RESUMO
SETTING: Nine public health care centres in four Spanish cities. OBJECTIVE: To evaluate the efficacy and safety of 2 months of rifampicin (R) plus pyrazinamide (Z) therapy (2RZ) compared with a 6-month course of isoniazid therapy (6H) for treating latent tuberculosis infection (LTBI). DESIGN: Multicentered, randomised, comparative and prospective trial conducted in HIV-seronegative contacts of infectious pulmonary TB cases. RESULTS: Of 352 individuals, 199 received 6H and 153 2RZ; 73% of contacts receiving 6H and 71% receiving 2RZ completed treatment (P = 0.73). Treatment interruption due to hepatotoxicity (ALT/AST > 5 times upper limit of normal) was observed in 10% of contacts in the 2RZ group and in 2.5% of the 6H group (P = 0.007). This higher than expected rate of hepatotoxicity in the 2RZ arm led to premature termination of the study. Severe or fatal liver injury was not detected. Liver function tests normalised after discontinuation of treatment. We conclude that the use of RZ should only be considered when other regimens are unsuitable and intensive monitoring of liver function is feasible.
Assuntos
Antibióticos Antituberculose/uso terapêutico , Soronegatividade para HIV , Pirazinamida/uso terapêutico , Rifampina/uso terapêutico , Tuberculose Pulmonar/tratamento farmacológico , Adolescente , Adulto , Antibióticos Antituberculose/administração & dosagem , Criança , Pré-Escolar , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Feminino , Seguimentos , HIV/imunologia , Anticorpos Anti-HIV/imunologia , Humanos , Lactente , Masculino , Estudos Prospectivos , Pirazinamida/administração & dosagem , Rifampina/administração & dosagem , Espanha , Resultado do Tratamento , Teste Tuberculínico , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/diagnósticoRESUMO
La infección tuberculosa en adultos no es muy conocida en nuestro país a pesar del interés epidemiológico que tiene. Se diseñó un estudio observacional en un grupo homogéneo de adultos funcionarios de Cataluña (n = 8.202) de 20 a 54 años de edad que se sometieron a un examen de salud, en el que se incluyó una prueba de tuberculina, con objeto de estudiar la infección tuberculosa en ellos y evaluar los factores relacionados con la misma. Resultados. La prevalencia global a la reactividad de la prueba de la tuberculina es del 22,36 por ciento y la prevalencia de la infección tuberculosa del 14,76 por ciento. Los factores relacionados con la infección tuberculosa son: edad, sexo masculino, antecedentes de exposición a fuentes de contagio y vacunación antituberculosa (BCG) previa. Conclusiones. La prevalencia de la infección tuberculosa en adultos ha descendido, siendo mayor en hombres que en mujeres, entre los que reconocen haber tenido contacto con un enfermo tuberculoso y entre los que fueron vacunados con BCG (AU)
Assuntos
Pessoa de Meia-Idade , Adulto , Masculino , Feminino , Humanos , Espanha , Tuberculose Pulmonar , Tuberculina , Prevalência , Incidência , Mycobacterium tuberculosis , Inquéritos e Questionários , Teste TuberculínicoRESUMO
UNLABELLED: Tuberculous infection in adults is not a well known entity in our country, despite its epidemiological importance. We have designed an observational study in a homogeneous group of adult civil servants of Catalonia (n = 8,202) from 20 to 54 years old that were submitted to a health examination which included a tuberculin test, in order to study the tuberculous infection in these people and to evaluate the factors associated with this infection. RESULTS: The global prevalence of reactivity in tuberculin test was 22.36% and the prevalence of the tuberculous infection was 14.76%. The factors related to the tuberculous infection were the following: age, male sex, background of exposure to sources of contagion, and previous BCG vaccination. CONCLUSIONS: The prevalence of tuberculous infection in adults has declined, and is currently greater in men than women, among patients who recognize previous contact with a tuberculous patient, and among patients with previous BCG vaccination.
