Phenotypic and genotypic variant of MDR-Mycobacterium tuberculosis multiple isolates in the same tuberculosis episode, Rio de Janeiro, Brazil

Assuming that the IS6110-restriction fragment length polymorphism (RFLP) changes at a constant rate of 3.2 years, this methodology was applied to demonstrate, for the first time, variant patterns of Mycobacterium tuberculosis (MTB) in multiple isolates obtained at short time intervals from sputum and blood of an HIV+ patient with multiple admissions to the Emergency Room and to the multidrug-resistant tuberculosis (MDR-TB) Reference Center of a secondary-care hospital in Rio de Janeiro, Brazil. In sputum, the IS6110-RFLP appeared in isolates with two variant patterns with 10 and 13 IS6110 copies. However, blood presented only the pattern corresponding to 10 copies, suggesting compartmentalization. With regard to the exact match of 10 of 13 bands, this may be a subpopulation with the same clonal origin and this may be related to the IS6110 transposition. A susceptibility test demonstrated an MDR profile (INH R, RIF R, SM R, and EMB R), with the sputum isolate also exhibiting EMB S (R = resistant; S = sensitive). A gene mutation confirmed resistance only to streptomycin. There was agreement between the results of the phenotypic test and the clinical response to MDR-TB treatment, suggesting serious implications with regard to treatment administration based exclusively on molecular methods, and calling attention to the fact that more effective control strategies against the emergence of MDR strains must be implemented by the TB control program to prevent transmission of MDR-MTB strains at health facilities in areas highly endemic for TB.

A multivariate analysis of socio-demographic factors, water contact patterns and Schistosoma mansoni infection in an endemic area in Brazil

Foi examinada a existencia de associacao entre fatores socio-demograficos, padroes de contatos com a agua e a infeccao pelo Schistosoma mansoni em uma area endemica em Minas Gerais (Divino), com o objetivo de determinar medidas prioritarias para prevenir a infeccao; 506 individuos (87 por cento dos habitantes com mais de 1 ano de idade) participaram do estudo. Aqueles que apresentavam ovos (n=198) foram comparados aos que nao apresentavam ovos de S. mansoni nas fezes (n=308). As seguintes variaveis exploratorias foram consideradas: idade, sexo, cor, tratamento anterior com esquistossomicida, local de nascimento, qualidade da habitacao, origem da agua para o domicilio, distancia do domicilio em relacao ao corrego, frequencia e motivos de contatos com agua. As variaveis que apresentaram associacoes independentes com a infeccao foram: idade (10-19 e * 20 anos), contato com aguas para trabalho agricola, pesca e natacao ou banho (Odds relativas ajustadas = 5.0, 2.4, 3.2, 2.1 e 2.0, respectivamente). Estes resultados sugerem que medidas para prevenir a infeccao devem priorizar os contatos com aguas para o trabalho e o lazer nesta area endemica.