Multidrug-resistant tuberculosis in the Amazonas State, Brazil, 2000–2011

Garrido, Marlucia da Silva; Bührer-Sékula, Samira; Souza, Ana Beatriz Floriano de; Oliveira, Gisele Pinto de; Antunes, Irineide Assumpção; Mendes, Joycenea Matsuda; Saraceni, Valéria; Martínez-Espinosa, Flor Ernestina; Ramasawmy, Rajendranath

doi:10.5588/ijtld.14.0291

Cited by 8 publications

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“…Among the Brazilian studies with secondary data, there is great variability of results, given the distinct characteristics of the populations studied. In these studies, the rate of resistance to any drug has varied from 9.4% to 19.2% and for MDR-TB it has varied from 3.4% to 15% 4 , 5 , 10 , 15 , 21 .…”

Section: Discussionmentioning

confidence: 99%

Risk factors associated with multidrug-resistant tuberculosis in Espírito Santo, Brazil

et al. 2017

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OBJECTIVE To analyze the prevalence and factors associated with multidrug-resistant tuberculosis in Espírito Santo, Brazil.METHODS This is a cross-sectional study of cases of tuberculosis tested for first-line drugs (isoniazid, rifampicin, pyrazinamide, ethambutol, and streptomycin) in Espírito Santo between 2002 and 2012. We have used laboratory data and registration of cases of tuberculosis – from the Sistema Nacional de Agravos de Notificação and Sistema para Tratamentos Especiais de Tuberculose. Individuals have been classified as resistant and non-resistant and compared in relation to the sociodemographic, clinical, and epidemiological variables. Some variables have been included in a logistic regression model to establish the factors associated with resistance.RESULTS In the study period, 1,669 individuals underwent anti-tuberculosis drug susceptibility testing. Of these individuals, 10.6% showed resistance to any anti-tuberculosis drug. The rate of multidrug resistance observed, that is, to rifampicin and isoniazid, has been 5%. After multiple analysis, we have identified as independent factors associated with resistant tuberculosis: history of previous treatment of tuberculosis [recurrence (OR = 7.72; 95%CI 4.24–14.05) and re-entry after abandonment (OR = 3.91; 95%CI 1.81–8.43)], smoking (OR = 3.93; 95%CI 1.98–7.79), and positive culture for Mycobacterium tuberculosis at the time of notification of the case (OR = 3.22; 95%CI 1.15–8.99).CONCLUSIONS The partnership between tuberculosis control programs and health teams working in the network of Primary Health Care needs to be strengthened. This would allow the identification and monitoring of individuals with a history of previous treatment of tuberculosis and smoking. Moreover, the expansion of the offer of the culture of tuberculosis and anti-tuberculosis drug susceptibility testing would provide greater diagnostic capacity for the resistant types in Espírito Santo.

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Section: Discussionmentioning

confidence: 99%

Risk factors associated with multidrug-resistant tuberculosis in Espírito Santo, Brazil

et al. 2017

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“…This disparity is widely assumed to suggest that a large proportion of MDR-TB arises from selection of drug resistance mutations during previous ineffective TB treatment, as opposed to transmission of pre-existing MDR strains. 2 – 5 This interpretation has major implications for the control of MDR-TB: if most MDR arises from ineffective treatment of drug-susceptible TB, then better treatment of susceptible strains should be the focus in preventing additional cases of MDR-TB. 6 , 7 Previous transmission modeling analyses, which illustrated the difficulty of controlling established MDR-TB epidemics, urged programs to improve the treatment of drug-susceptible TB.…”

Section: Introductionmentioning

confidence: 99%

Burden of transmitted multidrug resistance in epidemics of tuberculosis: a transmission modelling analysis

Kendall

Fofana

Dowdy

2015

The Lancet Respiratory Medicine

180

142

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BackgroundMultidrug-resistant tuberculosis (MDR-TB) can be acquired through de novo mutation during TB treatment or through transmission from other individuals with active MDR-TB. Understanding the balance between these two mechanisms is essential when allocating resources for MDR-TB.MethodsWe constructed a dynamic transmission model of an MDR-TB epidemic, allowing for both treatment-related acquisition and person-to-person transmission of resistance. We used national TB notification data to inform Bayesian estimates of the fraction of each country’s 2013 MDR-TB incidence that resulted from MDR transmission rather than treatment-related MDR acquisition.FindingsGlobal estimates of 3·5% MDR-TB prevalence among new TB notifications and 20·5% among retreatment notifications translate into an estimate that resistance transmission rather than acquisition accounts for a median 96% (95% UR: 68–100%) of all incident MDR-TB, and 61% (16–95%) of incident MDR-TB in previously-treated individuals. The estimated percentage of MDR-TB resulting from transmission varied substantially with different countries’ notification data; for example, we estimated this percentage at 48% (30–75%) of MDR-TB in Bangladesh, versus 99% (91–100%) in Uzbekistan. Estimates were most sensitive to estimates of the transmissibility of MDR strains, the probability of acquiring MDR during tuberculosis treatment, and the responsiveness of MDR TB to first-line treatment.InterpretationNotifications of MDR prevalence from most high-burden settings are most consistent with the vast majority of incident MDR-TB resulting from transmission rather than new treatment-related acquisition of resistance. Merely improving the treatment of drug-susceptible TB is unlikely to greatly reduce future MDR-TB incidence. Improved diagnosis and treatment of MDR-TB – including new tests and drug regimens – should be highly prioritized.

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…Exclusively in relation to alcohol, the result of our study is notably higher than the data for the state of Amazonas between 2000 and 2011 (6.2%). 20 In general, the high percentages suggest that TB services need to be capable of providing care focused on DR-TB patients and psycho-social support. 26 These are priorities of the End TB Strategy.…”

Section: Discussionmentioning

confidence: 99%

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Caracterização da tuberculose drogarresistente no Brasil, 2014*

Jacobs

Pinto

2020

Epidemiologia e Serviços de Saúde

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Objective: to describe drug-resistant tuberculosis (DR-TB) notifications in Brazil. Methods: this is a descriptive study of clinical and epidemiological characteristics of DR-TB notifications in 2014 on SITETB and TBWeb, these being information systems on which cases involving special treatment regimens are registered. Results: there were 1,574 cases, 94.8% of which had the pulmonary form, 27.6% involved primary resistance, and 50.9% were multidrug-resistant; 70.6% of cases were male, 87.0% were between 20 and 59 years old, 60.9% were of Afro-Brazilian, and 68.0% had less than 8 years of schooling; as for comorbidities, 13.1% of patients had AIDS, 11.3% had diabetes, 25.8% made harmful use of alcohol, 21.0% were illegal drugs users, and 22.2% were tobacco users. Conclusion: the majority of DR-TB notifications were related to men, young people, Afro-Brazilian and people with low levels of education; there was a high percentage of primary resistance, as well as multidrug-resistance and comorbidities, with emphasis on substance use.

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Multidrug-resistant tuberculosis in the Amazonas State, Brazil, 2000–2011

Abstract: The number of MDR-TB cases seems incompatible with the high TB prevalence in the Amazonas. Most patients were unaware of contact with TB patients. TB is endemic in the Amazonas. This highlights the need for improving resistance investigation among all TB cases.

Cited by 8 publications

References 0 publications

Risk factors associated with multidrug-resistant tuberculosis in Espírito Santo, Brazil

Risk factors associated with multidrug-resistant tuberculosis in Espírito Santo, Brazil

Burden of transmitted multidrug resistance in epidemics of tuberculosis: a transmission modelling analysis

Caracterização da tuberculose drogarresistente no Brasil, 2014*

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