full-text, see below please ►
Clinical and Therapeutic Features of Pulmonary Nontuberculous Mycobacterial Disease, Rio de Janeiro, Brazil - Vol. 19 No. 3 - March 2013 - Emerging Infectious Disease journal - CDC
Table of Contents
Volume 19, Number 3– March 2013
Volume 19, Number 3—March 2013
CME ACTIVITY
Clinical and Therapeutic Features of Pulmonary Nontuberculous Mycobacterial Disease, Rio de Janeiro, Brazil
Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit.
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians.
Medscape, LLC designates this Journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 70% minimum passing score and complete the evaluation at www.medscape.org/journal/eid; (4) view/print certificate.
• Analyze the epidemiology of pulmonary nontuberculous mycobacterial (PNTM) disease
• Evaluate the clinical presentation of PNTM disease
• Distinguish mycobacteria associated with the most cases of PNTM disease in the current study
• Distinguish the mycobacterium species associated with the lowest cure rates of PNTM in the current study.
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians.
Medscape, LLC designates this Journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 70% minimum passing score and complete the evaluation at www.medscape.org/journal/eid; (4) view/print certificate.
Release date: February 22, 2013; Expiration date: February 22, 2014
Learning Objectives
Upon completion of this activity, participants will be able to:• Analyze the epidemiology of pulmonary nontuberculous mycobacterial (PNTM) disease
• Evaluate the clinical presentation of PNTM disease
• Distinguish mycobacteria associated with the most cases of PNTM disease in the current study
• Distinguish the mycobacterium species associated with the lowest cure rates of PNTM in the current study.
CME Editor
Carol E. Snarey, MA, Technical Writer/Editor, Emerging Infectious Diseases. Disclosure: Carol E. Snarey, MA, has disclosed no relevant financial relationships.CME Author
Charles P. Vega, MD, Health Sciences Clinical Professor; Residency Director, Department of Family Medicine, University of California, Irvine. Disclosure: Charles P. Vega, MD, has disclosed no relevant financial relationships.Authors
Disclosures: Karla Mello, Fernanda Mello, Liamar Borga, Rafael Duarte, Elizabeth Sampaio, Steven Holland, Rebecca Prevots, and Margareth Dalcolmo have disclosed no relevant financial relationships. Valeria Rolla has disclosed the following relevant financial relationships: served as an advisor or consultant for Janssen-Cilag; received grants for clinical research from Janssen-Cilag.Table of Contents
Volume 19, Number 3– March 2013
full-text ►
Clinical and Therapeutic Features of Pulmonary Nontuberculous Mycobacterial Disease, Rio de Janeiro, Brazil - Vol. 19 No. 3 - March 2013 - Emerging Infectious Disease journal - CDC
Volume 19, Number 3—March 2013
CME ACTIVITY
Clinical and Therapeutic Features of Pulmonary Nontuberculous Mycobacterial Disease, Rio de Janeiro, Brazil
Abstract
To identify clinical and therapeutic features of pulmonary nontuberculous mycobacterial (PNTM) disease, we conducted a retrospective analysis of patients referred to the Brazilian reference center, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil, who received a diagnosis of PNTM during 1993–2011 with at least 1 respiratory culture positive for NTM. Associated conditions included bronchiectasis (21.8%), chronic obstructive pulmonary disease (20.7%), cardiovascular disease (15.5%), AIDS (9.8%), diabetes (9.8%), and hepatitis C (4.6%).Two patients had Hansen disease; 1 had Marfan syndrome. Four mycobacterial species comprised 85.6% of NTM infections: Mycobacterium kansasii, 59 cases (33.9%); M. avium complex, 53 (30.4%); M. abscessus, 23 (13.2%); and M. fortuitum, 14 (8.0%). A total of 42 (24.1%) cases were associated with rapidly growing mycobacteria. In countries with a high prevalence of tuberculosis, PNTM is likely misdiagnosed as tuberculosis, thus showing the need for improved capacity to diagnose mycobacterial disease as well as greater awareness of PNTM disease prevalence.Recent studies have documented the emergence of NTM lung diseases in industrialized countries, such as the United States (4,5). The current prevalence estimated for PNTM is ≈6 cases/100,000 population, with the highest prevalence in persons >50 years of age (4–6). In many developing countries with a high prevalence of TB, the prevalence of PNTM among immunocompetent persons remains unknown, largely because of the lack of routine culture and species identification from samples of persons with suspected cases. In Brazil in 2010, 70,601 cases of TB were reported, indicating a prevalence of 38 cases/100,000 population. In the same year, 4,500 deaths from TB were reported. In 2011, TB was the third leading cause of death (from infectious diseases) and the first among AIDS patients, according to surveillance data from Brazil’s National TB Control Program (7). However, because TB is routinely diagnosed presumptively, solely on the basis of identifying acid-fast bacilli (AFB) from sputum samples, an unknown proportion of patients may in fact be infected with NTM. Therefore, the true prevalence of NTM in Brazil remains unknown.
In Brazil, the Professsor Helio Fraga Reference Center (CRPHF) has served as a reference center for multidrug-resistant TB (MDR TB) and NTM since 1993. From 1993 to 2011, 5,638 cases of MDR TB were reported in Brazil, 1,894 of them in Rio de Janeiro; 1,595 of these patients were treated at CRPHF (8).
Prior studies have described some of the features of clinical isolates from PNTM patients (9–14), and others have described the clinical features for small populations infected with NTM clinical isolates in Brazil (15,16). To more fully describe the emerging prevalence and associated conditions of PNTM in a large urban population in Brazil, we present results of a large and detailed review of PNTM case-patients with PNTM who were treated at CRPHF.
No hay comentarios:
Publicar un comentario