Editorial
Tuberculosis Outbreaks: Beyond the Tuberculin Skin Test
Brotes de tuberculosis: más allá de la prueba de la tuberculina
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true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Tuberculosis Outbreaks: Beyond the Tuberculin Skin Test" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "287" "paginaFinal" => "288" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Maria Luiza de Souza-Galvão, Mateu Espasa Soley" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Maria Luiza" "apellidos" => "de Souza-Galvão" "email" => array:1 [ 0 => "msouza@vhebron.net" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Mateu" "apellidos" => "Espasa Soley" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Tuberculosis Vall d’Hebron-Drassanes, Servicio de Neumología, Hospital Universitario Vall d’Hebron, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Tuberculosis Vall d’Hebron-Drassanes, Servicio de Microbiología, Hospital Universitario Vall d’Hebron, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Brotes de tuberculosis: más allá de la prueba de la tuberculina" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Essential elements in the proper control of tuberculosis include an early diagnosis, the correct treatment of patients, a contact study for the detection of new cases, and the treatment of carriers at risk of developing the disease.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Epidemic outbreaks of tuberculosis have been and continue to be common in our setting. Factors facilitating outbreaks of disease include tight-knit communities, delay in diagnosis of the index cases, the susceptibility of the affected population and the “fitness” of the strain (how efficiently it spreads).</p><p id="par0015" class="elsevierStylePara elsevierViewall">In 2005, Sarrat Torres et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> described a tuberculosis outbreak in a kindergarten in Zaragoza, in which 11 of the 94 children studied were infected (11.7%). Of these, 10 were diagnosed with active disease, confirmed microbiologically from gastric aspirate samples in 9. The disease was all the more easily transmitted because of the pulmonary and laryngeal infection sites, the significant delay in diagnosing the index case (the teaching assistant), and the close contact between the young children.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In another school outbreak in a primary school in Madrid, the contagion rate, including patients and carriers, was 94%.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> After identification of the initial 3 pediatric cases, the real index case turned out to be the teacher, who was diagnosed with bacilliferous cavitating pulmonary tuberculosis. In this outbreak, all infected contacts provided gastric aspirate sampling as part of a full diagnostic evaluation before starting treatment for latent tuberculous infection. This lead to the diagnosis of 7 new cases, 2 of which were asymptomatic with normal chest X-rays. In another school microepidemic, induced sputum samples were found to give a good yield, with isolation of <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> in 3 of the 7 pupils who were diagnosed with the disease.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In Catalonia, 27 tuberculosis outbreaks were described between 1998 and 2002. A total of 70% of these had occurred among family groups, while figures among the immigrant population remained low.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> In subsequent years (2003–2004), a study performed in the city of Barcelona used molecular epidemiological techniques to investigate tuberculosis transmission patterns in Spanish-born and foreign-born populations. This study revealed that almost 40% of strains occurred in 65 clusters, of which approximately 55% involved Spanish-born subjects only, 11% foreign-born subjects only, while 34% were a mixed population sharing the strain. It should be pointed out that most foreign-born patients included in the mixed clusters were from South America, leading the authors to surmise that cultural similarities may act as a significant factor in encouraging contact, hence bi-directional transmission of tuberculosis among communities.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In this edition of <span class="elsevierStyleSmallCaps">Archivos de Bronconeumología</span>, Hernán García et al. describe an outbreak of isoniazid-resistant tuberculosis in an immigrant community in Valladolid.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> After notification of a case of tuberculosis in a Bolivian-born patient, an active search was conducted among cohabitants and contacts, and 5 new cases were detected. Genotyping and antibiotic resistance profiling of the sputum samples revealed isoniazid-resistant <span class="elsevierStyleItalic">M. tuberculosis</span> in all patients. Transmission among communities was not addressed in this outbreak, since all secondary cases were born in Spain or were descendants of the Bolivian family, who had been living in Spain for over 10 years, and who had not recently traveled to their country of origin. As the authors rightly point out, it is difficult to determine if the disease in the index case was a reactivation of imported tuberculosis or if it was a recent infection. This can only be determined by using molecular epidemiological techniques and/or studies of the lineage of other similar strains in a research setting.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">By conducting a comprehensive study of samples from contacts, new cases can be definitively diagnosed, sensitivity to antituberculous drugs can be determined, and molecular coincidences corroborating the epidemiological suspicions can be identified. In London, in 2000, the use of molecular epidemiological techniques (IS6110-restriction fragment length polymorphism [RFLP]) helped to retrospectively determine the extent of a highly transmissible tuberculosis outbreak with single isoniazid resistance – the first case had appeared 5 years previously.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Commercial molecular techniques that have been validated in recent years (GenoType<span class="elsevierStyleSup">®</span> MDRTBplus-Hain, GeneXpert<span class="elsevierStyleSup">®</span>-TB-Cepheid) facilitate the detection of genetic mechanisms determining isoniazid and/or rifampicin resistance, not only from cultivated strains but also from direct samples.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Early diagnosis of possible resistances makes them very useful tools for speeding up contact studies, avoiding delays and inappropriate treatment regimens for tuberculous disease and infection. The World Health Organization has declared the GeneXpert<span class="elsevierStyleSup">®</span>-TB technique as the gold standard for the diagnosis of tuberculosis in countries with a high burden of resistant disease and poor laboratory support infrastructures.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> In Spain, the use of these techniques is recommended in positive cultures or directly on samples with strongly positive sputum smear results, if resistance seems likely: immigrant population, previous treatments, therapeutic failure, or contact with resistant patients.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Nevertheless, no clinical–analytical protocol has been established for the use of these molecular techniques in direct samples, and each hospital still adopts their own criteria. Since most laboratories in Spain have the technical capacity to perform these tests, and since most new cases are from immigrant populations in areas of high resistance rates, one possibility would be to routinely perform molecular resistance studies directly on clinical samples, particularly in bacilliferous cases.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The study of Hernán García et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> is an example of how the use of new laboratory techniques and close coordination between the microbiologist, the clinician, and the public health system are the cornerstones of good management of tuberculosis outbreaks in the community, particularly when resistant strains are suspected.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: de Souza-Galvão ML, Espasa Soley M. Brotes de tuberculosis: más allá de la prueba de la tuberculina. Arch Bronconeumol. 2016;52:287–288.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Documento de consenso sobre diagnóstico, tratamiento y prevención de la tuberculosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. González-Martín" 1 => "J.M. García-García" 2 => "L. Anibarro" 3 => "R. Vidal" 4 => "J. Esteban" 5 => "R. Blanquer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2010.02.010" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2010" "volumen" => "46" "paginaInicial" => "255" "paginaFinal" => "274" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20444533" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Brote epidémico de tuberculosis en una guardería de Zaragoza" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Sarrat Torres" 1 => "R. Macipe Costa" 2 => "F. de Juan Martín" 3 => "M.A. Lezcano Carreras" 4 => "M. Bouthelier Moreno" 5 => "M.A. Marín Bravo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr (Barc)" "fecha" => "2006" "volumen" => "65" "paginaInicial" => "219" "paginaFinal" => "224" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Brote de tuberculosis en un colegio de primaria: descripción y consideraciones sobre el valor del jugo gástrico en el manejo de microepidemias" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Tagarro" 1 => "S. Jiménez" 2 => "A. Sánchez" 3 => "A. Arroyo" 4 => "J. Aracil" 5 => "A. Cañete" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eimc.2010.08.006" "Revista" => array:6 [ "tituloSerie" => "Enferm Infecc Microbiol Clin" "fecha" => "2011" "volumen" => "29" "paginaInicial" => "90" "paginaFinal" => "95" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21353724" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estudio de los brotes de tuberculosis que han generado informes epidemiológicos en Cataluña (1998–2002)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.M. Bran" 1 => "J.A. Cayla" 2 => "A. Domínguez" 3 => "N. Camps" 4 => "P. Godoy" 5 => "A. Orcau" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2006" "volumen" => "42" "paginaInicial" => "260" "paginaFinal" => "266" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16827973" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Brote de tuberculosis en una escuela" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.P. Antón" 1 => "J.A.G. Carrasco" 2 => "G.L. Lois" 3 => "I.M. Villeneuve" 4 => "M.L. Beckouche" 5 => "E. García" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr (Barc)" "fecha" => "2007" "volumen" => "67" "paginaInicial" => "18" "paginaFinal" => "21" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tuberculosis transmission patterns among Spanish-born and foreign-born populations in the city of Barcelona" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Borrell" 1 => "M. Español" 2 => "A. Orcau" 3 => "G. Tudo" 4 => "F. March" 5 => "J.A. Cayla" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1469-0691.2009.02886.x" "Revista" => array:6 [ "tituloSerie" => "Clin Microbiol Infect" "fecha" => "2010" "volumen" => "16" "paginaInicial" => "568" "paginaFinal" => "574" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19681961" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Brote de tuberculosis resistente a isoniacida en una comunidad de inmigrantes en España" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Hernán García" 1 => "L. Moreno Cea" 2 => "V. Fernández Espinilla" 3 => "G. Ruiz Lopez del Prado" 4 => "S. Fernández Arribas" 5 => "I. Andrés García" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2016" "volumen" => "52" "paginaInicial" => "289" "paginaFinal" => "292" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outbreak of isoniazid resistant tuberculosis in north London" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.C. Ruddy" 1 => "A.P. Davies" 2 => "M.D. Yates" 3 => "S. Yates" 4 => "S. Balasegaram" 5 => "Y. Drabu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Thorax" "fecha" => "2004" "volumen" => "59" "paginaInicial" => "279" "paginaFinal" => "285" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15047945" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673608600732" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Update on the diagnosis and treatment of pulmonary tuberculosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 1 | 4 |
| 2024 October | 36 | 16 | 52 |
| 2024 September | 41 | 19 | 60 |
| 2024 August | 67 | 36 | 103 |
| 2024 July | 32 | 18 | 50 |
| 2024 June | 52 | 23 | 75 |
| 2024 May | 74 | 29 | 103 |
| 2024 April | 28 | 27 | 55 |
| 2024 March | 34 | 15 | 49 |
| 2024 February | 36 | 25 | 61 |
| 2023 March | 6 | 4 | 10 |
| 2023 February | 50 | 21 | 71 |
| 2023 January | 23 | 31 | 54 |
| 2022 December | 39 | 29 | 68 |
| 2022 November | 41 | 22 | 63 |
| 2022 October | 34 | 34 | 68 |
| 2022 September | 24 | 31 | 55 |
| 2022 August | 34 | 37 | 71 |
| 2022 July | 22 | 42 | 64 |
| 2022 June | 18 | 35 | 53 |
| 2022 May | 37 | 38 | 75 |
| 2022 April | 26 | 33 | 59 |
| 2022 March | 29 | 28 | 57 |
| 2022 February | 35 | 23 | 58 |
| 2022 January | 23 | 44 | 67 |
| 2021 December | 30 | 36 | 66 |
| 2021 November | 34 | 35 | 69 |
| 2021 October | 81 | 45 | 126 |
| 2021 September | 54 | 43 | 97 |
| 2021 August | 48 | 55 | 103 |
| 2021 July | 44 | 33 | 77 |
| 2021 June | 51 | 36 | 87 |
| 2021 May | 33 | 39 | 72 |
| 2021 April | 66 | 78 | 144 |
| 2021 March | 39 | 35 | 74 |
| 2021 February | 22 | 22 | 44 |
| 2021 January | 32 | 15 | 47 |
| 2020 December | 29 | 18 | 47 |
| 2020 November | 21 | 21 | 42 |
| 2020 October | 21 | 7 | 28 |
| 2020 September | 16 | 8 | 24 |
| 2020 August | 23 | 14 | 37 |
| 2020 July | 21 | 20 | 41 |
| 2020 June | 14 | 13 | 27 |
| 2020 May | 43 | 16 | 59 |
| 2020 April | 35 | 18 | 53 |
| 2020 March | 37 | 19 | 56 |
| 2020 February | 25 | 22 | 47 |
| 2020 January | 31 | 19 | 50 |
| 2019 December | 29 | 21 | 50 |
| 2019 November | 24 | 16 | 40 |
| 2019 October | 19 | 9 | 28 |
| 2019 September | 13 | 10 | 23 |
| 2019 August | 20 | 13 | 33 |
| 2019 July | 27 | 22 | 49 |
| 2019 June | 13 | 8 | 21 |
| 2019 May | 33 | 18 | 51 |
| 2019 April | 25 | 24 | 49 |
| 2019 March | 26 | 16 | 42 |
| 2019 February | 29 | 16 | 45 |
| 2019 January | 18 | 19 | 37 |
| 2018 December | 27 | 17 | 44 |
| 2018 November | 50 | 21 | 71 |
| 2018 October | 72 | 25 | 97 |
| 2018 September | 30 | 10 | 40 |
| 2018 June | 1 | 0 | 1 |
| 2018 May | 5 | 2 | 7 |
| 2018 April | 43 | 4 | 47 |
| 2018 March | 28 | 2 | 30 |
| 2018 February | 24 | 7 | 31 |
| 2018 January | 115 | 8 | 123 |
| 2017 December | 60 | 6 | 66 |
| 2017 November | 27 | 5 | 32 |
| 2017 October | 23 | 5 | 28 |
| 2017 September | 21 | 7 | 28 |
| 2017 August | 18 | 5 | 23 |
| 2017 July | 29 | 5 | 34 |
| 2017 June | 33 | 11 | 44 |
| 2017 May | 37 | 9 | 46 |
| 2017 April | 37 | 26 | 63 |
| 2017 March | 18 | 8 | 26 |
| 2017 February | 23 | 7 | 30 |
| 2017 January | 18 | 9 | 27 |
| 2016 December | 28 | 17 | 45 |
| 2016 November | 42 | 22 | 64 |
| 2016 October | 50 | 35 | 85 |
| 2016 September | 32 | 6 | 38 |
| 2016 August | 2 | 0 | 2 |
Show all
