A Decade Trend of Multidrug Resistant Tuberculosis in São Paulo State, Brazil

Abstract

SUMMARYThe aim of this retrospective study was to review all the notified cases of multidrug-resistant tuberculosis (MDR-TB) in São Paulo State (Brazil), as well as to describe and discuss the clinical, microbiological and radiologic aspects in a single reference center, within the same state, from 2000 to 2012. There were 1,097 notifications of MDR-TB in São Paulo State over this period, 70% affecting men aged on average 38 years (10-77). There was a significant fall in the MDR-TB mortality rate from 30% to 8% (2000-2003 versus 2009-2012). The same trend was observed in the cases studied at the reference center. The number of notified cases increased and death rate reduced from 37.5% (2000-2005) to 3.4% (2006-2012). Among the 48 drug-resistant TB cases, 17 non-tuberculous Mycobacteria were isolated in the sputum culture of nine patients, without any clinical significance. TB and fungus co-infection was diagnosed in 15% (7/48) of these cases: three with confirmed chronic pulmonary aspergillosis and four with positive serological markers for paracoccidioidomycosis. Overall, the reports show that MDR-TB diagnosis and cure rates have increased, while the mortality rate has decreased significantly in São Paulo State including in the studied reference center.

Predictive model of unfavorable outcomes for multidrug-resistant tuberculosis

“…The results showed that in the state of São Paulo there was a growth in the proportion of patients’ cure and a trend to reduce treatment failure, highlighting a visible conversion of these outcomes mainly from 2011, something also observed by Valdes et al 10 . These trends are presumed to be related to the application of norms for diagnosis and treatment published in 2007, which allowed over time to reverse the state scenario of MDR-TB treatment observed between the 2006 and 2010 and to incorporate new drugs and regimens treatment in the state 11 .…”

“…Os resultados mostraram que no estado de São Paulo houve um crescimento na proporção de cura dos pacientes e uma tendência de redução da falência no tratamento, destacando uma visível conversão desses desfechos principalmente a partir de 2011, algo também observado por Valdes et al 10 . Presume-se que tais tendências estejam relacionadas à aplicação de normas para o diagnóstico e tratamento publicadas em 2007, que possibilitaram com o tempo reverter o cenário estadual de tratamento da TB-MDR observado entre os anos de 2006 e 2010 e incorporar novas drogas e esquemas de tratamento mais efetivos no estado 11 .…”

Correlation between the BACTEC MGIT 960 culture system with Genotype MTBDRplus and TB-SPRINT in multidrug resistant Mycobacterium tuberculosis clinical isolates from Brazil

“…84,000 new cases were estimated in 2015 with an incidence of 41 per 100,000 and a mortality rate of 2.7 per 100,000 ( WHO 2016 ). Despite Brazil not being among the high-burden MDR-TB countries ( WHO 2016 ), the number of MDR-TB cases in Brazil identified after 2007 almost doubled (from approximately 300 cases in 2007 to 702 cases in 2014) ( Bollela et al 2016 ). In the state of Minas Gerais, the second most populated state in the southeast region of the country, the mean MDR TB rate was 0.2% among the notified TB cases between 2002 and 2009 ( Augusto et al 2013 ).…”

Trends of Drug Resistance Tuberculosis from 2014 to 2018, Bale Zone, Oromia Region, Ethiopia

“…This finding consistent with the study conducted in China, 8 , 9 however, contrary to the study conducted in India and Brazil. 12 , 13 Our findings indicated that the majority of the cases were among people aged greater than 15 years. This finding consistent with the study conducted in China and India.…”