Serial Mass Screening for Tuberculosis Among Incarcerated Persons in Brazil.

BACKGROUND: An active search for tuberculosis cases through mass screening is widely described as a tool to improve case detection in hyperendemic settings. However, its effectiveness in high-risk populations, such as incarcerated people, is debated. METHODS: Between 2017 and 2021, 3 rounds of mass screening were carried out in 3 Brazilian prisons. Social and health questionnaires, chest X-rays, and Xpert MTB/RIF were performed. RESULTS: More than 80% of the prison population was screened. Overall, 684 cases of pulmonary tuberculosis were diagnosed. Prevalence across screening rounds was not statistically different. Among incarcerated persons with symptoms, the overall prevalence of tuberculosis per 100 000 persons was 8497 (95% confidence interval [CI], 7346-9811), 11 115 (95% CI, 9471-13 082), and 7957 (95% CI, 6380-9882) in screening rounds 1, 2, and 3, respectively. Similar to our overall results, there were no statistical differences between screening rounds and within individual prisons. We found no statistical differences in Computer-Aided Detection for TB version 5 scores across screening rounds among people with tuberculosis-the median scores in rounds 1, 2, and 3 were 82 (interquartile range [IQR], 63-97), 77 (IQR, 60-94), and 81 (IQR, 67-92), respectively. CONCLUSIONS: In this environment with hyperendemic rates of tuberculosis, 3 rounds of mass screening did not reduce the overall tuberculosis burden. In prisons, where a substantial number of tuberculosis cases is undiagnosed annually, a range of complementary interventions and more frequent tuberculosis cases screening may be required.

[Antituberculosis-drug resistance in the border of Brazil with Paraguay and Bolivia]. / Resistência às drogas antituberculose na fronteira do Brasil com Paraguai e Bolívia.

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.

Performance of diagnostic tests for pulmonary tuberculosis in indigenous populations in Brazil: the contribution of Rapid Molecular Testing.

OBJECTIVE: To evaluate the accuracy of rapid molecular testing as a diagnostic tool and estimate the incidence of smear-positive pulmonary tuberculosis among the indigenous population. METHODS: This is an epidemiological study based on secondary data. We calculated the incidence of smear-positive pulmonary tuberculosis between January 1st, 2011 and December 31, 2016, and the performance of bacilloscopy and rapid molecular testing in diagnosing pulmonary tuberculosis compared to sputum culture (standard test). RESULTS: We included 4,048 cases of indigenous people with respiratory symptoms who provided sputum samples for analysis. Among them, 3.7%, 6.7%, and 3.7% had positive results for bacilloscopy, sputum culture, and rapid molecular testing, respectively. The mean incidence of pulmonary tuberculosis was 269.3/100 thousand inhabitants. Rapid molecular testing had 93.1% sensitivity and 98.2% specificity, compared to sputum culture. Bacilloscopy showed 55.1% sensitivity and 99.6% specificity. CONCLUSIONS: Rapid molecular testing can be useful in remote areas with limited resources and a high incidence of tuberculosis, such as indigenous villages in rural regions of Brazil. In addition, the main advantages of rapid molecular testing are its easy handling, fast results, and the possibility of detecting rifampicin resistance. Together, these attributes enable the early start of treatment, contributing to reduce the transmission in communities recognized as vulnerable to infection and disease.

Genetic Diversity and Molecular Epidemiology of Mycobacterium tuberculosis in Roraima State, Brazil.

National border areas are special places for the spread of Mycobacterium tuberculosis (MTB). These regions concentrate vulnerable populations and constant population movements. Understanding the dynamics of the transmission of MTB is fundamental to propose control measures and to monitor drug resistance. We conducted a population-based prospective study of tuberculosis (TB) to evaluate molecular characteristics of MTB isolates circulating in Roraima, a state on the border of Venezuela and Guyana. Eighty isolates were genotyped by IS6110-RFLP (restriction fragment length polymorphism), spoligotyping, and 24-locus mycobacterial interspersed repetitive unit-variable number of repeats tandem (MIRU-VNTR). Drug susceptibility tests were performed by using the proportion method and GeneXpert® MTB/RIF (Cepheid, Sunnyvale, CA). Isolates showing a phenotypic resistance profile were submitted to polymerase chain reaction (PCR) and sequencing. Spoligotyping showed 40 distinct patterns with a high prevalence of Latin-American and Mediterranean (LAM), Haarlem (H), and the "ill-defined" T clades. Mycobacterial interspersed repetitive unit -VNTR and IS6110-RFLP showed clustering rates of 21.3% and 30%, respectively. Drug resistance was detected in 11 (15.1%) isolates, and all were found to have primary resistance; among these, six (8.2%) isolates were streptomycin mono-resistant, four (5.4%) isoniazid mono-resistant, and one (1.3%) multidrug resistant. This is the first study on the molecular epidemiology and drug resistance profile of MTB from Roraima. Herein, we describe high diversity of genetic profiles circulating in this region that may be driven by the introduction of new strain types because of large population flow in this region. In summary, our results showed that analyses of these circulating strains can contribute to a better understanding of TB epidemiology in the northern Brazilian border and be useful to establish public health policies on TB prevention.

Identification of non-tuberculous mycobacteria from the Central Public Health Laboratory from Mato Grosso do Sul and analysis of clinical relevance.

Non-tuberculous mycobacteria isolated at the Central Public Health Laboratory from Mato Grosso do Sul in 2003 and 2004 were identified by conventional phenotypic methods (TI) and by PCR-Restriction Enzyme Analysis (PRA) using the hsp65 gene as target (PRA-hsp65). With 15 of the 32 analysed isolates, results of both methods were concordant, being 8 Mycobacterium avium, 3 M. fortutium, 1 M. kansasii, 1 M. flavescens, 1 M. peregrinum and 1 Nocardia brasiliensis. TI of 12 isolates was inconclusive. Novel PRA-hsp65 patterns were observed with 11 isolates. Medical data were evaluated for inference of clinical relevance of these isolates.

A diagnosis of pulmonary tuberculosis and drug resistance among inmates in Mato Grosso do Sul, Brazil.

INTRODUCTION: High endemic levels of pulmonary tuberculosis in prisons result from overcrowding, limited access to healthcare, delayed diagnosis, sustained transmission owing to poor control measures, and multidrug resistance. This study evaluated locally implemented measures for early pulmonary tuberculosis diagnosis and evaluated resistance to anti-tuberculosis drugs. METHODS: This transversal study employed data from the Mato Grosso do Sul State Tuberculosis Control Program obtained from 35 correctional facilities in 16 counties for 2 periods (2007-2010 and 2011-2014). RESULTS: Statewide prevalence (per 100,000) was 480.0 in 2007 and 972.9 in 2014. The following indicators showed improvement: alcohol-acid-fast bacillus testing (from 82.7% to 92.9%); cultures performed (55.0% to 81.8%); drug susceptibility testing of positive cultures (71.6% to 62.4%); and overall drug susceptibility testing coverage (36.6% to 47.4%). Primary and acquired resistance rates for 2007-2014 were 21.1% and 30.0%, respectively. Primary and acquired multidrug resistance rates were 0.3% and 1.3%, respectively. CONCLUSIONS: Prevalence rates increased, and laboratory indicators improved as a result of capacity building and coordination of technical teams and other individuals providing healthcare to inmates. Resistance rates were high, thereby negatively affecting disease control.

Performance of diagnostic tests for pulmonary tuberculosis in indigenous populations in Brazil: the contribution of Rapid Molecular Testing / Desempenho de testes para o diagnóstico de tuberculose pulmonar em populações indígenas no Brasil: a contribuição do Teste Rápido Molecular

ABSTRACT Objective: To evaluate the accuracy of rapid molecular testing as a diagnostic tool and estimate the incidence of smear-positive pulmonary tuberculosis among the indigenous population. Methods: This is an epidemiological study based on secondary data. We calculated the incidence of smear-positive pulmonary tuberculosis between January 1st, 2011 and December 31, 2016, and the performance of bacilloscopy and rapid molecular testing in diagnosing pulmonary tuberculosis compared to sputum culture (standard test). Results: We included 4,048 cases of indigenous people with respiratory symptoms who provided sputum samples for analysis. Among them, 3.7%, 6.7%, and 3.7% had positive results for bacilloscopy, sputum culture, and rapid molecular testing, respectively. The mean incidence of pulmonary tuberculosis was 269.3/100 thousand inhabitants. Rapid molecular testing had 93.1% sensitivity and 98.2% specificity, compared to sputum culture. Bacilloscopy showed 55.1% sensitivity and 99.6% specificity. Conclusions: Rapid molecular testing can be useful in remote areas with limited resources and a high incidence of tuberculosis, such as indigenous villages in rural regions of Brazil. In addition, the main advantages of rapid molecular testing are its easy handling, fast results, and the possibility of detecting rifampicin resistance. Together, these attributes enable the early start of treatment, contributing to reduce the transmission in communities recognized as vulnerable to infection and disease.

RESUMO Objetivo: Avaliar a acurácia do teste rápido molecular como ferramenta diagnóstica e estimar a incidência de casos pulmonares positivos entre a população indígena. Métodos: Estudo epidemiológico baseado em dados secundários. Foi calculada a incidência de casos de tuberculose pulmonar positiva entre 1° de janeiro de 2011 e 31 de dezembro de 2016, e o desempenho da baciloscopia e do teste rápido molecular no diagnóstico de tuberculose pulmonar, em comparação à cultura de escarro (teste padrão). Resultados: Foram incluídos 4.048 casos de indígenas considerados sintomáticos respiratórios, que forneceram amostras de escarro para análise. Destes, 3,7%, 6,7% e 3,7% apresentaram resultados positivos para baciloscopia, cultura e teste rápido molecular, respectivamente. A incidência média de tuberculose pulmonar foi de 269,3/100 mil habitantes. A sensibilidade do teste rápido molecular, em relação à cultura, foi 93,1% e a especificidade foi 98,2%. A baciloscopia apresentou sensibilidade 55,1% e especificidade 99,6%. Conclusões: O teste rápido molecular pode ser útil em áreas remotas, com recursos limitados e incidência de tuberculose elevada, como as aldeias indígenas nas áreas rurais do país. Ademais, o teste rápido molecular apresenta como principais vantagens o fácil manuseio, os resultados rápidos e a possibilidade de identificar a resistência à rifampicina. Em conjunto, esses atributos facilitam o início do tratamento precoce, contribuindo para reduzir a transmissão em comunidades reconhecidamente vulneráveis à infecção e à doença.

Benefícios advindos da técnica de ogawa-kudoh para diagnóstico, controle e avaliação da tuberculose em Mato Grosso do Sul, Brasil / Gains from applying the ogawa-kudoh technique to the diagnosis, control and evaluation of tuberculosis in Mato Grosso do Sul, Brazil

A tuberculose continua sendo grave problema mundial de saúde pública. Seu diagnóstico precoce e tratamento ainda constituem desafios. Entre os recursos diagnósticos, a cultura de Mycobacterium tuberculosis é padrão-ouro. Objetivo: Relatar como a semeadura com a técnica Ogawa-Kudoh foi descentralizada em Mato Grosso do Sul e descrever os benefícios de diagnosticar precocemente a doença e a resistência, bem como o uso dos resultados como fonte de pesquisa. Materiais e Métodos: A técnica foi escolhida por sua simplicidade, sensibilidade e baixo custo, por não requerer centrífuga, estufa ou cabine de segurança biológica e pela facilidade de transporte dos semeados em temperatura ambiente, favorecendo o atendimento de populações distantes dos grandes centros. A descentralização da semeadura ocorreu após identificação ou adaptação de estruturas locais, capacitação de pessoal e fornecimento de insumos. Subsequente apoio técnico, supervisões e monitoramento foram proporcionados. Resultados: O uso da técnica iniciou-se em 1999 no laboratório do Hospital Porta da Esperança, em Dourados, então único serviço para tratamento de tuberculose em povos indígenas. Gradativamente, expandiu-se a outros municípios e populações. Atualmente, cerca de 60% da população sul-mato-grossense é coberta por este recurso laboratorial, destacando-se populações privadas de liberdade, fronteiriças e de áreas prioritárias para o controle da doença. Conclusão: A nova rotina contribuiu para o controle da tuberculose no estado, tanto pelo diagnóstico precoce da doença como da resistência a drogas, favorecendo também estudos e avaliações de relevância epidemiológica.

Worldwide, tuberculosis remains a serious public health problem. Its early diagnosis and treatment still constitute challenges. Mycobacterium tuberculosis culture is the gold standard among diagnostic resources. Objective: To report how culture seeding employing the Ogawa-Kudoh technique was decentralized in Mato Grosso do Sul and describe the benefits obtained from early diagnosis and detection of drug resistance. The use of the resulting data as sources for further research is also reported. Materials and Methods: The technique was selected for its simplicity, sensitivity, and low cost, for not requiring centrifuges, incubators, or biosafety cabins, and for the convenience of seeded plate transportation at room temperature, facilitating the provision of diagnostic services to populations living far from major centers. Decentralization of culture seeding was preceded by identification or adaptation of local structures and by staff training and supply of materials and equipment. Subsequent technical support, supervision, and monitoring were provided. Results: The technique was implemented in 1999 in the laboratory of the Hospital Porta da Esperança, in Dourados county, then the only service providing tuberculosis treatment to indigenous patients, and gradually expanded to other counties and populations. Today, roughly 60% of Mato Grosso do Sul residents are covered by the resource, and more crucially populations deprived of freedom and those living in border regions or areas prioritized for tuberculosis control. Conclusion: The new routine contributed to tuberculosis control in the state, improving early diagnosis and detection of drug resistance and fostering epidemiologically relevant studies and evaluations

[Social inequalities and tuberculosis: an analysis by race/color in Mato Grosso do Sul, Brazil]. / Desigualdades sociais e tuberculose: análise segundo raça/cor, Mato Grosso do Sul.

OBJECTIVE: To describe the sociodemographic and clinical-epidemiological characteristics of tuberculosis cases and identify associated factors with abandoning treatment and death whilst undergoing treatment. METHODS: Epidemiological study based on cases of tuberculosis recorded in indigenous and non-indigenous individuals according to race/color in Mato Grosso do Sul, Midwestern Brazil, between 2001 and 2009. Descriptive analysis of the cases was carried out according to the variables of sex, age group, residence, type of test used in the diagnosis, clinical form, supervised treatment and final status, according to race/color. Univariate/multivariate logistic regression analyses were used to identify predictors of abandoning treatment and death, using odds ratio as a measure of association. A time series of incidence according to race/color was constructed. RESULTS: In the period, 6,962 new cases of tuberculosis were registered, 15.6% being among indigenous. The illness was predominantly found in men and adults (20-44 years old) in all groups. Most of the indigenous patients lived in rural areas (79.8%) and 13.5% of the records in indigenous occurred in children aged < 10 years. The average incidence in the state was 34.5/100,000 inhabitants, being 209.0, 73.1, 52.7, 23.0 and 22.4 in indigenous, and those with yellow, black, white and brown skin, respectively. Patients aged 20 to 44 years (OR = 13.3, 95%CI 1.9;96.8), male (OR = 1.6, 95%CI 1.1;2.3) and of black race/color (OR = 2.5, 95%CI 1.0;6.3) were associated with abandoning treatment, while patients aged > 45 years (OR = 3.0, 95%CI 1.2;7.8) and with the mixed form (OR = 2.3, 95%CI 1.1;5.0) showed association with death. Although they only account for 3.0% of the population, the indigenous were responsible for 15.6% of cases recorded during the period. CONCLUSIONS: Major inequalities in the tuberculosis illness process were found between the categories studied. Incidence in the indigenous population was consistently higher than recorded in any other group, reaching more than six times the national average. It was among those with black and brown skin that the worst treatment results were observed, as they were twice as likely to abandon treatment as the indigenous. Poor program performance was strongly associated with abandoning treatment and death. It is thought that as long as there is no reduction in poverty inequalities in health indicators will remain.

A diagnosis of pulmonary tuberculosis and drug resistance among inmates in Mato Grosso do Sul, Brazil

Abstract INTRODUCTION: High endemic levels of pulmonary tuberculosis in prisons result from overcrowding, limited access to healthcare, delayed diagnosis, sustained transmission owing to poor control measures, and multidrug resistance. This study evaluated locally implemented measures for early pulmonary tuberculosis diagnosis and evaluated resistance to anti-tuberculosis drugs. METHODS: This transversal study employed data from the Mato Grosso do Sul State Tuberculosis Control Program obtained from 35 correctional facilities in 16 counties for 2 periods (2007-2010 and 2011-2014). RESULTS: Statewide prevalence (per 100,000) was 480.0 in 2007 and 972.9 in 2014. The following indicators showed improvement: alcohol-acid-fast bacillus testing (from 82.7% to 92.9%); cultures performed (55.0% to 81.8%); drug susceptibility testing of positive cultures (71.6% to 62.4%); and overall drug susceptibility testing coverage (36.6% to 47.4%). Primary and acquired resistance rates for 2007-2014 were 21.1% and 30.0%, respectively. Primary and acquired multidrug resistance rates were 0.3% and 1.3%, respectively. CONCLUSIONS: Prevalence rates increased, and laboratory indicators improved as a result of capacity building and coordination of technical teams and other individuals providing healthcare to inmates. Resistance rates were high, thereby negatively affecting disease control.

Resistência às drogas antituberculose na fronteira do Brasil com Paraguai e Bolívia / Antituberculosis-drug resistance in the border of Brazil with Paraguay and Bolivia

Objetivo. Estimar as taxas de resistência às drogas entre casos de tuberculose pulmonar (TBP) para o estado de Mato Grosso do Sul, Brasil, e especificamente para a região da fronteira com Paraguai e Bolívia, além de identificar fatores de risco associados. Métodos. O presente estudo epidemiológico, transversal, enfocou os casos de TBP registrados de janeiro de 2007 a dezembro de 2010 no Sistema de Informação de Agravos de Notificação da Secretaria de Estado de Saúde com resultados do teste de suscetibilidade a rifampicina, isoniazida, etambutol e estreptomicina. Definiram-se como variáveis dependentes o desenvolvimento de resistência a uma única droga e a qualquer combinação de drogas. As variáveis independentes foram ser caso novo ou tratado, residência em região de fronteira ou outra região, presença ou ausência de diabetes e história de alcoolismo. Resultados. Foram identificados 789 casos de TBP com teste de suscetibilidade. As características associadas à resistência foram: caso tratado (P=0,0001), região de fronteira (P=0,0142), alcoolismo (P=0,0451) e diabetes (P=0,0708). As taxas de resistência combinada, primária 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 resistência a múltiplas drogas combinada, primária e adquirida no estado foram de 1,8%, 0,6% e 6,3%, e na fronteira, de 3,1%, 1,2% e 12,5%. Conclusões. O estado deve, na região de fronteira, realizar cultura em todos os sintomáticos respiratórios, investigar o padrão de resistência nos casos confirmados, adotar o tratamento diretamente observado nos casos de TBP e desencadear ações de saúde conjuntas com os países fronteiriços. Em todo o estado, é necessário monitorar os níveis de resistência adquirida, ampliar a investigação de resistência para todos os casos tratados e adotar o tratamento diretamente observado prioritariamente entre pacientes com alcoolismo e diabetes.

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.

Resistência às drogas antituberculose na fronteira do Brasil com Paraguai e Bolívia / Antituberculosis-drug resistance in the border of Brazil with Paraguay and Bolivia

RESUMO Objetivo Estimar as taxas de resistência às drogas entre casos de tuberculose pulmonar (TBP) para o estado de Mato Grosso do Sul, Brasil, e especificamente para a região da fronteira com Paraguai e Bolívia, além de identificar fatores de risco associados. Métodos O presente estudo epidemiológico, transversal, enfocou os casos de TBP registrados de janeiro de 2007 a dezembro de 2010 no Sistema de Informação de Agravos de Notificação da Secretaria de Estado de Saúde com resultados do teste de suscetibilidade a rifampicina, isoniazida, etambutol e estreptomicina. Definiram-se como variáveis dependentes o desenvolvimento de resistência a uma única droga e a qualquer combinação de drogas. As variáveis independentes foram ser caso novo ou tratado, residência em região de fronteira ou outra região, presença ou ausência de diabetes e história de alcoolismo. Resultados Foram identificados 789 casos de TBP com teste de suscetibilidade. As características associadas à resistência foram: caso tratado (P=0,0001), região de fronteira (P=0,0142), alcoolismo (P=0,0451) e diabetes (P=0,0708). As taxas de resistência combinada, primária 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 resistência a múltiplas drogas combinada, primária e adquirida no estado foram de 1,8%, 0,6% e 6,3%, e na fronteira, de 3,1%, 1,2% e 12,5%. Conclusões O estado deve, na região de fronteira, realizar cultura em todos os sintomáticos respiratórios, investigar o padrão de resistência nos casos confirmados, adotar o tratamento diretamente observado nos casos de TBP e desencadear ações de saúde conjuntas com os países fronteiriços. Em todo o estado, é necessário monitorar os níveis de resistência adquirida, ampliar a investigação de resistência para todos os casos tratados e adotar o tratamento diretamente observado prioritariamente entre pacientes com alcoolismo e diabetes.

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.

[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.

Desigualdades sociais e tuberculose: analise segundo raca/cor, Mato Grosso do Sul / Desigualdades sociales y tuberculosis: analisis de acuerdo a raza/color, Mato Grosso do Sul, Brasil / Social inequalities and tuberculosis: an analysis by race/color in Mato Grosso do Sul, Brazil

OBJETIVO Analisar características sociodemográficas e clínico-epidemiológicas dos casos de tuberculose e fatores associados ao abandono e ao óbito na vigência do tratamento. MÉTODOS Estudo epidemiológico baseado em dados notificados de tuberculose em indígenas e não indígenas, segundo raça/cor, em Mato Grosso do Sul, entre 2001 e 2009. Realizou-se análise descritiva dos casos de acordo com as variáveis sexo, faixa etária, zona de residência, exames empregados para o diagnóstico, forma clínica, tratamento supervisionado e situação de encerramento, segundo raça/cor. Utilizou-se análise univariada e múltipla por meio de regressão logística para identificar preditores de abandono e óbito, e odds ratio como medida de associação. Foi construída série histórica de incidência, segundo raça/cor. RESULTADOS Registraram-se 6.962 casos novos de tuberculose no período, 15,6% entre indígenas. Houve predomínio em homens e adultos (20 a 44 anos) em todos os grupos. A maior parte dos doentes indígenas residia na zona rural (79,8%) e 13,5% dos registros nos indígenas ocorreram em < 10 anos. A incidência média no estado foi 34,5/100.000 habitantes, 209,0; 73,1; 52,7; 23,0 e 22,4 entre indígenas, amarelos, pretos, brancos e pardos, respectivamente. Doentes de 20 a 44 anos (OR = 13,3; IC95% 1,9;96,8), do sexo masculino (OR = 1,6; IC95% 1,1;2,3) e de raça/cor preta (OR = 2,5; IC95% 1,0;6,3) mostraram associação com abandono de tratamento, enquanto doentes > 45 anos (OR = 3,0; IC95% 1,2;7,8) e com a forma mista (OR = 2,3; IC95% 1,1;5,0) apresentaram associação com óbito. Apesar de representarem 3,0% da população, os indígenas foram responsáveis por 15,6% das notificações no período. ...

OBJETIVO Analizar características sociodemográficas y clínico-epidemiológicas de los casos de tuberculosis y factores asociados con el abandono y el óbito en la vigencia del tratamiento. MÉTODOS Estudio epidemiológico basado en datos notificados de tuberculosis en indígenas y no indígenas, de acuerdo a la raza y el color, en Mato Grosso do Sul, entre 2001 y 2009. Se realizó análisis descriptivo de los casos de acuerdo con las variables sexo, grupo etario, zona de residencia, exámenes empleados para el diagnóstico, forma clínica, tratamiento supervisado y situación de conclusión, de acuerdo a raza/color. Se utilizó análisis univariado y múltiple por medio de regresión logística para identificar predictores de abandono y óbito, y odds ratio como medida de asociación. Se construyó serie histórica de incidencia, de acuerdo a raza/color. RESULTADOS Se registraron 6.962 casos nuevos de tuberculosis en el período, 15,6% entre indígenas. Hubo predominio en hombres y adultos (20 a 44 años) en todos los grupos. La mayor parte de los indígenas enfermos residía en la zona rural (79,8%) y 13,5% de los registros en los indígenas ocurrieron en < 10 años. La incidencia promedio en el estado fue 34,5/100.000 habitantes, 209,0; 73,1; 52,7; 23,0 y 22,4 entre indígenas amarillos, negros, blancos y pardos, respectivamente. Enfermos de 20 a 44 años (OR=13,3; IC95% 1,9;96,8), del sexo masculino (OR = 1,6; IC95% 1,1;2,3) y de raza/color negra (OR= 2,5; IC95% 1,0;6,3) mostraron asociación con abandono del tratamiento, mientras que los enfermos > 45 años (OR= 3,0; IC95% 1,2;7,8) y con la forma mixta (OR= 2,3; IC95% 1,1;5,0) presentaron asociación con óbito. A pesar de representar 3,0% de la población, los indígenas fueron responsables por 15,6% de las ...

OBJECTIVE To describe the sociodemographic and clinical-epidemiological characteristics of tuberculosis cases and identify associated factors with abandoning treatment and death whilst undergoing treatment. METHODS Epidemiological study based on cases of tuberculosis recorded in indigenous and non-indigenous individuals according to race/color in Mato Grosso do Sul, Midwestern Brazil, between 2001 and 2009. Descriptive analysis of the cases was carried out according to the variables of sex, age group, residence, type of test used in the diagnosis, clinical form, supervised treatment and final status, according to race/color. Univariate/multivariate logistic regression analyses were used to identify predictors of abandoning treatment and death, using odds ratio as a measure of association. A time series of incidence according to race/color was constructed. RESULTS In the period, 6,962 new cases of tuberculosis were registered, 15.6% being among indigenous. The illness was predominantly found in men and adults (20-44 years old) in all groups. Most of the indigenous patients lived in rural areas (79.8%) and 13.5% of the records in indigenous occurred in children aged < 10 years. The average incidence in the state was 34.5/100,000 inhabitants, being 209.0, 73.1, 52.7, 23.0 and 22.4 in indigenous, and those with yellow, black, white and brown skin, respectively. Patients aged 20 to 44 years (OR = 13.3, 95%CI 1.9;96.8), male (OR = 1.6, 95%CI 1.1;2.3) and of black race/color (OR = 2.5, 95%CI 1.0;6.3) were associated with abandoning treatment, while patients aged > 45 years (OR = 3.0, 95%CI 1.2;7.8) and with the mixed form (OR = 2.3, 95%CI 1.1;5.0) showed association with death. Although they only account for 3.0% of the population, the indigenous were responsible for 15.6% of cases recorded during the period. CONCLUSIONS Major inequalities in the tuberculosis illness process were found between the categories studied. Incidence in ...

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, ...

Contribuição do LACEN-MS no diagnóstico da tuberculose e da resistência às drogas antituberculosas em Mato Grosso do Sul / The contribution of the Public Health Central Laboratory of Mato Grosso do Sul to the diagnosis

Com a disseminacao da AIDS e o surgimento de cepas de Mycobacterium tuberculosis resistentes a quimioterapicos, a tuberculosetem recrudescido mundialmente. Avaliar a demanda ao Laboratorio Central de Mato Grosso do Sul (LACEN-MS) por diagnostico de M. tuberculosis e a prevalencia da resistencia a drogas antituberculose entre casos notificados ao SINAN em 2000-2006. Estudo descritivo de dados de cultivo e de testes de sensibilidade (com metodo das proporcoes) a rifampicina, isoniazida, estreptomicina e etambutol de casos notificados. Materiais biologicos (pulmonares e/ou extrapulmonares) de casos suspeitos foram semeados emmeios Lowenstein–Jensen e Ogawa–Kudoh e no sistema automatizado Bactec MGIT 960. No periodo, 66 dos 78 municipios enviaram 18 392 amostras, sendo 2 009 (10,9%) positivas. Em 1 174 (58,4%) destas realizou-se TS. Selecionaram-se 783 (66,7%) para o levantamento de resistencia, sendo 645 (82,4%) de casos nunca tratados e 138 (17,6%) com registro de tratamento. Constatou-se resistencia primaria, adquirida e combinada em 12,4%, 45,7% e 18,3% dos casos, respectivamente. O LACEN-MS atendeu 84,6% dos municipios. Entre os casos notificados ao SINAN verificou-se alta resistencia, com tuberculose multirresistente adquirida em 20,3%, evidenciando o uso previo de medicamentos como indicador de resistencia.

With the spread of AIDS and the emergence of drug-resistant Mycobacterium tuberculosis strains, tuberculosis has made a vigorous comeback worldwide. To evaluate the demands placed on the Public Health Central Laboratory of the State of MatoGrosso do Sul (LACEN-MS) for the diagnosis of M. tuberculosis and to determine the prevalence of antituberculosis drug resistanceamong cases notified to the Brazilian Information System of Notifiable Hazards (SINAN) in 2000-2006. A descriptive study of the results of culture tests and of sensitivity tests performed for rifampicin, isoniazid, streptomycin, and ethambutol (proportion method) on material from notified cases. Pulmonary and/or extrapulmonary materials from suspected cases were seeded on Lõwenstein–Jensen and Ogawa–Kudoh. The Bactec MGIT 960 automated system was used. In the period investigated, 18 392 samples referred by 66 of the 78 counties in Mato Grosso do Sul were analyzed, 2 009 (10.9%) of which were positive. Sensitivity tests were performed on 1 174 (58.4%) of these. Resistance was investigated in 783 (66.7%) cases, of which 645 (82.4%) were naive to treatment and 138 (17.6%) had been previously treated. Primary, acquired, and combined resistance were found in 12.4%, 45.7%, and 18.3% of cases, respectively. LACEN-MS served 84.6% of Mato Grosso do Sul’s counties. Acquired multidrug resistance was found in 20.3% of the notified cases,demonstrating that previous use of drug therapy can be viewed as an indicator of resistance.

Identification of non-tuberculous mycobacteria from the Central Public Health Laboratory from Mato Grosso do Sul and analysis of clinical relevance / Identificação de micobactérias não-tuberculosas do Laboratório Central de Saúde Pública de Mato Grosso de Sul e análise de dados clínicos dos pacientes

Non-tuberculous mycobacteria isolated at the Central Public Health Laboratory from Mato Grosso do Sul in 2003 and 2004 were identified by conventional phenotypic methods (TI) and by PCR-Restriction Enzyme Analysis (PRA) using the hsp65 gene as target (PRA-hsp65). With 15 of the 32 analysed isolates, results of both methods were concordant, being 8 Mycobacterium avium, 3 M. fortutium, 1 M. kansasii, 1 M. flavescens, 1 M. peregrinum and 1 Nocardia brasiliensis. TI of 12 isolates was inconclusive. Novel PRA-hsp65 patterns were observed with 11 isolates. Medical data were evaluated for inference of clinical relevance of these isolates.

Micobactérias não-tuberculosas isoladas no Laboratório Central de Saúde Pública de Mato Grosso do Sul em 2003 e 2004 foram identificadas usando métodos fenotípicos convencionais (TI) e PCR-Restriction Enzyme Analysis (PRA) tendo o gene hsp65 como alvo (PRA-hsp65). Em 15 dos 32 isolados analisados os resultados obtidos com ambos métodos foram concordantes, sendo 8 Mycobacterium avium, 3 M. fortutium, 1 M. kansasii, 1 M. flavescens, 1 M. peregrinum e 1 Nocardia brasiliensis. TI de 12 isolados não foi conclusiva. Perfis não descritos de PRA-hsp65 foram observados com 11 isolados. Dados dos prontuários médicos foram avaliados para inferir a relevância clínica dos isolados.