Tuberculosis Series 2021

This issue of the Jornal Brasileiro de Pneumologia (JBP) is dedicated to World Tuberculosis Day, which is celebrated every year on March 24. In 2015, tuberculosis surpassed HIV infection to become the leading cause of death from infectious disease worldwide. In 2019, 73,864 new tuberculosis cases were reported in Brazil (incidence of 35.0 cases/100,000 population). In 2018, 4,490 tuberculosis-related deaths were reported (2.2 deaths/100,000 population).¹ The lead article in the current issue of the JBP is the new consensus statement from the Brazilian Thoracic Association on the diagnosis of tuberculosis, based on the latest recommendations on the topic.²

Since the beginning of the COVID-19 pandemic, various cases of the tuberculosis-COVID-19 combination have been reported, increasing the already high potential for morbidity and mortality of each disease.^3-5 In this issue of the JBP, a review article⁶ provides an overview of that combination, focusing on the differences between Brazil and Europe.

With regard to the epidemiology of tuberculosis in Brazil, the issue contains one ecological study⁷ in which data on the prevalence and incidence of the disease, as well as on the associated mortality, were assessed for the various regions of the country. The authors of the study demonstrated that, although all of those indicators decreased slightly from 2006 to 2015, Brazil failed to reach the United Nations Millennium Development Goals target of reducing tuberculosis-related mortality by 50%. The authors suggested that regional differences were responsible for that failure and that this must be taken into account in the development of tuberculosis control measures in the country.

In this same issue, there are three articles on the diagnosis of tuberculosis: one regarding the quantification of adenosine deaminase to diagnose tuberculous pleural effusion in children⁸; and two related to the Xpert MTB/RIF test.^9,10 Pagano et al.⁹ described the association between Xpert MTB/RIF cycle threshold (C_T) values and sputum smear microscopy findings in patients with pulmonary tuberculosis; a C_T cutoff value of 22.7 showed good predictive value for smear microscopy positivity, that being the first study in Brazil to assess the accuracy of C_T values as a measure of bacillary burden. Brito et al.¹⁰ demonstrated that, in BAL fluid samples from patients under clinical suspicion of having pulmonary tuberculosis who have tested negative for AFB in sputum samples or those with scarce sputum production, the diagnostic performance of Xpert MTB/RIF is superior to that of smear microscopy.

This issue also contains a brief communication on tuberculosis treatment, in which Santos et al.¹¹ analyze and compare tuberculosis treatment outcomes between the homeless population and the general population in Brazil. Although there were differences among the Brazilian regions, all indicators were worse in the homeless population. The rates of loss to follow-up and mortality were, respectively, 2.9 and 2.5 times higher in the homeless population than in the general population. In addition, the rate of treatment success was approximately 50% lower in the former.

In another article included in this issue, Inoue et al.¹² describe the effects that advanced extrapulmonary solid cancer has on the progression of Mycobacterium avium complex lung disease. The authors retrospectively evaluated 286 patients and demonstrated that the median time to progression of M. avium complex lung disease was shorter in patients with coexisting advanced solid cancer. In addition, although indirectly related to Mycobacterium tuberculosis and nontuberculous mycobacteria, one letter to the editor reports a case of giant Rasmussen’s aneurysm,¹³ and one suggests a new pathophysiological theory for Lady Windermere syndrome.¹⁴

In summary, this tuberculosis series features several articles focusing on diverse aspects of the disease, highlighting the challenges faced in tuberculosis control, especially during the COVID-19 pandemic, and providing a comprehensive overview of some of the latest research in the field.

REFERENCES

• ¹
  Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde [homepage on the Internet]. Brasília: the Ministry; [cited 2021 Feb 1]. Boletim Epidemiológico - Tuberculose 2020. Available from: https://www.saude.gov.br/images/pdf/2020/marco/24/Boletim-tuberculose-2020-marcas--1-.pdf
  » https://www.saude.gov.br/images/pdf/2020/marco/24/Boletim-tuberculose-2020-marcas--1-.pdf
• ²
  Diagnosis of tuberculosis: a consensus document from the Brazilian Thoracic Association. J Bras Pneumol 2021;47(2):20210054.
• ³
  Tadolini M, Codecasa LR, García-García JM, Blanc FX, Borisov S, Alffenaar JW, et al. Active tuberculosis, sequelae and COVID-19 co-infection: first cohort of 49 cases. Eur Respir J. 2020;56(1):2001398. https://doi.org/10.1183/13993003.01398-2020
  » https://doi.org/10.1183/13993003.01398-2020
• ⁴
  Motta I, Centis R, D'Ambrosio L, García-García JM, Goletti D, Gualano G, et al. Tuberculosis, COVID-19 and migrants: Preliminary analysis of deaths occurring in 69 patients from two cohorts. Pulmonology. 2020;26(4):233-240. https://doi.org/10.1016/j.pulmoe.2020.05.002
  » https://doi.org/10.1016/j.pulmoe.2020.05.002
• ⁵
  Visca D, Ong CWM, Tiberi S, Centis R, D'Ambrosio L, Chen B, et al. Tuberculosis and COVID-19 interaction: A review of biological, clinical and public health effects. Pulmonology. 2021;27(2):151-165. https://doi.org/10.1016/j.pulmoe.2020.12.012
  » https://doi.org/10.1016/j.pulmoe.2020.12.012
• ⁶
  Silva DR, Mello FCQ, D'Ambrosio L, Centis R, Dalcolmo MP, Migliori GB. Tuberculosis and COVID-19, the new cursed duet: what differs between Brazil and Europe? J Bras Pneumol. 2021;47(2):20210044.
• ⁷
  Cortez AO, Melo AC, Neves LO, Resende KA, Camargos P. Tuberculosis in Brazil: one country, multiple realities. J Bras Pneumol. 2021;47(2):e20200119.
• ⁸
  Vieira JL, Foschiera L, Ferreira ICS, Chakr VCBG. Performance of the quantification of adenosine deaminase, versus other tests performed in pleural fluid samples, for the diagnosis of tuberculous pleural effusion in children and adolescents. J Bras Pneumol. 2021;47(2):20200558.
• ⁹
  Pagano GC, Pereira GR, D'Ávila KG, Monaiar LR, Silva DR. Association between Xpert MTB/RIF cycle threshold values and sputum smear microscopy in patients with pulmonary tuberculosis. J Bras Pneumol. 2021;47(2):e20200549.
• ¹⁰
  Brito GMX, Mafort TT, Ribeiro-Alves M, Reis LVT, Leung J, Leão RS, et al. Diagnostic performance of GeneXpert MTB/RIF in BAL fluid samples of patients with clinical suspicion of pulmonary tuberculosis and negative AFB or scarce sputum: a tertiary care experience in a high-tuberculosis-burden area. J Bras Pneumol. 2021;47(2):20200581.
• ¹¹
  Santos ACE, Brunfentrinker C, Pena LS, Saraiva SS, Boing AF. Analysis and comparison of tuberculosis treatment outcomes in the homeless population and in the general population of Brazil. J Bras Pneumol. 2021;47(2):e20200178.
• ¹²
  Inoue R, Watanabe K, Saigusa Y, Hirama N, Hara Y, Kobayashi N, et al. Effect of coexisting advanced extrapulmonary solid cancer on progression of Mycobacterium avium complex lung disease. J Bras Pneumol 2021;47(2):20200520.
• ¹³
  Branco MT, Mello DFE, Ibrahim INAF, Marchiori E, Valentin MVN. Giant Rasmussen's aneurysm. J Bras Pneumol. 2021;47(2):20200648.
• ¹⁴
  Schuh SJ, Dias CF, Schuh GJ, Unis G. Pulmonary disease and the autonomic nervous system: a new pathophysiological mechanism for Lady Windermere syndrome. J Bras Pneumol. 2021;47(2):20200529.

Publication Dates

• Publication in this collection
  30 Apr 2021
• Date of issue
  2021