Perfil de resistência de Mycobacterium tuberculosis no estado de Mato Grosso do Sul, 2000-2006

Abstract

Objective: To determine the drug resistance profile of Mycobacterium tuberculosis in the state of Mato Grosso do Sul, Brazil, between 2000 and. Methods: Descriptive study of reported tuberculosis cases in the Brazilian Case Registry Database. We included only those cases in which M. tuberculosis culture was positive and sensitivity to drugs (rifampicin, isoniazid, streptomycin and ethambutol) was tested. Löwenstein-Jensen and Ogawa-Kudoh solid media were used for cultures, as was an automated liquid medium system. Sensitivity tests were based on the proportion method. Results: Among the 783 cases evaluated, males predominated (69.7%), as did patients in the 20-49 year age bracket (70%), a diagnosis of pulmonary tuberculosis (94.4%) and positive HIV serology (8.6%); 645 (82.4%) were new cases, and 138 (17.6%) had previously been treated. Resistance to at least one drug was found in 143 cases (18.3%). The primary resistance (PR) rate was, respectively, 8.1%, 1.6%, 2.8% and 12.4%, for monoresistance, multidrug resistance (MDR), other patterns of resistance and resistance to at least one drug, whereas the acquired resistance (AR) rate was 14.5%, 20.3%, 10.9% and 45.7%, respectively, and the combined resistance (CR) rate was 9.2%, 4.9%, 4.2% and 18.3%, respectively. In PR, streptomycin was the most common drug, whereas isoniazid was the most common in AR and CR (7.2% and 3.7%, respectively). Conclusions: These high levels of resistance undermine the efforts for tuberculosis control in Mato Grosso do Sul. Acquired MDR was 12.7 times more common than was primary MDR, demonstrating that the previous use of drug therapy is an indicator of resistance. These levels reflect the poor quality of the health care provided to these patients, showing the importance of using the directly observed treatment, short course strategy, as well as the need to perform cultures and sensitivity tests for the early diagnosis of drug resistance.Keywords: Tuberculosis; Drug resistance, multiple; Mycobacterium tuberculosis. ResumoObjetivo: Determinar o perfil de resistência a drogas de Mycobacterium tuberculosis no estado de Mato Grosso do Sul no período entre 2000 e 2006. Métodos: Estudo descritivo de casos notificados de tuberculose no Sistema de Informação de Agravos de Notificação, com cultura positiva para M. tuberculosis e testes de sensibilidade a rifampicina, isoniazida, estreptomicina e etambutol. Para as culturas, utilizaram-se os meios sólidos Löwenstein-Jensen e Ogawa-Kudoh, assim como um sistema automatizado com meio líquido; para os testes de sensibilidade, o método das proporções. Resultados: De 783 casos, 69,7% eram de pacientes masculinos, na faixa etária de 20-49 anos (70%), com forma pulmonar (94,4%) e sorologia positiva para HIV (8,6%); 645 (82,4%) eram casos novos, e 138 (17,6%) eram casos tratados. Identificou-se qualquer resistência em 143 casos (18,3%). A taxa de resistência primária (RP) foi, respectivamente, 8,1%, 1,6%, 2,8% e 12,4%, para monorresistência, multirresistência (MR), outros padrões de associação de...

Annual frequency and distribution of tuberculosis resistance in the public health laboratory network of Pará State, Brazil

“…In our report, the studied population was predominantly male, as it has been in studies conducted previously by others 7,15,17 . Regarding the age distribution of cases, 79.4% (673/848) and 80.1% (180/223) of individuals with TB and MDR-TB, respectively, belonged to the 15 to 54 year old age group, which is considered an economically active group.…”

“…Previous studies have revealed great variation in the levels of resistance detected. Such disparities may be product of different study methodologies used by different laboratories 5,7,15,16,17,18 .…”

Prevalência de resistência primária em pacientes com tuberculose pulmonar sem fatores de risco conhecidos para resistência primária

“…(11) In fact, even in Central and Western Europe, where the rate of drug resistance is lower, resistance to rifampin is 1.1%. (11) In a study conducted in the state of Mato Grosso do Sul, Brazil, and involving 645 samples collected from new cases between 2000 and 2006, the rates of primary drug resistance were 3.4% for streptomycin, 2.9% for isoniazid, and 1.7% for ethambutol, (12) i.e., the prevalence of primary drug resistance was approximately half of that found in our sample. As in our study, no resistance to rifampin was found.…”

Estudo dinâmico da mortalidade por tuberculose no Estado de São Paulo, Brasil: uma abordagem bayesiana

“…O abandono do tratamento pode levar ao desenvolvimento da TB multirresistente, associada à elevada taxa de mortalidade 4 . Os altos níveis de TB multirresistente detectados no estudo realizado por Cunha et al 5 indicam a falta de medidas públicas para o controle de TB no Brasil.…”