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Garrido MDS, Bührer-Sékula S, Souza AB, de Oliveira GP, Antunes IA, Mendes JM, Saraceni V, Martinez-Espinosa FE, Ramasawmy R. Multidrug-resistant tuberculosis in the Amazonas State, Brazil, 2000-2011. Int J Tuberc Lung Dis 2016; 19:531-6. [PMID: 25868020 DOI: 10.5588/ijtld.14.0291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTINGS Amazonas is facing increasing challenges in tuberculosis (TB) control, with nearly 3000 cases per year, and multidrug-resistant TB (MDR-TB) may jeopardise the TB control programme. OBJECTIVE To assess the number of MDR-TB cases in the Amazonas and to improve estimates of the burden of TB. DESIGNS The Brazilian National Mandatory Disease Reporting System (SINAN) and the Brazilian Epidemiological Surveillance System of Multidrug Resistance (TBMR) were searched for MDR-TB cases in the State of Amazonas from 2000 to 2011. RESULTS Eighty-one MDR-TB cases were notified. The rates of primary MDR-TB, initial MDR-TB during the first treatment regimen and acquired MDR-TB were respectively 3.8%, 13.7% and 82.7%; 26.9% of previously treated patients had ⩾ 4 treatment cycles. The MDR-TB cases reported 263 contacts, only 35.0% of whom were examined. The cure and death rates among the 81 patients with MDR-TB were respectively 45.7% and 25.9%. CONCLUSIONS 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.
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Affiliation(s)
- M da S Garrido
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Fundação de Vigilância em Saúde do Amazonas, Manaus, Amazonas, Brazil; Secretaria Municipal de Saúde de Manaus, Manaus, Amazonas, Brazil
| | - S Bührer-Sékula
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Instituto de Patologia e Saúde Pública, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - A B Souza
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - G P de Oliveira
- Programa Nacional de Tuberculose, Ministério da Saúde, Brasília, Brazil
| | - I A Antunes
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil, Centro de Referência para Tuberculose Cardoso Fontes, Manaus, Amazonas, Brazil
| | - J M Mendes
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Centro de Referência para Tuberculose Cardoso Fontes, Manaus, Amazonas, Brazil
| | - V Saraceni
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - F E Martinez-Espinosa
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz Amazônia, Manaus, Amazonas, Brazil
| | - R Ramasawmy
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Universidade Nilton Lins, Manaus, Amazonas, Brazil; Programa de Pós-graduação em Imunologia Básica e Aplicada, Universidade Federal de Amazonas, Manaus, Amazonas, Brazil
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da Silva Garrido M, Ramasawmy R, Perez-Porcuna TM, Zaranza E, Chrusciak Talhari A, Martinez-Espinosa FE, Bührer-Sékula S. Primary drug resistance among pulmonary treatment-naïve tuberculosis patients in Amazonas State, Brazil. Int J Tuberc Lung Dis 2015; 18:559-63. [PMID: 24903793 DOI: 10.5588/ijtld.13.0191] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multidrug-resistant tuberculosis (MDR-TB) is the main indicator of previous treatment in tuberculosis (TB) patients. MDR-TB among treatment-naïve patients indicates infection with drug-resistant Mycobacterium tuberculosis strains, and such cases are considered primary drug-resistant cases. OBJECTIVE To estimate the prevalence of drug resistance in pulmonary TB (PTB) treatment-naïve patients and to identify the socio-demographic and clinical characteristics of the resistant population. METHODS A total of 205 treatment-naïve PTB patients from Manaus, Amazonas State, Brazil, were enrolled. Drug susceptibility testing (DST) was performed on all positive mycobacterial cultures using the 1% proportion method. RESULTS Positive M. tuberculosis cultures were obtained from only 175 patients for DST. The prevalence of primary MDR-TB was 1.7% (3/175); 14.3% (25/175) of the cultures presented resistance to at least one of the drugs. Resistance to streptomycin, isoniazid, rifampicin and ethambutol was respectively 8.6%, 6.9%, 3.4% and 2.3%. An association between TB patients with resistance to more than one drug and known previous household contact with a TB patient was observed (P= 0.008, OR 6.7, 95%CI 1.2-67.3). CONCLUSIONS Although the prevalence of primary MDR-TB currently is relatively low, it may become a major public health problem if tailored treatment is not provided, as resistance to more than one drug is significantly associated with household contact.
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Affiliation(s)
- M da Silva Garrido
- Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - R Ramasawmy
- Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - T M Perez-Porcuna
- Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - E Zaranza
- Laboratório Central de Saúde Pública do Amazonas, Manaus, Amazonas, Brazil
| | - A Chrusciak Talhari
- Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - F E Martinez-Espinosa
- Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - S Bührer-Sékula
- Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Amazonas, Brazil
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