Laboratory-based study of drug resistance and genotypic profile of multidrug-resistant tuberculosis isolates in Salvador, Bahia, Brazil.

BACKGROUND: Surveillance of multidrug resistant/extensively drug-resistant tuberculosis (MDR/XDR-TB) is essential to guide disease dissemination control measures. Brazil contributes to a significant fraction of tuberculosis (TB) cases worldwide, but only few reports addressed MDR/XDR-TB in the country. METHODS: This cross-sectional, laboratory-based study describes the phenotypic resistance profiles of isolates obtained between January 2008 and December 2011 in Bahia, Brazil, and sociodemographic, epidemiological, and clinical characteristics (obtained from mandatory national registries) of the corresponding 204 MDR/XDR-TB patients. We analyzed the mycobacterial spoligotyping and variable number of tandem repeats of mycobacterial interspersed repetitive units in 12-loci profiles obtained from Salvador. RESULTS: MDR/XDR-TB patients were predominantly male, had a median age of 43 years, belonged to black ethnicity, and failed treatment before MDR-TB diagnosis. Nearly one-third of the isolates had phenotypic resistance (evaluated by mycobacteria growth indicator tube assay) to second-line anti-TB drugs (64/204, 31%), of which 22% cases (14/64) were diagnosed as XDR-TB. Death was a frequent outcome among these individuals and was associated with resistance to second-line anti-TB drugs. Most isolates successfully genotyped belonged to the Latin-American Mediterranean (LAM) Family, with an unprecedented high proportion of LAM10-Cameroon subfamily bacilli. More than half of these isolates were assigned to a unique cluster by the genotyping methods performed. Large clusters of identical genotypes were also observed among LAM SIT42 and SIT376 strains. CONCLUSIONS: We highlight the need for strengthening local and national efforts to perform early detection of TB drug resistance and to prevent treatment discontinuation to limit the emergence of drug-resistant strains.

Laboratory-based study of drug resistance and genotypic profile of multidrug-resistant tuberculosis isolates in Salvador, Bahia, Brazil

Abstract Background: Surveillance of multidrug resistant/extensively drug-resistant tuberculosis (MDR/XDR-TB) is essential to guide disease dissemination control measures. Brazil contributes to a significant fraction of tuberculosis (TB) cases worldwide, but only few reports addressed MDR/XDR-TB in the country. Methods: This cross-sectional, laboratory-based study describes the phenotypic resistance profiles of isolates obtained between January 2008 and December 2011 in Bahia, Brazil, and sociodemographic, epidemiological, and clinical characteristics (obtained from mandatory national registries) of the corresponding 204 MDR/XDR-TB patients. We analyzed the mycobacterial spoligotyping and variable number of tandem repeats of mycobacterial interspersed repetitive units in 12-loci profiles obtained from Salvador. Results: MDR/XDR-TB patients were predominantly male, had a median age of 43 years, belonged to black ethnicity, and failed treatment before MDR-TB diagnosis. Nearly one-third of the isolates had phenotypic resistance (evaluated by mycobacteria growth indicator tube assay) to second-line anti-TB drugs (64/204, 31%), of which 22% cases (14/64) were diagnosed as XDR-TB. Death was a frequent outcome among these individuals and was associated with resistance to second-line anti-TB drugs. Most isolates successfully genotyped belonged to the Latin-American Mediterranean (LAM) Family, with an unprecedented high proportion of LAM10-Cameroon subfamily bacilli. More than half of these isolates were assigned to a unique cluster by the genotyping methods performed. Large clusters of identical genotypes were also observed among LAM SIT42 and SIT376 strains. Conclusions: We highlight the need for strengthening local and national efforts to perform early detection of TB drug resistance and to prevent treatment discontinuation to limit the emergence of drug-resistant strains.

Microplastics in corals: An emergent threat.

This article seeks to present a summary of knowledge and thus improve awareness of microplastic impacts on corals. Recent research suggests that microplastics have a variety of species-specific impacts. Among them, a reduced growth, a substantial decrease of detoxifying and immunity enzymes, an increase in antioxidant enzyme activity, high production of mucus, reduction of fitness, and negative effects on coral-Symbiodiniaceae relationships have been highlighted in recent papers. In addition to this, tissue necrosis, lower fertilization success, alteration of metabolite profiles, energetic costs, decreased skeletal growth and calcification, and coral bleaching have been observed under significant concentrations of microplastics. Furthermore, impairment of feeding performance and food intake, changes in photosynthetic performance and increased exposure to contaminants, pathogens and other harmful compounds have also been found. In conclusion, microplastics may cause a plethora of impacts on corals in shallow, mesophotic, and deep-sea zones at different latitudes; underlining an emerging threat globally.

Rapid molecular test for tuberculosis: impact of its routine use at a referral hospital.

OBJECTIVE: To evaluate the impact of the use of the molecular test for Mycobacterium tuberculosis and its resistance to rifampin (Xpert MTB/RIF), under routine conditions, at a referral hospital in the Brazilian state of Bahia. METHODS: This was a descriptive study using the database of the Mycobacteriology Laboratory of the Octávio Mangabeira Specialized Hospital, in the city of Salvador, and georeferencing software. We evaluated 3,877 sputum samples collected from symptomatic respiratory patients, under routine conditions, between June of 2014 and March of 2015. All of the samples were submitted to sputum smear microscopy and the Xpert MTB/RIF test. Patients were stratified by gender, age, and geolocation. RESULTS: Among the 3,877 sputum samples evaluated, the Xpert MTB/RIF test detected M. tuberculosis in 678 (17.5%), of which 60 (8.8%) showed resistance to rifampin. The Xpert MTB/RIF test detected M. tuberculosis in 254 patients who tested negative for sputum smear microscopy, thus increasing the diagnostic power by 59.9%. CONCLUSIONS: The use of the Xpert MTB/RIF test, under routine conditions, significantly increased the detection of cases of tuberculosis among sputum smear-negative patients.

Rapid molecular test for tuberculosis: impact of its routine use at a referral hospital / Teste rápido molecular para tuberculose: avaliação do impacto de seu uso na rotina em um hospital de referência

ABSTRACT Objective: To evaluate the impact of the use of the molecular test for Mycobacterium tuberculosis and its resistance to rifampin (Xpert MTB/RIF), under routine conditions, at a referral hospital in the Brazilian state of Bahia. Methods: This was a descriptive study using the database of the Mycobacteriology Laboratory of the Octávio Mangabeira Specialized Hospital, in the city of Salvador, and georeferencing software. We evaluated 3,877 sputum samples collected from symptomatic respiratory patients, under routine conditions, between June of 2014 and March of 2015. All of the samples were submitted to sputum smear microscopy and the Xpert MTB/RIF test. Patients were stratified by gender, age, and geolocation. Results: Among the 3,877 sputum samples evaluated, the Xpert MTB/RIF test detected M. tuberculosis in 678 (17.5%), of which 60 (8.8%) showed resistance to rifampin. The Xpert MTB/RIF test detected M. tuberculosis in 254 patients who tested negative for sputum smear microscopy, thus increasing the diagnostic power by 59.9%. Conclusions: The use of the Xpert MTB/RIF test, under routine conditions, significantly increased the detection of cases of tuberculosis among sputum smear-negative patients.

RESUMO Objetivo: Avaliar o impacto do teste rápido molecular automatizado Xpert MTB/RIF, utilizado para a detecção de Mycobacterium tuberculosis e sua resistência à rifampicina, em condições de rotina, em um hospital de referência no estado da Bahia. Métodos: Estudo descritivo retrospectivo utilizando o banco de dados do Laboratório de Micobacteriologia do Hospital Especializado Octávio Mangabeira, localizado na cidade de Salvador, e um programa de georreferenciamento. Entre junho de 2014 e março de 2015, foram incluídas no estudo 3.877 amostras de escarro coletadas de pacientes sintomáticos respiratórios em condições de rotina. Todas as amostras coletadas foram submetidas tanto à baciloscopia quanto a Xpert MTB/RIF. Os pacientes foram estratificados por sexo, idade e georreferenciamento. Resultados: Das 3.877 amostras de escarro analisadas, Xpert MTB/RIF detectou a presença de M. tuberculosis em 678 pacientes (17,5%). Desses, 60 (8,8%) apresentaram resistência à rifampicina. O Xpert MTB/RIF detectou 254 pacientes com baciloscopia negativa, representando um acréscimo diagnóstico de 59,9%. Conclusões: A implantação do Xpert MTB/RIF, sob condições de rotina, teve um impacto significativo no aumento da detecção de casos de tuberculose em pacientes com baciloscopia negativa.

Multidrug-resistant tuberculosis

Despite the efforts made worldwide to reduce the number of cases of drug-susceptible tuberculosis, multidrug-resistant tuberculosis (MDR-TB) constitutes an important public health issue. Around 440,000 new cases of MDR-TB are estimated annually, although in 2008 only 7% of these (29,423 cases) were notified. The laboratory tests for diagnosing resistance may be phenotypic (based on culture growth in the presence of drugs) or genotypic (i.e. identification of the presence of mutations that confer resistance). The urgent need for a rapid means of detecting resistance to anti-TB drugs has resulted in the development of many genotypic methods over recent years. The treatment of MDR-TB is expensive, complex, prolonged (18-24 months) and associated with a higher incidence of adverse reactions. Some basic principles must be observed when prescribing an adequate treatment regimen for MDR-TB: (a) the association of at least four drugs (three of which should not have been used previously); (b) use of a fluoroquinolone; and (c) use of an injectable anti-TB drug. In Brazil, the therapeutic regimen for MDR-TB has been standardized and consists of five drugs: terizidone, levofloxacin, pyrazinamide, ethambutol and an aminoglycoside (streptomycin or amikacin). Pulmonary resection is an important tool in the coadjuvant treatment of MDR-TB. While a recent meta-analysis revealed an average cure rate of MDR-TB of 69%, clinical studies are currently being conducted with new drugs and with drugs already available on the market but with a new indication for TB, with encouraging results that will enable more effective treatment regimens to be planned in the future.

Multidrug-resistant tuberculosis.

Despite the efforts made worldwide to reduce the number of cases of drug-susceptible tuberculosis, multidrug-resistant tuberculosis (MDR-TB) constitutes an important public health issue. Around 440,000 new cases of MDR-TB are estimated annually, although in 2008 only 7% of these (29,423 cases) were notified. The laboratory tests for diagnosing resistance may be phenotypic (based on culture growth in the presence of drugs) or genotypic (i.e. identification of the presence of mutations that confer resistance). The urgent need for a rapid means of detecting resistance to anti-TB drugs has resulted in the development of many genotypic methods over recent years. The treatment of MDR-TB is expensive, complex, prolonged (18-24 months) and associated with a higher incidence of adverse reactions. Some basic principles must be observed when prescribing an adequate treatment regimen for MDR-TB: (a) the association of at least four drugs (three of which should not have been used previously); (b) use of a fluoroquinolone; and (c) use of an injectable anti-TB drug. In Brazil, the therapeutic regimen for MDR-TB has been standardized and consists of five drugs: terizidone, levofloxacin, pyrazinamide, ethambutol and an aminoglycoside (streptomycin or amikacin). Pulmonary resection is an important tool in the coadjuvant treatment of MDR-TB. While a recent meta-analysis revealed an average cure rate of MDR-TB of 69%, clinical studies are currently being conducted with new drugs and with drugs already available on the market but with a new indication for TB, with encouraging results that will enable more effective treatment regimens to be planned in the future.

III Brazilian Thoracic Association Guidelines on tuberculosis.

New scientific articles about tuberculosis (TB) are published daily worldwide. However, it is difficult for health care workers, overloaded with work, to stay abreast of the latest research findings and to discern which information can and should be used in their daily practice on assisting TB patients. The purpose of the III Brazilian Thoracic Association (BTA) Guidelines on TB is to critically review the most recent national and international scientific information on TB, presenting an updated text with the most current and useful tools against TB to health care workers in our country. The III BTA Guidelines on TB have been developed by the BTA Committee on TB and the TB Work Group, based on the text of the II BTA Guidelines on TB (2004). We reviewed the following databases: LILACS (SciELO) and PubMed (Medline). The level of evidence of the cited articles was determined, and 24 recommendations on TB have been evaluated, discussed by all of the members of the BTA Committee on TB and of the TB Work Group, and highlighted. The first version of the present Guidelines was posted on the BTA website and was available for public consultation for three weeks. Comments and critiques were evaluated. The level of scientific evidence of each reference was evaluated before its acceptance for use in the final text.

III Diretrizes para Tuberculose da Sociedade Brasileira de Pneumologia e Tisiologia / III Brazilian Thoracic Association Guidelines on Tuberculosis

Diariamente novos artigos científicos sobre tuberculose (TB) são publicados em todo mundo. No entanto, é difícil para o profissional sobrecarregado na rotina de trabalho acompanhar a literatura e discernir o que pode e deve ser aplicado na prática diária juntos aos pacientes com TB. A proposta das "III Diretrizes para TB da Sociedade Brasileira de Pneumologia e Tisiologia (SBPT)" é revisar de forma crítica o que existe de mais recente na literatura científica nacional e internacional sobre TB e apresentar aos profissionais da área de saúde as ferramentas mais atuais e úteis para o enfrentamento da TB no nosso país. As atuais "III Diretrizes para TB da SBPT" foram desenvolvidas pela Comissão de TB da SBPT e pelo Grupo de Trabalho para TB a partir do texto das "II Diretrizes para TB da SBPT" (2004). As bases de dados consultadas foram LILACS (SciELO) e PubMed (Medline). Os artigos citados foram avaliados para determinação do ...

New scientific articles about tuberculosis (TB) are published daily worldwide. However, it is difficult for health care workers, overloaded with work, to stay abreast of the latest research findings and to discern which information can and should be used in their daily practice on assisting TB patients. The purpose of the III Brazilian Thoracic Association (BTA) Guidelines on TB is to critically review the most recent national and international scientific information on TB, presenting an updated text with the most current and useful tools against TB to health care workers in our country. The III BTA Guidelines on TB have been developed by the BTA Committee on TB and the TB Work Group, based on the text of the II BTA Guidelines on TB (2004). We reviewed the following databases: LILACS (SciELO) and PubMed (Medline). The level of evidence of the cited articles was determined, and 24 recommendations ...

Prevalence of active and latent TB among inmates in a prison hospital in Bahia, Brazil.

OBJECTIVE: To determine the prevalence of latent and active TB among detainees in a prison hospital in Bahia, Brazil. METHODS: A cross-sectional study with prospective data collection was carried out comprising 237 inmates in the Bahia State Prison Hospital between July 2003 and April 2004. A standardized questionnaire was applied and completed by medical students. The detainees were systematically submitted to the following tests: tuberculin skin test, chest X-ray (anteroposterior), sputum smear microscopy and culture for mycobacteria. The events of interest were active TB and latent TB. RESULTS: The mean age of the participants was 36.6 years, and 89.9% were male. Smoking and alcohol consumption were reported by 70.0% and 43.9% of the inmates, respectively. A history of treatment for TB was reported by 11.3% of the inmates. Of the inmates evaluated, 36.3% reported cough and 31.4% reported expectoration. Other less common symptoms were asthenia (in 26.2%), weight loss (in 23.1%), loss of appetite (in 17.7%), fever (in 11.3%) and hemoptysis (in 6.7%). Of the 86 inmates tested, none presented positive HIV serology. The prevalence of latent TB was 61.5% (96 of the 156 inmates submitted to tuberculin skin tests), whereas that of active TB was 2.5% (6 of the 237 inmates evaluated). The presence of cough was a determinant of active TB (prevalence ratio = 8.8; 95% CI: 1.04-73.9; p = 0.025). CONCLUSIONS: Active and latent TB are highly prevalent among inmates hospitalized in the Bahia State Prison Hospital. Our findings justify the need to implement public policies specifically directed towards the control of TB in this population.

Prevalência de TB ativa e TB latente em internos de um hospital penal na Bahia / Prevalence of active and latent TB among inmates in a prison hospital in Bahia, Brazil

OBJETIVO: Estimar as prevalências de TB latente e TB ativa entre custodiados de um hospital penal na Bahia. MÉTODOS: Foram avaliados através de estudo de corte transversal com coleta prospectiva de dados 237 internos no Hospital Penal da Bahia entre julho de 2003 e abril de 2004. Um questionário padronizado foi preenchido por estudantes de medicina. Os indivíduos foram sistematicamente submetidos aos seguintes exames: teste tuberculínico, radiografia de tórax em incidência póstero-anterior, baciloscopia e cultura para micobactérias. Os eventos de interesse foram TB ativa e TB latente. RESULTADOS: A média de idade foi de 36,6 anos, sendo 89,9 por cento homens. Tabagismo e alcoolismo foram relatados por 70.0 por cento e 43.9 por cento dos internos, respectivamente. História de tratamento para TB foi relatada por 11,3 por cento dos indivíduos. Dos internos avaliados, 36,3 por cento relataram tosse e 31,4 por cento, expectoração. Outros sintomas menos frequentemente referidos foram astenia (26,2 por cento), perda de peso (23,1 por cento), inapetência (17,7 por cento), febre (11,3 por cento) e hemoptise (6,7 por cento). Nenhum dos 86 internos testados apresentou sorologia anti-HIV positiva. Entre os 156 submetidos ao teste tuberculínico, a prevalência de TB latente foi de 61,5 por cento (146 casos). Do total, 6 casos de TB ativa foram detectados (prevalência de 2,5 por cento). A presença de tosse foi um determinante de TB ativa (razão de prevalência = 8,8; IC95 por cento: 1,04-73,9; p = 0,025). CONCLUSÕES: A população de internos do Hospital Penal da Bahia tem altas prevalências de TB latente e ativa. Estes achados justificam a necessidade de implantação de políticas públicas especificamente direcionadas para o controle da TB nesta população

OBJECTIVE: To determine the prevalence of latent and active TB among detainees in a prison hospital in Bahia, Brazil. METHODS: A cross-sectional study with prospective data collection was carried out comprising 237 inmates in the Bahia State Prison Hospital between July 2003 and April 2004. A standardized questionnaire was applied and completed by medical students. The detainees were systematically submitted to the following tests: tuberculin skin test, chest X-ray (anteroposterior), sputum smear microscopy and culture for mycobacteria. The events of interest were active TB and latent TB. RESULTS: The mean age of the participants was 36.6 years, and 89.9 percent were male. Smoking and alcohol consumption were reported by 70.0 percent and 43.9 percent of the inmates, respectively. A history of treatment for TB was reported by 11.3 percent of the inmates. Of the inmates evaluated, 36.3 percent reported cough and 31.4 percent reported expectoration. Other less common symptoms were asthenia (in 26.2 percent), weight loss (in 23.1 percent), loss of appetite (in 17.7 percent), fever (in 11.3 percent) and hemoptysis (in 6.7 percent). Of the 86 inmates tested, none presented positive HIV serology. The prevalence of latent TB was 61.5 percent (96 of the 156 inmates submitted to tuberculin skin tests), whereas that of active TB was 2.5 percent (6 of the 237 inmates evaluated). The presence of cough was a determinant of active TB (prevalence ratio = 8.8; 95 percent CI: 1.04-73.9; p = 0.025). CONCLUSIONS: Active and latent TB are highly prevalent among inmates hospitalized in the Bahia State Prison Hospital. Our findings justify the need to implement public policies specifically directed towards the control of TB in this population.

Anti-tuberculosis drug resistance in strains of Mycobacterium tuberculosis isolated from patients in a tertiary hospital in Bahia.

Anti-tuberculosis drug resistance, particularly multiresistance, is a crucial issue in the control of tuberculosis (TB). This study estimated the prevalence of primary and acquired anti-tuberculosis drug resistance in strains of Mycobacterium tuberculosis isolated from hospitalized patients, to identify the risk factors for resistance, and to evaluate the its impact on hospital mortality for tuberculosis. Strains of Mycobacterium tuberculosis from 217 patients hospitalized for TB were analyzed. Subjects were recruited sequentially at a TB reference hospital in Salvador, Bahia, Brazil from July 2001 to July 2003. Multiresistant (MR) strains were defined as strains resistant to rifampicin and isoniazid. Of a total of 217 strains isolated, 41 (19.0%, 95%CI: 14.1-24.5%) were resistant to at least one drug. Prevalence of primary resistance was 7.0% (10/145), while a prevalence of 43.1% (31/72) was found for acquired resistance. Primary resistance to one drug alone was found in 2.1% (3/145) and acquired monoresistance in 5.6% (4/72). Prevalence of MR strains in general was 14.3% (31/217), of which 4.2% (6/145) consisted of primary MR and 34.7% (25/72) of acquired MR. Three strains showed resistance to more than one drug, but were not classified as MR. In the multivariate analysis, abandoning treatment remained strongly associated with resistance (adjusted OR: 7.21; 95%CI: 3.27-15.90; p<0.001) following adjustment for 3 potential confounders (gender, alcohol dependence and HIV-infection). An association was found between resistance and mortality from tuberculosis, even after adjustment for HIV status, age, sex and alcohol dependence (adjusted OR: 7.13; 95%CI: 2.25-22.57; p<0.001). High prevalences of resistance, principally acquired resistance including MR, were found in patients hospitalized for TB in Bahia. This finding was strongly associated with having abandoned treatment, and confirmed the need to standardize the procedure for requesting sensitivity tests in this population at the time of hospital admission.

Paragonimiasis: first case reported in Brazil.

The authors present a case from a 59 years old white female Brazilian patient, based in Salvador-Bahia, Brazil's northeastern side area, who experienced irritative cough and progressive dyspnea, and, after 18 months, was admitted to a hospital with respiratory insufficiency. The physical exam showed diffuse rales in both hemithoraces. Initial leukogram showed 14,400 cells/microL with 14% of eosinophils and chest X-ray showed peribronchovascular infiltrate, predominating in the lower half of the lung fields, and small opaque nodules. The high-resolution computed tomography scan of the chest (HRCT) presented compatible pattern with airways disease, especially from the small airways, with air trapping, tree sprouting images, central lobular nodules and bronchiectasis, making the results compatible with bronchiolitis and bronchiectasis. The transbroncho biopsy unveiled granulomatous lesion with necrosis, where was noticed a structure compatible to a parasitic case, and the research of the parasite eggs in the sputum was positive to paragonimus. After the praziquantel use, the patient presented a thick ferruginous expectoration and the result for BAAR examination was positive. The PCR exam and the sputum culture confirmed M. tuberculosis, and then the treatment for M. tuberculosis was initiated. The authors warn that this infection may have been a consequence of economics globalization process, where the importation of parasitized crustaceans might be the cause. However, there is the need of an accurate examination for the possibility of paragonimus specimens in this area of Brazil.

Prevalence of HIV infection in patients hospitalized for tuberculosis in Bahia, Brazil.

HIV infection is an important risk factor for the development of tuberculosis (TB), and also affects its morbidity and mortality. This study estimated the prevalence of HIV infection in patients hospitalized for TB in Bahia (in northeastern Brazil) and to evaluate its impact on in-hospital mortality. A total of 375 patients with TB, admitted consecutively to a TB reference hospital in Salvador (Bahia, Brazil), were evaluated between July 2001 and July 2003. Anti-HIV serology was performed in all patients irrespective of clinical and/or epidemiological data suggestive of HIV infection. Death during hospitalization was the principal event-dependent variable. Mean age of patients was 41.4 +/- 16.2 years and the male/female ratio was 3.4:1.0. The prevalence of HIV infection was 8.8% (95%CI: 6.2-12.0%). Patients in the HIV-positive group were younger than those in the HIV-negative group (37.1 versus 41.9 years; p=0.05). In-hospital mortality was 10.9% for the whole group (95%CI: 9.4-15.9%), but was significantly greater in the HIV-positive group compared to the HIV-negative group (27.3% versus 9.4%; RR=2.9; 95%CI: 1.5-5.6; p=0.002). The prevalence of HIV infection in patients hospitalized for TB in Bahia (northeastern Brazil) is relatively high (8.8%) and mortality is significantly higher (2.9-fold) in the HIV-positive group. These findings justify carrying out HIV testing, as recommended by the Brazilian Ministry of Health, in all TB patients, particularly those requiring hospitalization.

Anti-tuberculosis drug resistance in strains of Mycobacterium tuberculosis isolated from patients in a tertiary hospital in Bahia

Anti-tuberculosis drug resistance, particularly multiresistance, is a crucial issue in the control of tuberculosis (TB). This study estimated the prevalence of primary and acquired anti-tuberculosis drug resistance in strains of Mycobacterium tuberculosis isolated from hospitalized patients, to identify the risk factors for resistance, and to evaluate the its impact on hospital mortality for tuberculosis. Strains of Mycobacterium tuberculosis from 217 patients hospitalized for TB were analyzed. Subjects were recruited sequentially at a TB reference hospital in Salvador, Bahia, Brazil from July 2001 to July 2003. Multiresistant (MR) strains were defined as strains resistant to rifampicin and isoniazid. Of a total of 217 strains isolated, 41 (19.0 percent, 95 percentCI: 14.1-24.5 percent) were resistant to at least one drug. Prevalence of primary resistance was 7.0 percent (10/145), while a prevalence of 43.1 percent (31/72) was found for acquired resistance. Primary resistance to one drug alone was found in 2.1 percent (3/145) and acquired monoresistance in 5.6 percent (4/72). Prevalence of MR strains in general was 14.3 percent (31/217), of which 4.2 percent (6/145) consisted of primary MR and 34.7 percent (25/72) of acquired MR. Three strains showed resistance to more than one drug, but were not classified as MR. In the multivariate analysis, abandoning treatment remained strongly associated with resistance (adjusted OR: 7.21; 95 percentCI: 3.27-15.90; p<0.001) following adjustment for 3 potential confounders (gender, alcohol dependence and HIV-infection). An association was found between resistance and mortality from tuberculosis, even after adjustment for HIV status, age, sex and alcohol dependence (adjusted OR: 7.13; 95 percentCI: 2.25-22.57; p<0.001). High prevalences of resistance, principally acquired resistance including MR, were found in patients hospitalized for TB in Bahia. This finding was strongly associated with having abandoned...

Prevalence of HIV infection in patients hospitalized for tuberculosis in Bahia, Brazil

HIV infection is an important risk factor for the development of tuberculosis (TB), and also affects its morbidity and mortality. This study estimated the prevalence of HIV infection in patients hospitalized for TB in Bahia (in northeastern Brazil) and to evaluate its impact on in-hospital mortality. A total of 375 patients with TB, admitted consecutively to a TB reference hospital in Salvador (Bahia, Brazil), were evaluated between July 2001 and July 2003. Anti-HIV serology was performed in all patients irrespective of clinical and/or epidemiological data suggestive of HIV infection. Death during hospitalization was the principal event-dependent variable. Mean age of patients was 41.4 ± 16.2 years and the male/female ratio was 3.4:1.0. The prevalence of HIV infection was 8.8 percent (95 percentCI: 6.2-12.0 percent). Patients in the HIV-positive group were younger than those in the HIV-negative group (37.1 versus 41.9 years; p=0.05). In-hospital mortality was 10.9 percent for the whole group (95 percentCI: 9.4-15.9 percent), but was significantly greater in the HIV-positive group compared to the HIV-negative group (27.3 percent versus 9.4 percent; RR=2.9; 95 percentCI: 1.5-5.6; p=0.002). The prevalence of HIV infection in patients hospitalized for TB in Bahia (northeastern Brazil) is relatively high (8.8 percent) and mortality is significantly higher (2.9-fold) in the HIV-positive group. These findings justify carrying out HIV testing, as recommended by the Brazilian Ministry of Health, in all TB patients, particularly those requiring hospitalization.

Paragonimiasis: first case reported in Brazil

The authors present a case from a 59 years old white female Brazilian patient, based in Salvador-Bahia, Brazil's northeastern side area, who experienced irritative cough and progressive dyspnea, and, after 18 months, was admitted to a hospital with respiratory insufficiency. The physical exam showed diffuse rales in both hemithoraces. Initial leukogram showed 14,400 cells/mL with 14 percent of eosinophils and chest X-ray showed peribronchovascular infiltrate, predominating in the lower half of the lung fields, and small opaque nodules. The high-resolution computed tomography scan of the chest (HRCT) presented compatible pattern with airways disease, especially from the small airways, with air trapping, tree sprouting images, central lobular nodules and bronchiectasis, making the results compatible with bronchiolitis and bronchiectasis. The transbroncho biopsy unveiled granulomatous lesion with necrosis, where was noticed a structure compatible to a parasitic case, and the research of the parasite eggs in the sputum was positive to paragonimus. After the praziquantel use, the patient presented a thick ferruginous expectoration and the result for BAAR examination was positive. The PCR exam and the sputum culture confirmed M. tuberculosis, and then the treatment for M. tuberculosis was initiated. The authors warn that this infection may have been a consequence of economics globalization process, where the importation of parasitized crustaceans might be the cause. However, there is the need of an accurate examination for the possibility of paragonimus specimens in this area of Brazil.

Infection with the Mycobacterium avium complex in patients without predisposing conditions: a case report and literature review.

Nontuberculous Mycobacteria (NTM), especially Mycobacterium avium-intracellulare complex (MAC), has been considered responsible for human disease, especially in HIV patients. Nevertheless, it has been diagnosed in immunocompetent elderly men, frequently with previous pulmonary disease: chronic obstructive lung disease (COPD), complications of tuberculosis, pulmonary fibrosis and bronchiectasis. We relate the case of a female patient, 51 years old, with continuously acid fast bacilli (AFB) smears and with three previous treatments, which were conducted at the multiresistant tuberculosis (MRTB) service. MAC was identified in the sputum culture, and she received treatment for one year. The posterior sputum exams were negative. The cavity lesions observed in the high-resolution computed tomography (HRCT) were reduced, and some of the nodule lesions became bronchiectasis, even after the end of treatment. We agree with the literature reports that indicate that MAC is the cause of bronchiectasis. It is necessary to identify the type of mycobacteria in immunocompetent individuals with positive AFB smears that do not become negative with tuberculosis treatment.

Infection with the Mycobacterium avium complex in patients without predisposing conditons: a case report and literature review

Nontuberculous Mycobacteria (NTM), especially Mycobacterium avium-intracellulare complex (MAC), has been considered responsible for human disease, especially in HIV patients. Nevertheless, it has been diagnosed in immunocompetent elderly men, frequently with previous pulmonary disease: chronic obstructive lung disease (COPD), complications of tuberculosis, pulmonary fibrosis and bronchiectasis. We relate the case of a female patient, 51 years old, with continuously acid fast bacilli (AFB) smears and with three previous treatments, which were conducted at the multiresistant tuberculosis (MRTB) service. MAC was identified in the sputum culture, and she received treatment for one year. The posterior sputum exams were negative. The cavity lesions observed in the high-resolution computed tomography (HRCT) were reduced, and some of the nodule lesions became bronchiectasis, even after the end of treatment. We agree with the literature reports that indicate that MAC is the cause of bronchiectasis. It is necessary to identify the type of mycobacteria in immunocompetent individuals with positive AFB smears that do not become negative with tuberculosis treatment.

Risk of tuberculosis among household contacts in Salvador, Bahia

Tuberculosis is one of the most important infectious diseases in the world. Only 68 percent of the estimated new tuberculosis (TB) cases in Brazil are diagnosed. Our aim was to determine the risk of infection among household contacts. Study design. Cohort of tuberculin-negative household contacts followed for 12 Months. Methods. Household contacts of randomly selected index acid-fast bacilli (AFB)-positive TB cases were evaluated through clinical examination, thorax X-ray, tuberculin, AFB smear and culture. Contacts with a negative response to the tuberculin test (less than 10 mm diameter) were retested after 90 days. Tuberculin reversal (used as a parameter of infection risk) was defined as an increase of at least 10 mm from the last measurement. Results. 269 household contacts were followed. The prevalence of disease in this population was 3.7 percent. The prevalence of infection after the 12-month follow-up period was 63.9 percent. The risk of infection was 31.1 percent within 120 ± 48 days. Conclusion. Household contacts of AFB positive tuberculosis patients have a very high prevalence and risk of tuberculosis infection. TB preventive or therapeutic measures directed towards this group should be implemented in Brazil.