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1.
Int J Infect Dis ; 87: 119-125, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31357057

RESUMO

OBJECTIVE: To determine the prevalence of resistance to rifampicin alone; rifampicin and isoniazid, and second-line anti-TB drugs among sputum smear-positive tuberculosis patients in Zimbabwe. DESIGN: A health facility-based cross-sectional survey. RESULTS: In total, 1114 (87.6%) new and 158 (12.4%) retreatment TB patients were enrolled. MTB was confirmed by Xpert MTB/RIF among 1184 (93%) smear-positive sputum samples. There were 64 samples with Xpert MTB/RIF-determined rifampicin resistance. However, two were rifampicin susceptible on phenotypic drug susceptibility testing. The prevalence of RR-TB was [4.0% (95% CI, 2.9, 5.4%), n=42/1043) and 14.2% (95% CI, 8.9, 21.1%; n=20/141) among new and retreatment patients, respectively. The prevalence of MDR-TB was 2.0% (95% CI, 1.3, 3.1%) and 6.4% (95% CI, 2.4, 10.3%) among new and retreatment TB patients, respectively. Risk factors for RR-TB included prior TB treatment, self-reported HIV infection, travel outside Zimbabwe for ≥one month (univariate), and age <15 years. Having at least a secondary education was protective against RR-TB. CONCLUSION: The prevalence of MDR-TB in Zimbabwe has remained stable since the 1994 subnational survey. However, the prevalence of rifampicin mono-resistance was double that of MDR-TB.


Assuntos
Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia , Adolescente , Adulto , Idoso , Antibacterianos/farmacologia , Criança , Estudos Transversais , Farmacorresistência Bacteriana , Feminino , Instalações de Saúde , Humanos , Isoniazida/farmacologia , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Mycobacterium tuberculosis/genética , Prevalência , Rifampina/farmacologia , Fatores de Risco , Sensibilidade e Especificidade , Escarro/microbiologia , Inquéritos e Questionários , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Adulto Jovem , Zimbábue/epidemiologia
2.
Clin Infect Dis ; 37(12): 1686-92, 2003 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-14689352

RESUMO

Injection drug users (IDUs) were heavily affected by the tuberculosis (TB) resurgence in New York City in the 1990s. We assessed the effectiveness of screening for latent TB infection in methadone users and of selective treatment with isoniazid. Risk for future TB was classified as low or high on the basis of tuberculin, anergy, and HIV test results. The cohort of 2212 IDUs was followed up for a median of 4.2 years; 25 IDUs, of whom 20 (80%) were infected with human immunodeficiency virus (HIV), developed TB. In an adjusted Cox proportional hazards model of high-risk IDUs, the risk of TB was associated with HIV infection (HR 10.3; 95% CI, 3.4-31.3); receipt of <6 months of isoniazid therapy (HR 7.6; 95% CI, 1.02-57.1); a CD4+ T lymphocyte count of <200 cells/mm3 (HR 6.6; 95% CI, 1.7-25.9); and tuberculin positivity (HR 4.0; 95% CI, 1.6-10.2). Treatment with isoniazid was beneficial in HIV-infected, tuberculin-positive IDUs.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antituberculosos/uso terapêutico , Infecções por HIV/complicações , Isoniazida/uso terapêutico , Abuso de Substâncias por Via Intravenosa/tratamento farmacológico , Tuberculose/tratamento farmacológico , Adulto , Idoso , Feminino , HIV , Humanos , Masculino , Metadona/uso terapêutico , Pessoa de Meia-Idade , Fatores de Risco , Resultado do Tratamento , Teste Tuberculínico , Tuberculose/epidemiologia
3.
Pediatrics ; 111(4 Pt 1): e309-15, 2003 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-12671144

RESUMO

OBJECTIVES: To assess adherence to a 1996 health policy change, which discontinued mandatory tuberculin skin testing (TST) of new entrants to NYC primary schools and continued mandatory testing of new entrants to secondary schools. METHODS: The proportion tested before (1991-1995) and after (1996-1998) the change in health policy was determined. Factors associated with TST positivity and the cost of continued testing were assessed. RESULTS: A total of 76.6% of 551 636 new entrants to primary schools were tested in 1991-1995; slightly fewer, 71.1% of 339 958, were tested in 1996- 1998. Among new entrants to secondary schools, 31.0% of 106 463 were tested in 1991-1995 and 51.4% of 53 762 were tested in 1996-1998. The proportion who were TST-positive continued to decrease after 1996 to 1.2% among primary and 9.7% among secondary schoolchildren in 1998. Older age and birth outside the United States were associated with TST positivity. The estimated minimum cost of continued testing in primary schools was $123 152 per tuberculosis case prevented. CONCLUSION: An approach aimed at reducing testing of children at low risk for latent tuberculosis infection did not decrease testing of younger children. More important, older children who were more likely to be born in countries of high tuberculosis incidence were not tested. Additional efforts are needed to increase awareness among medical and school personnel to decrease testing among children who do not have risk factors for latent tuberculosis infection and to increase tuberculin testing of children who are entering school for the first time at the secondary level and do have risk factors for tuberculosis infection.


Assuntos
Teste Tuberculínico/estatística & dados numéricos , Tuberculose/epidemiologia , Adolescente , Vacina BCG/uso terapêutico , Criança , Pré-Escolar , Contraindicações , Emigração e Imigração/estatística & dados numéricos , Humanos , Programas de Imunização/métodos , Programas de Imunização/estatística & dados numéricos , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Análise Multivariada , Mycobacterium tuberculosis/imunologia , Mycobacterium tuberculosis/isolamento & purificação , Cidade de Nova Iorque/epidemiologia , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Teste Tuberculínico/economia , Teste Tuberculínico/métodos , Tuberculose/diagnóstico , Tuberculose/etnologia , Tuberculose/prevenção & controle
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