Drug-resistant tuberculosis in subjects included in the Second National Survey on Antituberculosis Drug Resistance in Porto Alegre, Brazil

Abstract

OBJECTIVE: To describe the prevalence of multidrug-resistant tuberculosis (MDR-TB) among tuberculosis patients in a major Brazilian city, evaluated via the Second National Survey on Antituberculosis Drug Resistance, as well as the social, demographic, and clinical characteristics of those patients. METHODS: Clinical samples were collected from tuberculosis patients seen between 2006 to 2007 at three hospitals and five primary health care clinics participating in the survey in the city of Porto Alegre, Brazil. The samples were subjected to drug susceptibility testing. The species of mycobacteria was confirmed using biochemical methods. RESULTS: Of the 299 patients included, 221 (73.9%) were men and 77 (27.3%) had a history of tuberculosis. The mean age was 36 years. Of the 252 patients who underwent HIV testing, 66 (26.2%) tested positive. The prevalence of MDR-TB in the sample as a whole was 4.7% (95% CI: 2.3-7.1), whereas it was 2.2% (95% CI: 0.3-4.2) among the new cases of tuberculosis and 12.0% (95% CI: 4.5-19.5) among the patients with a history of tuberculosis treatment. The multivariate analysis showed that a history of tuberculosis and a longer time to diagnosis were both associated with MDR-TB. CONCLUSIONS: If our results are corroborated by other studies conducted in Brazil, a history of tuberculosis treatment and a longer time to diagnosis could be used as predictors of MDR-TB.

Caracterização da tuberculose drogarresistente no Brasil, 2014*

“…Similar results were found in previous studies. 5,7,9 Notwithstanding, predominant mono-resistance to streptomycin had already been reported in the municipality of São José do Rio Preto, in the state of São Paulo, between 2009 and 2013. 6 The number of pulmonary MDR-TB cases reported in 2014 accounted for 43.7% of those estimated by WHO for Brazil that year (19.4% of primary cases and 64.7% of acquired cases).…”

“…The predominance of men, Afro-Brasilian, young people, and people with low levels of education was also found in other municipal, state and local studies between 2000 and 2013; with an exception in the municipality of Porto Alegre, in the state of Rio Grande do Sul, between 2006 and 2007, when most DR-TB cases (64.3%) were w hite individuals. [5][6][7][8][9][17][18][19][20] This variation is possibly due to regional differences in the ethnic composition of population. The DR-TB case profile is the same as that associated with treatment of drug-sensitive TB cases loss to follow-up.…”

“…24 In relation to diabetes, the percentage we found was in-between those found in Porto Alegre and in the states of Espírito Santo and Amazonas between 2000 and 2013 (they ranged from 7.7% to Drug-resistant tuberculosis in Brazil 13.6%). 5,9,20 Diabetes has the potential to interfere with TB treatment, with higher risk of treatment failure, TB recurrence and death. 25 The relative frequency of substance use is consistent with that found in São José do Rio Preto between 2009 and 2013, 6 as well as among MDR-TB cases at the São Paulo State Referral Center in 2010.…”

“…3 In 2006, 1.4% of new TB cases and 7.5% of previously treated cases were MDR-TB. 4 When describing the epidemiological profile of DR-TB, recent Brazilian studies have used local data [5][6][7][8][9] rather than national data.…”

Série Histórica da Tuberculose Resistente a Múltiplos Medicamentos (TB-MR) no Estado do Pará, Brasil, 2005- 2010.

“…19 A elevada proporção de abandono entre pacientes com TB-MR observada na pesquisa é preocupante, por favorecer a disseminação do bacilo resistente entre a população e consequentemente, aumentar os índices de morbi-mortalidade da doença. 20 Segundo em estudo realizado no Estado do Acre, as taxas de abandono foram superiores a 5%, conforme preconizado pelo MS, corroborando com os achados desta pesquisa. 21 Em um estudo realizado em Porto Alegre, os índices de abandono também foram altos e variaram entre 8 e 17%, e destacou também que o abandono é mais frequente durante os três primeiros meses do tratamento.…”