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M. tuberculosis resistant to first-line antituberculosis drugs : case series and literature review
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A tuberculose é uma doença infeciosa transmitida por via aérea, causada pelo Mycobacterium tuberculosis, sendo a segunda principal causa de morte por um agente infecioso em todo o mundo. Tratamentos inadequados ou incompletos e comorbilidades, como a infeção por VIH, podem contribuir para o desenvolvimento de resistência aos medicamentos antituberculosos. Globalmente, a proporção de pessoas com TB que apresentaram MDR/RR-TB (TB multirresistente ou resistente a Rifampicina) tem vindo a diminuir lentamente. Combater a resistência aos medicamentos antituberculosos requer técnicas de diagnóstico rápidas e avançadas e instituição de esquemas de tratamento adaptados aos perfis de suscetibilidade aos medicamentos. Os esquemas de tratamento para a TB resistente tendem a ser mais complexos e prolongados, com mais elevadas taxas de falência terapêutica e maior morbilidade e mortalidade. Este é um estudo descritivo, transversal e retrospetivo para investigar as características epidemiológicas, sociodemográficas e clínicas, bem como os desfechos clínicos, dos doentes com tuberculose resistente aos medicamentos no Hospital Prof. Doutor Fernando Fonseca ao longo de um período de seis anos. De um total de 36 doentes, uma parte substancial eram imigrantes provenientes de países endémicos. Foi encontrada história de tratamento prévio para tuberculose em 5 doentes, e 13,9% tinham coinfeção por VIH. A prevalência de tuberculose multirresistente foi de aproximadamente 1,4% ao longo do estudo, com um aumento para 3,7% em 2023. Foram ainda identificados dois casos de pré-XDR-TB (TB préextensivamente resistente). O impacto da tuberculose resistente aos medicamentos alerta para a necessidade de melhorar a literacia em saúde sobre TB, abordar as pessoas com fatores de risco conhecidos e implementar estratégias adicionais para rastrear, diagnosticar e tratar adequadamente os casos, prevenindo a transmissão comunitária.
Tuberculosis (TB) is an airborne infectious disease caused by Mycobacterium tuberculosis, posing as second leading cause of death from an infectious agent worldwide. Inadequate or incomplete treatment and underlying conditions, like HIV infection, may contribute to development of antituberculosis drugs resistance. Globally, the proportion of people with TB who have MDR/RR-TB (multidrug- or Rifampinresistant TB) has been slowly declining. Addressing antituberculosis drugs resistance requires rapid and advanced diagnostic techniques with treatment regimens being tailored to drug susceptibility profiles. Treatment regimens of resistant-TB tend to be more complex and have longer duration, with higher rates of treatment failure and greater morbidity and mortality. This is a descriptive, cross-sectional, and retrospective study to investigate the epidemiological, sociodemographic, and clinical characteristics and outcomes of patients with drug-resistant tuberculosis at Hospital Prof. Doutor Fernando Fonseca over a six-year period. From a total of 36 patients, a substantial portion were immigrants from endemic countries. Reported history of previous tuberculosis treatment was found in 5 patients and 13.9% had HIV co-infection. Prevalence of multidrug-resistant tuberculosis was approximately 1.4% throughout the study with an increase to 3.7% in 2023. Two cases of pre-XDR-TB (pre-extensively drug-resistant TB) were identified. The burden of drug-resistant tuberculosis highlights the need to improve health literacy regarding TB, address people with known risk factors and implement additional strategies to screen, diagnose and adequately treat cases, preventing community transmission.
Tuberculosis (TB) is an airborne infectious disease caused by Mycobacterium tuberculosis, posing as second leading cause of death from an infectious agent worldwide. Inadequate or incomplete treatment and underlying conditions, like HIV infection, may contribute to development of antituberculosis drugs resistance. Globally, the proportion of people with TB who have MDR/RR-TB (multidrug- or Rifampinresistant TB) has been slowly declining. Addressing antituberculosis drugs resistance requires rapid and advanced diagnostic techniques with treatment regimens being tailored to drug susceptibility profiles. Treatment regimens of resistant-TB tend to be more complex and have longer duration, with higher rates of treatment failure and greater morbidity and mortality. This is a descriptive, cross-sectional, and retrospective study to investigate the epidemiological, sociodemographic, and clinical characteristics and outcomes of patients with drug-resistant tuberculosis at Hospital Prof. Doutor Fernando Fonseca over a six-year period. From a total of 36 patients, a substantial portion were immigrants from endemic countries. Reported history of previous tuberculosis treatment was found in 5 patients and 13.9% had HIV co-infection. Prevalence of multidrug-resistant tuberculosis was approximately 1.4% throughout the study with an increase to 3.7% in 2023. Two cases of pre-XDR-TB (pre-extensively drug-resistant TB) were identified. The burden of drug-resistant tuberculosis highlights the need to improve health literacy regarding TB, address people with known risk factors and implement additional strategies to screen, diagnose and adequately treat cases, preventing community transmission.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Tuberculose resistente Medicamentos antituberculosos de primeira linha Mycobacterium tuberculosis Tuberculose Tratamento da tuberculose Doenças transmissíveis