Resistência aos medicamentos anti-tuberculose de cepas de Mycobacterium tuberculosis isoladas de pacientes atendidos em hospital geral de referência para tratamento de AIDS no Rio de Janeiro
01 Aug 2004-Jornal Brasileiro De Pneumologia (Sociedade Brasileira de Pneumologia e Tisiologia)-Vol. 30, Iss: 4, pp 425-432
TL;DR: High resistance rates was found at a general hospital, reference for aids treatment in Rio de Janeiro and to identify associated factors corroborates that hospitals needs attention for TB control.
Abstract: INTRODUCAO: A tuberculose tem trazido importantes desafios ao setor de saude. O Brasil tem alta prevalencia da doenca e o Estado do Rio de Janeiro possui as maiores taxas de incidencia do pais. O municipio do Rio de Janeiro e responsavel pela maior notificacao do estado e cerca de 30% dos casos diagnosticados tem origem em hospitais. OBJETIVO: Estimar a prevalencia de resistencia inicial e adquirida e identificar fatores associados a ocorrencia de resistencia em hospital geral referencia para tratamento de AIDS no Rio de Janeiro. METODO: Foram analisadas cepas de Mycobacterium tuberculosis de 165 pacientes, entre agosto de 1.996 e fevereiro de 1.998. RESULTADOS: Vinte por cento (33/165) apresentaram resistencia a pelo menos um medicamento: 13% (22/165) a isoniazida, 1,8% (3/165) a rifampicina e 3,6% (6/165) a ambas. Entre pacientes infectados pelo HIV (52/165), 28,85% (15/52) apresentaram resistencia a pelo menos um farmaco. Resistencia adquirida ocorreu em 12,5% dos pacientes que referiram tratamento anterior (3/24), com associacao significativa com imagem radiologica nao cavitaria (p = 0,05). Resistencia inicial ocorreu em 18,4% dos pacientes virgens de tratamento (26/141), com associacao significativa com ser profissional de saude (p = 0,004), desemprego (p = 0,03) e diarreia (p = 0,01) na analise bivariada. Na analise multivariada, ser profissional de saude manteve-se fortemente associado com a ocorrencia de resistencia inicial (p = 0,002). CONCLUSAO: Taxas de resistencia elevadas foram encontradas nesta serie. Estes achados corroboram a necessidade de que atencao maior seja dada a tuberculose em ambiente hospitalar, em especial no que diz respeito a preocupante associacao entre resistencia nas cepas isoladas e profissionais de saude.
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TL;DR: The first three-dimensional molecular model of the hypothetical structures for the Mycobacterium tuberculosis DNA gyrase was elucidated by a homology modeling method and could be helpful for the design of new more potent gatifloxacin analogs.
Abstract: Mycobacterium tuberculosis (Mt) is a leading cause of infectious disease in the world today. This outlook is aggravated by a growing number of Mt infections in individuals who are immunocompromised as a result of HIV infections. Thus, new and more potent anti-tuberculosis agents are necessary. Therefore, DNA gyrase was selected as a target enzyme to combat Mt. In this work, the first three-dimensional molecular model of the hypothetical structures for the Mycobacterium tuberculosis DNA gyrase (mtDNAg) was elucidated by a homology modeling method. In addition, the orientations and binding affinities of some gatifloxacin analogs with those new structures were investigated. Our findings could be helpful for the design of new more potent gatifloxacin analogs.
74 citations
TL;DR: The high rate of tuberculosis prevalence among the seropositive patients underscores the urgent need to implement strategies that combine rapid identification and prompt treatment of individuals with active or latent infection, as well as of those with whom they have been in contact.
Abstract: OBJETIVO: Considerando a relevância da co-infeccao virus da imunodeficiencia humana/tuberculose, este estudo foi desenvolvido para determinar a prevalencia e os fatores associados a tuberculose em pacientes residentes em uma zona de alta prevalencia das duas infeccoes. METODOS: Todos os pacientes atendidos no ano de 1999 no Servico HIV/AIDS do Hospital Universitario da Universidade Federal do Rio Grande foram avaliados retrospectivamente desde o momento do diagnostico da presenca do virus da imunodeficiencia humana, em relacao a ocorrencia de tuberculose e sua associacao com fatores sociodemograficos, comportamentais e imunologicos. RESULTADOS: A amostra incluiu 204 pacientes e a prevalencia encontrada de tuberculose foi de 27%. A analise multivariada mostrou que existe uma associacao significativa do desenvolvimento de tuberculose com a raca negra (razao de chance: 4,76; intervalo de confianca de 95%: 1,93 -11,72) e uma relacao inversa com a contagem de linfocitos TCD4+ no momento do diagnostico do virus da imunodeficiencia humana (razao de chance: 0,995; intervalo de confianca de 95%: 0,993-0,997). O sexo masculino (razao de chance: 2,49; intervalo de confianca de 95%: 1,15-5,39) e o uso de drogas (razao de chance: 2,1; intervalo de confianca: 95% de 1,02-4,31) podem tambem ser fatores de risco quando analisados separadamente. CONCLUSAO: Os fatores responsaveis pelo desenvolvimento da tuberculose entre os pacientes soropositivos para o virus da imunodeficiencia humana incluem os aspectos imunitarios e fatores socioeconomicos e demograficos. A alta taxa de tuberculose em pacientes soropositivos torna urgente implementar estrategias que combinem rapida identificacao e tratamento dos casos, comunicantes e individuos com infeccao latente.
39 citations
TL;DR: In the present study, previous treatment for tuberculosis was found to be an independent risk factor for multidrug-resistant tuberculosis.
Abstract: OBJETIVO: Estudar os fatores determinantes da multirresistencia do Mycobacterium tuberculosis as drogas tuberculostaticas em centro de referencia de doencas infecto-contagiosas do Estado de Minas Gerais, Hospital Eduardo de Menezes. METODOS: Estudo tipo caso-controle, retrospectivo, realizado de setembro de 2000 a janeiro de 2004. Nesse periodo, 473 culturas com crescimento de M. tuberculosis relativas a 313 pacientes foram analisadas quanto ao perfil de sensibilidade, no Laboratorio Central de Minas Gerais. Foram selecionados os casos multirresistentes definidos como resistencia a pelo menos rifampicina e isoniazida, depois de pareados com o grupo controle de pacientes com tuberculose sensivel a todas as drogas na razao de 1:3. A associacao dos dados demograficos e clinicos foi feita por analise estatistica uni e multivariada. RESULTADOS: Durante o periodo de estudo, doze casos de tuberculose multirresistente foram identificados (3,83%). Na analise univariada, a tuberculose multirresistente foi mais comum no sexo masculino, em pacientes com baciloscopia de escarro positiva, pacientes com cavitacoes maiores que 4 cm de diâmetro e pacientes com um ou mais tratamentos previos para tuberculose (p = 0,10). Apos a analise multivariada somente o tratamento anterior para tuberculose permaneceu estatisticamente significativo (p = 0,0374), com odds ratio de 14,36 (1,96 - 176,46). CONCLUSAO: O fator de risco que se mostrou independentemente associado ao desenvolvimento de tuberculose multirresistente neste estudo foi a presenca de um ou mais tratamentos previos para tuberculose.
30 citations
TL;DR: In this paper, an entrevista semiestruturada, aplicada a quarenta e cinco profissionais, atuam em uma Unidade de Referencia no Para.
Abstract: Este estudo objetivou analisar os motivos que levam os pacientes coinfectados TB/HIV a abandonar o tratamento da TB e conhecer a conduta da equipe de saude frente a esse abandono. A abordagem foi qualitativa. Utilizou-se a entrevista semiestruturada, aplicada a quarenta e cinco profissionais que atuam em uma Unidade de Referencia no Para. Apos analise tematica, foram construidas duas unidades: fatores relacionados aos doentes que dificultam adesao ao tratamento da TB; e fatores relacionados ao servico que contribuem para o abandono. Mostrou-se, com relacao aos pacientes, que a baixa condicao socioeconomica foi o fator mais frequente que propicia o abandono. Tambem efeitos adversos dos medicamentos, uso de drogas licitas, e pouca motivacao pessoal facilitam esse desfecho. Quanto ao Servico, as questoes relacionadas a estrutura fisica, organizacao do processo de trabalho e acesso mostraram-se relevantes para nao adesao. Os resultados apontam para a necessidade de alterar as praticas desenvolvidas nos Servicos.
28 citations
Journal Article•
TL;DR: High levels of DR- and MDR-TB are found in hospitals in Rio de Janeiro, Brazil, and hospitals should be recognised as a potential source of transmission of resistant TB strains and urgent measures to avoid nosocomial TB transmission should be taken.
Abstract: CONTEXTE: Enquete sur la resistance aux medicaments antituberculeux dans six hopitaux a Rio de Janeiro, Bresil. OBJECTIF: Estimer le taux de resistance a l'egard d'au moins un medicament (DR) et celui de la multiresistance (MDR) et identifier les facteurs qui y sont associes. SCHEMA: Enquete transversale au cours d'une periode d'un an dans chaque hopital entre 2004 et 2006. Les hopitaux ont ete inclus sous forme d'echantillon de convenance. RESULTATS: Parmi 55 patients investigues, 156 (26,2%) avaient beneficie anterieurement de traitements antituberculeux ; 433 (72,8%) n'avaient pas ete traites anterieurement et chez 6 (1,0%) aucune information n'etait disponible. Parmi les individus non traites anterieurement, il y a eu 17 cas de MDR (3,9% ; IC95% 2,4-6,3) et apres analyse multivariee, le seul facteur independamment associe avec la TB-MDR a ete le diagnostic de TB dans un hopital de reference (ratio de prevalence [PR] 3,3 ; IC95 % 1,2-8,7). Parmi ces individus anterieurement traites, la MDR a concerne 27 (1,3% ; IC95% 11,7-24,2) et a ete en association independante avec les facteurs suivants: le diagnostic dans un hopital de reference TB (PR 3,6 ; IC95% 1,5-8,7) ; le sexe masculin (PR 2,3 ; IC95% 1,2-4,4) ; et la dyspnee (PR 0,3 ; IC95% 0,1-0,7). CONCLUSION: Les niveaux de DR et de TB-MDR se sont averes eleves. La methodologie de cette etude ne nous a pas permis de determiner les contributions relatives de la transmission communautaire et nosocomiale, et d'autres etudes sont necessaires. Neanmoins, l'hopital doit etre considere comme un contexte potentiel de transmission des souches resistantes de TB et il est urgent d'ameliorer les politiques d'evitement de la transmission nosocomiale de la TB.
27 citations
References
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Book•
01 Mar 1989
TL;DR: This updated and expanded edition now offers 297 chapters that cover the basic principles of diagnosis and management, major clinical syndromes, all important pathogenic microbes and the diseases they cause, plus a number of specialised topics useful to the practitioner.
Abstract: This updated and expanded edition now offers 297 chapters that cover the basic principles of diagnosis and management, major clinical syndromes, all important pathogenic microbes and the diseases they cause, plus a number of specialised topics useful to the practitioner. It contains 24 totally-new chapters, offers a whole section on AIDS with seven chapters and a chapter "Microsporidium Disease", which deals with a new disease just discovered because of AIDS. The text is designed for clinical pathologists, microbiologists, virologists, medical scientists, mycologists, allergists, general practitioners and lecturers of medicine.
13,514 citations
TL;DR: Resistance to antituberculosis drugs was found in all 35 countries and regions surveyed, suggesting that it is a global problem.
Abstract: Background Drug-resistant tuberculosis threatens efforts to control the disease. This report describes the prevalence of resistance to four first-line drugs in 35 countries participating in the World Health Organization–International Union against Tuberculosis and Lung Disease Global Project on Anti-Tuberculosis Drug Resistance Surveillance between 1994 and 1997. Methods The data are from cross-sectional surveys and surveillance reports. Participating countries followed guidelines to ensure the use of representative samples, accurate histories of treatment, standardized laboratory methods, and common definitions. A network of reference laboratories provided quality assurance. The median number of patients studied in each country or region was 555 (range, 59 to 14,344). Results Among patients with no prior treatment, a median of 9.9 percent of Mycobacterium tuberculosis strains were resistant to at least one drug (range, 2 to 41 percent); resistance to isoniazid (7.3 percent) or streptomycin (6.5 percent) ...
851 citations
Journal Article•
TL;DR: In WHO's South-East Asian Region and in Central and South America the age-specific incidence rates are expected to fall during 1990-2000, but at a slower rate than in previous years because of the expected increase in HIV seroprevalence.
Abstract: Forecasts of tuberculosis morbidity and mortality are presented for the decade 1990-99. An estimated 88 million new cases of tuberculosis, of which 8 million will be attributable to HIV infection, will occur in the world during the decade; 30 million people are predicted to die of tuberculosis in the same period, including 2.9 million attributable to HIV infection. The number of new tuberculosis cases occurring each year is predicted to increase from 7.5 million (143 cases per 100,000) in 1990 to 8.8 million (152 per 100,000) in 1995 and 10.2 million (163 per 100,000) in the year 2000. In 1990, 2.5 million persons were estimated to have died of tuberculosis; at the same level of availability of treatment, it is predicted that 3.0 million tuberculosis deaths will occur in 1995 and 3.5 million in 2000. Demographic factors, such as population growth and changes in the age structure of populations, will account for 79.5% of the predicted increases in new cases. Age-specific incidence rates in sub-Saharan Africa are increasing due to the HIV epidemic and will account for the remaining 20.5% of the forecast increase in new cases. In WHO's South-East Asian Region and in Central and South America the age-specific incidence rates are expected to fall during 1990-2000, but at a slower rate than in previous years because of the expected increase in HIV seroprevalence.(ABSTRACT TRUNCATED AT 250 WORDS)
809 citations
TL;DR: The survey conducted by the World Health Organization and the International Union against Tuberculosis and Lung Disease to assess trends in resistance to antituberculosis drugs in countries on six continents found that for patients with newly diagnosed tuberculosis, the frequency of resistance to at least one antituber tuberculosis drug ranged from 1.7 percent in Uruguay to 36.9 percent in Estonia.
Abstract: Background Data on global trends in resistance to antituberculosis drugs are lacking. Methods We expanded the survey conducted by the World Health Organization and the International Union against Tuberculosis and Lung Disease to assess trends in resistance to antituberculosis drugs in countries on six continents. We obtained data using standard protocols from ongoing surveillance or from surveys of representative samples of all patients with tuberculosis. The standard sampling techniques distinguished between new and previously treated patients, and laboratory performance was checked by means of an international program of quality assurance. Results Between 1996 and 1999, patients in 58 geographic sites were surveyed; 28 sites provided data for at least two years. For patients with newly diagnosed tuberculosis, the frequency of resistance to at least one antituberculosis drug ranged from 1.7 percent in Uruguay to 36.9 percent in Estonia (median, 10.7 percent). The prevalence increased in Estonia, from 28....
650 citations
TL;DR: In the 1980s, after decades of steadily declining rates of tuberculosis, ambitious plans were made to eliminate the disease in the United States, but despite these plans, the control of tuberculosis was neglected, resulting in a resurgence of the disease.
Abstract: In the 1980s, after decades of steadily declining rates of tuberculosis, ambitious plans were made to eliminate the disease in the United States. Despite these plans, the control of tuberculosis was neglected, resulting in a resurgence of the disease.1 This resurgence has reminded us that the overall goal of public health programs must be not merely the provision of health care for marginalized persons, but a systematic commitment to protect the health of the general public in a time of increasing globalization. Regrettably, these lessons have come at considerable costs, in terms of both individual health and health care budgets. . . .
334 citations