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
- Departamento de Genética, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bernard Larouzé
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
- INSERM U707, Paris, France
- Université Pierre et Marie Curie - Paris 6, Paris, France
| | - Marcelo A. Soares
- Programa de Genética, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
- Departamento de Genética, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Esmeralda A. Soares
- Programa de Genética, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
- * E-mail:
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Sanchez A, Huber F, Massari V, Camacho L, Saad M, Larouzé B. Circulation massive de Mycobacterium tuberculosis en milieu carcéral, Rio de Janeiro, Brésil. Rev Epidemiol Sante Publique 2012. [DOI: 10.1016/j.respe.2012.06.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Le Loup G, Fleury S, Camargo K, Larouzé B. International institutions, global health initiatives and the challenge of sustainability: lessons from the Brazilian AIDS programme. Trop Med Int Health 2009; 15:5-10. [PMID: 19891757 DOI: 10.1111/j.1365-3156.2009.02411.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The sustainability of successful public health programmes remains a challenge in low and middle income settings. These programmes are often subjected to mobilization-demobilization cycle. Indeed, political and organizational factors are of major importance to ensure this sustainability. The cooperation between the World Bank and the Brazilian AIDS programme highlights the role of international institutions and global health initiatives (GHI), not only to scale up programmes but also to guarantee their stability and sustainability, at a time when advocacy is diminishing and vertical programmes are integrated within health systems. This role is critical at the local level, particularly when economic crisis may hamper the future of public health programmes. Political and organizational evolution should be monitored and warnings should trigger interventions of GHI before the decline of these programmes.
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Sanchez A, Larouzé B, Espinola AB, Pires J, Capone D, Gerhardt G, Cesconi V, Procopio MJ, Hijjar M, Massari V. Screening for tuberculosis on admission to highly endemic prisons? The case of Rio de Janeiro State prisons. Int J Tuberc Lung Dis 2009; 13:1247-1252. [PMID: 19793429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
SETTING Rio de Janeiro (RJ) State prisons, where tuberculosis (TB) is highly endemic. OBJECTIVE To measure TB prevalence, identify risk factors and ascertain the most appropriate screening method among inmates of the RJ prisons. DESIGN Systematic chest X-rays (CXRs) were performed in 1696 male inmates of three RJ prisons. Inmates were selected for sputum examination and culture if their CXRs showed evidence of any pulmonary, pleural or mediastinal abnormality. TB diagnosis was based on bacteriological results or, if bacteriological results were negative, on response to TB treatment. RESULTS TB prevalence was 2.7% (46/1696), and 32/46 cases (69%) were bacteriologically confirmed, including 19 smear-positive cases. CXR lesions were extensive in 43% of cases. In the logistic regression model, TB-associated variables were being illiterate (adjusted OR 2.10, 95%CI 1.02-4.34), cough >or=3 weeks (aOR 2.85, 95%CI 1.54-5.27), history of TB treatment (aOR 3.61, 95%CI 1.76-7.39), and living in Rio City suburbs (aOR 4.54, 95%CI 1.02-20.07) and in Rio City (aOR 5.48, 95%CI 1.29-23.33). A screening based on cough >or=3 weeks followed by sputum smear examination would have identified only 9 of the 46 cases. CONCLUSION These results call for screening on admission to prison based, if feasible, on CXR, and demonstrate the urgent need to improve detention conditions and medical assistance in police remand cells.
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Affiliation(s)
- A Sanchez
- Programa de Controle de Tuberculose, Coordenação de Gestão em Saude Penitenciária, Rio de Janeiro, Rio de Janeiro, Brazil.
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Le Loup G, de Assis A, Costa-Couto MH, Thoenig JC, Fleury S, de Camargo K, Larouzé B. A public policy approach to local models of HIV/AIDS control in Brazil. Am J Public Health 2009; 99:1108-15. [PMID: 19372523 DOI: 10.2105/ajph.2008.138123] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated involvement and cooperation patterns of local Brazilian AIDS program actors and the consequences of these patterns for program implementation and sustainability. METHODS We performed a public policy analysis (documentary analysis, direct observation, semistructured interviews of health service and nongovernmental organization [NGO] actors) in 5 towns in 2 states, São Paulo and Pará. RESULTS Patterns suggested 3 models. In model 1, local government, NGOs, and primary health care services were involved in AIDS programs with satisfactory response to new epidemiological trends but a risk that HIV/AIDS would become low priority. In model 2, mainly because of NGO activism, HIV/AIDS remained an exceptional issue, with limited responses to new epidemiological trends and program sustainability undermined by political instability. In model 3, involvement of public agencies and NGOs was limited, with inadequate response to epidemiological trends and poor mobilization threatening program sustainability. CONCLUSIONS Within a common national AIDS policy framework, the degree of involvement and cooperation between public and NGO actors deeply impacts population coverage and program sustainability. Specific processes are required to maintain actor mobilization without isolating AIDS programs.
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Affiliation(s)
- Guillaume Le Loup
- Paris Hospital and Institut National de la Santé et la Recherche Médicale UMRS, France.
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Diuana V, Lhuilier D, Sánchez AR, Amado G, Araújo L, Duarte AM, Garcia M, Milanez E, Poubel L, Romano E, Larouzé B. Saúde em prisões: representações e práticas dos agentes de segurança penitenciária no Rio de Janeiro, Brasil. CAD SAUDE PUBLICA 2008; 24:1887-96. [DOI: 10.1590/s0102-311x2008000800017] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Accepted: 01/10/2008] [Indexed: 11/22/2022] Open
Abstract
O papel limitante dos agentes de segurança penitenciária no acesso dos detentos aos serviços sanitários e o impacto de suas representações e práticas de saúde no cotidiano prisional foram objeto de pesquisa-ação visando tanto à produção de conhecimento como à melhoria das ações de controle da tuberculose e HIV/AIDS pela participação e conscientização. Desenvolveu-se em três prisões e dois hospitais por meio de entrevistas individuais e grupos de discussão. Revelou que concepções de saúde e doença, hierarquização de riscos e estratégias de preservação no contexto carcerário relacionam-se às posições nessa organização social, aos conflitos e tensões ali existentes e aos pertencimentos grupais que reforçam identidades e antagonismos, refletindo-se nas práticas rotineiras e no acesso aos serviços. A negação da saúde como um direito dos presos e a restrição de sua autonomia contribuem para ações de saúde prescritivas. A tomada de consciência dos agentes de segurança penitenciária quanto às representações e práticas de saúde pode contribuir para a desconstrução de idéias estereotipadas e aumentar seu envolvimento nas ações de prevenção e assistência. A melhoria das condições de saúde dos detentos implica também mudanças nas condições de encarceramento.
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Affiliation(s)
- Vilma Diuana
- Secretaria de Estado de Administração Penitenciária do Rio de Janeiro, Brasil
| | | | | | - Gilles Amado
- Centre National de la Recherche Scientifique, France
| | - Leopoldina Araújo
- Secretaria de Estado de Administração Penitenciária do Rio de Janeiro, Brasil
| | - Ana Maria Duarte
- Secretaria de Estado de Administração Penitenciária do Rio de Janeiro, Brasil
| | - Mônica Garcia
- Secretaria de Estado de Administração Penitenciária do Rio de Janeiro, Brasil
| | - Eliane Milanez
- Secretaria de Estado de Administração Penitenciária do Rio de Janeiro, Brasil
| | - Luciene Poubel
- Secretaria de Estado de Administração Penitenciária do Rio de Janeiro, Brasil
| | - Elizabeth Romano
- Secretaria de Estado de Administração Penitenciária do Rio de Janeiro, Brasil
| | - Bernard Larouzé
- INSERM, France; Université Pierre et Marie Curie-Paris, France
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Normann A, Badur S, Önel D, Kilic A, Sidal M, Larouzé B, Massari V, Müller J, Flehmig B. Acute hepatitis A virus infection in Turkey. J Med Virol 2008; 80:785-90. [DOI: 10.1002/jmv.21137] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Pistone T, Guibert P, Gay F, Malvy D, Ezzedine K, Receveur MC, Siriwardana M, Larouzé B, Bouchaud O. Malaria risk perception, knowledge and prophylaxis practices among travellers of African ethnicity living in Paris and visiting their country of origin in sub-Saharan Africa. Trans R Soc Trop Med Hyg 2007; 101:990-5. [PMID: 17643457 DOI: 10.1016/j.trstmh.2007.05.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2006] [Revised: 05/22/2007] [Accepted: 05/22/2007] [Indexed: 11/19/2022] Open
Abstract
An observational prospective cohort study assessed malaria risk perception, knowledge and prophylaxis practices among individuals of African ethnicity living in Paris and travelling to their country of origin to visit friends or relatives (VFR). The study compared two groups of VFR who had visited a travel clinic (TC; n=122) or a travel agency (TA; n=69) before departure. Of the 47% of VFR citing malaria as a health concern, 75% knew that malaria is mosquito-borne and that bed nets are an effective preventive measure. Perception of high malaria risk was greater in the TA group (33%) than in the TC group (7%). The availability of a malaria vaccine was mentioned by 35% of VFR, with frequent confusion between yellow fever vaccine and malaria prevention. Twenty-nine percent took adequate chemoprophylaxis with complete adherence, which was higher among the TC group (41%) than the TA group (12%). Effective antivector protection measures used were bed nets (16%), wearing long clothes at night (14%) and air conditioning (8%), with no differences between the study groups except in the use of impregnated bed nets (11% of the TC group and none of the TA group). Media coverage, malaria chemoprophylaxis repayment and cultural adaptation of preventive messages should be improved to reduce the high rate of inadequate malaria prophylaxis in VFR.
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Sánchez AR, Massari V, Gerhardt G, Barreto AW, Cesconi V, Pires J, Espínola AB, Biondi E, Larouzé B, Camacho LAB. A tuberculose nas prisões do Rio de Janeiro, Brasil: uma urgência de saúde pública. CAD SAUDE PUBLICA 2007; 23:545-52. [PMID: 17334569 DOI: 10.1590/s0102-311x2007000300013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2005] [Accepted: 07/26/2006] [Indexed: 11/21/2022] Open
Abstract
Em 2004, a taxa de incidência da tuberculose nas prisões do Estado do Rio de Janeiro, Brasil, foi trinta vezes superior à da população geral do Estado. Essa taxa provavelmente é subestimada, especialmente pela dificuldade de acesso ao serviço de saúde nesse ambiente. Com o objetivo de melhor avaliar a situação, um primeiro inquérito radiológico sistemático foi realizado e mostrou taxa de prevalência de 4,6% (prisão A, n = 1.052). Dois inquéritos adicionais revelaram, nas unidades B (n = 590) e C (n = 1.372), taxas maiores (6,3% e 8,6%, respectivamente). A comparação das características sócio-demográficas das prisões A, B e C mostrou que a população encarcerada não é homogênea. Em comparação com prisão A, os indivíduos encarcerados nas prisões B e C são oriundos de comunidades mais desfavorecidas e têm mais freqüentemente história de encarceramento anterior e de tuberculose. Essas diferenças, coerentes com os dados de prevalência, implicam a adaptação das medidas de controle da tuberculose ao perfil epidemiológico e sócio-demográfico de cada unidade prisional.
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Affiliation(s)
- Alexandra Roma Sánchez
- Superintendência de Saúde, Secretaria de Administração Penitenciária do Estado do Rio de Janeiro, Estrada Guandu do Sena 1902, Rio de Janeiro, RJ 21540-000, Brazil.
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Fournet N, Sanchez A, Massari V, Penna L, Natal S, Biondi E, Larouzé B. Development and evaluation of tuberculosis screening scores in Brazilian prisons. Public Health 2006; 120:976-83. [PMID: 16965796 DOI: 10.1016/j.puhe.2006.06.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2005] [Revised: 04/28/2006] [Accepted: 06/14/2006] [Indexed: 11/17/2022]
Abstract
BACKGROUND Tuberculosis (TB) is highly endemic in Rio de Janeiro State prisons. In addition to TB screening at entry and passive case detection, active case identification may be warranted. OBJECTIVES To develop and evaluate performances of scores aimed at identifying "tuberculosis suspects" in order to target TB screening among inmates. METHODS Systematic chest X-ray screening was carried out in two prisons (n=1910). TB was diagnosed among individuals with X-ray abnormalities by sputum microscopic examination and culture or, if bacteriological results were negative, by response to TB treatment. Using this strategy as a reference, the clinical score proposed in WHO guidelines "TB Control in Prisons" was evaluated. Using the same variables in a logistic regression comparing TB and non-TB cases, another score was developed and evaluated. Finally, a 'new score', based on socio-demographic and clinical variables was developed and evaluated. RESULTS When applied to our study population (prevalence of active TB: 4.6%), these scores missed many TB cases (sensitivities: 56%, 72%, 74%, respectively). Among the "TB suspects", the probability of finding TB cases was low (positive predictive value: 10%). The scores had high negative predictive values (>97%); specificities (75%, 60%, 67%) were low. Performances were similarly poor for smear-negative and smear-positive cases. CONCLUSION The scores investigated performed poorly and would be unhelpful to target TB screening. Therefore, systematic X-ray screening may be considered, at least during the initial stages of the reinforced TB programme, in order to reduce the impressive burden of TB.
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Affiliation(s)
- N Fournet
- INSERM, UMR-S 707, Université Pierre et Marie Curie, Paris 6, Paris F-75012, France
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Kudjawu Y, Massari V, Sow O, Bah B, Larouzé B, Murray JF. Benefit of amoxicillin in differentiating between TB suspects whose initial AFB sputum smears are negative. Int J Tuberc Lung Dis 2006; 10:441-6. [PMID: 16602410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
Abstract
SETTING Out-patient dispensary in Conakry, Guinea, West Africa. OBJECTIVE To differentiate between pulmonary tuberculosis (PTB) and non-PTB diseases among 204 acid-fast bacilli (AFB) smear-negative adult TB suspects. DESIGN We derived scores from clinical, serological and radiological findings among PTB suspects aged > or = 15 years who, after having had three AFB-negative smears, were treated for 10 days with amoxicillin (AMX, 1.5 g/day). RESULTS At the selected cut-off score from model 1 (clinical), sensitivity for PTB was 95%, specificity 40%, negative predictive value (NPV) 84%, and positive predictive value (PPV) 69%. Comparable values from model 2 (clinical + serological + radiological) were: sensitivity 99%, specificity 45%, NPV 97%, and PPV 71%. Results from AMX were better: sensitivity 92%, specificity 93%, NPV 94%, and PPV 91%. Of the 117 suspects who failed to respond clinically and radiographically to AMX and remained AFB smear-negative, 110 (94%) had PTB, confirmed either by positive culture (73 patients) or response to anti-tuberculosis treatment (37 patients). CONCLUSION The clinical and radiographic response to AMX is better than derived scores at differentiating between PTB and non-PTB in TB suspects presenting to a dispensary in Guinea, a low HIV-seroprevalence country.
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Affiliation(s)
- Y Kudjawu
- INSERM, U707Université Pierre et Marie Curie, Paris, France
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Sanchez A, Gerhardt G, Natal S, Capone D, Espinola A, Costa W, Pires J, Barreto A, Biondi E, Larouzé B. Prevalence of pulmonary tuberculosis and comparative evaluation of screening strategies in a Brazilian prison. Int J Tuberc Lung Dis 2005; 9:633-9. [PMID: 15971390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
SETTING A prison (1171 male inmates) in Rio de Janeiro, Brazil. OBJECTIVES To determine the prevalence of active pulmonary tuberculosis (TB) and to assess the performance of several screening strategies. DESIGN In a cross-sectional study, all inmates underwent chest radiographic screening. Subjects with abnormal findings underwent sputum smear examination and sputum culture. Taking this strategy as the reference, we assessed three targeted screening strategies to identify TB suspects: Strategy 1: cough >3 weeks; Strategy 2: WHO score > or = 5; Strategy 3: presence of at least one potentially TB-related symptom. RESULTS The prevalence of TB cases was 4.6% (48/1052) and 2.7% for definite TB cases. If TB suspects identified by targeted screening had sputum smear examination alone, 37 (86.0%) of the 43 cases would have been missed by Strategy 1, 34/43 (79.1%) by Strategy 2 and 34/43 (79.1%) by Strategy 3. If TB suspects had both sputum smear examination and, for smear-negative subjects, chest radiography, respectively 28/43 (65.1%), 18/43 (41.9%) and 13/43 (30.2%) of cases would have been missed. CONCLUSION All three targeted screening strategies were unreliable. Given the importance of early TB diagnosis in overcrowded and highly endemic settings, routine radiography-based screening may be warranted.
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Affiliation(s)
- A Sanchez
- Secretaria de Administração Penitenciária do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
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Parienti JJ, Massari V, Descamps D, Vabret A, Bouvet E, Larouzé B, Verdon R. Predictors of virologic failure and resistance in HIV-infected patients treated with nevirapine- or efavirenz-based antiretroviral therapy. Clin Infect Dis 2004; 38:1311-6. [PMID: 15127346 DOI: 10.1086/383572] [Citation(s) in RCA: 179] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2003] [Accepted: 12/17/2003] [Indexed: 11/03/2022] Open
Abstract
Resistance to nonnucleoside reverse transcriptase inhibitors (NNRTIs) increases with the wider use of this class of antiretroviral therapy. The association between adherence and resistance to NNRTI-based regimens is poorly understood. Predictors of virologic failure and resistance according to a baseline evaluation of nonadherence risk factors were determined in a cohort of 71 human immunodeficiency virus (HIV)-infected patients with early virologic response who received an NNRTI-based regimen. During the median follow-up of 29 months, 20 (28%) of 71 patients experienced virologic failure with an NNRTI-based regimen. Virologic failure was associated with repeated drug holidays (> or =48 h of unplanned drug cessation), depression, younger age, and low adherence to therapy during baseline evaluation. Moreover, repeated drug holidays was the only risk factor for developing a major mutation conferring cross-resistance to the NNRTI class (hazard ratio, 22.5; 95% confidence interval, 2.8-180.3; P<.0001). Patients' previous adherence to therapy and drugs genetic barriers, not only the number of pills or doses involved, should be taken into consideration in the decision to simplify highly active antiretroviral therapy.
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Affiliation(s)
- Jean-Jacques Parienti
- Department of Infectious Diseases and Virology, Côte de Nacre Hospital, Caen, France.
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Perret JL, Moussavou-Kombila JB, Delaporte E, Minko-Mi-Etoua D, Pemba LF, Boguikouma JB, Nzenze JR, Deparis X, Larouzé B. [Prevalence of hepatitis B and C virus, HTLV-1 and HIV in type B lymphoproliferative syndromes in Gabon]. Bull Soc Pathol Exot 2003; 96:275-8. [PMID: 14717040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
B lymphoproliferative disorders (B-LPD) are the most frequent types of lymphoid malignancies encountered in Gabon where HCV, HBV, HTLV-I and HIV are highly prevalent and all known for lymphotropism. Prevalences of HBs Ag, antibodies to HCV, HTLV-I and HIV were compared in 40 patients (21 men, 19 women; 17 < age < 75 years) with newly diagnosed B-LPD (low grade lymphoma = 6, intermediate grade = 21, high grade = 8: chronic lymphocytic leukaemia = 5) and 160 age and sex-matched controls. None of the B-LPD patients had got transfusion or parenteral care from the onset of symptoms to the inclusion day. In the B-LPD group, 13 patients had HBs Ag and antibodies to HCV, HIV and HTLV-1 were detected in 11, 6 and 10 subjects. In monovariate analysis, HBs Ag, antibodies to HIV or HTLV-1 were risk factors for B-LPD but antibodies to HCV were not associated with such diseases. Multivariate analysis showed only a relationship between HBs Ag and B-LPD (OR = 3.86; IC: 1.11-13.48). In such patients, reactivation of B hepatitis by treatment of B-LBD may be an important concern. If a background poor immune system could explain both susceptibility to long standing virus carriage and lymphoma development, a participating action of the HBV in lymphomagenesis could not be excluded.
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Affiliation(s)
- J L Perret
- Institut de médecine tropicale, service de santé des armées, Le Pharo, Marseille, France.
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Bah B, Massari V, Sow O, Siriwardana M, Camara LM, Larouzé B, Murray JF. Useful clues to the presence of smear-negative pulmonary tuberculosis in a West African city. Int J Tuberc Lung Dis 2002; 6:592-8. [PMID: 12102298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE Tuberculosis suspects with negative sputum smears for acid-fast bacilli (AFB) may have either pulmonary tuberculosis (PTB) or some other pulmonary disease (non-PTB). The aim of this study was to improve the differentiation between PTB and non-PTB. DESIGN We enrolled 396 tuberculosis suspects 15 years of age or older who had cough of 21 days or longer and three negative AFB smears. Non-PTB was diagnosed by clinical and radiographic responses to amoxicillin; smear-negative PTB was diagnosed by positive culture for Mycobacterium tuberculosis or response to antituberculosis chemotherapy. RESULTS Multivariate analysis, without X-ray variables, of 79 patients with a final diagnosis of non-PTB and 110 patients with smear-negative PTB indicated that age less than 37 years, family contact with TB, never having been married, loss of weight, lack of expectoration, human immunodeficiency virus (HIV) seropositivity, and tuberculin reactivity were significantly associated with PTB. When the initial X-ray findings were included, age younger than 37 years, lack of expectoration, HIV seropositivity, and tuberculin reactivity remained in the model, and cavitation and patchy densities were significantly associated. CONCLUSION The response to 10 days of amoxicillin and certain demographic, clinical and radiographic characteristics are useful in separating non-PTB from PTB in tuberculosis suspects with negative AFB smears.
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Affiliation(s)
- B Bah
- National Tuberculosis Program, Conakry, Guinea
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Seng R, Gustafson P, Gomes VF, Vieira CS, Rabna P, Larsen O, Larouzé B, Norberg R, Lisse IM, Samb B. Community study of the relative impact of HIV-1 and HIV-2 on intrathoracic tuberculosis. AIDS 2002; 16:1059-66. [PMID: 11953473 DOI: 10.1097/00002030-200205030-00013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND HIV-1 infection is associated with an increased incidence of and mortality from tuberculosis. Few community studies have examined the effect of HIV-2 on tuberculosis. METHODS We investigated the association between HIV-1, HIV-2 and active tuberculosis in four districts (population 42 709) in Bissau, capital of Guinea-Bissau, with the highest known seroprevalence of HIV-2 infection in the world. From May 1996 to June 1998, tuberculosis surveillance and active case finding among contacts was conducted. Patients were HIV-tested, given specific tuberculosis treatment for 8 months and followed regarding mortality. Simultaneously, an HIV sero-survey was performed in a random sample of 1748 permanent residents. RESULTS During a 25-month period, 366 tuberculosis cases were identified. After excluding cases among visitors to the area, and adjusting for age, the incidence of tuberculosis was 18.3 times higher (95% CI 12.9-26.0) among HIV-1-positive individuals, 13.7 times higher (9.0-20.7) among dually infected (HIV-1 and HIV-2), and 3.0 times higher (2.1-4.3) among HIV-2-infected compared with HIV-negative individuals. HIV-1 and dually infected tuberculosis patients had a higher mortality rate than HIV-negative tuberculosis patients [mortality ratio (MR) 2.68; CI 1.11-6.48 and 2.89; CI 1.13-7.39, respectively]. The survival of HIV-2-positive tuberculosis patients was similar to that of HIV-negative tuberculosis patients (MR 1.19; CI 0.46-3.06). CONCLUSION The presence of HIV-2 infection increases the incidence of tuberculosis compared with that in non-HIV-infected individuals, but does not affect tuberculosis-related mortality in the short term. In contrast, the presence of HIV-1 infection, alone or with HIV-2, has a several-fold greater impact on both the incidence of and mortality from tuberculosis.
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Pistone T, Kony S, Faye-Niang MA, Ndour CT, Gueye PM, Henzel D, Delaporte E, Badiane S, N'Doye I, Coulaud JP, Larouzé B, Bouchaud O. A simple clinical and paraclinical score predictive of CD4 cells counts below 400/mm3 in HIV-infected adults in Dakar University Hospital, Senegal. Trans R Soc Trop Med Hyg 2002; 96:167-72. [PMID: 12055807 DOI: 10.1016/s0035-9203(02)90292-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
In industrialized countries the decision to start co-trimoxazole (CMX) prophylaxis of HIV-related opportunistic infections is based on the CD4+ cell count. The value of CMX prophylaxis has also been demonstrated in Africa, where CD4+ cell counts are rarely available. We therefore developed a simple score predictive of a threshold CD4+ cell count (400/mm3) below which CMX prophylaxis is indicated. In a retrospective cross-sectional study, we collected clinical and biological data on 211 HIV-infected patients recruited from January 1996 through January 1998 at Fann University Hospital in Dakar, Senegal. Several variables were identified as being predictive of a CD4+ cell count below 400/mm3 by stepwise logistic regression. Each variable was weighted according to its regression coefficient, as follows: male sex (+1), weight loss (+2), body mass index < 22 (+2), herpes zoster (+4), tuberculin induration < 5 mm (+3) and haemoglobin < or = 10 g/dL (+1). A score of > or = 4 (sum of weights) selected patients with CD4+ cell counts below 400/mm3 with a sensitivity of 98% and a negative predictive value of 83%. Such a score should be applicable in the African context and should facilitate the management of HIV-infected patients, especially the prescription of CMX prophylaxis.
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Affiliation(s)
- T Pistone
- Institut de Médecine et d'Epidémiologie Africaines, Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris, France
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Laurent C, Henzel D, Mulanga-Kabeya C, Maertens G, Larouzé B, Delaporte E. Seroepidemiological survey of hepatitis C virus among commercial sex workers and pregnant women in Kinshasa, Democratic Republic of Congo. Int J Epidemiol 2001; 30:872-7. [PMID: 11511619 DOI: 10.1093/ije/30.4.872] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Studies conducted mainly in industrialized countries have shown that the transmission of hepatitis C virus (HCV) is mainly parenteral, and have emphasized the role of nosocomial transmission. In Equatorial Africa, the respective contributions of parenteral and non-parenteral routes of transmission are unknown. The potential role of sexual transmission in this area of high HCV endemicity, where sexually transmitted infections (STI) are frequent, is suggested by the fact that HCV infection is rare in infants and young adolescents, but increases thereafter with age. The present study, conducted in Democratic Republic of Congo, was designed to determine the prevalence of HCV infection and associated sexual risk factors in two female populations with different sexual behaviour. METHODS Cross-sectional studies conducted among commercial sex workers (CSW; n = 1144) and pregnant women (n = 1092) in the late 1980s in Kinshasa showed a high frequency of at-risk sexual behaviour, STI and human immunodeficiency virus (HIV) infection, particularly among CSW. We screened samples collected during these epidemiological studies for antibodies to HCV using a second-generation ELISA with confirmation by a third-generation LIA. We also assessed sociodemographic variables, medical history, STI markers and sexual behaviour, and their potential association with HCV infection. RESULTS The overall prevalence of anti-HCV was 6.6% (95% CI : 5.2-8.2) among CSW and 4.3% (95% CI : 3.2-5.7) among pregnant women (age-adjusted OR = 1.5, 95% CI : 1.0-2.1, P = 0.05). Multivariate analysis showed that the presence of anti-HCV among CSW was independently associated with a previous history of blood transfusion (P < 0.001), age >30 years (P < 0.001) and the presence of at least one biological marker of STI (P < 0.03). No such links were found among pregnant women (although the history of blood transfusions was not investigated in this group). Anti-HCV was not associated with sociodemographic variables or sexual behaviour in either group, or with individual markers of STI. Despite the high-risk sexual behaviour and the higher prevalence of STI in CSW, the difference in HCV seroprevalence between CSW and pregnant women (6.6% versus 4.3%) was small, particularly when compared with the difference in the seroprevalence of HIV (34.1% versus 2.8%). CONCLUSION The role of sexual transmission in the spread of HCV seems to be limited. Parenteral transmission (including blood transfusion and injections), possibly related to the treatment of STI, probably plays a major role.
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Affiliation(s)
- C Laurent
- Laboratoire des Rétrovirus, Institut de Recherche pour le Développement (IRD), Montpellier, France
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Kony SJ, Hane AA, Larouzé B, Samb A, Cissoko S, Sow PS, Sané M, Maynart M, Diouf G, Murray JF. Tuberculosis-associated severe CD4+ T-lymphocytopenia in HIV-seronegative patients from Dakar. SIDAK Research Group. J Infect 2000; 41:167-71. [PMID: 11023763 DOI: 10.1053/jinf.2000.0721] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To determine the frequency and associated features of severe CD4+ T-lymphocytopenia (<300 cells/mm(3)) in HIV-seronegative patients with tuberculosis. METHODS Statistical analysis of 430 consecutively enrolled HIV-seronegative inpatients with tuberculosis in two teaching hospitals in Dakar, Senegal. RESULTS The mean CD4 + cell count was 602+/-318.3 cells/mm(3). CD4 + cell counts were below 300 cells/mm(3)in 62 patients (14.4%). Patients with fewer than 300 CD4+ cells/mm(3)differed from those with higher counts in being less likely to have a positive smear for acid-fast bacilli; in having a higher frequency of extrapulmonary involvement (pleural effusion, adenopathy and miliary disease) and oral candidiasis; and in having smaller tuberculin reactions, lower haemoglobin levels, less cavitation and less patchy infiltration. After adjustment for gender and age, all differences remained except miliary disease. CONCLUSIONS A substantial percentage (14.4%) of HIV-seronegative hospitalized patients for tuberculosis in a West African country presented with severe CD4 + T-lymphocyte depletion and had clinical and radiographic features indicative of more advanced disease and accompanying immunodepression. These results and those already published suggest that tuberculosis should be regarded as one of the diseases associated with a subgroup of patients with "idiopathic CD4 + T-lymphocytopenia".
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Affiliation(s)
- S J Kony
- Institut de Médecine et d'Epidémiologie Africaines/INSERM U444, hôpital Bichat-Claude Bernard, Paris, France
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Abstract
Malnutrition is a frequent complication of human immunodeficiency virus (HIV) infection and is associated with a poor prognosis. To compare different measures of nutritional status in HIV-infected patients, we prospectively studied 88 outpatients seen at a Paris AIDS outpatient clinic for routine follow-up examinations. Nutritional status was assessed according to body weight loss (BWL, 4 classes), anthropometry, bioelectric impedance analysis (BIA), and subjective global assessment of nutritional status (SGA). Malnutrition was diagnosed in 22.4% of subjects using SGA, and 37.1% by BWL. SGA rapidly detected a worsening of nutritional status, while BWL detected malnutrition at an earlier stage. A good correlation was found between SGA class and body composition assessed by anthropometry and BIA. Deteriorating nutritional status diagnosed by SGA correlated with the CDC HIV disease class. SGA, a simple nutritional assessment, can serve as a basis for prescribing artificial nutrition, while BWL detects malnutrition at an earlier stage.
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Affiliation(s)
- T Niyongabo
- Département de Médecine Interne, CHU de Bujumbura, Burundi
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Domart M, Mlika-Cabanne N, Henzel D, Pouliquen A, Florentin A, Marande JL, Xerri B, Aufrere A, Larouzé B. Hepatitis A among health workers in Paris hospitals. Occupational Health Physicians of Paris Hospital (AP-HP). J Med Virol 1999; 58:321-4. [PMID: 10421396 DOI: 10.1002/(sici)1096-9071(199908)58:4<321::aid-jmv1>3.0.co;2-#] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To design a vaccination strategy against hepatitis A among hospital employees, we carried out a serological survey of hepatitis A virus (HAV) infection in 10 university hospitals in the Paris area. Subjects under 60 years of age were consecutively enrolled by occupational health services and tested for IgG to HAV by ELISA. Of the 1,516 subjects recruited, 926 were health workers (HW), 322 clerks, and 268 cooks or kitchen employees. Among HW and clerks the HAV seroprevalence was 53.8% (95% CI: 44.0-65.6), increasing with age and being higher among employees of African or Caribbean origin than those from Europe (83.6% vs 45.6%, P < .001). Age correlated closely with the duration of hospital work, so only age was taken into account for further analysis. The HAV seroprevalences among HW and clerks originating from Europe were close (46.8% vs 42.6%) and remained so after adjustment for age. HAV seroprevalences in HW caring for adults and those caring for children were also similar (45.2% vs 40.1%). Seroprevalence was higher in assistant nurses than in nurses (51.3% vs. 39.8%, P < .02). Among cooks and kitchen employees, 53.4% were HAV-seropositive. This study shows that hospital employees need not routinely be vaccinated against HAV; the decision should be taken by the occupational physician according to the type of work, but should be routine for cooks and kitchen employees. The need for prevaccinal screening for anti-HAV should be assessed in the light of employees' geographical origin and age.
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Affiliation(s)
- M Domart
- Service de Médecine du Travail, AP-HP, hôpital Raymond Poincaré, Garches, France
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Gomes I, Melo A, Proietti FA, Moreno-Carvalho O, Loures LA, Dazza MC, Said G, Larouzé B, Galvão-Castro B. Human T lymphotropic virus type I (HTLV-I) infection in neurological patients in Salvador, Bahia, Brazil. J Neurol Sci 1999; 165:84-9. [PMID: 10426153 DOI: 10.1016/s0022-510x(99)00083-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
HTLV-I infection represents a major health concern in endemic areas throughout the world, such as Salvador, the main city of Bahia State, with socio-demographic characteristics similar to sub-Saharan African cities, located in the Northeast of Brazil. In order to provide an estimate of the frequency distribution, and range of neurological manifestations potentially related to HTLV-I infection in this city, we conducted a cross-sectional clinical-epidemiological study to determine the prevalence of this infection in patients with neurological diseases. Patients exhibiting vascular diseases, tumoral diseases or trauma were excluded. Over a period of 16 months, we studied 322 consecutive patients with chronic neurological diseases, who attended the neurological clinics of two major hospitals in Salvador. Overall, the prevalence of HTLV-I infection among the patients was 20.9% (67/320). However, the prevalence among the 104 patients with chronic myelopathy was 50.0% (52/104). It was observed that the major prevalence of HTLV-I was between the ages of 40 and 60 years with a female predominance. Our data indicate that, in Salvador city, HTLV-I is associated with chronic myelopathies or myeloneuropathies, which seem to be the only neurological diseases associated with HTLV-I.
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Affiliation(s)
- I Gomes
- Laboratório Avançado de Saúde Pública, CPqGM, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
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Samb B, Sow PS, Kony S, Maynart-Badiane M, Diouf G, Cissokho S, Bâ D, Sané M, Klotz F, Faye-Niang MA, Mboup S, Ndoye I, Delaporte E, Hane AA, Samb A, Coulaud JP, Coll-Seck AM, Larouzé B, Murray JF. Risk factors for negative sputum acid-fast bacilli smears in pulmonary tuberculosis: results from Dakar, Senegal, a city with low HIV seroprevalence. Int J Tuberc Lung Dis 1999; 3:330-6. [PMID: 10206504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
SETTING Two teaching hospitals in Dakar, Senegal, a West African country with a low prevalence of human immunodeficiency virus (HIV) infection. OBJECTIVE To determine whether patients with HIV-associated pulmonary tuberculosis have fewer acid-fast bacilli (AFB) in their sputum as assessed by routine microscopy, and to correlate the findings with systematically obtained clinical, radiographic and laboratory variables. DESIGN Prospective study from November 1995 to October 1996 of 450 consecutive patients diagnosed with pulmonary tuberculosis. RESULTS Tuberculosis was diagnosed in 380 patients (84.4%) by positive bacteriology, in 61 (13.6%) by a favorable response to anti-tuberculosis chemotherapy, and in nine (2.0%) by the presence of a miliary radiographic pattern. Forty (8.9%) patients were HIV-seropositive. AFB-negative smears were found in 14/40 (35.0%) of the HIV-seropositive patients with pulmonary tuberculosis compared with 71/410 (17.3%) of the seronegative patients (risk ratio [RR] = 2.02, 95% confidence interval [CI] 1.26-3.24, P = 0.01). Multivariate analysis revealed that AFB smear negativity was associated with absence of cavitation (P = 0.002), lack of cough (P = 0.005), the presence of HIV seropositivity (P = 0.02), a CD4+ cell count above 200/mm3 (P = 0.02), and age over 40 years (P = 0.03). CONCLUSIONS Compared with HIV-seronegative patients with pulmonary tuberculosis, seropositive patients in Dakar, Senegal, are more likely to have negative sputum-AFB smears. This phenomenon has now been observed in seven of eight sub-Saharan African countries with varying HIV seroprevalence from which reports are available.
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Affiliation(s)
- B Samb
- INSERM U13/IMEA, Paris, France.
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Cochereau I, Mlika-Cabanne N, Godinaud P, Niyongabo T, Poste B, Ngayiragije A, Dazza MC, Aubry P, Larouzé B. AIDS related eye disease in Burundi, Africa. Br J Ophthalmol 1999; 83:339-42. [PMID: 10365044 PMCID: PMC1722983 DOI: 10.1136/bjo.83.3.339] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To determine the prevalence of ocular manifestations in AIDS patients hospitalised in Bujumbura, Burundi, according to their CD4+ lymphocyte count, serological status for CMV and VZV, and general health status. METHODS Prospective study of 154 consecutive patients who underwent general and ophthalmological examinations, including dilated fundus examination. AIDS was diagnosed on the basis of Bangui criteria and HIV-1 seropositivity. CD4+ lymphocyte counts were determined by the Capcellia method. CMV and VZV antibodies were detected with ELISA methods. RESULTS The mean age was 37 (SD 9) years and 65% of the patients were male. Active tuberculosis was the most frequent underlying disease (61%). Almost all the patients (99%) were seropositive for CMV and VZV. Among the 115 patients for whom CD4+ lymphocyte counts were available, 86 (75%) had more than 100 cells x 10(6)/l. Ocular involvement comprised 16 cases of microangiopathy, six of opalescence of the anterior chamber, five of retinal perivasculitis, two of zoster ophthalmicus, two of viral retinitis, and one of opalescence of the vitreous. CONCLUSION In Africa, the prevalence of ocular involvement in HIV infection is far lower than in Europe and the United States, possibly because most African patients die before ocular opportunistic infections occur.
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Affiliation(s)
- I Cochereau
- IMEA/INSERM U13, Hôpital Bichat, Paris, France
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42
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Samb B, Badiane M, Kony S, Larouzé B, Faye MA, Sow PS, Badiane S, Metro A, Costagliola D, Ndoye I, Delaporte E, Coll-Seck AM, Coulaud JP. Is it necessary to conduct trials with trimethoprim-sulphamethoxazole amongst HIV-infected individuals in Africa? AIDS 1998; 12:447. [PMID: 9520181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Larouzé B, Bouchaud O, Dazza MC, Samb B. [Prevention of viral hepatitis in travelers and expatriots in a tropical and subtropical environment]. Rev Epidemiol Sante Publique 1998; 46:56-62. [PMID: 9533235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Hepatitis A and B are hyperendemic in tropical and, to a lesser extent, subtropical countries. This high level of endemicity is in sharp contrast with the low frequency of these infections in the industrialized world. As a consequence, the incidences of hepatitis A and B are high among travellers to or foreigners living in tropical or subtropical countries. Therefore, these subjects should be vaccinated against hepatitis A and B. Furthermore, the usual preventive measures should be maintained. Risk of infection with the hepatitis C and E virus are much lower. Given the increasing number of travellers to tropical and subtropical countries, imported hepatitis is a public health problem for industrialized countries. Preventive measures must, then, be reinforced.
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Affiliation(s)
- B Larouzé
- IMEA/INSERM U13, hôpital Bichat-Claude Bernard, Paris
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Niyongabo T, Bouchaud O, Henzel D, Melchior JC, Samb B, Dazza MC, Ruggeri C, Begue JC, Coulaud JP, Larouzé B. Nutritional status of HIV-seropositive subjects in an AIDS clinic in Paris. Eur J Clin Nutr 1997; 51:637-40. [PMID: 9306092 DOI: 10.1038/sj.ejcn.1600461] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To measure the prevalence and analyse the characteristics of malnutrition among subjects attending an AIDS outpatient clinic and a day care center, to improve the nutritional management of HIV-infected subjects. DESIGN Prospective cross-sectional study. SETTING AIDS clinic in a University Hospital in Paris. SUBJECTS 124 HIV-seropositive adults attending the clinic. MAIN OUTCOME MEASURES Evaluation of nutritional status using anthropometry, impedancemetry, plasma albumin and pre-albumin assays. Degree of malnutrition, defined by the percentage of body weight loss (BWL), calculated by reference to the usual body weight. RESULTS Among the 124 subjects recruited (M:F sex ratio: 3.3, mean age: 36.3 +/- 7.2 y), 77 (62.1%, 95%CI: 53.9-70.3) had normal nutrition status (BWL < or = 5%), 16 (12.9%, 95%CI: 7.0-18.2) moderate malnutrition (5% < BWL < or = 10%), 21 (16.9% 95%CI: 10.3-23.5) intermediate malnutrition (10% < BWL < or = 20%), and 10 (8.1%, 95%CI: 3.3-12.9) severe malnutrition (BWL > 20%). BWL was related to the CDC class (variance analysis, P < 9 x 10(-5)) and CD4 cell count (P < 3 x 10(-5)). Malnutrition was observed even among CDC class A subjects (14.9%). BWL was also related to the body mass index (P < 3 x 10(-6)), lean body mass (P < 3 x 10(-5)), body fat (P < 7 x 10(-6)), and as assessed by impedancemetry, body cell mass (P < 10(-5)) an the extra/intra cellular water ratio (P < 2 x 10(-4)). The decrease in lean body mass was related to the decrease in body cell mass. CONCLUSIONS Given its high frequency, malnutrition should be prevented, detected, monitored and treated from the early stages of HIV infection among patients attending AIDS clinics in order to improve survival and quality of life.
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Affiliation(s)
- T Niyongabo
- IMEA/INSERM U13, Hôpital Bichat-Claude Bernard, Paris, France
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Samb B, Henzel D, Daley CL, Mugusi F, Niyongabo T, Mlika-Cabanne N, Kamanfu G, Aubry P, Mbaga I, Larouzé B, Murray JF. Methods for diagnosing tuberculosis among in-patients in eastern Africa whose sputum smears are negative. Int J Tuberc Lung Dis 1997; 1:25-30. [PMID: 9441054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
SETTING Two University hospitals in Eastern African capital cities where large prospective studies had been carried out on hospitalized patients to determine the cause of their respiratory diseases. OBJECTIVE To identify features that differentiated between tuberculosis (TB) and non-tuberculous respiratory disease (non-TB) in hospitalized patients from Bujumbura, Burundi (n = 111) and Dar es Salaam, Tanzania (n = 71) whose sputum smears were negative on microscopic examination for acid-fast bacilli (AFB). DESIGN Review of clinical findings, radiologic abnormalities, and laboratory test results from 182 patients, first by univariate and then by multivariate (stepwise logistic regression) analysis to assess the contribution of each factor to the final diagnosis. RESULTS Of the 182 patients with two or more negative AFB smears, 41 had TB and 141 had non-TB. Stepwise regression analysis revealed four easily ascertained symptoms were associated with TB: 1) cough > 21 days; 2) chest pain > 15 days; 3) absence of expectoration; and 4) absence of shortness of breath. Any two of the four diagnosed TB with 85% sensitivity and 67% specificity; any three of the four with 49% sensitivity and 86% specificity. Multivariate analysis showed that adding lymphadenopathy and hematocrit < 30% improved discrimination. CONCLUSION This methodological approach provides a means for diagnosing TB among all AFB smear-negative hospitalized patients. In this setting, simple clinical symptoms alone are helpful. Similar studies are needed to develop a system for out-patient TB suspects.
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Affiliation(s)
- B Samb
- INSERM U13/IMEA, Groupe Hospitalier Bichat-Claude Bernard, Paris, France
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Delaporte E, Janssens W, Peeters M, Buvé A, Dibanga G, Perret JL, Ditsambou V, Mba JR, Courbot MC, Georges A, Bourgeois A, Samb B, Henzel D, Heyndrickx L, Fransen K, van der Groen G, Larouzé B. Epidemiological and molecular characteristics of HIV infection in Gabon, 1986-1994. AIDS 1996; 10:903-10. [PMID: 8828748 DOI: 10.1097/00002030-199607000-00014] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe trends in the prevalence of HIV-1 infection in different populations in Gabon, and the molecular characteristics of circulating HIV strains. METHODS Data were collected on HIV prevalence through sentinel surveillance surveys in different populations in Libreville (the capital) and in Franceville. In Libreville, a total of 7082 individuals (hospitalized patients, tuberculosis patients, pregnant women, asymptomatic adults, prisoners) were recruited between 1986 and 1994. In Franceville, we tested 771 pregnant women and 886 healthy asymptomatic adults (1986-1988). Sera were screened for HIV antibodies by enzyme-linked immunosorbent assay (ELISA) and confirmed by Western blot or line immunoassay (LIA). Reactive samples in ELISA were tested for the presence of antibodies to HIV-1 group O viruses by ELISA using V3 peptides from HIV-1 ANT-70 and HIV-1 MVP-5180 followed by confirmation by LIA and a specific Western blot. Seventeen HIV-1 strains were isolated (1988-1993) and a 900 base-pair fragment encoding the env region containing V3, V4, V5 and beginning of gp41 was sequenced and a phylogenetic tree was constructed. RESULTS HIV prevalence was relatively low and remained stable (0.7-1.6% in pregnant women, 2.1-2.2% in the general population). The prevalence was also stable among prisoners (2.1-2.6%). Among hospitalized and tuberculosis patients prevalence was higher and increased (1.8-12.7% and 1.5-16.2%, respectively). Only three sera had antibodies to HIV-1 group O. The 17 HIV-1 strains represent six different genetic subtypes including type O. CONCLUSION Our data from 1986 to 1994 show a stable and low HIV prevalence in Gabon, and a high genetic diversity of HIV-1 strains. This, also observed in Cameroon, is in contrast to that found elsewhere in Africa. Differences in rate of spread of HIV infection are probably explained by interplay between numerous factors. The role of different HIV subtypes in the dynamics of the HIV epidemic should be examined further.
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Affiliation(s)
- E Delaporte
- AIDS Programme, Institut Français de Recherche Scientifique pour le Développement (ORSTOM), Montpellier, France
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Larouzé B. L'hépatite C, 5 ans après. Med Mal Infect 1995. [DOI: 10.1016/s0399-077x(05)80892-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mlika-Cabanne N, Brauner M, Kamanfu G, Grenier P, Nikoyagize E, Aubry P, Larouzé B, Murray JF. Radiographic abnormalities in tuberculosis and risk of coexisting human immunodeficiency virus infection. Methods and preliminary results from Bujumbura, Burundi. Am J Respir Crit Care Med 1995; 152:794-9. [PMID: 7633744 DOI: 10.1164/ajrccm.152.2.7633744] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
We evaluated the age profile and chest radiographic abnormalities in 158 patients from Bujumbura, Burundi, with new-onset intrathoracic tuberculosis (pulmonary, pleural, or hilar/mediastinal adenopathy), to identify features that were associated with and would allow prediction of HIV seropositivity or seronegativity. Using agreed-upon criteria and prepared reporting forms, initial chest radiographs were reviewed by three readers, first independently and then at a consensus conference. Of the 158 patients, 105 (66%) were HIV seropositive and 53 patients were seronegative. Seropositive subjects (mean age, 35.8 yr) were older (p = 0.001) than seronegative subjects (mean age, 29.4 yr). Significant or borderline differences between HIV-seropositive and -seronegative patients included the frequency of small nodular lesions (p = 0.03), upper lobe cavitation (p = 0.05), and lymphadenopathy (p = 0.12), and the location of parenchymal abnormalities (p = 0.0006). Stepwise logistic regression revealed four important variables: age, small lesions, location, and lymphadenopathy; these were then used to derive an equation to calculate the probability that a given tuberculosis patient was HIV seropositive. Our mathematical model fit the observed data and the equation predicted serologic findings reasonably well. We conclude that it is possible to determine with useful probability a Burundian tuberculosis patient's HIV serologic status.
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Affiliation(s)
- N Mlika-Cabanne
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité 13, Hôpital Claude Bernard, Paris, France
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Mlika-Cabanne N, Brauner M, Mugusi F, Grenier P, Daley C, Mbaga I, Larouzé B, Murray JF. Radiographic abnormalities in tuberculosis and risk of coexisting human immunodeficiency virus infection. Results from Dar-es-Salaam, Tanzania, and scoring system. Am J Respir Crit Care Med 1995; 152:786-93. [PMID: 7633743 DOI: 10.1164/ajrccm.152.2.7633743] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
First, we evaluated the age profile and chest radiographic abnormalities in 146 patients from Dar-es-Salaam, Tanzania, with new-onset intrathoracic tuberculosis (pulmonary, pleural, or hilar/mediastinal adenopathy), to identify features that were associated with human immunodeficiency virus (HIV) seropositivity or seronegativity; then, we combined these data with those from a companion investigation in Burundi to develop a simple scoring system to predict HIV serologic status. Using agreed-upon criteria and simplified reporting forms, initial chest radiographs were reviewed by three readers, first independently and then at a consensus conference. Of the 146 patients, 80 (55%) were HIV seropositive and 66 were seronegative. More seropositive than seronegative subjects were 31 to 40 yr old (p = 0.03). Because the radiographic characteristics of the two serologic groups were similar in Tanzania and Burundi, we combined the data for stepwise logistic regression that revealed four highly significant variables: age, small lesions, location, and lymphadenopathy. From these, we obtained an equation to calculate the probability that a given tuberculosis patients was HIV seropositive and then we derived a scoring system that in its simplest form (threshold) predicted serologic status correctly in 68.1% of patients; a graded scale was even more accurate in the high (89.1%) and low (82.6%) ranges. This scoring system should be useful when serologic testing is unavailable or refused.
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Affiliation(s)
- N Mlika-Cabanne
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité 13, Hôpital Claude Bernard, Paris, France
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