RESUMO
Introducción: la coexistencia de tuberculosis y el Virus de la Inmunodeficiencia Humana es un evento grave en salud pública que incrementa el riesgo de muerte, para el año 2013 la Organización Mundial de la Salud estimó nueve millones de personas con tuberculosis en el mundo, 1,1 millones (13%) serian positivos al Virus de la Inmunodeficiencia Humana y de estos, 360 000 morirían por esta causa. Objetivo: determinar la prevalencia de la resistencia a isoniazida y rifampicina en pacientes con coexistencia de tuberculosis y el Virus de la Inmunodeficiencia Humana durante los años 2010 a 2012. Materiales y Métodos: análisis de una serie de casos, que incluyo 902 casos de tuberculosis con coexistencia del Virus de la Inmunodeficiencia Humana; donde se evaluaron las variables de procedencia, sexo, edad, tipo de muestra y patrón de resistencia en casos nuevos y previamente tratados. Resultados: el 78,4% de los casos eran de sexo masculino, la mediana de edad fue 34 años, se identificó multirresistencia en casos nuevos en un 3,6% y una resistencia a isoniazida y rifampicina de 6,7% y 1,4% respectivamente. En los casos previamente tratados la multirresistencia fue de 16,2%, la resistencia a isoniazida de 6,3% y a rifampicina de 3,7%. Conclusión: se evidenció que la presencia de resistencia es mayor en previamente tratados, en casos nuevos se observó resistencia a rifampicina sin ser multirresistentes, algo que no se documentó en la última encuesta nacional, estos hallazgos indican que es fundamental realizar prueba de sensibilidad. MÉD.UIS. 2016;29(2):31-9.
Introduction: the coexistence of tuberculosis and HIV is a serious public health event that increases the risk of death by 2013 the World Health Organization estimated nine million people with tuberculosis in the world, 1,1 million (13%) would be positive to HIV and of these, 360 000 would die for this cause. Objective: to determine the prevalence of resistance to isoniazid and rifampicin in patients with coexisting tuberculosis and HIV during the years 2010 to 2012. Methods: analysis of a number of cases, which included 902 cases of tuberculosis with coexistence of HIV, the variables of origin, sex, age, sample type and pattern of resistance in new cases were evaluated and previously treated. Results: 78.4% of cases were male, the median age was 34 years multidrug resistance was identified in new cases and 3.6% resistance to isoniazid and rifampicin 6.7% and 1, 4% respectively. In cases previously treated multidrug resistance was 16.2%, resistance to isoniazid and rifampicin 6.3% from 3.7%. Conclusion: it was shown that the presence of drug resistance is higher in previously treated patients; in new cases rifampicin resistance without being multiresistant, something that was not documented in the latest national survey, these findings indicate that it is essential to conduct sensitivity test. MÉD.UIS. 2016;29(2):31-9.
Assuntos
Humanos , Tuberculose , HIV , Tuberculose Resistente a Múltiplos Medicamentos , Colômbia , Mycobacterium tuberculosisRESUMO
INTRODUÇÃO: A incidência de tuberculose (TB) em Santos (SP) situa-se em 73/100.000 habitantes-ano. A prevalência média de coinfecção TB/HIV é de 16%, taxas de cura e abandono de tratamento, entre casos novos são, respectivamente, 71% e 12%. Tais indicadores sugerem elevado risco para TB multidroga resistente (TBMR) no município, com incidência estimada em 1,9/100.000 habitantes-ano. OBJETIVO: Descrever e analisar o perfil de sensibilidade às drogas (TS) de primeira e segunda linha de tratamento entre pacientes com TB pulmonar (TBP), estimar a incidência de TBMR e a proporção de TB extensivamente resistente (TBXR); analisar aspectos moleculares, epidemiológicos e institucionais dos casos de TBP resistentes em Santos (SP). MÉTODOS: Estudo descritivo de uma coorte de pacientes de TBP, com início de tratamento ou retratamento entre 01 de janeiro de 2011 a 31 de dezembro de 2012. Definiu-se como caso de TBP, indivíduos com 15 anos ou mais, de ambos os sexos, residentes no município de Santos, com manifestações clínicas compatíveis com TBP e confirmação por cultura com isolamento de Mycobacterium tuberculosis. As variáveis de interesse para o estudo foram as características sociodemográficas, história atual e pregressa de TB, aspectos relativos ao tratamento, co-morbidades, ao diagnóstico e resistência a drogas. Para as análises comparativas entre proporções foram usados os testes qui-quadrado de Pearson e o Exato de Fisher e para variáveis contínuas o teste T de Student ou o de Kruskal - Wallis. Os perfis genéticos dos isoladas resistentes a ao menos uma droga foram obtidos pela técnica RLFP e analisados pelo programa Bionumerics versão 5.0 (Applied Maths - Bélgica). A descrição da distribuição espacial da TB resistentes e clusters foram feitas mediante a inserção dos casos no mapa de Santos, por endereço de residência, segundo o índice de vulnerabilidade social. RESULTADOS: Dos 263 casos de TBP selecionados, 68,4% (180/263) eram do sexo masculino, a mediana da...
INTRODUCTION: The incidence of tuberculosis (TB) in Santos (SP) is located around 73 / 100,000-year, approximately double that found on average in the country. The average prevalence of TB / HIV is 16% cure rates and treatment dropout among new cases are, respectively, 71% and 12%. Such indicators suggest high risk for multidrug-resistant TB (MR-TB) in the city, with the incidence estimated at 1.9 / 100,000-year. OBJECTIVE: To describe and analyze the sensitivity to drugs of first and second line treatment of patients with pulmonary TB (PTB) to estimate the incidence of MR-TB and extensively drugresistant TB (TBXR), describe molecular and institutional aspects, spatial distribution, epidemiological PTB resistant cases in the city of Santos (SP). METHODS: A descriptive study of a cohort of patients with PTB residing in the city who started treatment or retreatment in the period January 2011 to December 31, 2012. The case definition PTB individuals 15 years or more, both sexes, living in the city of Santos (SP), who present clinical manifestations compatible with PTB and whose confirmation was made by culture with isolation of M. tuberculosis. The variables of interest for the study were: bacteriological / laboratory socio-demographic characteristics, current and previous history of TB, aspects related to treatment, and comorbidities. For comparative analyzes of proportions the chi-squared tests and Fisher's exact were used for continuous variables and the Student t test or the Kruskal - Wallis. The genetic profiles of isolates resistant to at least one drug were obtained by RFLP (length polymorphism restriction fragment) and analyzed using version BioNumerics 5.0 (Applied Maths - Belgium) software. The description of the spatial distribution of resistant TB and the clusters was made by inserting the cases in Santos map, by address of residence, which was according to the index of social vulnerability. RESULTS: Of the 263 cases of PTB selected, 68.4% (180/263)...