High frequency of resistance to the drugs isoniazid and rifampicin among tuberculosis cases in the city of Cabo de Santo Agostinho, an urban area in Northeastern Brazil

Abstract

The objective of the present study was to investigate the frequency and risk factors for developing multidrug-resistant tuberculosis in Cabo de Santo Agostinho, PE. This was a prospective study conducted from 2000 to 2003, in which suspected cases were investigated using bacilloscopy and culturing. Out of 232 confirmed cases of tuberculosis, culturing and antibiotic susceptibility tests were performed on 174. Thirty-five of the 174 cultures showed resistance to all drugs. The frequencies of primary and acquired resistance to any drug were 14% and 50% respectively, while the frequencies of primary and acquired multidrug resistance were 8.3% and 40%. Previous tuberculosis treatment and abandonment of treatment were risk factors for drug resistance. The high levels of primary and acquired resistance to the combination of isoniazid and rifampicin contributed towards the difficulties in controlling tuberculosis transmission in the city. Key-words:Tuberculosis. Drug resistance. Multidrug resistance. Risk factors.Multidrug resistance. Risk factors. RESUMOO objetivo do presente estudo foi investigar a freqüência e fatores de risco para o desenvolvimento de tuberculose multidroga resistente, na Cidade do Cabo de Santo Agostinho, PE. Este é um estudo prospectivo realizado entre 2000-2003 onde casos suspeitos foram investigados por baciloscopia e cultura. De 232 casos de tuberculose confirmados, 174 tiveram cultura e antibiograma realizados. Trinta e cinco das 174 culturas mostraram resistência a qualquer uma das drogas. A freqüência de resistência primária e adquirida a qualquer droga foi 14% e 50% respectivamente enquanto a freqüência primária e adquirida para multidroga resistência foi 8,3% e 40%. Tratamento prévio para tuberculose ou abandono de tratamento consistiu em fatores de risco para resistência a drogas. Os altos níveis de resistência primária e adquirida a combinação isoniazida e rifampicina contribuem para as dificuldades no controle da transmissão da tuberculose no Cabo. The increasing frequency of drug-resistant tuberculosis (TB), which has been leading to failure to respond to either isoniazid (INH) or rifampicin (RMP) is of great concern in relation to successful implementation of large-scale regional TB control programs. In Brazil, the first-line drugs for TB treatment in use since 1982 are INH and RMP for six months in association with pyrazinamide (PZA) for the first two months. The drugs are supplied by the government, without cost to the patient, and the treatment is based on self-administration. PalavrasThe World Health Organization (WHO) defines multidrugresistant tuberculosis (MDR-TB) as TB involving resistance to at least INH and RMP. However, the Brazilian Consensus

Evaluation of memory immune response to mycobacterium extract among household contact of tuberculosis cases

“…The TB cases present in this analysis formed part of a cohort study in Cabo de Santo Agostinho, Brazil (17). The 232 individuals with TB who were registered in the cohort database were investigated for household contacts with TB.…”

Successes and failures in the control of infectious diseases in Brazil: social and environmental context, policies, interventions, and research needs

“…109 Because prevention of acquired resistance depends on early case fi nding and eff ective treatment, standardised In Brazil, multi-drug resistance seems to be largely associated with retreatment, probably because of irregular treatment schedules or patients' abandon ment of treatment. 115,116 Of all individuals with tuber culosis in Brazil, an estimated 6•0% are infected with strains resistant to isoniazid and 1•4% are infected with strains resistant to both isoniazid and rifam picin. [116][117][118] The prevalence of such resistant strains might decrease with a decision made in 2009 to change the fi rst-line treatment regimen, introducing ethambu tol as a fourth drug during the fi rst 2 months of treatment and the use of one pill containing the four drugs.…”

“…115,116 Of all individuals with tuber culosis in Brazil, an estimated 6•0% are infected with strains resistant to isoniazid and 1•4% are infected with strains resistant to both isoniazid and rifam picin. [116][117][118] The prevalence of such resistant strains might decrease with a decision made in 2009 to change the fi rst-line treatment regimen, introducing ethambu tol as a fourth drug during the fi rst 2 months of treatment and the use of one pill containing the four drugs. 117 Extensive data for the prevalence of extensively drug-resistant tuberculosis are not available, but cases have been reported.…”

Role of TNF-Alpha, IFN-Gamma, and IL-10 in the Development of Pulmonary Tuberculosis

“…It is estimated that, on average, a person with active TB can infect between 10 and 15 individuals per year [2]. The World Health Organization (WHO) works intensively to significantly reduce the TB cases and halve this disease death number until 2015 [3]; however, the number of multidrug-resistant TB cases is rising, and this increasingly compromises the disease control [4, 5]. …”