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1.
Microb Drug Resist ; 23(8): 1045-1052, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28447869

RESUMO

BACKGROUND: Simultaneous use of genotypic and phenotypic diagnostic tools for detection of rifampicin (RIF) susceptibility may yield discrepant results. OBJECTIVE: To measure the discordance between the RIF-susceptibility results by Xpert MTB/RIF and Mycobacterium Growth Indicator Tube (MGIT), to evaluate if application of both tests to the same sample affects the discrepancy, and to evaluate treatment outcome in patients with the discordant strains. DESIGN: Sputa from patients with tuberculosis managed in the penitentiary system of Azerbaijan during 2011-2015 were examined for RIF susceptibility using Xpert MTB/RIF and MGIT. Strains with discrepant results were sequenced. RESULTS: Of 532 patients included, 6.2% had discordant RIF-susceptibility results. No significant association of the discordant RIF-susceptibility results with application of both tests on one sample versus sequential samples was found. L511P mutation accounted significantly (p = 0.006) for the discrepancy among those RIF resistant on Xpert MTB/RIF, but sensitive on MGIT. No significant association was identified between the outcomes of treatment with the first- or second-line drugs and the presence of any mutation. CONCLUSION: The Xpert MTB/RIF and MGIT testing may be used in sequential sputum samples without increase in the RIF-susceptibility discordance rate. L511P mutation significantly accounts for discordant RIF-susceptibility results, but its clinical relevance may be low.


Assuntos
Antibacterianos/uso terapêutico , Mycobacterium tuberculosis/efeitos dos fármacos , Rifampina/uso terapêutico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Pulmonar/microbiologia , Azerbaijão , Farmacorresistência Bacteriana/efeitos dos fármacos , Humanos , Escarro/microbiologia
2.
Eur Respir J ; 46(6): 1563-76, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26405286

RESUMO

Latent tuberculosis infection (LTBI) is characterised by the presence of immune responses to previously acquired Mycobacterium tuberculosis infection without clinical evidence of active tuberculosis (TB). Here we report evidence-based guidelines from the World Health Organization for a public health approach to the management of LTBI in high risk individuals in countries with high or middle upper income and TB incidence of <100 per 100 000 per year. The guidelines strongly recommend systematic testing and treatment of LTBI in people living with HIV, adult and child contacts of pulmonary TB cases, patients initiating anti-tumour necrosis factor treatment, patients receiving dialysis, patients preparing for organ or haematological transplantation, and patients with silicosis. In prisoners, healthcare workers, immigrants from high TB burden countries, homeless persons and illicit drug users, systematic testing and treatment of LTBI is conditionally recommended, according to TB epidemiology and resource availability. Either commercial interferon-gamma release assays or Mantoux tuberculin skin testing could be used to test for LTBI. Chest radiography should be performed before LTBI treatment to rule out active TB disease. Recommended treatment regimens for LTBI include: 6 or 9 month isoniazid; 12 week rifapentine plus isoniazid; 3-4 month isoniazid plus rifampicin; or 3-4 month rifampicin alone.


Assuntos
Antituberculosos/uso terapêutico , Isoniazida/uso terapêutico , Tuberculose Latente/tratamento farmacológico , Rifampina/análogos & derivados , Rifampina/uso terapêutico , Antirreumáticos/uso terapêutico , Coinfecção/epidemiologia , Comorbidade , Gerenciamento Clínico , Usuários de Drogas , Emigrantes e Imigrantes , Medicina Baseada em Evidências , Infecções por HIV/epidemiologia , Pessoal de Saúde , Pessoas Mal Alojadas , Humanos , Testes de Liberação de Interferon-gama , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Tuberculose Latente/diagnóstico , Tuberculose Latente/epidemiologia , Programas de Rastreamento , Guias de Prática Clínica como Assunto , Prisioneiros , Saúde Pública , Radiografia Torácica , Diálise Renal , Medição de Risco , Silicose/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transplantados , Teste Tuberculínico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Organização Mundial da Saúde
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