|1030-3||MULTIDRUG-RESISTANT TUBERCULOSIS IN A HYPERENDEMIC AREA, SANTOS, BRAZIL.|
|Autores:||Andrea Gobetti Coelho Bombonatte (CLR IAL - SANTOS - Instituto Adolfo Lutz) ; Liliana Aparecida Zamarioli (CLR IAL - SANTOS - Instituto Adolfo Lutz) ; Ana Carolina Chiou Nascimento (CLR IAL - SANTOS - Instituto Adolfo Lutz) ; Felipe Araujo de Souza Ferreira (CLR IAL - SANTOS - Instituto Adolfo Lutz) ; Lucilaine Ferazoli (LACEN - Instituto Adolfo Lutz) ; Ivonete Cuntiere (SMS - SVE - Secretaria Municipal de Santos - Seção de Vig. Epidem.) ; Eliseu Alves Waldman (FSP - USP - Faculdade de Saúde Pública da USP) |
Background: The incidence rate of tuberculosis (TB) in the city of Santos is 85 cases per 100,000 inhabitants - year, which is twice as much the average rate in the state of São Paulo, southeastern Brazil. The mean prevalence of TB/HIV coinfection is 16%, and TB cure and treatment dropout rates are 71% and 12%, respectively. These unfavorable indicators indicate the need for monitoring the magnitude, profile and trend of multidrug-resistant tuberculosis (MDRTB) in this city. Objective: To examine the profile of Mycobacterium tuberculosis drug resistant in patients with and without risk factors for MDRTB and to estimate the incidence of MDRTB. Methods: A descriptive study was conducted with patients with pulmonary TB confirmed by Mycobacterium tuberculosis isolation. Patients were 15 years or older, living in the city of Santos, southeastern Brazil, and started treatment in 2011. TB cases were defined according to the National Tuberculosis Control Program criteria and MDRTB cases were those resistant to at least isoniazid and rifampicin. We included only cases with drug susceptibility testing (DST) performed. The study variables included sociodemographic factors and factors associated with MDRTB (prior history of TB; TB/HIV coinfection; cavitary lung lesion; being a health provider or homeless). Comparative analyzes were performed using appropriate statistics. Results: Of all TB cases reported in Santos in 2011, 108 were confirmed by culture and performed DST. Of these, 42 cases (38.9%) had risk factors for MDRTB: 78.6% were sensitive to all drugs; 4.9% were resistant to one drug; and 14.6% were MDRTB. Among 68 cases with no risk factors for MDRTB, 92.4% were sensitive to all drugs; 4.5% were resistant to one drug; and 3% were MDRTB; and 37% (3/8) of all cases of MDRTB presented primary resistance. Prior treatment and cavitary lung lesion were more prevalent among patients with MDRTB (p<0.05) when compared to cases showing Mycobacterium tuberculosis strains sensitive to all drugs. The incidence of MDRTB during the study period was 2.1/100,000 inhabitants-year. Conclusions: The study results showed high MDRTB, though potentially underestimated, and high primary resistance rates. They highlight the importance of monitoring patients and household contacts for two years after treatment is completed, particularly contacts of those dropping out of treatment.
Palavras-chave: TBMDR, Co-infection HIV/TB, TB treatment, TB control