Doença pulmonar por Mycobacterium tuberculosis e micobactérias não-tuberculosas entre pacientes recém-diagnosticados como HIV positivos em Moçambique, África

Abstract

Objective: Mycobacteriosis is frequently diagnosed among HIV-infected patients. In Mozambique, where few patients are under antiretroviral therapy and the prevalence of tuberculosis is high, there is need for better characterization of mycobacteria at the species level, as well as for the identification of patterns of resistance to antituberculous drugs. Methods: We studied a sample of 503 HIV-infected individuals suspected of having pulmonary tuberculosis. Of those 503, 320 tested positive for mycobacteria through sputum smear microscopy or culture of bronchoalveolar lavage fluid. Results: Acid-fast bacilli were observed in the sputum of 73% of the individuals presenting positivecultures. Of 277 isolates tested, only 3 were nontuberculous mycobacteria: 2 were identified as Mycobacterium avium and one was identified as M. simiae. Strains initially characterized as M. tuberculosis complex through polymerase chain reaction restriction analysis (PRA) of the hsp65 gene were later confirmed as such through PRA of the gyrB gene. Among the M. tuberculosis isolates, resistance patterns were as follows: to isoniazid, 14%; to rifampin, 6%; and multidrug resistance, 5%. Previously treated cases showed significantly higher rates of resistance to first-line antituberculous drugs. The most common radiological pattern was interstitial infiltrate (in 67%), followed by mediastinal lymph node enlargement (in 30%), bronchiectasis (in 28%), miliary nodules (in 18%) and cavitation (in 12%). Patients infected with nontuberculous mycobacteria presented clinical profiles indistinguishable from those of other patients. The median CD4 lymphocyte count in this group was 134 cells/mm 3 . Conclusions: There is a strong association between tuberculosis and AIDS in Mozambique, as expected in a country with a high prevalence of tuberculosis. Although drug resistance rates are high, the isoniazid-rifampin regimen continues to be the appropriate choice for initial therapy.Keywords: Tuberculosis; Mycobacteria, atypical; HIV; Acquired immunodeficiency syndrome; Drug Resistance, Multiple; Mozambique. ResumoObjetivo: A micobacteriose é frequentemente diagnosticada entre pacientes infectados pelo HIV. Em Moçambique, onde apenas um pequeno número de pacientes encontra-se sob tratamento anti-retroviral, e a tuberculose tem alta prevalência, existe a necessidade de melhor caracterização destes agentes bacterianos, em nível de espécie, bem como de se caracterizar os padrões de resistência às drogas antituberculosas. Métodos: Em uma coorte de 503 indivíduos HIV positivos suspeitos de tuberculose pulmonar, 320 apresentaram positividade para baciloscopia ou cultura no escarro e no lavado brônquico. Resultados: Bacilos álcool-ácido resistentes foram detectados no escarro em 73% dos casos com cultura positiva. De 277 isolados em cultura, apenas 3 mostraram-se tratar de micobactérias não-tuberculosas:2 Mycobacterium avium e uma M. simiae. Todos os isolados de M. tuberculosis inicialmente caracterizados através de reação em cadeia de polimerase (RCP) do...

Anti tuberculosis drug resistance in west of Iran

“…This is in agreement with the observations of other Iranian researchers. [1415] Resistance to isoniazid in this study was 16.1%, and was also higher than that seen in Ethiopia,[15] and in Mozambique (14.9%). In 2008, the WHO reported a worldwide resistance rate to isoniazid of 5.9%.…”

The Role of Speciation in Positive Lowenstein-Jensen Culture Isolates from a High Tuberculosis Burden Country

“…Similarly, studies from South Africa describe NTM as a frequent isolate from LJ cultures of sputum samples from miners (incidence 47.6 per 100,000 person-years) and from HIV-infected populations [2]. In a study from Mozambique, Nunes et al found NTM in 3 (1%) out of 277 isolates grown from LJ cultures of sputum or BAL samples of patients who were HIV positive [16]. The frequency of patients with cultures positive for both M.TB and NTM varies also depending on the population and the region studied.…”

Tuberculin skin testing in HIV-infected patients in Campo Grande, Mato Grosso do Sul State, Brazil

“…In Europe and North America, although the prevalence of tuberculosis is lower, the reemergence of this disease has been well described, due to HIV/AIDS pandemics afflicting especially immigrants from Latin American countries and vulnerable populations (refugees, healthcare professionals, inmates and drugs addicts), who are more exposed to tuberculosis infection and disease (4,(21)(22)(23)(24)(25). Brazilian studies indicate a 20 to 50% prevalence of tuberculosis infection in susceptible persons such as healthcare professionals (25).…”

“…The increase of tuberculosis and HIV/AIDS coinfection rates has given rise to serious implications for tuberculosis control programs due to the augmentation of cases and elevated mortality rates in the coinfected population (13,24). Several studies carried out in Latin American countries demonstrated that tuberculosis infection rates in HIV/AIDS population range from 0 to 25% (15,20,22,26,27).…”