Recent transmission of drug-resistant Mycobacterium tuberculosis in a prison population in southern Brazil

Reis, Ana Júlia; David, Simone Maria Martini de; Nunes, Luciana Neves; Valim, Andréia Rosane de Moura; Possuelo, Lia Gonçalves

doi:10.1590/s1806-37562016000000023

Cited by 11 publications

(16 citation statements)

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“…and Reis et al . reported resistance rates of 15 and 22.9 %, respectively [28, 33]. On the other hand, a study conducted in India in 2019 found a low rate of resistance, 6.25 %, to RIF among prisoners [4, 39], but in the same year, 38 % of M.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis cases in a prison in the extreme south of Brazil

Bierhals

Busatto

Silveira³

et al. 2021

Journal of Medical Microbiology

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Introduction. Tuberculosis (TB) control is a challenge, especially in vulnerable populations, such as prisoners. Hypothesis. In prison houses, the transmission of micro-organisms that cause infectious diseases can occur due to the susceptibility and immune compromise of prisoners, and due to the precarious physical conditions of the prison houses. However, strategies such as monitoring by health professionals, can mitigate the transmission of these micro-organisms, as well as, reduce the number of coinfections and antimicrobials resistance. Aim. This study attempted to analyse the dynamics of transmission and the antimicrobial resistance profile of Mycobacterium tuberculosis strains obtained from prisoners and to characterize the epidemiological, clinical and laboratory profiles of prisoners diagnosed with TB. Methodology. A cross-sectional and retrospective study was conducted with sputum samples collected from 228 distinct prisoners who were treated at the Health Unit located in the Regional Penitentiary of Rio Grande, Rio Grande do Sul, Brazil. The antimicrobial resistance profile of the strains was evaluated using the Resazurin Microtiter Assay and the transmission dynamics was investigated using 15-loci MIRU-VNTR. Results. Thirty-five patients (15.4 %) were diagnosed with TB, and when a TB/HIV coinfection was assessed, 8.6 % (3/35) of the patients were positive. In addition, all patients with results available for HBV, HCV, syphilis and diabetes mellitus were negative. Based on the genotypic profile, 55.9 % of the clinical isolates were grouped into five groups. One isolate with mono-resistance to isoniazid and two with mono-resistance to streptomycin were found. Conclusion. The presence of a Health Unit may have influenced the low numbers of TB/HIV, TB/HBV, TB/HCV, TB/syphilis coinfections and TB cases resistant to antimicrobials. Recent M. tuberculosis transmission can be inferred based on the high percentage of formatting of clusters. This situation stresses the need to improve active and passive detection, the screening of individuals for TB upon entrance into prison for early detection, and the implementation of prophylactic measures to reduce M. tuberculosis transmission.

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Section: Discussionmentioning

confidence: 99%

Tuberculosis cases in a prison in the extreme south of Brazil

Bierhals

Busatto

Silveira³

et al. 2021

Journal of Medical Microbiology

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“…In addition, considering the increased incidence of TB-DR cases, it is possible to verify the occurrence of transmission of genetically similar strains inside the prison cells [5], as well prevent inadequate treatments and late detection of the cases. It is therefor very important that health care workers request the sputum culture and the sensitivity tests [23].…”

Section: Discussionmentioning

confidence: 99%

“…In this sense, it is observed that in most cases there is a prioritization of safety over health, which hinders actions within the penitentiary complexes , such as health team access to cells, evaluation of contacts, DOT, programs to control drug abuse and smoking, as well as continuing education for prison workers, which could contribute to reducing the incidence of TB and morbidity in these settings [5,6,14,27].…”

Section: Discussionmentioning

confidence: 99%

“…Penitentiary complexes represent environments of TB propagation due to confinement, which is marked by overcrowded prison cells, unhealthy and inadequate infrastructure conditions, lack of equipment and human resources, difficulties of communication with the health system, misconceptions about the disease, poor performance of unqualified multi-professional teams for detection and management [3][4][5], as well as failure to accomplish health education for PDL.…”

Section: Introductionmentioning

confidence: 99%

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Tuberculosis in prison and aspects associated with the diagnosis site

Ferreira

Bonfim

Siqueira

et al. 2019

J Infect Dev Ctries

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Introduction: Tuberculosis (TB) is highly endemic in prison environments, and requires special attention in the population deprived of liberty (PDL). Thus, we aimed to describe the epidemiological situation of TB among PDL in a large municipality of the Brazilian Legal Amazon, from 2012 to 2016, and to identify the factors associated with the site of TB cases notification. Methodology: Both descriptive and cross-sectional studies were conducted. Sociodemographic, clinical, diagnostic and treatment data of PDL with TB were collected from the National Disease Notification System - SINAN. Data analysis included frequency distribution, Chi-square test, Fisher exact test and residue analysis, with a significance level of 95%. Results: 256 cases of TB have been notified among PDL in the penitentiary complex situated in the municipality and 100 cases in local health services, such as Primary Health Care units or referral services. Notification in the penitentiary complex was associated with non-X-ray and more than ten contacts identified. An association was found between diagnosis in local health services and female sex, AIDS, alcoholism, illicit drug use, extrapulmonary clinical form, extrapulmonary pulmonary disease, suspected X-ray, sputum smear-negative for diagnosis, HIV positive, culture of sputum not performed/ in progress, DOT ignored/ blank, less than five contacts identified, transfer and others as closure situation. Conclusions: The results show that intricate TB cases were notified by the local health services. Strategies of surveillance and articulation with these health services seem to contribute to the identification of TB cases among PDL.

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“…Intense transmission of DR-TB, in prisons is well documented. 62, 63 However, these congregate settings are a challenge for active case finding approaches due to the high inmate turnover, crowded living conditions and the marginalized nature of the population at risk. Evidence of the impact in reducing prison transmission through active case finding interventions has been mixed.…”

Section: Introductionmentioning

confidence: 99%

Treatment as prevention and other interventions to reduce transmission of multidrug-resistant tuberculosis

Nathavitharana

Lederer

Tierney

et al. 2019

int j tuberc lung dis

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Summary Drug resistant tuberculosis (DR-TB) represents a major programmatic challenge at the national and global level. Only ~30% of patients with multidrug-resistant (MDR) TB were diagnosed and ~25% were initiated on therapy for MDR-TB in 2016. Increasing evidence now points towards primary transmission of DR-TB rather than inadequate treatment as the major driver of the DR-TB epidemic. The cornerstone of DR-TB transmission prevention should be earlier diagnosis and prompt initiation of effective treatment for all patients with DR-TB. Despite the extensive scale up of Xpert MTB/RIF testing, major implementation barriers continue to limit its impact. Although there is longstanding evidence in support of the rapid impact of treatment on patient infectiousness, delays in the initiation of effective DR-TB treatment persist, resulting in ongoing transmission. However, it is also imperative to address the burden of latent DR-TB infection, since it is estimated that many DR-TB patients will become infectious prior to seeking care and encounter various diagnostic delays before treatment. Addressing latent DR-TB primarily consists of identifying, treating and following contacts of patients with MDR-TB, typically through household contact evaluation. Adjunctive measures such as improved ventilation and use of germicidal ultraviolet (GUV) technology can further decrease TB transmission in high-risk congregate settings. Although many gaps remain in our biological understanding of TB transmission, implementation barriers to early diagnosis and rapid initiation of effective DR-TB treatment can and must be overcome if we are to impact DR-TB incidence in the short and long-term.

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Recent transmission of drug-resistant Mycobacterium tuberculosis in a prison population in southern Brazil

Cited by 11 publications

References 13 publications

Tuberculosis cases in a prison in the extreme south of Brazil

Tuberculosis cases in a prison in the extreme south of Brazil

Tuberculosis in prison and aspects associated with the diagnosis site

Treatment as prevention and other interventions to reduce transmission of multidrug-resistant tuberculosis

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