Epidemiological profile and follow-up of patients with pulmonary disease by non-tuberculous mycobacteria in Baixada Santista area, São Paulo.

OBJECTIVE: To present the frequency and species diversity of non-tuberculous mycobacteria, estimate the prevalence of non-tuberculous mycobacterial pulmonary disease, describe the epidemiological profile, and determine the follow-up of patients with non-tuberculous mycobacterial pulmonary disease living in a region with a high burden of tuberculosis. METHODS: This a retrospective cohort observational study using data records obtained from the Instituto Adolfo Lutz - Santos and from the São Paulo Sistema de Vigilância de Tuberculose do Estado de São Paulo in the period between 2000 and 2009. The studied variables were: socio-demographic characteristics, current and past history of tuberculosis, aspects related to diagnosis, and treatment and associated diseases. RESULTS: We included 319 non-tuberculous mycobacteria isolates in the study, corresponding to 257 patients. The species Mycobacterium kansasii (28.5%) and Mycobacterium fortuitum (16.6%) presented the higher occurrence. In 10.9% (24) of the patients, there was a criterion for confirming a case of pulmonary disease due to non-tuberculous mycobacteria. In relation to gender and age, male and individuals over 50 years old were the most frequent. Considering the confirmed cases, 47.8% had a past history of tuberculosis. CONCLUSION: The lack of information about the cases is evident, since pulmonary disease due to non-tuberculous mycobacteria is not mandatory. The therapeutic regimen according to the identified species is fundamental for success in combating the infections caused by non-tuberculous mycobacteria. Besides that, information about the regional epidemiology of pulmonary disease caused by non-tuberculous mycobacteria and the search for associations with other comorbidities are important to establish the correct treatment. In order to improve surveillance of pulmonary diseases by non-tuberculous mycobacteria, we suggest the implantation of a sentinel surveillance and of population-based studies.

Epidemiological profile and follow-up of patients with pulmonary disease by non-tuberculous mycobacteria in Baixada Santista area, São Paulo

ABSTRACT Objective To present the frequency and species diversity of non-tuberculous mycobacteria, estimate the prevalence of non-tuberculous mycobacterial pulmonary disease, describe the epidemiological profile, and determine the follow-up of patients with non-tuberculous mycobacterial pulmonary disease living in a region with a high burden of tuberculosis. Methods This a retrospective cohort observational study using data records obtained from the Instituto Adolfo Lutz - Santos and from the São Paulo Sistema de Vigilância de Tuberculose do Estado de São Paulo in the period between 2000 and 2009. The studied variables were: socio-demographic characteristics, current and past history of tuberculosis, aspects related to diagnosis, and treatment and associated diseases. Results We included 319 non-tuberculous mycobacteria isolates in the study, corresponding to 257 patients. The species Mycobacterium kansasii (28.5%) and Mycobacterium fortuitum (16.6%) presented the higher occurrence. In 10.9% (24) of the patients, there was a criterion for confirming a case of pulmonary disease due to non-tuberculous mycobacteria. In relation to gender and age, male and individuals over 50 years old were the most frequent. Considering the confirmed cases, 47.8% had a past history of tuberculosis. Conclusion The lack of information about the cases is evident, since pulmonary disease due to non-tuberculous mycobacteria is not mandatory. The therapeutic regimen according to the identified species is fundamental for success in combating the infections caused by non-tuberculous mycobacteria. Besides that, information about the regional epidemiology of pulmonary disease caused by non-tuberculous mycobacteria and the search for associations with other comorbidities are important to establish the correct treatment. In order to improve surveillance of pulmonary diseases by non-tuberculous mycobacteria, we suggest the implantation of a sentinel surveillance and of population-based studies.

Epidemiological and laboratorial profile of patients with isolation of nontuberculous mycobacteria.

BACKGROUND: An increase in NTM diseases in the international scenario has been observed in recent years. AIMS: To analyze the epidemiological and laboratory profiles of patients with isolation of nontuberculous mycobacteria (NTM) over one decade. A retrospective analysis of records of a mycobacterial reference laboratory found 135 cases with isolation of NTM. METHODS: Clinical and epidemiological data were collected from the records of government health clinics and from the State notification system (TBWEB). The cases were geocoded by location based on the street address in the Mercator Transverse Universal projection, Datum SAD/69 and MapInfo software. RESULTS: Most patients were male (66.7%), older than 50 years (40%) and had only completed elementary schooling (38.5%). Associated health problems were found in 71.8% of the subjects, with 43.7% being HIV positive and 25.9% having had tuberculosis in the past. Hospitals were the most able institutions to diagnose cases (45.2%). Sputum was the most common material tested (63.0%) with the bacilloscopy being positive in 33.3% of cases. The most common mycobacteria species in the region were Mycobacterium avium and M. abscessus/M. massiliense/M. bolletii. When the regional reference municipality was analyzed, M. avium and M. fortuitum were the most common species isolated in the urban area. CONCLUSIONS: In the study region, mycobacteriosis most affected adult males with low schooling. Most patients presented comorbidities in particular co-infection with the HIV virus. M. avium is the most prevalent species in the region with the M. abscessus/M. massiliense/M. bolletii species being the main cause of nosocomial infections.

Molecular assessment of invasive Streptococcus pneumoniae serotype 1 in Brazil: evidence of clonal replacement.

In Brazil, serotype 1 Streptococcus pneumoniae is one of the most prevalent causes of severe infection. This study investigated the genetic relatedness of 134 serotype 1 isolates obtained from invasive diseases during the period 1977-2005. Molecular typing by PFGE revealed two major lineages using visual inspection and computer analysis. Type A comprised 94 isolates (70.2 %) with four subtypes, whereas type B comprised 40 isolates (29.8 %) with eight subtypes. Subtype A3, the most frequent genotype, accounting for 65 % of the total isolates, was identified as a representative of clone Sweden(1)-40 (ST304). Type B was predominant in the period 1977-1988. In contrast, an increase in the type A lineage was detected from 1990 in Brazil, significantly associated with isolates recovered from pneumonia cases and from young patients. This study clearly established a temporal switch between two lineages of S. pneumoniae serotype 1 in Brazil, with a wide dispersion of clone Sweden(1)-40 in recent years.

Caracterização molecular das cepas de Streptococcus pneumoniae do sorotipo 1, isoladas de pacientes com doença invasiva no Brasil em três décadas, 1977 - 2005

Streptococcus pneumoniae ou pneumococo é o principal agente etiológico das pneumonias adquiridas na comunidade, um dos mais freqüentes agentes de meningites e bacteremias, como também é causa importante de otites médias e sinusites. Com a alta prevalência do pneumococo sorotipo 1 no Brasil, e a não inclusão deste sorotipo na vacina pneumocóccica conjugada, somados à descrição de clones internacionais pertencentes a este sorotipo, justificam-se os estudos de caracterização molecular de cepas desse sorotipo. O presente estudo teve como objetivo avaliar as cepas de pneumococo sorotipo 1 isoladas de 1977 a 2005 em diferentes regiões do Brasil por metodologia molecular e comparar os padrões dos clones internacionais reconhecidos pela rede mundial “Pneumococcal Molecular Epidemiology Network” (PMEN). Um total de 134 cepas de pneumococo sorotipo 1 isoladas de pacientes com diferentes faixas etárias e diagnósticos clínicos foram estudadas. As cepas foram selecionadas a partir da coleção de cepas do Setor de Bactérias Piogênicas e Toxigênicas, do Instituto Adolfo Lutz de São Paulo. Os sorotipos foram determinados pela reação de Quellung utilizando antisoros policlonais (“Staten Serum Institute”, Dinamarca). Para tipagem molecular utilizou-se a eletroforese em campo pulsado dos fragmentos de DNA, após digestão com SmaI, e os perfis eletroforéricos foram analisados conforme os critérios de Tenover et al., 1995. A similaridade genética entre as linhagens de cepas foi calculada através da construção de dendrogramas. Foram identificados 2 tipos genéticos denominados A (70,2%) e B(29,8%). Entre as cepas do tipo A, observou-se os subtipos A1 (4,3%), A2 (2,1%), A3 (92,5%) e A4 (1,1%); entre as cepas do tipo B observou-se ossubtipos B1 (2,5%), B2 (27,5%), B3 (10,0%), B4 (27,5%), B5 (2,5%), B6 (5,0%), B7 (5,0%), B8 (17,5%) e B9 (2,5%). A similaridade genética entre as cepas do tipo A foi de 85,53% e entre as cepas do tipo B foi de 84,25%. A similaridade do subtipo A3 ...

Caracterização molecular das cepas de Streptococcus pneumoniae do sorotipo 1, isoladas de pacientes com doença invasiva no Brasil em três décadas, 1977 - 2005 / Molecular characterization of strains of the streptococcus pneumoniae serotype 1, isolated of disease invasive in Brazil in three decade, 1977 - 2005

Streptococcus pneumoniae ou pneumococo é o principal agente etiológico das pneumonias adquiridas na comunidade, um dos mais freqüentes agentes de meningites e bacteremias, como também é causa importante de otites médias e sinusites. Com a alta prevalência do pneumococo sorotipo 1 no Brasil, e a não inclusão deste sorotipo na vacina pneumocóccica conjugada, somados à descrição de clones internacionais pertencentes a este sorotipo, justificam-se os estudos de caracterização molecular de cepas desse sorotipo. O presente estudo teve como objetivo avaliar as cepas de pneumococo sorotipo 1 isoladas de 1977 a 2005 em diferentes regiões do Brasil por metodologia molecular e comparar os padrões dos clones internacionais reconhecidos pela rede mundial “Pneumococcal Molecular Epidemiology Network” (PMEN). Um total de 134 cepas de pneumococo sorotipo 1 isoladas de pacientes com diferentes faixas etárias e diagnósticos clínicos foram estudadas. As cepas foram selecionadas a partir da coleção de cepas do Setor de Bactérias Piogênicas e Toxigênicas, do Instituto Adolfo Lutz de São Paulo. Os sorotipos foram determinados pela reação de Quellung utilizando antisoros policlonais (“Staten Serum Institute”, Dinamarca). Para tipagem molecular utilizou-se a eletroforese em campo pulsado dos fragmentos de DNA, após digestão com SmaI, e os perfis eletroforéricos foram analisados conforme os critérios de Tenover et al., 1995. A similaridade genética entre as linhagens de cepas foi calculada através da construção de dendrogramas. Foram identificados 2 tipos genéticos denominados A (70,2%) e B(29,8%). Entre as cepas do tipo A, observou-se os subtipos A1 (4,3%), A2 (2,1%), A3 (92,5%) e A4 (1,1%); entre as cepas do tipo B observou-se ossubtipos B1 (2,5%), B2 (27,5%), B3 (10,0%), B4 (27,5%), B5 (2,5%), B6 (5,0%), B7 (5,0%), B8 (17,5%) e B9 (2,5%). A similaridade genética entre as cepas do tipo A foi de 85,53% e entre as cepas do tipo B foi de 84,25%. A similaridade do subtipo A3 com os sub...