[Drug resistance profile of Mycobacterium tuberculosis in the state of Mato Grosso do Sul, Brazil, 2000-2006]. / Perfil de resistência de Mycobacterium tuberculosis no estado de Mato Grosso do Sul, 2000-2006.

OBJECTIVE: To determine the drug resistance profile of Mycobacterium tuberculosis in the state of Mato Grosso do Sul, Brazil, between 2000 and 2006. METHODS: Descriptive study of reported tuberculosis cases in the Brazilian Case Registry Database. We included only those cases in which M. tuberculosis culture was positive and sensitivity to drugs (rifampicin, isoniazid, streptomycin and ethambutol) was tested. Löwenstein-Jensen and Ogawa-Kudoh solid media were used for cultures, as was an automated liquid medium system. Sensitivity tests were based on the proportion method. RESULTS: Among the 783 cases evaluated, males predominated (69.7%), as did patients in the 20-49 year age bracket (70%), a diagnosis of pulmonary tuberculosis (94.4%) and positive HIV serology (8.6%); 645 (82.4%) were new cases, and 138 (17.6%) had previously been treated. Resistance to at least one drug was found in 143 cases (18.3%). The primary resistance (PR) rate was, respectively, 8.1%, 1.6%, 2.8% and 12.4%, for monoresistance, multidrug resistance (MDR), other patterns of resistance and resistance to at least one drug, whereas the acquired resistance (AR) rate was 14.5%, 20.3%, 10.9% and 45.7%, respectively, and the combined resistance (CR) rate was 9.2%, 4.9%, 4.2% and 18.3%, respectively. In PR, streptomycin was the most common drug, whereas isoniazid was the most common in AR and CR (7.2% and 3.7%, respectively). CONCLUSIONS: These high levels of resistance undermine the efforts for tuberculosis control in Mato Grosso do Sul. Acquired MDR was 12.7 times more common than was primary MDR, demonstrating that the previous use of drug therapy is an indicator of resistance. These levels reflect the poor quality of the health care provided to these patients, showing the importance of using the directly observed treatment, short course strategy, as well as the need to perform cultures and sensitivity tests for the early diagnosis of drug resistance.

Perfil de resistência de Mycobacterium tuberculosis no estado de Mato Grosso do Sul, 2000-2006 / Drug resistance profile of Mycobacterium tuberculosis in the state of Mato Grosso do Sul, Brazil, 2000-2006

OBJETIVO: Determinar o perfil de resistência a drogas de Mycobacterium tuberculosis no estado de Mato Grosso do Sul no período entre 2000 e 2006. MÉTODOS: Estudo descritivo de casos notificados de tuberculose no Sistema de Informação de Agravos de Notificação, com cultura positiva para M. tuberculosis e testes de sensibilidade a rifampicina, isoniazida, estreptomicina e etambutol. Para as culturas, utilizaram-se os meios sólidos Lõwenstein-Jensen e Ogawa-Kudoh, assim como um sistema automatizado com meio líquido; para os testes de sensibilidade, o método das proporções. RESULTADOS: De 783 casos, 69,7 por cento eram de pacientes masculinos, na faixa etária de 20-49 anos (70 por cento), com forma pulmonar (94,4 por cento) e sorologia positiva para HIV (8,6 por cento); 645 (82,4 por cento) eram casos novos, e 138 (17,6 por cento) eram casos tratados. Identificou-se qualquer resistência em 143 casos (18,3 por cento). A taxa de resistência primária (RP) foi, respectivamente, 8,1 por cento, 1,6 por cento, 2,8 por cento e 12,4 por cento, para monorresistência, multirresistência (MR), outros padrões de associação de drogas e qualquer resistência, ao passo que a taxa de resistência adquirida (RA) foi, respectivamente, 14,5 por cento, 20,3 por cento, 10,9 por cento e 45,7 por cento, e a taxa de resistência combinada (RC) foi, respectivamente, 9,2 por cento, 4,9 por cento, 4,2 por cento e 18,3 por cento. A estreptomicina foi a droga mais comum na RP (3,4 por cento), e a isoniazida foi a mais comum na RA e RC (7,2 por cento e 3,7 por cento, respectivamente). CONCLUSÕES: Os níveis de resistência são elevados, prejudicando o controle da tuberculose em Mato Grosso do Sul. A MR adquirida, 12,7 vezes superior à MR primária, evidencia o uso prévio de medicamentos como indicativo de resistência. Os níveis refletem a fragilidade da atenção ao doente, mostrando a importância do tratamento diretamente observado, assim como das culturas e testes de sensibilidade ...

OBJECTIVE: To determine the drug resistance profile of Mycobacterium tuberculosis in the state of Mato Grosso do Sul, Brazil, between 2000 and 2006. METHODS: Descriptive study of reported tuberculosis cases in the Brazilian Case Registry Database. We included only those cases in which M. tuberculosis culture was positive and sensitivity to drugs (rifampicin, isoniazid, streptomycin and ethambutol) was tested. Lõwenstein-Jensen and Ogawa-Kudoh solid media were used for cultures, as was an automated liquid medium system. Sensitivity tests were based on the proportion method. RESULTS: Among the 783 cases evaluated, males predominated (69.7 percent), as did patients in the 20-49 year age bracket (70 percent), a diagnosis of pulmonary tuberculosis (94.4 percent) and positive HIV serology (8.6 percent); 645 (82.4 percent) were new cases, and 138 (17.6 percent) had previously been treated. Resistance to at least one drug was found in 143 cases (18.3 percent). The primary resistance (PR) rate was, respectively, 8.1 percent, 1.6 percent, 2.8 percent and 12.4 percent, for monoresistance, multidrug resistance (MDR), other patterns of resistance and resistance to at least one drug, whereas the acquired resistance (AR) rate was 14.5 percent, 20.3 percent, 10.9 percent and 45.7 percent, respectively, and the combined resistance (CR) rate was 9.2 percent, 4.9 percent, 4.2 percent and 18.3 percent, respectively. In PR, streptomycin was the most common drug, whereas isoniazid was the most common in AR and CR (7.2 percent and 3.7 percent, respectively). CONCLUSIONS: These high levels of resistance undermine the efforts for tuberculosis control in Mato Grosso do Sul. Acquired MDR was 12.7 times more common than was primary MDR, demonstrating that the previous use of drug therapy is an indicator of resistance. These levels reflect the poor quality of the health care provided to these patients, showing the importance of using the directly observed treatment, ...

Manifestações clínicas do dengue entre indígenas e não-indígenas durante a epidemiologia de 2007, Dourados- MS / Clinical manifestations of dengue among indigenous and non-indigenous people during the 2007 epidemiology, Dourados- MS

Introdução: desde seu aparecimento, cujas teorias correntes apontam para o Velho Mundo (África ou Asia), e sua circulação entre humanos, o dengue tem se constituído na principal doença emergente nos países tropicais. Diante do aumento da incidência do dengue, observa-se a descrição de características novas ou exóticas em suas manifestações, o que remete pesquisadores e profissionais de saúde a conduzirem novas pesquisas e a redobrarem o cuidado no manejo clínico dos casos. Ainda não estão completamente elucidados os fatores envolvidos nas manifestações clínicas dessa doença e, tão pouco, sua relação com fatores individuais - exemplo a raça. Este artigo descreve as manifestações clínicas da infecção por dengue em indígenas de Dourados/Mato Grosso do Sul, durante a epidemia de 2007, comparando-as com as manifestações de não­indígenas. Metodologia: trata­se de um estudo descritivo, com dados secundários do Sistema de Informação de Agravos de Notificação ­ SINAN. Resultados e Discussão: dos 3886 casos notificados no período, apenas 0,5% são indígenas, com 18 casos registrados de dengue clássico. Os resultados descrevem baixa incidência na população indígena, sem diferenças observáveis nas manifestações clínicas em relação à população não­indígena. Conclusões: não se observam diferenças nas manifestações clinicas do dengue entre as populações estudadas, ainda que entre os indígenas tenha uma faixa etária mais jovem acometida, não houve ocorrência de casos graves de dengue (episódios hemorrágicos e derrames cavitários), inclusive com ausência de óbitos e menor frequência de diarreia.

Introduction: since its appearance, whose current theories point to the Old World (Africa or Asia), and its circulation among humans, dengue has been formed on the main emerging disease in tropical countries face the increasing incidence of dengue, there is a description of new or exotic features in its manifestations. which brings researchers and health professionals to conduct further research and to redouble their care in the Clinical management of cases. Are not yet fully elucidated the factors involved in the clinical manifestations of this disease, and so little, its relation to individual factors - such race. This article describes the clinical manifestations of dengue infection in the Dourados Indigenous / Mato Grosso do Sul, during the epidemic of 2007, comparing them with the manifestations of non-Indians. Methodology: this is a descriptive study using secondary data from the Information System for Notiriable Diseases - SINAN, Results and Discussion: of the 3886 cases reported in the period. only 05% are indigenous, with 18 reported cases of classic dengue. The results describe the low incidence in the indigenous population, With no observable differences in clinical manifestations in relation to non­indigenous population. Conclusions: do not show differences in clinical manifestations ot dengue among populations, even among the lndians have a younger age group involved, there was no occurrence of severe dengue (hemorrhagic episodes and cavity effusion), also with no deaths and less frequency of diarrhea.