RESUMO
OBJECTIVE: To assess the spatial distribution of TB and malaria incidence, as well as their spatial association with each other, regardless of environmental and socio-economic factors commonly reported as determinants of both disease rates among the municipalities of Amazonas State, Brazil between 2012 and 2015. METHODS: Through an ecological approach considering municipalities of Amazonas, Brazil, as unit of analysis, a negative binomial regression model was used to assess association between malaria and TB rates, in which the dependent variable was the average municipal tuberculosis incidence rate. RESULTS: Positive associations of overall malaria (ß = 0.100 [CI = 0.032, 0.168], P = 0.004), P. vivax malaria (ß = 0.115 [CI = 0.036, 0.195], P = 0.005), and P. falciparum malaria (ß = 0.389 [CI = -0.0124, 0.791], P = 0.057) with TB rates were found, regardless of the sociodemographic factors included in the study. CONCLUSION: In the Brazilian Amazon, TB and malaria are spatially associated. Therefore, it is very likely that co-infections also occur in this region, regardless of the HIV status.
OBJECTIF: Evaluer la distribution spatiale de l'incidence de la tuberculose (TB) et du paludisme, ainsi que leur association spatiale, indépendamment des facteurs environnementaux et socioéconomiques communément rapportés comme déterminants des taux des deux maladie dans les municipalités de l'Etat d'Amazonas, au Brésil, entre 2012 et 2015. MÉTHODES: Dans le cadre d'une approche écologique prenant en considération les municipalités d'Amazonas, au Brésil, comme unité d'analyse, un modèle de régression binomiale négatif a été utilisé pour évaluer l'association entre les taux de paludisme et de TB, dans laquelle la variable dépendante était le taux moyen d'incidence municipale de la TB. RÉSULTATS: Des associations positives entre le paludisme en général (ß = 0,100 [IC= 0,032 à 0,168], p = 0,004), le paludisme à P. vivax (ß = 0,115 [IC: 0,036 à 0,195], p = 0,005) et le paludisme à P. falciparum (ß = 0,389 [IC: - 0,0124 à 0,791], p = 0,057) avec des taux de TB ont été retrouvées quels que soient les facteurs sociodémographiques inclus dans l'étude. CONCLUSION: En Amazonie brésilienne, la TB et le paludisme sont associés spatialement. Par conséquent, il est très probable que des coinfections se produisent également dans cette région, quel que soit le statut VIH.
Assuntos
Malária/epidemiologia , Tuberculose/epidemiologia , Brasil/epidemiologia , Comorbidade , Humanos , IncidênciaRESUMO
The occurrence of tuberculosis with first-line multidrug resistance leads to the use of alternative medications, often at higher costs, longer treatment periods, and greater clinical complexity. Here, we report 3 patients with multidrug-resistant tuberculosis. One patient with human immunodeficiency virus died before the sensitivity test was performed. The early diagnosis of multidrug-resistant tuberculosis and appropriate treatment should be priorities of the National Tuberculosis Control Program in order to break the chain of transmission. In addition, the possibility of substituting the proportion method with more modern and faster techniques should be urgently evaluated.
Assuntos
Antituberculosos/uso terapêutico , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Pulmonar/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Adulto , Evolução Fatal , Humanos , Masculino , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Pulmonar/tratamento farmacológico , Adulto JovemRESUMO
The occurrence of tuberculosis with first-line multidrug resistance leads to the use of alternative medications, often at higher costs, longer treatment periods, and greater clinical complexity. Here, we report 3 patients with multidrug-resistant tuberculosis. One patient with human immunodeficiency virus died before the sensitivity test was performed. The early diagnosis of multidrug-resistant tuberculosis and appropriate treatment should be priorities of the National Tuberculosis Control Program in order to break the chain of transmission. In addition, the possibility of substituting the proportion method with more modern and faster techniques should be urgently evaluated.
O surgimento de resistência múltipla às drogas de primeira linha implica na utilização de fármacos de maior custo, com duração mais longa, maior complexidade e mais efeitos colaterais. Relatamos os casos de três pacientes com multirresistência primária aos tuberculostáticos. O portador de HIV evoluiu para óbito antes do resultado do teste de sensibilidade. Portanto, o diagnóstico precoce de tuberculose multirresistente e o tratamento adequado devem ser prioridades do Programa Nacional do Controle da Tuberculose, visando interromper a cadeia de transmissão. Além disto, é urgente que seja avaliada a substituição do método das proporções por técnicas mais modernas e mais rápidas.