Caracterização da tuberculose multidroga resistente durante a gravidez, em Campinas, Estado de São Paulo, Brasil, no período de 1995 a 2007

Abstract

RESUMOIntrodução: Foi feito um acompanhamento das gestantes tratadas para tuberculose multidroga resistente (TB-MDR) durante a gravidez, em Campinas, Estado de São Paulo, no período de 1995 a 2007. Métodos: No estudo retrospectivo, foram incluídas pacientes com cepa resistente, pelo menos à isoniazida e à rifampicina e gravidez em qualquer momento, durante o tratamento. Os casos receberam esquema individualizado baseado nos padrões de resistência medicamentosa e nos antecedentes de tratamento de cada paciente. Resultados: Sete gestantes apresentaram resistência a duas ou mais drogas. Três já estavam grávidas, antes do início do tratamento e quatro engravidaram depois. Duas estavam com Aids, uma foi a óbito e em outra ocorreu falência de tratamento. Todas apresentaram tuberculose avançada com achados radiológicos graves e para cinco pacientes o tempo médio da conversão do escarro foi de quatro meses. Duas gestantes foram curadas. Dois recém-nascidos foram infectados com o HIV por suas progenitoras. Conclusões: O resultado do tratamento foi insatisfatório e a supervisão direta é imperativa na TB-MDR durante a gestação. O planejamento familiar deve ser fortemente recomendado. Palavras-chaves:Tuberculose. Multidroga resistente. Gravidez. ABSTRACT Introduction:There was a follow-up of pregnant women treated for multidrug-resistance tuberculosis (MDR-TB) during pregnancy in Campinas, State of São Paulo, Brazil, from 1995 to 2007. Methods: In a retrospective study, patients with tuberculosis who were resistant to at least isoniazid and rifampicin and had pregnancy at any time during the treatment were included. The cases were individually treated, considering drug susceptibility test results and patients' prior treatments. Results: Seven cases presented resistance to two or more drugs. Three were already pregnant before the beginning of the treatment, and four conceived after. Two were with AIDS; one died, and the therapeutic program in the other one failed. All showed advanced tuberculosis with acute radiological findings, and the median sputum conversion time for five patients was four months. Two patients were cured. Two newborn babies were infected with HIV by their mothers. Conclusions: The outcome was unsatisfactory, and direct supervision is imperative in MDR-TB during pregnancy. The family planning program should be strongly recommended.

Tuberculosis care for pregnant women: a systematic review

“…In the MDR cases, the second line drugs, including drugs of the amino glycosides group, fluoroquinolone, thioamides, cycloserines, and terizidone, were used in combination with effective first line drugs, and the treatment regime depended on the drug resistance situation of the individual cases [36],[37],[43],[44]. …”

“…Regarding effectiveness and safety of anti-TB drugs, results of the reviewed studies showed no significant association between child abnormality and mother’s exposure to anti-TB drugs, both for 1 st and 2 nd line anti-TB drugs during pregnancy [14],[15],[37],[43],[44]. Other significant adverse effects were recorded in a very small number of pregnant women (2 cases of drug induced hepatitis, 2 of PZA allergy, 2 of sensorineural deafness, and 1 of severe nausea and jaundice) and led to termination of therapy without mortality [24],[44].…”

“…Unlike other studies, in these TB was detected in all the women before pregnancy. More specifically, 48/55 of the women had been diagnosed with MDR TB and had already taken 2 nd line anti-TB drugs before getting pregnant, while 7/55 were diagnosed MDR TB and started therapy during pregnancy [36],[37],[43],[44]. After being counselled by clinicians, only 6/55 women chose abortion, while the rest decided to continue the pregnancy and undergo MDR therapy [37],[44].…”

“…The results of the studies showed that, with an attentive follow-up and appropriate therapy, MDR-TB pregnant women can be cured and have a positive maternal outcome, and should therefore be given the option to continue with a pregnancy [36],[37],[44]. The results also showed that a delay in, or default, MDR treatment were the main causes of mortality and morbidity for mothers and babies [36],[43],[44]. …”

Treatment Outcomes Among Pregnant Patients With Multidrug-Resistant Tuberculosis

“…Our electronic database searches identified 487 records. After removal of duplicates, excluding studies by title and abstract screening and full-text review (eTable 5 in the Supplement), 10 studies [14][15][16][17][18][19][20][21][22][23] were included in the meta-analysis, which included 288 pregnant patients with MDR-TB (Figure 1).…”