Multidrug-resistant tuberculosis: case reports study in a central state of Brazil

Abstract

Multidrug-resistant tuberculosis (MDR-TB) is an emerging and worrisome health problem that threatens tuberculosis (TB) control worldwide. The clinical management of MDR-TB is a complex issue associated with the use of multiple drugs for a long period, usually accompanied by side effects and high costs. The objective of this work was to relate cases of MDR-TB occurring in Goiás, a central state of Brazil. We related five cases of MDR-TB, three women and two men. All were pulmonary cases. Three were in their second treatment and two in their first treatment. Surgical pulmonary resection was performed in one case. One death occurred. Lack of adherence, gastric intolerance to anti-TB drugs and poor clinical management were the main aspects related to the emergent resistance. A revision of the main clinical aspects of this disease was performed.

Clinical data and molecular analysis of Mycobacterium tuberculosis isolates from drug-resistant tuberculosis patients in Goiás, Brazil

“…In this study, two patients presented clinical evidence for primary drug resistance (i.e., contact with MDR-TB and a short interval for resistance development). However, the long period for resistance development/detection observed in the present study also suggests the possibility that the majority of drug-resistant cases are secondary cases in which the drug resistance emerged after inadequate previous treatments (Martin & Portaels 2007, Araújo-Filho et al 2008, Curry 2008). …”

“…Evaluating the clinical profile of the enrolled TB patients, as shown elsewhere (Drobeniewski et al 2002, Barroso et al 2003, Araújo-Filho et al 2008, WHO 2008, it was observed that the long period of time between the first diagnosis of TB and the resistance diagnosis is probably the result of poor clinical practices, such as not routinely performing culture and susceptibility tests. It is also important to point out that the previous TB treatment was not supervised because at the time the patient enrolled, direct observed treatment was not adopted.…”

“…MDR-TB is caused by Mycobacterium tuberculosis that is resistant to at least rifampin (R) and isoniazid (H), and XDR-TB is defined as M. tuberculosis that is resistant to R, H, a fluoroquinolone and at least one of three injectable second-line drugs (i.e., capreomycin, kanamycin and amikacin) (Raviglione & Smith 2007). Drug resistance generally emerges due to the long period of treatment necessary for TB that favours poor therapy adherence, especially when therapy is without clinical supervision (Araújo-Filho et al 2008, WHO 2008, Dye 2009, Santos et al 2010. Of the utmost importance is the fact that MDR-TB and XDR-TB necessitate longer periods of treatment, usually requiring a hospital facility with biosafety concerns, in addition to the high mortality rate of XDR-TB (Curry 2008, WHO 2008.…”

Representações sociais do abandono do tratamento da tuberculose: estudo com profissionais da saúde

“…A intolerância gástrica é um dos principais aspectos relacionados à tuberculose multirresistente. 25 A hepatotoxicidade secundária ocasionada pelas drogas antituberculose limita o tratamento em pacientes coinfectados com HIV e tuberculose. A manifestação mais frequente de hepatotoxicidade é hepatite tóxica com icterícia 26 .…”

A adesão ao tratamento no caso da tuberculose multirresistente

“…Conforme anteriormente destacado, a forma multirresistente da TB representa mais um desafio importante para o controle da doença (OPAS, 2006;Cutter, Wang, 2010;WHO, 2010a). Vários são os estudos que confirmam que a tuberculose multirresistente (TBMR) é um problema que deve ter atenção e constante vigilância por parte das autoridades de saúde (Constant et al, 2004;Oliveira, 2006;Brasil, 2007;Coelho, 2007;Lemos, 2007; Uplekar, Raviglione, 2007;Araújo Filho et al, 2008;WHO, 2008b;Loddenkemper, Hauer, 2010;Keshavjee, Farmer, 2010;Shin et al, 2010;Freire-Moran et al, 2011;WHO, 2011b).…”