Monitoring the extent of and trends in multidrug-resistant tuberculosis (MDR-TB) is a priority of the Brazilian National Tuberculosis Control Programme. The current study aimed to estimate the incidence of MDR-TB, describe the profile of TB drug resistance in risk groups and examine whether screening for MDR-TB adhered to the recommended guidelines. A descriptive study that examined diagnosed cases of pulmonary TB was conducted in the city of Santos, Brazil, between 2000–2004. Of the 2,176 pulmonary TB cases studied, 671 (30.8%) met the criteria for drug sensitivity testing and, of these cases, 31.7% (213/671) were tested. Among the tested cases, 9.4% were resistant to one anti-TB drug and 15% were MDR. MDR was observed in 11.6% of 86 new TB cases and 17.3% of 127 previously treated cases. The average annual incidence of MDR-TB was 1.9 per 100,000 inhabitants-years. The extent of known MDR-TB in the city of Santos is high, though likely to be underestimated. Our study therefore indicates an inadequate adherence to the guidelines for MDR-TB screening and suggests the necessity of alternative strategies of MDR-TB surveillance.

Objective: To characterize the profile of patients with pulmonary tuberculosis (PTB) in the city of Santos, Brazil, according to biological, environmental and institutional factors. Methods: Descriptive study, using the TB surveillance database, including patients with PTB, aged 15 years or older, residing in the city of Santos and whose treatment was initiated between 2000 and 2004. Results: We identified 2,176 cases, of which 481 presented a history of TB. Of those 481 patients, 29.3% were cured, and 70.7% abandoned treatment. In 61.6% of the cases, the diagnosis was confirmed by sputum smear microscopy, whereas it was confirmed based on clinical and radiological criteria in 33.8%; 69.0% were male; and 69.5% were between 20 and 49 years of age. There were 732 hospitalizations, and the mean length of hospital stay was 32 days (first hospitalization). The prevalence of alcoholism, diabetes and TB/HIV coinfection was, respectively, 11.7%, 8.2% and 16.2%. The prevalence of TB/HIV coinfection decreased from 20.7% to 12.9% during the study period. The treatment outcome was cure, abandonment, death from TB and death attributed to TB/HIV coinfection in 71.0%, 12.1%, 3.9% and 2.5%, respectively. The directly observed treatment, short-course (DOTS) was adopted in 63.4% of cases, and there were no significant differences between DOTS and the conventional treatment approach in terms of outcomes (p > 0.05). The mean annual incidence of PTB was 127.9/100,000 population (range: 72.8-272.92/100,000 population, varying by region). The mean annual mortality rate for PTB was 6.9/100,000 population. Conclusions: In areas hyperendemic for TB, DOTS should be prioritized for groups at greater risk of treatment abandonment or death, and the investigation of TB contacts should be intensified.Keywords: Tuberculosis, pulmonary; Epidemiology, descriptive; Control. ResumoObjetivo: Caracterizar o perfil dos pacientes com tuberculose pulmonar (TBP) no município de Santos (SP) segundo fatores biológicos, ambientais e institucionais. Métodos: Estudo descritivo, com dados obtidos na vigilância da TB, abrangendo pacientes com TBP maiores de 15 anos de idade, residentes em Santos (SP) e com tratamento iniciado entre 2000 e 2004. Resultados: Foram identificados 2.176 casos, e 481 apresentavam história prévia de TB. Desses, 29,3% curaram-se no episódio anterior, e 70,7% abandonaram o tratamento. Em 61,6% e em 33,8% dos casos, o diagnóstico foi confirmado por baciloscopia e por critérios clínico-radiológicos, respectivamente; 69.0% eram homens, e 69,5% situavam-se entre 20 a 49 anos. Houve 732 hospitalizações, com tempo médio de permanência de 32 dias na primeira internação. A prevalência de alcoolismo, diabetes e coinfecção TB/HIV foi de, respectivamente, 11,7%, 8,2% e 16,2%, com declínio dessa última de 20,7% para 12,9% no período de estudo. O desfecho do tratamento para 71,0%, 12,1%, 3,2% e 3,3% foi, respectivamente, cura, abandono, óbito por TB e óbito por TB/HIV. O tratamento supervisionado de curta duração foi aplicado em 63,4% dos ca...

Foram analisados retrospectivamente os registros (2000 a 2004) do Laboratório de Microbiologia do Instituto Adolfo Lutz de Santos, SP referentes a pacientes infectados pelo virus da imunodeficiência humana com suspeita de tuberculose pulmonar. Foram encaminhadas 1.321 amostras com finalidade de diagnóstico, correspondendo a 880 casos suspeitos de tuberculose em 693 pacientes. Cento e trinta e quatro baciloscopias foram positivas e em 188 culturas houve crescimento de micobactérias, correspondendo a 161 casos confirmados. Houve identificação de Mycobacterium tuberculosis em 126 (78,3%) e micobactérias não tuberculosas em 39 (24,2%). Em quatro casos, houve concomitância de Mycobacterium tuberculosis e micobactérias não tuberculosas (porém em amostras distintas). O perfil de sensibilidade às drogas antituberculose revelou 18 (14,3%) casos de resistência a pelo menos um medicamento. Estes resultados reforçam a necessidade de submeter à rotina laboratorial completa - baciloscopia, cultura com identificação e testes de sensibilidade às drogas - as amostras respiratórias de pacientes soropositivos para o vírus da imunodeficiência humana com suspeita de tuberculose para direcionamento terapêutico adequado.

OBJETIVO: Este estudo teve por objetivo descrever a freqüência das espécies de micobactérias não tuberculosas (MNT) identificadas laboratorialmente a partir do isolamento de sítios não estéreis (escarro) de indivíduos infectados ou não pelo vírus HIV na Baixada Santista (SP), período de 2000 a 2005. MÉTODOS: Foi realizada análise retrospectiva dos resultados de baciloscopia e cultura, disponíveis nos registros do laboratório regional de tuberculose, Instituto Adolfo Lutz-Santos. RESULTADOS: Analisou-se 194 cepas de MNT correspondentes a 125 indivíduos, sendo 73 (58,4%) HIV negativos e 52 (41,6%) HIV positivos. Foram identificadas 13 diferentes espécies: Mycobacterium kansasii; complexo M. avium; M. fortuitum; M. peregrinum; M. gordonae; M. terrae; M. nonchromogenicum; M. intracellulare; M. flavescens; M. bohemicum; M. chelonae; M. shimoidei; e M. lentiflavum. Em 19,2% dos casos obteve-se diagnóstico bacteriológico confirmado pelo isolamento da mesma espécie em no mínimo duas amostras consecutivas. CONCLUSÕES: Os resultados mostram a importância da realização sistemática da identificação de MNT na rotina laboratorial e sua integração com a clínica, podendo contribuir na caracterização da doença e ações de efetivo controle, como nas populações co-infectadas tuberculose e HIV.

Objective: Virulent strains of the Mycobacterium tuberculosis complex, under certain appropriate conditions, grow as characteristic ropes, bundles or serpentine cords known as cord factor or growth in cords. The objective of the present study was to evaluate cord factor detection as a method of achieving presumptive identification of the M. tuberculosis complex, comparing it to conventional typing tests. Methods: A total of 743 strains were analyzed from January of 2002 to December of 2005 in the Mycobacteria Sector of the Adolfo Lutz Institute, located in the city of Santos, Brazil. Samples were obtained from clinical specimens collected from patients with respiratory symptoms treated at basic health clinics in the greater metropolitan area of Santos. Ziehl-Neelsen-stained smears were prepared, 301 (40.5%) in MB/BacT broth and 442 (59.5%) on solid media, either Lowenstein-Jensen or Ogawa-Kudoh. Results: The sensitivity, specificity, positive predictive value and negative predictive value obtained during the performance comparison of the two methods (cord factor detection and conventional typing) using both isolation media were, respectively, 98.5, 88, 97 and 93%. The method was more sensitive on solid medium (100%), and the difference in sensitivity between the two media types was only 2.7%. Conclusions: Taking into consideration the results obtained, we conclude that, in laboratories with a high incidence of M. tuberculosis complex isolation and limited economic resources, cord factor detection is a fast and valid criterion for identifying these mycobacteria using liquid or solid medium. It also enables subsequent conclusive identification tests, as well as additional sensitivity tests when necessary.