RESUMO
The incidence of multidrug-resistant tuberculosis (MDRTB) is increasing. Rapid detection of resistance to second-line drugs is essential for patient management and efficient control of tuberculosis. The aim of the present study was to assess the ability of the GenoType MTBDRsl DNA strip and the Bactec MGIT 960 assay to detect resistance to second-line drugs and ethambutol in multidrug-resistant clinical isolates using the agar proportion method as a reference technique. Twenty-six Mycobacterium tuberculosis complex isolates identified as multidrug-resistant on the basis of conventional drug susceptibility testing were retrieved from our laboratory archive (1992-2010) for evaluation. The susceptibility of these strains to second-line drugs and ethambutol was tested prospectively using MGIT 960 and GenoType MTBDRsl. The turnaround time for agar proportion, MGIT 960, and GenoType MTBDRsl were, respectively, 21 days, 8 days, and 8 h. Sensitivity values for MGIT 960 and GenoType MTBDRsl were, respectively, ethambutol (85.7, 28.6%), amikacin (50, 75%), and ofloxacin (50, 83.3%). Specificity values were, respectively, ethambutol (73.7, 89.5%), amikacin (72.7, 95.5%), and ofloxacin (100, 100%). Our data show that both methods have significant limitations and cannot replace conventional drug susceptibility testing. The results of resistance testing should be interpreted with caution and confirmed using the reference method.
Assuntos
Ágar/farmacologia , Antituberculosos/farmacologia , DNA Bacteriano/genética , Etambutol/farmacologia , RNA Bacteriano/genética , Tuberculose Resistente a Múltiplos Medicamentos/genética , Análise Mutacional de DNA , DNA Bacteriano/química , Feminino , Predisposição Genética para Doença , Genótipo , Humanos , Masculino , Testes de Sensibilidade Microbiana/métodos , Valor Preditivo dos Testes , RNA Bacteriano/química , Fitas Reagentes , Sensibilidade e Especificidade , Tuberculose Resistente a Múltiplos Medicamentos/diagnósticoRESUMO
El objetivo de este trabajo es hacer una revisiónsistemática de los tipos de vacunas contra la malariay de cómo se encuentra actualmente su investigación.Además, se analizarán las barreras socioeconómicasque están impidiendo que la esperadavacuna sea una realidad en un futuro cercano.La malaria es la enfermedad parasitaria más importanteen el hombre, con cerca de 1 millón demuertes al año y enormes repercusiones económicasen los países donde es endémica.Esta enfermedad frena el desarrollo en África,dónde su coste económico, se ha estimado en unos12 billones de dólares anuales. Si la malaria se hubieraeliminado en el África Sub-Sahariana hace 35años, su PIB hubiera ascendido un 32%.Teniendo en cuenta su implicación social y económica,el desarrollo de una vacuna es una necesidadurgente. A pesar de la elevada morbimortalidadque produce, la malaria continúa siendo un reto parala Salud Pública Mundial
To make a systematic review of all the vaccinestypes against malaria and which is their current stageis the purpose of this research. Moreover, socioeconomicalconstraints, which are avoiding that thevaccine will become a reality in the near future, willbe analyzed.Malaria is the most important parasitic-infectionfor the human race with important economical effectsin endemic countries. At least, 1 million deathsper year are reported.This disease restrains Africas development whicheconomic burden was estimated around $12 billion.According to some estimates, Sub-Saharan AfricasGDP would be up to 32% greater if malaria had beeneliminated 35 years ago.Taking into account the social and economical impact,the vaccines development is an urgent need.In spite of its high morbi-mortality, malaria is still inthe focus of the World Health System
