Epidemiologia da tuberculose resistente e multidroga resistente no estado do Espírito Santo
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Data
2016-08-12
Autores
Carlesso, Geisa Fregona
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Universidade Federal do Espírito Santo
Resumo
The emergence of resistant strains of Mycobacterium tuberculosis (Mtb) has been a major challenge for the control and elimination of the disease worldwide. In Brazil, the number of reported cases is still small if compared to other countries with high incidence; in Espirito Santo the information about this disease are insufficient. Objectives: To describe and to analyze the sociodemographic, clinical and epidemiological characteristics and factors associated with tuberculosis (TB) resistant to first-line drugs in the ES (a cross-sectional study); to describe the sociodemographic, clinical and epidemiological characteristics of cases of MDRTB (retrospective study described); to analyze factors associated with the occurrence of MDRTB (case-control nested within a cohort); and to analyze the causes of death between TBMDR cases (retrospective study described). Results: In a descriptive and comparative cross-sectional study of resistant TB cases and not resistant, we found a rate of 10.6% resistance to any antituberculosis drugs, among the cases tested. The multidrug-resistant tuberculosis rate (MDRTB) was 5%. After multivariate analysis, were identified the following independent factors associated with resistant TB: history of previous treatment for TB (relapse [OR = 7.72, 95% CI 4.24 to 14.05] and return after default [OR = 3.91; CI 95% = 1.81 to 8.43]), smoking (OR = 3.93; CI 95% = 1.98 to 7.79) and positive culture for Mtb at the time of the event notification (OR = 3.22; CI 95% = 1.15 to 8.99). Descriptive study of cases of MDRTB found respectively 1.1% of primary cases, 18.5% of acquired cases and 5.4% of combined cases. In the characterization of the population, we found an average age of 39 years (SD = 13.8), 79% male, 55% nonwhite and 75% with less education than 8 years of study. The co-infection rate of TB / HIV was 9%; 45% of the cases reported alcohol use, and 43% smoke. Other comorbidities were less frequent, such as diabetes, illicit drug use and mental illness, respectively 12%, 16% and 4%. About clinical and epidemiological history, 99% had the pulmonary form; 67%, bilateral pulmonary involvement, and 88% had evidence of cavitation damage. Sputum smear microscopy was positive in 87% of the cases, and the history of contact with TB case, in 45%. Most of these cases were treated under directly observed treatment (DOT), and the cure rate, default and failure were, respectively, 81%, 5% and 4%. The conversion rate of sputum culture to the 2nd month of treatment was 85%, with 38 days of time mean (SD = 16.0). In study of risk factors for MDRTB, we found that, independently, white and more educated individuals have more risk to be affected by MDRTB in ES, respectively OR 1.87 (CI 95% = 1.08-3.26; p = 0.026) and OR 2.75 (CI 95% = 1.21-6.25; p = 0.000). Variables such as alcoholism, diabetes, mental illness, to be institutionalized, and HIV infection have not been associated with cases of MDRTB (p > 0.005). When TB was the underlying cause of death, the greater mumber of mentions among individuals diagnosed with MDRTB it was respiratory disease. Conclusions: The characteristics of resistant TB cases and MDRTB reproduce the general profile of TB, in ES and Brazil. The factors associated with these cases should serve as a warning to health professionals so that appropriate action can be taken. About higher education and white among the cases of MDRTB, these characteristics should be taken into consideration by the clinical suspicion disease investigation and further investigation in the future. The diagnosis and early treatment should prevent the movement of Mtb strains, thereby providing a reduction in the number of primary cases, besides they may have a greater impact on mortality.
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Tuberculosis , Epidemiology , Multidrug-resistant tuberculosis drugs , Risk factors , Mortality , Multiple causes , Tuberculose multirresistente a drogas , Fatores de Risco , Mortalidade , Causas múltiplas