RESUMO
The rapid molecular test (RMT) performed on the GeneXpert® system is widely used as a control strategy and surveillance technique for tuberculosis (TB). In the region of the Americas, TB incidence is slowly increasing owing to an upward trend in Brazil, which is among the high TB-burden countries (HBCs), ranking in the 19th position. In this context, we aimed to (i) describe the implementation and history of RMT-TB (Xpert® MTB/RIF and Xpert® MTB/RIF Ultra) in Brazil; (ii) to evaluate the national RMT laboratory distribution, TB, and resistance to RIF detection by RMT; and (iii) to correlate these data with Brazilian TB incidence. The quantitative data of Xpert® MTB/RIF and Xpert® MTB/RIF Ultra assays performed in the pulmonary TB investigation from 2014 to 2020 were provided by the Brazilian Ministry of Health. A spatial visualization using ArcGIS software was performed. The Southeast region constituted about half of the RMT laboratories-from 39.4% to 45.9% of the total value over the five regions. Regarding the federal units, the São Paulo state alone represented from 20.2% to 34.1% (5.0 to 8.5 times the value) of RMT laboratories over the years observed. There were significant differences (p < 0.0001) in the frequency of RMT laboratories between all years of the historical series. There was an unequal distribution of RMT laboratories between Brazilian regions and federal units. This alerts us for the surveillance of rapid molecular detection of TB in different parts of the country, with the possibility of improving the distribution of tests in areas of higher incidence in order to achieve the level of disease control recommended by national and worldwide authorities.
RESUMO
Objetivo: Relatar o perfil sociodemográfico e clínico epidemiológico de idosos portadores de tuberculose (TB) em uma capital do Norte do Brasil. Métodos: Estudo retrospectivo, de caráter descritivo, transversal e quantitativo, realizado em 2018, no município de Belém, Pará, Brasil, constituído por todos os casos novos de idosos com TB (n=1.134) notificados e confirmados ao Sistema de Informação de Agravos de Notificação (Sinan), no período de 2011 a 2015. Utilizou-se o teste quiquadrado de Pearson (x²) associando-se variáveis nominais (idade, sexo, escolaridade, zona de residência e resultado de baciloscopia, forma clínica da doença, tipo de encerramento do caso e os agravos da doença), adotando-se o valor de p<0,05. As variáveis com frequências menores que 5, com as quais não foi possível realizar o teste χ2, ocorreram pelo teste G. Resultados: A maioria dos idosos era do sexo masculino (n=684; 60,32%), na faixa etária de 60 a 69 anos (n=643; 56,70%), com baixa escolaridade (n=499; 44,08%) e residentes em zona urbana (n=1122; 99,12%). Predominaram a forma clínica pulmonar (n=986; 86,95%), a cura (n=783; 73,73%) e o diabetes mellitus (n=269; 23,72%) como comorbidade mais frequente. Houve resultado positivo para baciloscopia (n=693; 61,11%) e os de controle negativaram (n=352; 40,14%) no 1º mês de tratamento. Conclusão: A suspeitade TB em idosos tem fator decisivo para o diagnóstico devido à baixa presença e especificidade das características clínicas dos quadros de TB nessa população.
Objective: To report the clinical and epidemiological profile of older patients with tuberculosis (TB) in a capital city in Northern Brazil. Methods: A quantitative retrospective, descriptive, cross-sectional study was carried out in 2018 in the municipality of Belém, Pará, Brazil, with all new cases of older adults with TB reported and confirmed in the Notifiable Diseases Information System (Sistema de Informação de Agravos de Notificação SINAN) from 2011 to 2015. Pearson's chi-squared test (x²) was used to check for associations between nominal variables (age, sex, education, area of residence and sputum smear microscopy testersults, clinical form of the disease, type of case closure and the complications of the disease), with a value of p<0.05. Variables with frequencies lower than 5, where it was not possible to perform the χ2 Test, were analyzed using the G test. Results: Most of the older adults were male (n=684; 60.32%), in the age range 60 to 69 years (n=643; 56.70%), had low education (n=499; 44.08%), and lived in urban areas (n=1122; 99.12%). There was a predominance of pulmonary clinical form (n=986; 86.95%),cure (n=783; 73.73%), and Diabetes Mellitus (n=269; 23.72%) as the most frequent comorbidity. There was a positive result for sputum smear microscopy (n=693; 61.11%) and controls were negative (n=352; 40.14%) in the first month of treatment. Conclusion: Suspicion of TB in older adults is a decisive factor for the diagnosis due to the low presence and specificity of the clinical characteristics of TB cases in this population group.
Objetivo: Relatar el perfil sociodemográfico y clínico epidemiológico de mayores portadores de tuberculosis (TB) de una capital del Norte de Brasil. Métodos: Estudio retrospectivo de carácter descriptivo, transversal y cuantitativo realizado en 2018 en el municipio de Belém, Pará, Brasil, constituido por todos los casos nuevos de mayores con TB (n=1.134) que han sido notificados y confirmados en el Sistema de Información de Agravios de Notificación (SINAN) en el periodo entre 2011 y 2015. Se utilizó la prueba de chi-cuadrado de Pearson (x²) asociándose las variables nominales (edad, sexo, escolaridad, zona de vivienda y resultado de la baciloscopia, forma clínica de la enfermedad, tipo de cierre del caso y los agravios de la enfermedad) con el valor de p<0,05. Las variables con las frecuencias por debajo de 5 con las cuales no ha sido posible realizar la prueba χ2, se dieron por la prueba G. Resultados: La mayoría de los mayores era del sexo masculino (n=684;60,32%), en la franja de edad entre los 60 y 69 años (n=643; 56,70%), con baja escolaridad (n=499;44,08%) y que vivían en la zona urbana (n=1122; 99,12%).El predominio ha sido de la forma clínica pulmonar (n=986;86,95%), la cura (n=783; 73,73%) y la diabetes mellitus (n=269;23,72%) como comorbilidad más frecuente. Hubo un resultado positivo para la baciloscopia (n=693; 61,11%) y negativo para los individuos del grupo control (n=352;40,14%) en el primer mes de tratamiento. Conclusión: La sospecha de TB en mayores tiene el factor decisivo para el diagnóstico debido la baja presencia y especificidad de las características clínicas de los cuadros de TB para esa población.