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2.
Rev. bras. oftalmol ; 80(4): e0017, 2021. graf
Article in English | LILACS | ID: biblio-1288630

ABSTRACT

ABSTRACT Choroidal tuberculomas are present in patients with ocular tuberculosis. They usually occur in a patient with previous history of tuberculosis, and are rarely the initial presentation, with no prior systemic manifestations. We present a patient with unilateral choroidal tuberculoma as the initial presentation of presumed ocular tuberculosis, which enabled earlier initiation of treatment.


RESUMO Os tuberculomas de coroide apresentam-se em pacientes com tuberculose ocular. Geralmente, ocorrem em indivíduos com história prévia de tuberculose e raramente têm apresentação inicial sem manifestações sistêmicas anteriores. Relatamos o caso de um paciente com tuberculoma de coroide unilateral com apresentação inicial de tuberculose ocular presumida, permitindo o início mais precoce do tratamento.


Subject(s)
Humans , Female , Adult , Tuberculoma/diagnosis , Choroid Diseases/diagnosis , Tuberculoma/drug therapy , Fluorescein Angiography , Choroid Diseases/drug therapy , Uveitis, Posterior/diagnosis , Tuberculosis, Ocular , Choroid/diagnostic imaging , Fundus Oculi , Antitubercular Agents/therapeutic use
3.
Cad. Saúde Pública (Online) ; 37(10): e00293920, 2021. tab, graf
Article in Portuguese | LILACS | ID: biblio-1339528

ABSTRACT

Neste estudo, estimou-se a proporção e os fatores associados à subnotificação da tuberculose multirresistente (TB-MDR) no Estado do Rio de Janeiro, Brasil, assim como a proporção de óbitos nesse grupo. Realizou-se um estudo de coorte retrospectiva, utilizando a técnica de relacionamento probabilístico entre sistemas de informação. Os casos com resultado do teste de sensibilidade às drogas (TSA) com padrão TB-MDR registrados no Sistema Gerenciador de Ambiente Laboratorial (GAL), no período 2010 a 2017, foram relacionados com casos notificados no Sistema de Tratamentos Especiais de Tuberculose (SITETB). Regressões logísticas simples e múltipla foram realizadas para estimar os fatores associados à subnotificação. Para verificar o óbito, foi realizada a busca dos casos no Sistema de Informações sobre Mortalidade (SIM) e no portal do Tribunal de Justiça do Estado do Rio de Janeiro. Dos 651 casos TB-MDR no GAL, 165 não haviam sido notificados no SITETB, perfazendo uma subnotificação de 25,4% na amostra. Entre os casos subnotificados, 61 (37%) foram encontrados nos registros de óbito. Na análise múltipla, ter o exame solicitado por um hospital (OR = 2,86; IC95%: 1,72-4,73) esteve associado à subnotificação. No geral, o tempo médio entre a solicitação do exame e a liberação do resultado foi de 113 dias. Entre os casos notificados, o tempo médio entre a solicitação do exame e o início do tratamento foi de 169 dias. Diante disso, é urgente fortalecer as ações de vigilância epidemiológica na TB-MDR, estabelecer e monitorar núcleos de vigilância hospitalar e as rotinas de notificação de TB nos hospitais, rever etapas operacionais, além de unificar os diversos sistemas de informação tornando-os mais ágeis e integrados.


This study estimated the proportion of underreporting of multidrug-resistant tuberculosis (MDR-TB) and associated factors in the State of Rio de Janeiro, Brazil, as well as the proportion of deaths in this group. A retrospective cohort study was conducted using probabilistic database linkage. Cases with the results of the drug sensitivity test (DST) with MDR-TB pattern recorded in the Laboratory Environment Management System (GAL) from 2010 to 2017 were linked to cases reported to the Special TB Treatments System (SITETB). Simple and multiple logistic regressions were performed to estimate factors associated with underreporting. Death was verified by search for cases in the Mortality Information System (SIM) and in the portal of the Rio de Janeiro State Court of Justice. Of the 651 cases of MDR-TB in the GAL, 165 had not been reported to the SITETB, meaning an underreporting rate of 25.4% in the sample. Among the unreported cases, 61 (37%) were identified in the death records. In the multiple analysis, the fact that the test was ordered by a hospital (OR = 2.86; 95%CI: 1.72-4.73) was associated with underreporting. Overall, the mean turnaround time between ordering the test and releasing the result was 113 days. Among reported cases, the mean time between ordering the test and initiating treatment was 169 days. The results underline the urgent need to strengthen epidemiological surveillance activities for MDR-TB, establish and monitor hospital surveillance centers and routine TB reporting in hospitals, review operational stages, and integrate various information systems to make them more agile and integrated.


En este estudio se estimó la proporción y los factores asociados a la subnotificación de la tuberculosis resistente a múltiples fármacos (TB-MDR) en el Estado de Río de Janeiro, Brasil, así como la proporción de óbitos en ese grupo. Se realizó un estudio de cohorte retrospectiva, utilizando la técnica de relación probabilística entre sistemas de información. Los casos con resultado del test de sensibilidad a las drogas (TSA) con patrón TB-MDR, registrados en el Sistema Gerenciador de Ambiente Laboratorial (GAL), en el período 2010 a 2017, se relacionaron con casos notificados en el Sistema de Tratamientos Especiales de Tuberculosis (SITETB). Se realizaron regresiones logísticas simples y múltiples para estimar los factores asociados a la subnotificación. Para verificar el óbito, se realizó la búsqueda de los casos en el Sistema de Información sobre Mortalidad (SIM) y en el portal del Tribunal de Justicia del Estado de Río de Janeiro. De los 651 casos TB-MDR en el GAL, 165 no habían sido notificados en el SITETB, lo que equivale a una subnotificación de un 25,4% en la muestra. Entre los casos subnotificados, 61 (37%) se encontraron en los registros de óbito. En el análisis múltiple, que el examen haya sido solicitado por un hospital (OR = 2,86; IC95%: 1,72-4,73) estuvo asociado a la subnotificación. En general, el tiempo medio entre la solicitud del examen y la llegada del resultado fue de 113 días. Entre los casos notificados, el tiempo medio entre la solicitud del examen y el inicio del tratamiento fue de 169 días. Ante esto, es urgente fortalecer las acciones de vigilancia epidemiológica en la TB-MDR, establecer y supervisar núcleos de vigilancia hospitalaria y las rutinas de notificación de TB en los hospitales, revisar etapas operacionales, además de unificar los diversos sistemas de información haciéndolos más ágiles e integrados.


Subject(s)
Humans , Tuberculosis, Multidrug-Resistant/drug therapy , Tuberculosis, Multidrug-Resistant/epidemiology , Brazil/epidemiology , Logistic Models , Retrospective Studies , Hospitals , Antitubercular Agents/therapeutic use
4.
Rev. panam. salud pública ; 45: e5, 2021. tab
Article in Spanish | LILACS | ID: biblio-1252038

ABSTRACT

RESUMEN Objetivo. Identificar los factores asociados con el éxito del tratamiento de tuberculosis multidrogorresistente (TB-MDR) relacionados con los pacientes y el personal sanitario en seis municipios de Colombia con mayor número de casos. Métodos. Mediante regresiones logísticas bifactorial y multifactorial se analizó la asociación entre el tratamiento exitoso (curación o cumplimiento del tratamiento) y las características de los pacientes, y de los médicos, profesionales de enfermería y psicólogos vinculados al tratamiento. Se exploró la importancia del conocimiento en el manejo de los casos de TB-MDR mediante grupos focales con esos profesionales. Resultados. De los 128 casos con TB-MDR, 63 (49,2%) tuvieron un tratamiento exitoso. Solo 52,9% de los médicos y profesionales de enfermería tenía conocimientos satisfactorios sobre TB-MDR. La regresión logística mostró que ser negativo al VIH, estar afiliado al régimen de aseguramiento de salud contributivo, estar atendido por un médico del sexo masculino y por profesionales de enfermería con conocimientos suficientes se asociaron con un desenlace exitoso del tratamiento (p ≤ 0,05). El análisis cualitativo mostró la necesidad de profundizar y sistematizar la capacitación del personal sanitario que atiende los casos de TB-MDR. Conclusiones. En el éxito del tratamiento de los casos de TB-MDR influyen algunas características de los pacientes y el personal sanitario. Se requiere fortalecer los conocimientos sobre TB-MDR de médicos y enfermeros, y reforzar el seguimiento de los pacientes con TB-MDR positivos al VIH y de los que pertenecen al régimen subsidiado, dada su menor probabilidad de éxito al tratamiento.


ABSTRACT Objective. To identify patient- and provider-related factors associated with the success of multidrug-resistant tuberculosis (MDR-TB) treatment in the six municipalities of Colombia with the highest number of MDR-TB cases. Methods. Bivariate and multivariate logistic regressions were used to analyze the association between treatment success (cure or treatment completion) and characteristics of the patients and physicians, nursing professionals, and psychologists involved in their treatment. The importance of knowledge in the management of MDR-TB cases was explored through focus groups with these providers. Results. Of 128 cases of TB-MDR, 63 (49.2%) experienced treatment success. Only 52.9% of the physicians and nursing professionals had satisfactory knowledge about MDR-TB. Logistic regression showed that being HIV negative, being affiliated with the contributory health insurance scheme, being cared for by a male physician, and being cared for by nursing professionals with sufficient knowledge were associated with a successful treatment outcome (p ≤ 0.05). Qualitative analysis showed the need for in-depth, systematic training of health personnel who care for patients with MDR-TB. Conclusions. Some characteristics of patients and healthcare providers influence treatment success in MDR-TB cases. Physicians' and nurses' knowledge about MDR-TB must be improved, and follow-up of MDR-TB patients who are living with HIV and of those affiliated with the subsidized health insurance scheme in Colombia must be strengthened, as these patients have a lower likelihood of a successful treatment outcome.


RESUMO Objetivo. Identificar os fatores associados ao êxito do tratamento da tuberculose multirresistente (TBMR) relacionados ao paciente e à equipe de saúde nos seis municípios da Colômbia com o maior número de casos. Métodos. Mediante regressão logística bifatorial e multifatorial, analisou-se a associação entre o êxito do tratamento (cura ou completude do tratamento) e as características dos pacientes e dos médicos, profissionais de enfermagem e psicólogos envolvidos neste. Explorou-se a importância do conhecimento no manejo de casos de TBMR mediante grupos focais com os mesmos profissionais. Resultados. Dos 128 casos de TBMR, 63 (49.2%) lograram êxito no tratamento. Somente 52.9% dos médicos e profissionais de enfermagem tinham conhecimentos satisfatórios sobre TBMR. A regressão logística demonstrou que soronegatividade para o HIV, cobertura pelo sistema de saúde sob o regime de contribuinte, atendimento por um médico do sexo masculino e atendimento por profissionais de enfermagem com conhecimento suficiente foram fatores associados ao êxito do tratamento (p ≤ 0,05). A análise qualitativa demonstrou necessidade de aprofundar e sistematizar a capacitação do pessoal de saúde que atende casos de TBMR. Conclusões. Algumas características do paciente e da equipe de saúde influenciam no êxito do tratamento de casos de TBMR. É preciso fortalecer os conhecimentos dos médicos e profissionais de enfermagem sobre a TBMR e reforçar o seguimento dos pacientes com TBMR que vivem com HIV e os filiados ao sistema de saúde colombiano pelo regime subsidiado, os quais têm menor probabilidade de êxito do tratamento.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Health Personnel , Tuberculosis, Multidrug-Resistant/therapy , Logistic Models , Health Knowledge, Attitudes, Practice , Surveys and Questionnaires , Treatment Outcome , Clinical Competence , Focus Groups , Colombia , Antitubercular Agents/therapeutic use
5.
Rev. chil. enferm. respir ; 36(3): 215-222, set. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1138555

ABSTRACT

INTRODUCCIÓN: La prevención de la tuberculosis activa en los grupos de riesgo es clave para el control y eliminación de la tuberculosis. El tratamiento de la infección tuberculosa latente (TITL) con rifapentina e isoniazida en dosis semanales por 12 semanas es más corto que con otros esquemas, tiene menor hepatotoxicidad, mejor adherencia y es costo-efectivo. El OBJETIVO del estudio es evaluar la factibilidad de implementar este esquema a nivel programático en Chile. MÉTODOS: Se hizo una intervención piloto en territorios seleccionados entre mayo de 2018 y marzo de 2019. En esos territorios se reemplazó el esquema normado de TITL con isoniazida 6 meses por el esquema rifapentina-isoniazida 12 semanas. Además, se amplió la población objetivo, incluyendo a contactos mayores de 14 años. El tratamiento consistió en la administración conjunta de isoniazida y rifapentina por vía oral con frecuencia semanal, por 12 semanas, de forma supervisada por personal de salud. RESULTADOS: Ingresaron 238 pacientes al piloto, de los cuales 53% fueron mujeres y 54,2% fueron mayores de 14 años. Del total de pacientes, 203 (85,3%) completaron el tratamiento, 22 (9,2%) lo abandonaron, 8 (3,4%) presentaron reacciones adversas y 5 tuvieron otros motivos de egreso. CONCLUSIÓN: Tanto el TITL con rifapentinaisoniazida por 3 meses en dosis semanales supervisadas, como la incorporación de contactos adultos a TITL, son factibles de implementar a nivel programático en Chile.


INTRODUCTION: Prevention of active tuberculosis in risk groups is crucial in tuberculosis control and elimination. Treatment of latent tuberculosis (TITL) with rifapentine and isoniazid in weekly doses for 12 weeks is shorter than other pharmacological treatments, with less liver toxicity, better patient compliance and it is cost-effective. The OBJECTIVE of this study is to evaluate the feasibility to implement this treatment at a programmatic level in Chile. METHODS: A pilot intervention was conducted in selected territories between May 2018 and March 2019. Within these territories, the regulated treatment with isoniazid 6 months was replaced by the 12 weeks treatment with weekly rifapentine-isoniazide. Additionally, the target population was expanded to include contacts over 14 years old, currently not included in the national guidelines. Treatment consisted in oral administration of rifapentine and isoniazide together once a week for 12 weeks, under supervision of trained health workers. RESULTS: From 238 patients entered to the protocol, 53% of them were women and 54.2% were older than 14 years-old. Out of the total number of patients, 203 (85.3%) completed treatment, 22 (9.2%) abandoned, 8 (3.4%) had adverse drug reactions, and 5 ended treatment for different causes. CONCLUSION: Both TITL with rifapentine-isoniazide in 12 supervised weekly doses, and the inclusion of adult contacts in TITL, are feasible to implement at a programmatic level in Chile.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Young Adult , Rifampin/analogs & derivatives , Latent Tuberculosis/drug therapy , Isoniazid/therapeutic use , Antitubercular Agents/therapeutic use , Rifampin/therapeutic use , Time Factors , Drug Administration Schedule , Chile , Pilot Projects , Administration, Oral , Patient Compliance , Directly Observed Therapy , Drug Therapy, Combination , Treatment Adherence and Compliance , National Health Programs
6.
Rev. chil. obstet. ginecol. (En línea) ; 85(4): 366-370, ago. 2020. graf
Article in Spanish | LILACS | ID: biblio-1138633

ABSTRACT

INTRODUCCIÓN: La tuberculosis (TBC) genital es una infección relativamente poco frecuente en la mujer. Afecta principalmente a mujeres menores de 40 años, y el motivo de consulta más usual es la esterilidad, de ahí la importancia de su diagnóstico precoz. CASO CLÍNICO clínico: Se presenta el caso de una paciente con dolor pélvico crónico que acude a nuestras consultas para valoración. Durante el estudio se toma biopsia dirigida de la cavidad endometrial diagnosticándose la presencia de granulomas no necrotizantes. Posteriormente se realiza un cultivo microbiológico que resulta positivo para micobacterias y se determina el DNA, mediante reacción en cadena de la polimerasa, de mycobacterium tuberculosis, como causante del cuadro. DISCUSIÓN: El diagnóstico definitivo de TBC requiere el aislamiento en cultivo del bacilo de Koch, aunque en los casos de TBC genital, al ser una entidad paucibacilar, puede no resultar positivo. En éste caso, sería suficiente el diagnóstico de presunción basado en la sospecha clínica y el hallazgo histológico de granulomas. CONCLUSIÓN: La tuberculosis genital es una entidad poco frecuente en nuestro medio, aunque es una causa importante de infertilidad femenina y su predominio generalmente se subestima debido a la naturaleza paucisintomática de la misma. El diagnóstico temprano y el tratamiento multidisciplinar son fundamentales.


INTRODUCTION: Genital tuberculosis (TB) is a relatively rare afection in women. It mainly affects women younger than 40 years, and the most frequent reason for consultation is sterility, therefore early diagnosis is important. CLINICAL CASE: We presented the case of a patient with chronic pelvic pain who comes to our consultations. During the study, we take an endometrial biopsy diagnosing the presence of non-necrotizing granulomas. Finally, we determined the mycobacterium tuberculosis DNA through the polymerase chain reaction and positive microbiological culture, as the cause of pathology. DISCUSSION: The definitive diagnosis of TB requires the isolation in culture of the Koch bacillus, although in genital TB cases, as it is a paucibacillary entity, it may not be positive. In this case, the presumptive diagnosis based on clinical suspicion and the histological granulomas would be enough. CONCLUSIONS: Genital tuberculosis is a rare entity in our environment, although it is an important cause of female infertility and its prevalence is generally underestimated due to its paucisymptomatic nature. Early diagnosis and multidisciplinary treatment are essential.


Subject(s)
Humans , Female , Aged , Tuberculosis, Female Genital/complications , Tuberculosis, Female Genital/diagnosis , Endometritis/etiology , Tuberculosis, Female Genital/microbiology , Tuberculosis, Female Genital/pathology , Tuberculosis, Female Genital/drug therapy , Postmenopause , Pelvic Pain/etiology , Granuloma/etiology , Infertility, Female , Mycobacterium tuberculosis/isolation & purification , Antitubercular Agents/therapeutic use
7.
An. bras. dermatol ; 95(3): 343-346, May-June 2020. graf
Article in English | ColecionaSUS, LILACS, ColecionaSUS | ID: biblio-1130895

ABSTRACT

Abstract Cutaneous tuberculosis is a rare extrapulmonary manifestation of tuberculosis which, like disseminated tuberculosis, commonly occurs in immunocompromised patients. Poncet reactive arthritis is a seronegative arthritis affecting patients with extrapulmonary tuberculosis, which is uncommon even in endemic countries. We report a previously healthy 23-year-old male patient with watery diarrhea associated with erythematous ulcers on the lower limbs and oligoarthritis of the hands. Histopathological examination of the skin showed epithelioid granulomatous process with palisade granulomas and central caseous necrosis. AFB screening by Ziehl-Neelsen staining showed intact bacilli, the culture was positive for Mycobacterium tuberculosis, and colonoscopy revealed multiple shallow ulcers. Disseminated tuberculosis associated with reactive Poncet arthritis was diagnosed, with an improvement of the clinical and skin condition after appropriate treatment.


Subject(s)
Humans , Male , Young Adult , Tuberculosis, Cutaneous/immunology , Tuberculosis, Cutaneous/pathology , Immunocompromised Host , Arthritis, Reactive/immunology , Immunocompetence , Pyrazinamide/therapeutic use , Rifampin/therapeutic use , Skin Ulcer/immunology , Skin Ulcer/pathology , Skin Ulcer/drug therapy , Tuberculosis, Cutaneous/drug therapy , Treatment Outcome , Ethambutol/therapeutic use , Isoniazid/therapeutic use , Mycobacterium tuberculosis/isolation & purification , Antitubercular Agents/therapeutic use
8.
Rev. chil. enferm. respir ; 36(2): 100-108, jun. 2020. tab
Article in Spanish | LILACS | ID: biblio-1138541

ABSTRACT

INTRODUCCIÓN: La resistencia antibiótica y una inadecuada adherencia terapéutica son fenómenos que favorecen la proliferación de la tuberculosis. Los cambios sociodemográficos nos desafían a conocer la realidad actual de la enfermedad a través de antecedentes que nos permitan contextualizar un nuevo escenario. OBJETIVO: Caracterizar el perfil biopsicosocial del paciente con tuberculosis y su relación con la adherencia terapéutica. MATERIAL Y MÉTODO: Estudio descriptivo, transversal, correlacional. Muestra de 90 pacientes tratados en 35 Centros de Salud Familiar de los Servicios de Salud de Iquique, Metropolitano Norte, Concepción y Reloncaví. RESULTADOS: los componentes biopsicosociales como edad, antecedentes de enfermedad mental, autoestima, situación sentimental, pertenencia a grupos de riesgo, alcoholismo, drogadicción y situación de calle presentaron una relación estadísticamente significación con la adherencia terapéutica. CONCLUSIONES: La caracterización biopsicosocial del paciente con tuberculosis visibiliza nuevos factores relacionados con la adherencia que deben ser considerados para una atención interdisciplinaria.


BACKGROUND: Antibiotic resistance and inadequate therapeutic adherence are phenomena that promote the proliferation of tuberculosis. Sociodemographic changes challenge us to know the real situation of the disease and allows us to contextualize a new scenario. OBJECTIVE: To characterize the biopsychosocial profile of the patient with tuberculosis and its relationship to therapeutic adherence. MATERIAL AND METHOD: Descriptive, cross-sectional, correlational study. Sample of 90 patients treated at 35 Family Health Centers from the following Chilean Public Health Services: Iquique, Metropolitan northern (Santiago), Concepción and Reloncaví. RESULTS: Biopsychosocial components such as age, history of mental illness, self-esteem, sentimental status, belonging to risk groups, alcoholism, drug addiction and homeless situation presented a statistically significant relationship with therapeutic adherence. CONCLUSIONS: The biopsychosocial characterization of the TB patient evidence a new adherence-related factors that should be considered for interdisciplinary care.


Subject(s)
Humans , Male , Female , Adult , Tuberculosis/psychology , Tuberculosis/drug therapy , Medication Adherence/psychology , Treatment Adherence and Compliance/psychology , Self Concept , Socioeconomic Factors , Risk Groups , Homeless Persons , Chile , Family Health , Cross-Sectional Studies , Surveys and Questionnaires , Substance-Related Disorders/psychology , Drug Resistance, Bacterial , Alcoholism/psychology , Medication Adherence/statistics & numerical data , Treatment Adherence and Compliance/statistics & numerical data , Correlation of Data , Antitubercular Agents/therapeutic use
9.
Mem. Inst. Oswaldo Cruz ; 115: e200229, 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1135249

ABSTRACT

Malaria and tuberculosis are no longer considered to be neglected diseases by the World Health Organization. However, both are huge challenges and public health problems in the world, which affect poor people, today referred to as neglected populations. In addition, malaria and tuberculosis present the same difficulties regarding the treatment, such as toxicity and the microbial resistance. The increase of Plasmodium resistance to the available drugs along with the insurgence of multidrug- and particularly tuberculosis drug-resistant strains are enough to justify efforts towards the development of novel medicines for both diseases. This literature review provides an overview of the state of the art of antimalarial and antituberculosis chemotherapies, emphasising novel drugs introduced in the pharmaceutical market and the advances in research of new candidates for these diseases, and including some aspects of their mechanism/sites of action.


Subject(s)
Humans , Tuberculosis/drug therapy , Malaria/drug therapy , Antimalarials/therapeutic use , Antitubercular Agents/therapeutic use , Tuberculosis/diagnosis , Neglected Diseases , Malaria/diagnosis
10.
Rev. saúde pública (Online) ; 54: 67, 2020. tab, graf
Article in English | LILACS, BBO | ID: biblio-1127231

ABSTRACT

ABSTRACT OBJECTIVES To calculate the rate of tuberculosis cases per prison unit in Espírito Santo; present the individual, clinical, and institutional characteristics of the cases in persons deprived of liberty (PPL); and analyze the association between these characteristics and treatment outcome in this population. METHODS The study included cases of tuberculosis in the PPL of Espírito Santo from 2014 to 2016. Rate calculation, descriptive analysis and hierarchical logistic regression were performed considering the individual, clinical and institutional levels. RESULTS The rate of diagnosed cases per prison unit in the state ranged from 0 to 17.3 cases per 1,000 inmates. Of all reported cases, 218 (72.6%) healed, 21 (7.0%) dropped out, 1 (0.3%) died of tuberculosis, 2 (0.7%) died from other causes, 56 (18.7%) transferred the treatment site and 2 (0.7%) developed drug-resistant tuberculosis. The adjusted analysis showed that supervised treatment ensures success (CR = 0.29; 95%CI 0.01-0.76). CONCLUSIONS The study highlighted the importance of knowing the TB treatment outcome in the PPL to implement measures to reduce failure, and the contribution of supervised treatment in this process.


RESUMO OBJETIVOS Calcular a taxa de casos diagnosticados com tuberculose por unidades prisionais do Espírito Santo, apresentar as características individuais, clínicas e institucionais dos casos na população privada de liberdade (PPL) do ES e analisar a associação entre essas características e o encerramento do tratamento da tuberculose nessa população. MÉTODOS A população de estudo foram os casos de tuberculose na PPL do ES de 2014 a 2016. Realizou-se o cálculo de taxa, a análise descritiva e a regressão logística hierarquizada considerando os níveis individual, clínico e institucional. RESULTADOS A taxa de casos diagnosticados por unidade prisional no estado variou de 0 a 17,3 casos por 1.000 presos. Do total de casos notificados, 218 (72,6%) se curaram, 21 (7,0%) abandonaram o tratamento, 1 (0,3%) morreu por tuberculose, 2 (0,7%) morreram por outras causas, 56 (18,7%) transferiram o local de tratamento e 2 (0,7%) desenvolveram tuberculose drogarresistente. A análise ajustada mostrou que o tratamento supervisionado é um fator protetor para o insucesso (RC = 0,29; IC95% 0,01-0,76). CONCLUSÕES O estudo apontou a importância do conhecimento do desfecho do tratamento da TB na PPL visando à implementação de ações para a redução do insucesso, bem como a contribuição do tratamento supervisionado nesse processo.


Subject(s)
Humans , Male , Female , Adult , Prisons , Prisoners/statistics & numerical data , Tuberculosis/drug therapy , Health Services Accessibility , Antitubercular Agents/therapeutic use , Tuberculosis/diagnosis , Tuberculosis/epidemiology , Brazil , Treatment Outcome , Tuberculosis, Multidrug-Resistant , Freedom
11.
J. bras. pneumol ; 46(6): e20190345, 2020. tab
Article in Portuguese | LILACS | ID: biblio-1134909

ABSTRACT

RESUMO Objetivo Avaliar características clínicas, tomográficas e microbiológicas dos pacientes com doença pulmonar causada pela M. kansasii (DPMK) atendidos em unidade ambulatorial no período 2006-2016. Métodos Estudo descritivo, em que foram analisados 38 pacientes. Foram analisadas as características demográficas, clínico-radiológicas, laboratoriais e terapêuticas. Resultados A média de idade foi 64 anos (DP=10,6; IIQ=57-72; mediana=65,0) e 22 (57,9%) eram pacientes do sexo masculino. Comorbidade pulmonar estava presente em 89,5%. A comorbidade mais frequente foi a bronquiectasia (78,9%). Tratamento anterior para tuberculose pulmonar (TBP) foi relatado em 65,9%. O esquema terapêutico mais utilizado foi rifampicina, isoniazida e etambutol (44,7%). A tomografia de tórax (TCT) mostrou bronquiectasia (94,1%), distorção arquitetural (76,5%), espessamento de septo (67,6%) e cavidades (64,7%). A doença foi bilateral em 85,2%. Houve 10,7% de resistência à rifampicina, 67,9% resistentes ao etambutol e sensibilidade à claritromicina. Conclusão Em pacientes com doença pulmonar estrutural, é importante a busca de DPMNT, principal diagnóstico diferencial com TBP. TC de tórax demonstra diferentes padrões que se sobrepõem ao de doença estrutural causada por TBP ou outras enfermidades pulmonares. Destaca-se a resistência ao etambutol, fármaco componente do esquema preconizado.


ABSTRACT Objective To evaluate clinical, tomographic, and microbiological characteristics of pulmonary disease caused by M. kansasii (MKPD) in patients treated at an outpatient unit from 2006-2016. Methods We studied thirty eight patients, and analyzed socio-demographic, clinical-radiological, laboratory, and therapeutic characteristics. Results The mean age was 64 years (SD = 10.6; IIQ = 57-72; median = 65.0), and 22 (57.9%) male patients. Pulmonary comorbidity was present in 89.5% of the patients. The most frequent comorbidity was bronchiectasis (78.9%). Previous treatment for pulmonary tuberculosis (PTB) was found in 65.9%. The most used therapeutic regimen was rifampicin, isoniazid and ethambutol (44.7%). Chest tomography (CT) showed bronchiectasis (94.1%), architectural distortion (76.5%), septum thickening (67.6%), and cavities (64.7%). Disease was bilateral in 85.2%. We observed 10.7% resistance to rifampicin, 67.9% resistance to ethambutol, and sensitivity to clarithromycin. Conclusion In patients with structural lung disease, it is important to search for NTM, the main differential diagnosis with PTB. Chest CT showed different patterns that overlapped with structural disease caused by PTB or other lung diseases. We observed resistance to ethambutol, a drug component of the recommended regimen.


Subject(s)
Humans , Male , Female , Middle Aged , Mycobacterium kansasii/isolation & purification , Lung/diagnostic imaging , Lung Diseases/drug therapy , Mycobacterium Infections, Nontuberculous/drug therapy , Mycobacterium Infections, Nontuberculous/epidemiology , Antitubercular Agents/therapeutic use , Rifampin/therapeutic use , Brazil/epidemiology , Drug Resistance, Microbial , Tomography, X-Ray Computed , Treatment Outcome , Ethambutol/therapeutic use , Isoniazid/therapeutic use , Lung Diseases/microbiology , Mycobacterium Infections, Nontuberculous/diagnosis
12.
J. bras. pneumol ; 46(5): e20200015, 2020.
Article in English | LILACS | ID: biblio-1134895

ABSTRACT

ABSTRACT The epidemiological relevance of tuberculosis is directly related to the socioeconomic profile of a given country. Vulnerability to tuberculosis is influenced by biological factors (e.g., malnutrition, HIV infection, and age) and social factors (e.g., unhealthy housing, high population density, inappropriate working conditions, and lack of access to health services). In many cases, multiple vulnerabilities occur in conjunction. We propose here a reflection on tuberculosis from the point of view of the social determinants of health, as well as the costs associated with its diagnosis and treatment in Brazil, based not only on data in the international literature but also on evidence related to the national context. Given the magnitude of tuberculosis as a socially mediated disease, there is an evident need for greater involvement of health professionals and of the scientific community to implement relevant operational and research measures to understand the social conditions influencing the health-illness continuum for tuberculosis patients. Although the recent economic crisis in Brazil has contributed to increased mortality from all causes, including tuberculosis, health and social protection expenditures have mitigated detrimental health effects. The evidence presented here underscores the importance of public social protection policies for minimizing the effects of tuberculosis indicators, with the aim of eliminating tuberculosis in Brazil.


RESUMO A relevância epidemiológica da tuberculose está diretamente relacionada ao perfil socioeconômico dos países. A vulnerabilidade à tuberculose é influenciada por fatores biológicos, como desnutrição, infecção por HIV ou faixa etária, e fatores sociais, como habitações insalubres, alta densidade demográfica, condições de trabalho inadequadas e inacessibilidade aos serviços de saúde; porém, muitas vezes essas vulnerabilidades se somam. Propomos aqui uma reflexão sobre a tuberculose sob o ponto de vista dos determinantes sociais de saúde e dos custos associados ao seu diagnóstico e tratamento, baseando-nos não somente em dados publicados na literatura internacional, mas também nas evidências já presentes no panorama nacional. Considerando a magnitude da tuberculose como doença socialmente produzida, fica evidente a necessidade de maior envolvimento de profissionais de saúde e da comunidade científica no sentido de implementar medidas operacionais e de investigação relevantes para a compreensão dos condicionantes sociais do processo saúde-doença na tuberculose. A recente crise econômica pela qual passa o Brasil contribuiu para o aumento da mortalidade por todas as causas, incluindo por tuberculose; porém, investimentos em saúde e proteção social reduziram os danos à saúde. Essas evidências reforçam a importância de políticas públicas de proteção social para a redução dos indicadores da tuberculose visando sua eliminação no Brasil.


Subject(s)
Humans , Tuberculosis/economics , Catastrophic Illness/economics , Delivery of Health Care/economics , Social Determinants of Health , Tuberculosis/diagnosis , Tuberculosis/drug therapy , Tuberculosis/epidemiology , Brazil/epidemiology , Health Care Costs , Cost of Illness , Costs and Cost Analysis , Antitubercular Agents/therapeutic use
13.
J. bras. pneumol ; 46(2): e20190290, 2020. tab, graf
Article in English | LILACS | ID: biblio-1134862

ABSTRACT

ABSTRACT Over the years, various recommendations have been made in pursuit of controlling resistance to antituberculosis drugs, especially multidrug resistance, in Brazil. Given the importance of standardizing those recommendations, the aim of this study was to describe the main recommendations of the Brazilian guidelines, primarily those related to the treatment and follow-up of cases of tuberculosis. From August through October of 2018, a document search was conducted via the websites of the Brazilian National Ministry of Health, the Brazilian National Tuberculosis Control Program, the JBP, and the Official Gazette of the Federal Republic of Brazil. Data were collected systematically by using a protocol designed specifically for this study. Documents published between 2004 and 2018 were selected. It was possible to understand and trace the history of the measures for the control of multidrug-resistant tuberculosis in Brazil from 2004, when the first documents related to the disease were published, up to 2018, when the second edition of the Brazilian National Guidelines for the Control of Tuberculosis was published. The contents of the documents were analyzed and grouped by case definition, diagnostic criteria, treatment, use of directly observed treatment; mechanisms of social protection for patients; data tools; and organization of care. This analysis allowed us to understand the efforts towards standardizing some measures in Brazil, not only identifying advances in the alignment with international prerogatives (case definition, incorporation of diagnostic technology, and treatment regimens) but also underscoring the need for greater clarity regarding the mechanisms of social protection and the organization of the care provided via the Brazilian health care system.


RESUMO No Brasil, algumas recomendações têm sido feitas ao longo dos anos em busca de controlar a resistência às drogas antituberculose, em especial a multirresistência. Tendo em vista a importância dessa normatização, o objetivo do presente estudo foi descrever os elementos centrais dos documentos nacionais, especialmente em relação ao tratamento e acompanhamento dos casos. Entre agosto e outubro de 2018, foi realizada uma pesquisa documental, com busca eletrônica nos sites do Ministério da Saúde, Programa Nacional de Controle da Tuberculose, JBP e Diário Oficial da União. A coleta de dados ocorreu de forma sistematizada com roteiro construído para esta pesquisa. Os documentos foram publicados entre 2004 e 2018. Foi possível entender e traçar o histórico das medidas de controle da tuberculose multirresistente no Brasil a partir de 2004, com as primeiras publicações referentes à doença, até 2018, quando ocorreu a publicação da segunda edição do Manual de Recomendações para o Controle da Tuberculose no Brasil. Os conteúdos dos documentos foram analisados e agrupados quanto a definição de caso, critérios diagnósticos, tratamento, condução do tratamento diretamente observado, mecanismos de proteção social aos doentes, ferramentas de informação e organização da assistência. Tal análise permitiu compreender os esforços no sentido da padronização de algumas condutas no território nacional, identificando avanços quanto ao alinhamento com as prerrogativas internacionais (definição de caso, incorporação de tecnologia diagnóstica e esquemas de tratamento); porém, evidenciou-se a necessidade de maior clareza quanto aos mecanismos de proteção social e à organização da assistência no sistema de saúde nacional.


Subject(s)
Humans , Practice Guidelines as Topic , Tuberculosis, Multidrug-Resistant/drug therapy , Antitubercular Agents/therapeutic use , Brazil
14.
J. bras. pneumol ; 46(2): e20180386, 2020. tab
Article in English | LILACS | ID: biblio-1090807

ABSTRACT

ABSTRACT Objective: To evaluate the risk factors for the development of tuberculosis and multidrug-resistant tuberculosis (MDR-TB) in patients treated at a tertiary referral hospital. Methods: This was a cross-sectional study based on data obtained from patients treated at the Júlia Kubitschek Hospital, located in the city of Belo Horizonte, Brazil, between October of 2012 and October of 2014. We evaluated sociodemographic, behavioral, clinical, and radiological variables. The outcome considered to identify associations between tuberculosis and the explanatory variables was the treatment prescribed. To evaluate the associations between MDR-TB and the same explanatory variables, the change in MDR-TB treatment was considered. Results: The factors associated with tuberculosis were alcoholism, comorbidities, pulmonary cavitations, and a radiological pattern suggestive of tuberculosis. Cavitation and previous treatment for tuberculosis were associated with MDR-TB. Conclusions: Despite the significant progress made in the fight against tuberculosis, there is a need for coordinated actions that include social protection measures and patient support.


RESUMO Objetivo: Avaliar os fatores de risco de pacientes atendidos em um hospital de referência terciária para o desenvolvimento de tuberculose e tuberculose multirresistente (TBMR). Métodos: Estudo transversal baseado em dados obtidos de pacientes atendidos no Hospital Júlia Kubitschek, na cidade de Belo Horizonte (MG), entre outubro de 2012 e outubro de 2014. As variáveis utilizadas foram agrupadas em características sociodemográficas, comportamentais, clínicas e radiológicas. O desfecho considerado para verificar associações entre tuberculose e variáveis explicativas foi o tratamento prescrito para tuberculose. Para avaliar a associação entre a tuberculose resistente e as mesmas variáveis explicativas considerou-se a mudança de tratamento para TBMR. Resultados: Alcoolismo, padrão radiológico sugestivo de tuberculose, presença de comorbidades e presença de cavitações pulmonares foram fatores associados à tuberculose. A TBMR foi associada a tratamento prévio para tuberculose e presença de cavitações. Conclusões: Apesar dos importantes progressos na luta contra a tuberculose, é necessário um conjunto de ações articuladas que incluam medidas de proteção social e suporte aos pacientes.


Subject(s)
Humans , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Multidrug-Resistant/drug therapy , Mycobacterium tuberculosis/drug effects , Antitubercular Agents/pharmacology , Tuberculosis, Pulmonary/microbiology , Tuberculosis, Pulmonary/epidemiology , Brazil/epidemiology , Microbial Sensitivity Tests , Cross-Sectional Studies , Tuberculosis, Multidrug-Resistant/diagnosis , Tuberculosis, Multidrug-Resistant/epidemiology , Tertiary Care Centers , Antitubercular Agents/therapeutic use
15.
J. bras. pneumol ; 46(2): e20180198, 2020. tab
Article in English | LILACS | ID: biblio-1090801

ABSTRACT

ABSTRACT Objective: To compare patients with and without previous lung disease, in terms of the spirometry results after they had been treated for pulmonary tuberculosis (PTB) and cured, as well as to analyze risk factors related to functional severity. Methods: This was a cross-sectional, multicenter study conducted at four referral centers in Brazil. Patients were divided into two groups: those with a history of lung disease or smoking (LDS+ group); and those with no such history (LDS− group). Patients underwent spirometry (at least six months after being cured). Sociodemographic and clinical data were collected. Results: A total of 378 patients were included: 174 (46.1%) in the LDS+ group and 204 (53.9%) in the LDS− group. In the sample as a whole, 238 patients (62.7%) had spirometric changes. In the LDS+ group, there was a predominance of obstructive lung disease (in 33.3%), whereas restrictive lung disease predominated in the LDS− group (in 24.7%). Radiological changes were less common in the LDS− group than in the LDS+ group (p < 0.01), as were functional changes (p < 0.05). However, of the 140 (79.1%) LDS− group patients with a normal or minimally altered chest X-ray, 76 (54%) had functional changes (p < 0.01). The risk factors associated with functional severity in the LDS− group were degree of dyspnea (p = 0.03) and moderate or severe radiological changes (p = 0.01). Conclusions: Impaired pulmonary function is common after treatment for PTB, regardless of the history of lung disease or smoking. Spirometry should be suggested for patients who develop moderate/severe dyspnea or relevant radiological changes after treatment for PTB.


RESUMO Objetivo: Comparar os resultados da espirometria de pacientes tratados e curados para tuberculose pulmonar (TBP) com e sem doença pulmonar prévia e analisar os fatores de risco relacionados à gravidade funcional. Métodos: Estudo transversal, multicêntrico, em quatro centros de referência no Brasil. Os pacientes foram classificados em dois grupos: grupo com doença pulmonar prévia ou história de tabagismo (grupo DPT+) e grupo sem doença pulmonar prévia e sem tabagismo (grupo DPT−). Os pacientes realizaram espirometria (pelo menos seis meses após a cura), e foram coletados dados sociodemográficos e clínicos. Resultados: Foram incluídos 378 pacientes: 174 (46,1%) no grupo DPT+ e 204 (53,9%) no grupo DPT−. Na amostra total, 238 pacientes (62,7%) apresentaram alguma alteração espirométrica. No grupo DPT+ houve predominância de distúrbio ventilatório obstrutivo (em 33,3%), e distúrbio ventilatório restritivo predominou no grupo DPT− (em 24,7%). Quando comparados com o grupo DPT+, os pacientes do grupo DPT− apresentaram menos frequentemente alteração radiológica (p < 0,01) e funcional (p < 0,05). Porém, dos 140 (79,1%) do grupo DPT− com radiografia de tórax normal ou minimamente alterada, 76 (54%) apresentaram alguma alteração funcional (p < 0,01). Os fatores de risco relacionados com a gravidade funcional no grupo DPT− foram grau de dispneia (p = 0,03) e alterações radiológicas moderadas ou acentuadas. Conclusões: O comprometimento da função pulmonar é frequente após o tratamento da TBP independentemente do histórico de tabagismo ou doença pulmonar prévia. A espirometria deve ser sugerida para esses pacientes que evoluem com grau moderado/grave de dispneia e/ou alteração radiológica relevante após o tratamento da TBP.


Subject(s)
Humans , Spirometry/statistics & numerical data , Tuberculosis, Pulmonary/complications , Tuberculosis, Pulmonary/drug therapy , Lung/physiopathology , Lung Diseases/diagnosis , Antitubercular Agents/therapeutic use , Respiratory Function Tests/methods , Tuberculosis, Pulmonary/diagnostic imaging , Severity of Illness Index , Brazil , Smoking/adverse effects , Case-Control Studies , Cross-Sectional Studies , Lung/microbiology , Lung/diagnostic imaging , Lung Diseases/physiopathology
16.
J. bras. pneumol ; 46(2): e20200009, 2020. tab
Article in English | LILACS | ID: biblio-1090798

ABSTRACT

ABSTRACT Given the global burden of tuberculosis, shortened treatment regimens with existing or repurposed drugs are needed to contribute to tuberculosis control. The long duration of treatment of drug-susceptible tuberculosis (DS-TB) is associated with nonadherence and loss to follow up, and the treatment success rate of multidrug-resistant tuberculosis (MDR-TB) is low (approximately 50%) with longer regimens. In this review article, we report recent advances and ongoing clinical trials aimed at shortening regimens for DS-TB and MDR-TB. We discuss the role of high-dose rifampin, as well as that of clofazimine and linezolid in regimens for DS-TB. There are at least 5 ongoing clinical trials and 17 observational studies and clinical trials evaluating shorter regimens for DS-TB and MDR-TB, respectively. We also report the results of observational studies and clinical trials evaluating a standardized nine-month moxifloxacin-based regimen for MDR-TB. Further studies, especially randomized clinical trials, are needed to evaluate regimens including newer drugs, drugs proven to be or highly likely to be efficacious, and all-oral drugs in an effort to eliminate the need for injectable drugs.


RESUMO Em virtude da carga global da tuberculose, esquemas mais curtos de tratamento com medicamentos já existentes ou reaproveitados são necessários para contribuir para o controle da doença. A longa duração do tratamento da tuberculose sensível (TBS) está relacionada com não adesão e perda de seguimento, e a taxa de sucesso do tratamento da tuberculose multirresistente (TBMR) é baixa (de aproximadamente 50%) com esquemas mais longos. Neste artigo de revisão, relatamos avanços recentes e ensaios clínicos em andamento cujo objetivo é encurtar os esquemas de tratamento de TBS e TBMR. Discutimos o papel da rifampicina em altas doses, assim como o da clofazimina e linezolida em esquemas de tratamento de TBS. Relatamos também os resultados de estudos observacionais e ensaios clínicos de avaliação de um esquema padronizado de nove meses à base de moxifloxacina para o tratamento de TBMR. Mais estudos, especialmente ensaios clínicos randomizados, são necessários para avaliar esquemas que incluam medicamentos mais novos, medicamentos comprovadamente ou provavelmente eficazes e medicamentos exclusivamente orais na tentativa de dispensar o uso de medicamentos injetáveis.


Subject(s)
Humans , Tuberculosis/drug therapy , Tuberculosis, Multidrug-Resistant/drug therapy , Antitubercular Agents/therapeutic use , Rifampin/therapeutic use , Clinical Protocols , Clinical Trials as Topic , Clofazimine/therapeutic use , Linezolid/therapeutic use
18.
Mem. Inst. Oswaldo Cruz ; 115: e200520, 2020. tab, graf
Article in English | LILACS | ID: biblio-1154871

ABSTRACT

BACKGROUND The evaluation of procedures for drug susceptibility prediction of Mycobacterium tuberculosis based on genomic data against the conventional reference method test based on culture is realistic considering the scenario of growing number of tools proposals based on whole-genome sequences (WGS). OBJECTIVES This study aimed to evaluate drug susceptibility testing (DST) outcome based on WGS tools and the phenotypic methods performed on isolates of M. tuberculosis Lineage 1 from the state of Pará, Brazil, generally associated with low levels of drug resistance. METHODOLOGY Culture based DST was performed using the Proportion Method in Löwenstein-Jensen medium on 71 isolates that had been submitted to WGS. We analysed the seven main genome sequence-based tools for resistance and lineage prediction applied to M. tuberculosis and for comparison evaluation we have used the Kappa concordance test. FINDINGS When comparing the WGS-based tools against the DST, we observed the highest level of agreement using TB-profiler. Among the tools, TB-profiler, KvarQ and Mykrobe were those which identified the largest number of TB-MDR cases. Comparing the four most sensitive tools regarding resistance prediction, agreement was observed for 43 genomes. MAIN CONCLUSIONS Drug resistance profiling using next-generation sequencing offers rapid assessment of resistance-associated mutations, therefore facilitating rapid access to effective treatment.


Subject(s)
Humans , Tuberculosis, Multidrug-Resistant/genetics , Drug Resistance, Multiple, Bacterial/genetics , Mycobacterium tuberculosis/drug effects , Mycobacterium tuberculosis/genetics , Antitubercular Agents/pharmacology , Brazil , Pharmaceutical Preparations , Microbial Sensitivity Tests , Tuberculosis, Multidrug-Resistant/drug therapy , Drug Resistance, Multiple, Bacterial/drug effects , Whole Genome Sequencing , Mycobacterium tuberculosis/isolation & purification , Antitubercular Agents/therapeutic use
19.
Rev. Soc. Bras. Med. Trop ; 53: e20190284, 2020. graf
Article in English | LILACS | ID: biblio-1057285

ABSTRACT

Abstract Tuberculosis is one of the most common infections worldwide with particularly high incidence rates in countries with unfavorable socioeconomic conditions and among persons with impaired immune systems. While most patients with this disease will present with pulmonary tuberculosis, immunocompromised individuals also commonly present with extrapulmonary manifestations. We report the case of a 28-year-old male patient with end-stage renal disease who presented with long-standing systemic symptoms and genitourinary manifestations, who was diagnosed with urogenital tuberculosis both by clinical and microbiologic criteria. Clinicians should always suspect tuberculosis in patients with chronic symptoms, especially in those with immunosuppression.


Subject(s)
Humans , Male , Tuberculosis, Urogenital/diagnosis , Kidney Failure, Chronic/complications , Tuberculosis, Urogenital/complications , Tuberculosis, Urogenital/drug therapy , Immunocompromised Host , Antitubercular Agents/therapeutic use
20.
Braz. j. infect. dis ; 23(6): 381-387, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1089317

ABSTRACT

ABSTRACT Setting: Treatment of tuberculosis (TB) can result in Drug-Induced Liver Injury (DILI) since hepatotoxic metabolites are formed during the biotransformation of isoniazid (INH).DILI can be related to the genetic profile of the patient. Single nucleotide polymorphisms in the CYP2E1 gene and GSTM1 and GSTT1 deletion polymorphisms have been associated with adverse events caused by INH. Objective: To characterize the genetic polymorphisms of CYP2E1, GSTT1 and GSTM1 in TB carriers. Design: This is an observational prospective cohort study of 45 patients undergoing treatment of TB. PCR-RFLP and multiplex-PCR were used. Results: The distribution of genotypic frequency in the promoter region (CYP2E1 gene) was: 98% wild genotype and 2% heterozygous. Intronic region: 78% wild genotype; 20% heterozygous and 2% homozygous variant. GST enzyme genes: 24% Null GSTM1 and 22% Null GSTT1. Patients with any variant allele of the CYP2E1 gene were grouped in the statistical analyses. Conclusion: Patients with the CYP2E1 variant genotype or Null GSTT1 showed higher risk of presenting DILI (p = 0.09; OR: 4.57; 95% CI: 0.75-27.6). Individuals with both genotypes had no increased risk compared to individuals with one genotype.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Tuberculosis, Pulmonary/drug therapy , Genetic Predisposition to Disease/genetics , Chemical and Drug Induced Liver Injury/genetics , Antitubercular Agents/adverse effects , Polymorphism, Genetic , Tuberculosis, Pulmonary/enzymology , Prospective Studies , Cytochrome P-450 CYP2E1 , Cytochrome P-450 Enzyme System/genetics , Chemical and Drug Induced Liver Injury/enzymology , Cytochrome P450 Family 2 , Genotype , Liver/drug effects , Liver/enzymology , Antitubercular Agents/therapeutic use
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