Antituberculosis-drug resistance in the border of Brazil with Paraguay and Bolivia/Resistencia as drogas antituberculose na fronteira do Brasil com Paraguai e Bolivia.

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From: Revista Panamericana de Salud Publica(Vol. 41, Issue 1)
Publisher: Pan American Health Organization
Document Type: Article
Length: 5,214 words

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Abstract :

Objective. To estimate the rate of drug resistance among pulmonary tuberculosis (PTB) cases in the state of Mato Grosso do Sul, Brazil, and specifically in the border areas with Paraguay and Bolivia, as well as to identify associated risk factors. Method. The present cross-sectional, epidemiological study focused on PTB cases recorded between January 2007 and December 2010 in the State Reportable Disease Information System with results of susceptibility tests to rifampicin, isoniazid, ethambutol, and streptomycin. Dependent variables were development of resistance to a single drug or any combination of drugs. Independent variables were being a new or treated case, living in border areas, presence/absence of diabetes, and history of alcoholism. Results. There were 789 TBP cases with susceptibility testing. The following characteristics were associated with resistance: treated case (P=0.0001), border region (P=0.0142), alcoholism (P=0.0451), and diabetes (P=0.0708). The rates of combined, primary, and acquired resistance for the state were 16.3%, 10.6%, and 39.0%, vs. 22.3%, 19.2%, and 37.5% for the border region. The rates of combined, primary, and acquired multidrug resistance for the state were 1.8%, 0.6%, and 6.3%, vs. 3.1%, 1.2%, and 12.5% for the border region. Conclusions. In the border region, the state should investigate drug resistance in all patients with respiratory symptoms, determine the pattern of resistance in confirmed cases, adopt directly observed treatment for cases of PTB, and develop health actions together with neighboring countries. Across the state, the levels of acquired resistance should be monitored, with investigation of resistance in all treated cases and implementation of directly observed treatment especially among patients with diabetes or alcoholism. Key words Tuberculosis, pulmonary; drug resistance; border areas; diabetes mellitus; alcoholism; Brazil. Objetivo. Estimar as taxas de resistencia as drogas entre casos de tuberculose pulmonar (TBP) para o estado de Mato Grosso do Sul, Brasil, e especificamente para a regiao da fronteira com Paraguai e Bolivia, alem de identificar fatores de risco associados. Metodos. O presente estudo epidemiologico, transversal, enfocou os casos de TBP registrados de janeiro de 2007 a dezembro de 2010 no Sistema de Informacao de Agravos de Notificacao da Secretaria de Estado de Saude com resultados do teste de suscetibilidade a rifampicina, isoniazida, etambutol e estreptomicina. Definiram-se como variaveis dependentes o desenvolvimento de resistencia a uma unica droga e a qualquer combinacao de drogas. As variaveis independentes foram ser caso novo ou tratado, residencia em regiao de fronteira ou outra regiao, presenca ou ausencia de diabetes e historia de alcoolismo. Resultados. Foram identificados 789 casos de TBP com teste de suscetibilidade. As caracteristicas associadas a resistencia foram: caso tratado (P=0,0001), regiao de fronteira (P=0,0142), alcoolismo (P=0,0451) e diabetes (P=0,0708). As taxas de resistencia combinada, primaria e adquirida no estado foram de 16,3%, 10,6% e 39,0%, e na fronteira, de 22,3%, 19,2% e 37,5%. As taxas de resistencia a multiplas drogas combinada, primaria e adquirida no estado foram de 1,8%, 0,6% e 6,3%, e na fronteira, de 3,1%, 1,2% e 12,5%. Conclusoes. O estado deve, na regiao de fronteira, realizar cultura em todos os sintomaticos respiratorios, investigar o padrao de resistencia nos casos confirmados, adotar o tratamento diretamente observado nos casos de TBP e desencadear acoes de saude conjuntas com os paises fronteiricos. Em todo o estado, e necessario monitorar os niveis de resistencia adquirida, ampliar a investigacao de resistencia para todos os casos tratados e adotar o tratamento diretamente observado prioritariamente entre pacientes com alcoolismo e diabetes. Palavras-chave Tuberculose pulmonar; resistencia a medicamentos; areas de fronteira; diabetes mellitus; alcoolismo; Brasil.

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Gale Document Number: GALE|A520713496