Tuberculose pulmonar e infecção pelo virus da imunodeficiencia humana (HIV) : aspectos epidemiologicos e clinicos em Moçambique

Autor Principal: Elizabete Abrantes Nunes
Tipo: Teses/dissertações
Idioma: Português
Publicado em: 2005
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Tuberculosis, multidrug-resistant tuberculosis and mv are, today, the three greatest endemics with similar trends and immeasurable impairment to humanity,particular in low resources countries.

Obiectives: Determine the resistance pattern to anti-tuberculosis drugs (ATD) in mv positive patients with pulmonary disease by mycobacteria tuberculosis and mycobacteria non tuberculosis in the Maputo region and the prevalence of MOTT in this population.

Population and methods: the study was conducted in 503 patients with pulmonary tuberculosis and mv positive in two hospitaIs of Maputo City, Mozambique.

Two hundred and eighty two (282) sputum samples and/or bronchial wash were submitted for testing of baciloscopy, BK culture, MOTT and Drug Susceptibility Testing (DST) for ATD.

Clinical and radiographic characteristics, CD4 counting and hematological profile were also evaluated.

Results: M tuberculosis was the main organism identified in 229 (98,7%) of the isolated samples.

Non-tuberculosis mycobacteria were identified in sputum of only 3 (1,3%) of the cases with compatible clinic.

Drug sensitivity was observed in 232 (82%) patients and resistance in 50 (17%) of the 282 sampled cases.

In relation to the drug resistance patterns, 27 (13,6%) were in New Cases (NC) and 21 (26,6%) in Previously Treated cases (PT).

More observed resistance to ATD was recorded in 13,6% in NC and 26,6% in PT.

General resistant to different ATD was: 1° H- 14,9%, 2° S- 7,8%, 3° R- 6,4%.

The resistance to R increased both in the NC as in PT.

Overall, the MDR-TB was 5,7%, being 3% in NC and 11,4% in PT.

The risk factors identified for resistance and MDR-TB were: previous treatment to TB and CD4 <200.

These patients presented a median CD4 of 151 cells/mm3, a median of Hgb of 7,8 g/dl and of CTL 1140.

From a radiological point ofview, the atipic pattem was the most frequent and cavities were observed in a small group predominant1yin PT and in-the cases that presented poliresistance to ATD.

The pulmonary Kaposi sarcoma was observed in 4,8% ofthe patients and the fungall bacterial infections in 27,9%.

Conclusions: The high levels of MDR-TB recorded in this study suggests that the risk of TB transmission should be reduced through control measures of nosocomial transmission and in the community and amplify the DOTS strategy to a greater population number.

As a result of the high resistance to H, it is advised to introduce one of the 3o ATDin the maintenance phase of the treatment regime of NC, and sensitivity tests to ATD in the beginning of retreatment.

Prophylaxis with H in HIV positive for TB prevention and latent infection treatment should be analyzed carefully, due to the high resistance to H.

The use of cotrimoxazol to reduce the death causes associated to lllV/TB.

Anti-Retroviral Treatment (ATRV) is important and also counceling for HIV voluntary testing in all TB patients.