Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 129
Filter
1.
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
2.
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
3.
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
4.
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
5.
Braz. arch. biol. technol ; 63: e20190179, 2020. tab, graf
Article in English | LILACS | ID: biblio-1132181

ABSTRACT

Abstract (1) Background: The Commercial Kit SIRE Nitratase® PlastLabor, is a drug susceptibility test kit used to detect Mycobacterium tuberculosis resistance to first-line TB treatment drugs. The present study aimed at evaluating its performance in a multicenter study. (2) Methods: To determine its accuracy, the proportion methods in Lowenstein Jensen medium or the BACTECTMMGITTM960 system was used as a gold standard. (3) Results: The study revealed that the respective accuracies of the kit with 190 M. tuberculosis clinical isolates, using the proportion methods in Lowenstein Jensen medium or BACTECTMMGITTM960 system as a gold standard, were 93.9% and 94.6%, 96.9% and 94.6%, 98.0% and 97.8%, and 98.0% and 98.9%, for streptomycin, isoniazid, rifampicin, and ethambutol, respectively. (4) Conclusion: Thus, the kit can rapidly screen resistance to streptomycin, isoniazid, rifampicin, and ethambutol. Additionally, it does not require sophisticated equipment; hence, it can be easily used in the laboratories of low and middle income countries.


Subject(s)
Humans , Tuberculosis, Multidrug-Resistant/microbiology , Antibiotics, Antitubercular/pharmacology , Mycobacterium tuberculosis/isolation & purification , Mycobacterium tuberculosis/drug effects , Microbial Sensitivity Tests , Multicenter Studies as Topic , Sensitivity and Specificity , Tuberculosis, Multidrug-Resistant/drug therapy , Antibiotics, Antitubercular/classification
6.
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
7.
Mem. Inst. Oswaldo Cruz ; 115: e200215, 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1135232

ABSTRACT

The human-adapted strains of the Mycobacterium tuberculosis complex (MTBC) comprise seven phylogenetic lineages originally associated with their geographical distribution. Here, we report the genomes of three drug-resistant clinical isolates of the Latin American-Mediterranean (LAM) family collected in Kazakhstan. We utilised whole-genome sequencing to study the distribution and drug resistance of these isolates. Phylogenetic analysis grouped the genomes described in this study with the sequences from Russia, Uzbekistan, and Kazakhstan belonging to the LAM family. One isolate has acquired extensive drug resistance to seven antituberculosis drugs. Our results suggest at least two multi-drug resistant (MDR)/extensively drug-resistant (XDR)-associated genotypes of the LAM family circulate in Kazakhstan.


Subject(s)
Humans , Tuberculosis, Multidrug-Resistant/drug therapy , Drug Resistance, Multiple, Bacterial/drug effects , Mycobacterium tuberculosis/genetics , Antitubercular Agents/pharmacology , Phylogeny , Kazakhstan , Tuberculosis, Multidrug-Resistant/genetics , Genomics , Genotype , Latin America
8.
Rev. Soc. Bras. Med. Trop ; 53: e20190404, 2020. tab, graf
Article in English | LILACS, ColecionaSUS, SES-SP | ID: biblio-1136910

ABSTRACT

Abstract INTRODUCTION: We aimed to estimate the prevalence and transmission of drug-resistant tuberculosis in a high-burden Brazilian setting under directly observed therapy short-course strategy. METHODS: Isolates of culture-confirmed pulmonary tuberculosis patients from Guarulhos, Brazil, diagnosed in October 2007-2011 were subjected to drug susceptibility and IS6110-restriction fragment length polymorphism testing. RESULTS: The overall resistance prevalence was 11.5% and the multi-drug resistance rate was 4.2%. Twenty-six (43.3%) of 60 drug-resistant isolates were clustered. Epidemiological relationships were identified in 11 (42.3%) patients; 30.8% of the cases were transmitted in households. CONCLUSIONS: Drug-resistant tuberculosis was relatively low and transmitted in households and the community.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Tuberculosis, Multidrug-Resistant/epidemiology , Directly Observed Therapy/methods , Mycobacterium tuberculosis/drug effects , Polymorphism, Restriction Fragment Length , Brazil/epidemiology , Prevalence , Cross-Sectional Studies , Tuberculosis, Multidrug-Resistant , Tuberculosis, Multidrug-Resistant/drug therapy , Mycobacterium tuberculosis/genetics
9.
Rev. pesqui. cuid. fundam. (Online) ; 11(4): 962-967, jul.-set. 2019. tab
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1005814

ABSTRACT

Objetivos: Descrever as características dos casos de abandono do tratamento de tuberculose em pacientes que desenvolveram tuberculose multirresistente (TBMR). Métodos: Estudo descritivo de abordagem quantitativa, desenvolvido em uma instituição terciária de referência para tratamento de TBMR localizada na cidade do Rio de Janeiro. Foi utilizado instrumento estruturado com informações de quarenta prontuários entre os meses de agosto a dezembro de 2016. A análise dos dados foi realizada por meio do software SPSS. Resultados: Dos pacientes estudados, 35% abandonaram tratamento anterior de tuberculose. Conclusão e implicação para a prática: É necessária a identificação precoce de pacientes que apresentam maior risco para abandono do tratamento, bem como a criação de um modelo de assistência voltado ao perfil dos usuários que abandonam o tratamento, com uma prática participativa, com grupos educativos que promovam ações preventivas, identificando e estudando estratégias para a superação de barreiras ligadas à realidade de vida individual e coletiva


Objective: To describe the characteristics of cases of tuberculosis treatment abandonment in patients who developed MDR-TB. Methods: a descriptive study of a quantitative approach developed in a tertiary referral institution for the treatment of MDR-TB, located in the city of Rio de Janeiro. A structured instrument was used with information from forty medical records between August and December 2016. Data analysis was performed using SPSS software. Results: Of the patients studied, 35% abandoned previous treatment of tuberculosis. Conclusion and implication for the practice: early identification of patients who are at greater risk for treatment abandonment is required, as well as the creation of a model of assistance aimed at the profile of users who abandon treatment, with a participatory practice with educational groups That promote preventive actions, identifying, studying strategies for overcoming barriers linked to reality, individual and collective life


Objetivos: Describir las características de los casos de abandono del tratamiento de tuberculosis en pacientes que desarrollaron TBMR. Métodos: estudio descriptivo de abordaje cuantitativo, desarrollado en una institución terciaria de referencia para tratamiento de TBMR, ubicado en la ciudad de Río de Janeiro. Se utilizó instrumento estructurado con informaciones de cuarenta prontuarios entre los meses de agosto a diciembre de 2016. El análisis de los datos fue realizado a través del software SPSS. Resultados: de los pacientes estudiados, el 35% abandonó el tratamiento anterior de la tuberculosis.Conclusión e implicación para la práctica: es necesaria la identificación precoz de pacientes que presentan mayor riesgo para el abandono del tratamiento, así como la creación de un modelo de asistencia orientado al perfil de los usuarios que abandonan el tratamiento, con una práctica participativa, con grupos educativos Que promuevan acciones preventivas, identificando, estudiando estrategias para la superación de barreras ligadas a la realidad, de vida individual y colectiva


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Patient Dropouts/statistics & numerical data , Tuberculosis, Multidrug-Resistant/drug therapy , Tuberculosis, Multidrug-Resistant/therapy , Medication Adherence/statistics & numerical data
10.
Rev. saúde pública (Online) ; 53: 77, jan. 2019. tab, graf
Article in English | LILACS | ID: biblio-1043339

ABSTRACT

ABSTRACT OBJECTIVE to analyze the temporal trend, identify the factors related and elaborate a predictive model for unfavorable treatment outcomes for multidrug-resistant tuberculosis (MDR-TB). METHODS Retrospective cohort study with all cases diagnosed with MDR-TB between the years 2006 and 2015 in the state of São Paulo. The data were collected from the state system of TB cases notifications (TB-WEB). The temporal trend analyzes of treatment outcomes was performed through the Prais-Winsten analysis. In order to verify the factors related to the unfavorable outcomes, abandonment, death with basic cause TB and treatment failure, the binary logistic regression was used. Pictorial representations of the factors related to treatment outcome and their prognostic capacity through the nomogram were elaborated. RESULTS Both abandonment and death have a constant temporal tendency, whereas the failure showed it as decreasing. Regarding the risk factors for such outcomes, using illicit drugs doubled the odds for abandonment and death. Besides that, being diagnosed in emergency units or during hospitalizations was a risk factor for death. On the contrary, having previous multidrug-resistant treatments reduced the odds for the analyzed outcomes by 33%. The nomogram presented a predictive model with 65% accuracy for dropouts, 70% for deaths and 80% for failure. CONCLUSIONS The modification of the current model of care is an essential factor for the prevention of unfavorable outcomes. Through predictive models, as presented in this study, it is possible to develop patient-centered actions, considering their risk factors and increasing the chances for cure.


RESUMO OBJETIVO Analisar a tendência temporal, identificar os fatores relacionados e elaborar um modelo preditivo para os desfechos desfavoráveis do tratamento da tuberculose multidroga-resistente. MÉTODOS Estudo de coorte retrospectiva com todos os casos diagnosticados com tuberculose multidroga-resistente entre os anos de 2006 e 2015 no estado de São Paulo. Os dados secundários foram provenientes do sistema estadual de notificações de casos de tuberculose, o TBWeb. Foi realizada a análise de tendência temporal dos desfechos de tratamento por meio da regressão de Prais-Winsten. Para verificar os fatores relacionados com os desfechos desfavoráveis (óbito com tuberculose como causa básica, abandono e falência do tratamento), foi empregada a regressão logística binária. Representações pictóricas dos fatores relacionados ao desfecho do tratamento e sua capacidade prognóstica foram elaboradas por meio de nomogramas. RESULTADOS Tanto o abandono como o óbito tiveram tendência temporal estacionária, enquanto a falência apresentou tendência decrescente. Em relação aos fatores de risco para tais desfechos, utilizar drogas ilícitas dobrou as chances de abandono e óbito. Além disso, ser diagnosticado em unidades de urgência ou emergência ou durante internações hospitalares foi um fator de risco para o óbito. Ao contrário, ter feito tratamentos prévios da multidroga-resistência reduziu as chances dos desfechos analisados. O nomograma apresentou um modelo preditivo com precisão de 65% para os abandonos, 70% para os óbitos e 80% para a falência. CONCLUSÕES A prevenção de desfechos desfavoráveis no tratamento da tuberculose multidroga-resistente implica a modificação do modelo de atenção vigente. Utilizando modelos preditivos, como o apresentado neste estudo, torna-se possível elaborar ações centradas nos pacientes, considerando seus fatores de risco e aumentando as chances de cura.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Brazil/epidemiology , Tuberculosis, Multidrug-Resistant/mortality , Tuberculosis, Multidrug-Resistant/drug therapy , Time Factors , Illicit Drugs/adverse effects , Logistic Models , Retrospective Studies , Risk Factors , Mortality/trends , Treatment Failure , Risk Assessment , Nomograms , Middle Aged
11.
J. bras. pneumol ; 45(2): e20180075, 2019. tab, graf
Article in English | LILACS | ID: biblio-990112

ABSTRACT

ABSTRACT Objective: To identify transmitted or primary resistance among cases of multidrug-resistant tuberculosis and predictive factors for cure in multidrug-resistant tuberculosis after the first treatment. Method: Descriptive study of a cohort from 2006 to 2010, in a reference unit of tuberculosis in São Paulo, Brazil. The data were obtained by the revision of medical records. Clinical criteria were used to classify transmitted and acquired resistance. Extended primary resistance was also defined, in this study, as cases initially treated with a standardized scheme, but with no therapeutic success, and the pre-treatment drug susceptibility test (DST) showed presence of resistance. Results: 156 patients with multidrug-resistant tuberculosis and their respective sputum samples were eligible for the study. Only 7% of the patients were positive for the human immunodeficiency virus (HIV). Previous treatment occurred in 95% of the sample. The cure rate after the first treatment was 54%. The median bacteriological conversion time of those who healed was one month. Bacillary resistance was considered acquired resistance in 100 (64%) and transmitted resistance in 56 (36%). By logistic regression, patients who presented primary multidrug-resistant tuberculosis (odds ratio-OR = 6,29), without comorbidity (OR = 3,37) and with higher initial weight (OR = 1.04) were associated with cure after the first treatment. Conclusion: The early detection of bacillary resistance and appropriate treatment are in favor of healing. Thus, it is crucial to know exactly the primary resistance rate avoiding the use of inadequate treatments, amplification of bacillary resistance and its transmission.


RESUMO Objetivo: Identificar resistência transmitida ou primária entre casos de tuberculose multidrogarresistente e fatores preditivos associados à cura da tuberculose multidrogarresistente após o primeiro tratamento. Método: Estudo descritivo de uma coorte de 2006 a 2010, em uma unidade de referência em tuberculose no estado de São Paulo, Brasil. Os dados foram obtidos por meio de revisão de prontuários médicos. Critérios clínicos e laboratoriais foram utilizados para classificar resistência transmitida e adquirida. Resistência primária estendida por definição, neste estudo, abrange também casos inicialmente tratados com esquema padrão, porém sem sucesso terapêutico, e teste de sensibilidade colhido pré-tratamento demonstrou presença de resistência. Resultados: Foram elegíveis para o estudo 156 doentes com tuberculose multidrogarresistente e suas respectivas amostras de escarro. Apenas 7% dos doentes eram positivos ao vírus da imunodeficiência humana (HIV). Tratamento prévio aconteceu em 95% da amostra. A taxa de cura após o primeiro tratamento foi de 54%. A mediana do tempo de conversão bacteriológica dos que se curaram foi de um mês. Dos 156 doentes, 100 (64%) e 56 (36%) foram classificados como resistência adquirida e resistência transmitida, respectivamente. Pela regressão logística, os doentes que se apresentaram com tuberculose multidrogarresistente primária (razão de chance - RC = 6,29), sem comorbidade (RC = 3,37) e com maior peso inicial (RC = 1,04) foram associados ao desfecho cura ao final do primeiro tratamento. Conclusão: A detecção precoce da resistência bacilar e o tratamento adequado favorecem a cura. Dessa forma, é indispensável conhecer com exatidão a taxa de resistência primária evitando o uso de tratamentos inadequados, a ampliação da resistência bacilar e a sua transmissão.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Tuberculosis, Multidrug-Resistant/etiology , Tuberculosis, Multidrug-Resistant/drug therapy , Mycobacterium tuberculosis/drug effects , Antitubercular Agents/therapeutic use , Time Factors , Brazil/epidemiology , Logistic Models , Retrospective Studies , Risk Factors , Analysis of Variance , Treatment Outcome , Tuberculosis, Multidrug-Resistant/epidemiology , Statistics, Nonparametric , Hospitalization/statistics & numerical data
12.
Rev. chil. enferm. respir ; 34(2): 122-128, ago. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-959417

ABSTRACT

Resumen Se presenta parte de la información entregada durante un curso de capacitación en tuberculosis con resistencia a fármacos para referentes clínicos del PROCET de Chile, con la colaboración del Dr. José Antonio Caminero Luna. Se enfatizó el uso de métodos de diagnóstico rápidos de resistencia a fármacos basados en la biología molecular, técnicas más sensibles y específicas, con el análisis de algunos algoritmos de diagnóstico factibles de implementar en nuestro país. Se detallaron las nuevas propuestas de terapia de tuberculosis con resistencia a fármacos, especialmente TBC-MDR (multidrogo resistente), y las ventajas de nuevos esquemas terapéuticos de mayor eficacia como los que son recomendados actualmente por la Organización Mundial de la Salud (OMS).


This publication summarizes part of the information provided during a training in multidrug resistant tuberculosis (MDR-TB) for clinical specialists in all health services of Chile with the collaboration of Dr. Jose Antonio Caminero Luna and the Chilean Program of Control and Eradication of Tuberculosis (PROCET). Emphasis was placed on early, sensitive and specific diagnostic methods of resistance to drugs based on molecular biology, showing some diagnostic algorithms feasible to implement in our country. Some proposals were made for changes in the treatment of tuberculosis with resistance to drugs, especially MDR-TB, with more effective therapeutic regimens recommended by the World Health Organization (WHO).


Subject(s)
Humans , Tuberculosis/diagnosis , Tuberculosis/therapy , Tuberculosis, Multidrug-Resistant/diagnosis , Tuberculosis, Multidrug-Resistant/therapy , World Health Organization , Algorithms , Chile/epidemiology , Tuberculosis, Multidrug-Resistant/drug therapy
13.
Rev. Soc. Bras. Med. Trop ; 51(3): 324-330, Apr.-June 2018. tab
Article in English | LILACS | ID: biblio-957432

ABSTRACT

Abstract INTRODUCTION: High endemic levels of pulmonary tuberculosis in prisons result from overcrowding, limited access to healthcare, delayed diagnosis, sustained transmission owing to poor control measures, and multidrug resistance. This study evaluated locally implemented measures for early pulmonary tuberculosis diagnosis and evaluated resistance to anti-tuberculosis drugs. METHODS: This transversal study employed data from the Mato Grosso do Sul State Tuberculosis Control Program obtained from 35 correctional facilities in 16 counties for 2 periods (2007-2010 and 2011-2014). RESULTS: Statewide prevalence (per 100,000) was 480.0 in 2007 and 972.9 in 2014. The following indicators showed improvement: alcohol-acid-fast bacillus testing (from 82.7% to 92.9%); cultures performed (55.0% to 81.8%); drug susceptibility testing of positive cultures (71.6% to 62.4%); and overall drug susceptibility testing coverage (36.6% to 47.4%). Primary and acquired resistance rates for 2007-2014 were 21.1% and 30.0%, respectively. Primary and acquired multidrug resistance rates were 0.3% and 1.3%, respectively. CONCLUSIONS: Prevalence rates increased, and laboratory indicators improved as a result of capacity building and coordination of technical teams and other individuals providing healthcare to inmates. Resistance rates were high, thereby negatively affecting disease control.


Subject(s)
Humans , Prisons/statistics & numerical data , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Multidrug-Resistant/diagnosis , Tuberculosis, Multidrug-Resistant/drug therapy , Antitubercular Agents/administration & dosage , Tuberculosis, Pulmonary/epidemiology , Brazil/epidemiology , Prevalence , Cross-Sectional Studies , Risk Factors , Tuberculosis, Multidrug-Resistant/epidemiology , Early Diagnosis
14.
Rev. Soc. Bras. Med. Trop ; 51(2): 234-236, Mar.-Apr. 2018. graf
Article in English | LILACS | ID: biblio-1041454

ABSTRACT

Abstract INTRODUCTION The teste rápido molecular para tuberculose (TRM-TB) was introduced in 2014 in Brazil for tuberculosis screening. However, its role in adolescents in Brazil has not been studied. METHODS A descriptive study of adolescents with suspected tuberculosis using National Laboratory software. RESULTS Of 852 (15.4%) suspected cases, 131 were positive by TRM-TB and 2% were resistant to rifampicin. Among TRM-TB-positive cases, 105 (91.4%) were culture-positive. Sixty-four of 96 samples were sensitive to rifampicin by TRM-TB; 11 were resistant to other drugs by drug sensitivity test (DST). CONCLUSIONS Among suspected cases, 16% were diagnosed by TRM-TB, of which 17% were drug-resistant by DST.


Subject(s)
Humans , Child , Adolescent , Rifampin/pharmacology , Streptomycin/pharmacology , Tuberculosis, Multidrug-Resistant/diagnosis , Isoniazid/pharmacology , Antibiotics, Antitubercular/pharmacology , Mycobacterium tuberculosis/drug effects , Microbial Sensitivity Tests , Cross-Sectional Studies , Tuberculosis, Multidrug-Resistant/microbiology , Tuberculosis, Multidrug-Resistant/drug therapy , Genotype , Mycobacterium tuberculosis/isolation & purification , Mycobacterium tuberculosis/genetics
15.
Cad. Saúde Pública (Online) ; 34(5): e00048217, 2018. tab
Article in Portuguese | LILACS | ID: biblio-889984

ABSTRACT

Resumo: A tuberculose drogarresistente (TBDR) representa hoje uma grave ameaça aos avanços no controle da tuberculose (TB) no Brasil e no mundo. Neste estudo, investigam-se fatores associados ao abandono e ao óbito de casos em tratamento para TBDR, em um centro de referência terciária do Município do Rio de Janeiro, Brasil. Trata-se de um estudo de coorte retrospectiva, a partir dos casos notificados no Sistema de Informação de Tratamentos Especiais de Tuberculose (SITETB), no período de 1º de janeiro de 2012 a 31 de dezembro de 2013. Um total de 257 pacientes foi notificado no SITETB e iniciou o tratamento para TBDR. Desse total, 139 (54,1%) tiveram sucesso terapêutico como desfecho, 54 (21%) abandonaram o tratamento e 21 (8,2%) evoluíram para óbito. Após análise de regressão logística multinomial múltipla, a faixa etária acima de cinquenta anos foi observada como único fator de proteção ao abandono, ao passo que ter menos de oito anos de escolaridade e reingresso após abandono foram considerados como fatores de risco. Reingresso após abandono, recidiva e falência indicaram fatores de risco. Nossos dados reforçam a concepção de que o abandono do tratamento de tuberculose resistente é um sério problema de saúde pública, sendo necessário um adequado acompanhamento no tratamento de pacientes com esse histórico e com baixa escolaridade. Além disso, uma rede de apoio social ao paciente é imprescindível para que desfechos desfavoráveis sejam evitados.


Resumen: La tuberculosis farmacorresistente (TBFR) representa hoy una grave amenaza para los avances en el control de la tuberculosis (TB) en Brasil y en el mundo. En este estudio, se investigan factores asociados al abandono y al óbito de casos en tratamiento para TBDR, dentro de un centro de referencia de carácter terciario del municipio de Río de Janeiro, Brasil. Se trata de un estudio de cohorte retrospectiva, a partir de los casos notificados en el Sistema de Información de Tratamientos Especiales de Tuberculosis (SITETB), durante el período del 1 de enero de 2012 al 31 de diciembre de 2013. Un total de 257 pacientes fue notificado en el SITETB y comenzó el tratamiento para TBDR. De ese total, 139 (un 54,1%) tuvieron éxito terapéutico como desenlace, 54 (un 21%) abandonaron el tratamiento y un 21 (8,2%) evolucionaron hacia óbito. Tras el análisis de regresión logística multinomial múltiple, la franja de edad por encima de cincuenta años se observó como el único factor de protección al abandono, al mismo tiempo que tener menos de ocho años de escolaridad y reingresar en el sistema educativo tras el abandono fueron considerados como factores de riesgo. Reingreso tras abandono, recidiva e insolvencia indicaron factores de riesgo. Nuestros datos refuerzan la concepción de que el abandono del tratamiento de tuberculosis resistente es un serio problema de salud pública, siendo necesario un adecuado acompañamiento en el tratamiento de pacientes con este historial y con baja escolaridad. Además, una red de apoyo social entorno al paciente es imprescindible para que los desenlaces desfavorables sean evitados.


Abstract: Drug-resistant tuberculosis (DR-TB) poses a serious threat to tuberculosis (TB) control in Brazil and worldwide. The current study investigated factors associated with loss to follow-up and death in the course of treatment for DR-TB in a tertiary reference center in the city of Rio de Janeiro, Brazil. This was a retrospective cohort study of cases reported to the Information System on Special Treatments for Tuberculosis (SITETB) from January 1, 2012, to December 31, 2013. A total of 257 patients were reported to the SITETB and initiated treatment for DR-TB. Of this total, 139 (54.1%) achieved treatment success as the outcome, 54 (21%) were lost to follow-up, and 21 (8.2%) died. Following a multiple multinomial logistic regression analysis, the age bracket older than 50 years was the only protective factor against loss to follow-up, whereas less than eight years of schooling and reentry after loss to follow-up were considered risk factors. Reentry after loss to follow-up, relapse, and treatment failure appeared as risk factors. Our data reinforce the concept that loss to follow-up in drug-resistant tuberculosis is a serious public health problem, and that adequate follow-up of treatment is necessary in patients with this history and low schooling. A social support network for patients is also indispensable for avoiding unfavorable outcomes.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Referral and Consultation/statistics & numerical data , Tuberculosis, Multidrug-Resistant/mortality , Tuberculosis, Multidrug-Resistant/drug therapy , Lost to Follow-Up , Patient Readmission/statistics & numerical data , Socioeconomic Factors , Brazil/epidemiology , Regression Analysis , Retrospective Studies , Age Factors , Treatment Failure
16.
J. bras. pneumol ; 43(6): 472-486, Nov.-Dec. 2017. tab
Article in English | LILACS | ID: biblio-893876

ABSTRACT

ABSTRACT Tuberculosis treatment remains a challenge due to the need to consider, when approaching it, the context of individual and collective health. In addition, social and economic issues have been shown to be variables that need to be considered when it comes to treatment effectiveness. We conducted a critical review of the national and international literature on the treatment of tuberculosis in recent years with the aims of presenting health care workers with recommendations based on the situation in Brazil and better informing decision-making regarding tuberculosis patients so as to minimize morbidity and interrupt disease transmission.


RESUMO O tratamento da tuberculose permanece um desafio em função da necessidade de que, em sua abordagem, seja considerado o contexto da saúde do indivíduo e da saúde coletiva. Adicionalmente, as questões sociais e econômicas têm-se mostrado como variáveis a ser consideradas na efetividade do tratamento. Ao revisarmos de forma crítica a literatura científica nacional e internacional sobre o tratamento da tuberculose nos últimos anos, tivemos como objetivos apresentar aos profissionais da área de saúde as recomendações baseadas na realidade brasileira e fornecer os subsídios necessários para a melhor tomada de decisão frente ao paciente com tuberculose, de modo a minimizar a morbidade e interromper a transmissão da doença Em função disso, o TDO é recomendado.


Subject(s)
Humans , Child , Adult , Tuberculosis, Pulmonary/drug therapy , Directly Observed Therapy/standards , Tuberculosis, Pulmonary/complications , Brazil , Risk Factors , Health Personnel , Tuberculosis, Multidrug-Resistant/drug therapy , Decision Making
17.
J. bras. pneumol ; 43(6): 437-444, Nov.-Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-893878

ABSTRACT

ABSTRACT Objective: To analyze the impact that the 2009 changes in tuberculosis treatment in Brazil had on the rates of cure, tuberculosis recurrence, mortality, treatment abandonment, and multidrug-resistant tuberculosis (MDR-TB). Methods: An ordinary least squares regression model was used in order to perform an interrupted time series analysis of secondary data collected from the Brazilian Tuberculosis Case Registry Database for the period between January of 2003 and December of 2014. Results: The 2009 changes in tuberculosis treatment in Brazil were found to have no association with reductions in the total number of cases (β = 2.17; 95% CI: −3.80 to 8.14; p = 0.47) and in the number of new cases (β = −0.97; 95% CI: −5.89 to 3.94; p = 0.70), as well as having no association with treatment abandonment rates (β = 0.40; 95% CI: −1.12 to 1.93; p = 0.60). The changes in tuberculosis treatment also showed a trend toward an association with decreased cure rates (β = −4.14; 95% CI: −8.63 to 0.34; p = 0.07), as well as an association with increased mortality from pulmonary tuberculosis (β = 0.77; 95% CI: 0.16 to 1.38; p = 0.01). Although there was a significant increase in MDR-TB before and after the changes (p < 0.0001), there was no association between the intervention (i.e., the changes in tuberculosis treatment) and the increase in MDR-TB cases. Conclusions: The changes in tuberculosis treatment were unable to contain the decrease in cure rates, the increase in treatment abandonment rates, and the increase in MDR-TB rates, being associated with increased mortality from pulmonary tuberculosis during the study period. Keywords: Tuberculosis, pulmonary/epidemiology; Tuberculosis, pulmonary/drug therapy; Tuberculosis, pulmonary/mortality; Interrupted time series analysis; Drug resistance, multiple; Drug compounding.


RESUMO Objetivo: Analisar o impacto das mudanças do tratamento da tuberculose implantadas no Brasil em 2009 no número de casos de cura, de recidiva, de óbitos, de abandono e de tuberculose multirresistente (TBMR). Métodos: Foi realizada uma análise de séries temporais interrompida utilizando o modelo de regressão pelo método dos mínimos quadrados ordinários a partir de dados secundários coletados do Sistema de Informação de Agravos de Notificação da Tuberculose entre janeiro de 2003 e dezembro de 2014. Resultados: A análise mostrou independência entre as mudanças do tratamento e a redução do número total de casos (β = 2,17; IC95%: −3,80 a 8,14; 189 p = 0,47), a redução do número de novos casos (β = −0,97; IC95%: −5,89 a 3,94; p =190 0,70) e do abandono do tratamento (β = 0,40; IC95%: 199 −1,12 a 1,93; p = 0,60). Demonstrou ainda tendência à associação com a diminuição da cura (β = −4,14; IC95%: −8,63 a 0,34; p = 0,07) e associação com aumento da mortalidade por tuberculose pulmonar (β = 0,77; IC95%: 0,16 a 1,38; p = 0,01). A TBMR aumentou significativamente tanto no período anterior quanto no período posterior às mudanças do tratamento (p < 0,0001), embora de forma independente da intervenção (β = 0,13; IC95%: −0,03 a 0,29; p = 0,12). Conclusões: As mudanças no tratamento não impediram nem a diminuição na taxa de cura e nem o aumento do abandono e da TBMR; por outro lado, se associaram ao aumento de óbitos por tuberculose pulmonar durante o período do estudo.


Subject(s)
Humans , Tuberculosis, Pulmonary/prevention & control , Tuberculosis, Multidrug-Resistant/prevention & control , Antitubercular Agents/therapeutic use , Tuberculosis, Pulmonary/mortality , Tuberculosis, Pulmonary/drug therapy , Brazil/epidemiology , Risk Factors , Tuberculosis, Multidrug-Resistant/mortality , Tuberculosis, Multidrug-Resistant/drug therapy , Disease Notification , Drug Resistance, Bacterial , Interrupted Time Series Analysis , Mycobacterium tuberculosis/drug effects
18.
Braz. j. microbiol ; 48(4): 785-790, Oct.-Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-889167

ABSTRACT

ABSTRACT Early diagnosis of tuberculosis is of major clinical importance. Among 4733 clinical specimens collected from 3363 patients and subjected to Ziehl-Neelsen microscopy, 4109 were inoculated onto Löwenstein-Jensen slants and 3139 in Bactec/9000MB. Polymerase Chain Reaction (PCR) was performed in 3139 specimens, whereas, a genotypic assay was directly applied in 93 Mycobacterium tuberculosis complex PCR-positive for isoniazid and rifampicin resistance detection specimens (GenoType MTBDRplus). Recovered M. tuberculosis isolates (64) as well as, 21 more sent from Regional Hospitals were tested for antimycobacterial resistance with a phenotypic (manual MGIT-SIRE) and a genotypic assay (GenoType MTBDRplus). PCR in the clinical specimens showed excellent specificity (97.4%) and accuracy (96.8%), good sensitivity (70.4%), but low positive predictive value (40.3%). MGIT-SIRE performed to M. tuberculosis did not confer a reliable result in 16 isolates. Of the remaining 69 isolates, 15 were resistant to streptomycin, seven to isoniazid, seven to ethambutol and five to rifampicin. GenoType MTBDRplus correctly detected isoniazid (seven) and rifampicin-resistant M. tuberculosis strains (five), showing an excellent performance overall (100%). Susceptibility results by the molecular assay applied directly to clinical specimens were identical to those obtained from recovered isolates of the corresponding patients. Combining molecular and conventional methods greatly contribute to early diagnosis and accurate susceptibility testing of tuberculosis.


Subject(s)
Humans , Culture Techniques/methods , Molecular Diagnostic Techniques/methods , Mycobacterium tuberculosis/isolation & purification , Tuberculosis, Multidrug-Resistant/diagnosis , Tuberculosis, Pulmonary/diagnosis , Antitubercular Agents/pharmacology , Culture Techniques/economics , Drug Resistance, Bacterial , Genotype , Microbial Sensitivity Tests , Molecular Diagnostic Techniques/economics , Mycobacterium tuberculosis/drug effects , Mycobacterium tuberculosis/genetics , Mycobacterium tuberculosis/growth & development , Tuberculosis, Multidrug-Resistant/drug therapy , Tuberculosis, Multidrug-Resistant/microbiology , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/microbiology
19.
Mem. Inst. Oswaldo Cruz ; 112(11): 756-759, Nov. 2017. tab
Article in English | LILACS | ID: biblio-894849

ABSTRACT

BACKGROUND Mycobacterium tuberculosis (MTB) is one of the most significant causes of mortality and morbidity. Early diagnose is important especially in multiple drug resistant tuberculosis to avoid transmission. Traditional techniques requires at least one to three weeks for diagnosis of tuberculosis. Diagnostic delays with multiple drug resistant tuberculosis are associated with worse clinical outcomes and increased transmission The Xpert MTB/RIF assay is one of the new diagnostic device for the diagnosis of tuberculosis and rapid detection of rifampicin resistance. OBJECTIVE We assessed the performance of Xpert MTB/RIF assay for detecting rifampicin resistance using phenotypic drug susceptibility tests as automated BD MGIT 960. METHODS Total of 2136 specimens were included in the study. Xpert MTB/RIF testing was performed on samples, using version 4 cartridges, according to the manufacturer's recommendations. The MTBC culture and first-line phenotypic DST were performed in automated BD MGIT 960 (Becton & Dickinson, USA) according to the recommendations of the manufacturer. Agar proportion was used in the case of inconsistency for rifampicin resistance. FINDINGS Thirty-four samples (19 respiratory and 15 nonrespiratory samples) were determined as positive for M. tuberculosis complex by Xpert MTB/RIF (Cepheid GeneXpert® System, USA). Xpert MTB/RIF assay detected 4/34 (11.7%) specimens as rifampicin resistant. One of the rifampicin resistant isolates was determined susceptible in MGIT 960 automated system. This isolate was also tested with agar proportion method and found susceptible to rifampicin. MAIN CONCLUSION The Xpert MTB/RIF assay can be used as first-line assay for the detection of M. tuberculosis. However, microbiologists must be aware of the limitations of the assay.


Subject(s)
Humans , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/drug therapy , Microbial Sensitivity Tests , Tuberculosis, Multidrug-Resistant/diagnosis , Tuberculosis, Multidrug-Resistant/drug therapy , Antibiotics, Antitubercular/therapeutic use , Mycobacterium tuberculosis/drug effects , Phenotype , Sensitivity and Specificity
20.
Rev. Soc. Bras. Med. Trop ; 50(5): 646-651, Sept.-Oct. 2017. tab, graf
Article in English | LILACS | ID: biblio-897011

ABSTRACT

Abstract INTRODUCTION: A total of 771 cases of multidrug-resistant tuberculosis (MDR-TB) were reported in Brazil in 2014. Treatment of MDR-TB with aminoglycosides can produce serious side effects such as permanent and irreversible hearing loss, which occurs in 5-64% of cases, and severely compromise patient quality of life. The goal of this research was to evaluate auditory and vestibular side effects in patients treated for MDR-TB and to identify associations between these complaints and the type of aminoglycoside used. METHODS: We performed a retrospective review of 599 medical records from patients with MDR-TB who were treated at the Hélio Fraga/Fiocruz Reference Center between 2006 and 2010. Cases without auditory or vestibular complaints and patients who were not treated with aminoglycoside drugs were excluded from the study. RESULTS: Of 164 eligible cases, 55 (33.5%) reported an auditory or vestibular complaint and medication was subsequently suspended, although hearing damage was not confirmed in all cases. Audiometric testing confirmed hearing loss in 11 (21.7%) of 12 cases submitted for evaluation. Hearing loss related to ototoxicity was confirmed in 15 (62.5%) cases. Tinnitus was significantly associated with the use of amikacin and streptomycin. CONCLUSIONS: Evaluations of ototoxicity symptoms were not usually reported in the routine care of patients with MDR-TB. Complaints of tinnitus were associated with amikacin and streptomycin use. These results require confirmation in future studies.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Young Adult , Audiometry/methods , Tuberculosis, Multidrug-Resistant/drug therapy , Aminoglycosides/adverse effects , Hearing Loss/diagnosis , Hearing Loss/chemically induced , Anti-Bacterial Agents/adverse effects , Time Factors , Tinnitus/diagnosis , Tinnitus/chemically induced , Amikacin/adverse effects , Streptomycin/adverse effects , Vestibular Diseases/diagnosis , Vestibular Diseases/chemically induced , Sex Factors , Retrospective Studies , Age Factors , Tuberculosis, Multidrug-Resistant/complications , Dizziness/diagnosis , Dizziness/chemically induced , Middle Aged
SELECTION OF CITATIONS
SEARCH DETAIL