Reativação ou reinfecção em pacientes com recidiva de tuberculose

O melhor conhecimento dos fatores associados aos casos de recidivas de tuberculose (TB) constitui um desafio ao aprimoramento das estratégias de controle da doença. A recidiva pode ser resultante da reativação endógena, de bacilos persistentes na lesão, ou de uma nova infecção, (reinfecção exógena). Para fins de tratamento, é considerado que recidiva de TB é a situação na qual o paciente desenvolve a doença ativa novamente, após completar o tratamento e receber alta por cura. O objetivo do trabalho foi estimar a prevalência e caracterizar a reativação endógena e reinfecção exógena em pacientes com recidivas de TB após cura numa região de alta prevalência de TB e HIV. Tratou-se de um estudo retrospectivo, descritivo de levantamento laboratorial. A população de estudo foi constituída por pacientes com recidiva de TB do ambulatório do Hospital Sanatório Partenon, atendidos no período de 2004-2010. Dos 1449 pacientes que realizaram o tratamento entre 2004 e 2010, foram 1060 novos casos (CN) (73,2%), e 462 (26,8%) recidivas. Entre os casos de recidivas, 203 (14 %) eram de recorrência após cura (RC) e 186 (12,8 %) eram de recorrência após abandono (RA). O percentual de HIV positivo dos 3 grupos CN, RC e RA foram, respectivamente, 22,5 , 37,7 e 43,3 %. Dos 203 casos de TB recorrente, 24 tiveram culturas feitas em primeiro e segundo episódios, mas apenas 13 tiveram DNA disponível. Foi realizada a genotipagem por spoligotyping e MIRU-VNTR (Mycobacterial Interspersed Repetitive Unit), em todas as amostras de DNA disponíveis. A análise molecular demonstrou que em 4 (30,7%) pacientes, a doença foi atribuída a uma reinfecção e em 9 (69,3%) deles a doença era devido a uma reativação. A recidiva de TB tem implicações na saúde publica, podendo demonstrar uma ineficiência dos programas de controle da TB, tempo do tratamento, pois alguns estudos mostram que o prolongamento do tratamento nos pacientes HIV positivos diminui a taxa de recidiva.A better understanding of the factors associated with recurrence cases of tuberculosis is a challenge to the improvement of the strategies of disease control. The recurrence may result from endogenous reactivation of persistent bacilli in the lesion, or a new infection (exogenous reinfection). The Tuberculosis Control Program considers that disease recurrence is the situation in which the patient develops active disease after completing treatment and be declared cured. The objective of this study was to estimate the prevalence and characterize the endogenous reactivation and exogenous reinfection in patients with recurrence of TB after cure in a region of high prevalence of TB and HIV. This was a retrospective, descriptive study of laboratory surveillance. The study population was composed by patients with TB relapsed from Hospital Sanatorium Parthenon, treated among 2004-2010. Of the 1449 patients who did treatment between 2004 and 2010, there were 1060 new cases (CN) (73.2%), and 462 (26.8%) recurrences. Among the recurrent cases, 203 (14%) had recurrence after cure (RC) and 186 (12.8%) had recurrence after abandon (RA). The percentage of HIV positive in CN, RC and RA groups were, respectively, 22.5, 37.7 and 43.3%. Of the 203 recurrent TB cases, 24 had cultures performed in the first and second episodes, but only 13 had DNA available. Genotyping was performed by spoligotyping and MIRU-VNTR (Mycobacterial Interspersed Repetitive Unit) in all DNA samples available. Molecular analysis showed that 4 (30.7%) patients had reinfection and in 9 (69.3%) the disease was due to reactivation. Recurrence of TB has implications for public health and can demonstrate an inefficiency of TB control programs and treatments, since some studies show that prolonged treatment in HIV-positive patients decreases the rate of recurrence

Reativação ou reinfecção em pacientes com recidiva de tuberculose

O melhor conhecimento dos fatores associados aos casos de recidivas de tuberculose (TB) constitui um desafio ao aprimoramento das estratégias de controle da doença. A recidiva pode ser resultante da reativação endógena, de bacilos persistentes na lesão, ou de uma nova infecção, (reinfecção exógena). Para fins de tratamento, é considerado que recidiva de TB é a situação na qual o paciente desenvolve a doença ativa novamente, após completar o tratamento e receber alta por cura. O objetivo do trabalho foi estimar a prevalência e caracterizar a reativação endógena e reinfecção exógena em pacientes com recidivas de TB após cura numa região de alta prevalência de TB e HIV. Tratou-se de um estudo retrospectivo, descritivo de levantamento laboratorial. A população de estudo foi constituída por pacientes com recidiva de TB do ambulatório do Hospital Sanatório Partenon, atendidos no período de 2004-2010. Dos 1449 pacientes que realizaram o tratamento entre 2004 e 2010, foram 1060 novos casos (CN) (73,2%), e 462 (26,8%) recidivas. Entre os casos de recidivas, 203 (14 %) eram de recorrência após cura (RC) e 186 (12,8 %) eram de recorrência após abandono (RA). O percentual de HIV positivo dos 3 grupos CN, RC e RA foram, respectivamente, 22,5 , 37,7 e 43,3 %. Dos 203 casos de TB recorrente, 24 tiveram culturas feitas em primeiro e segundo episódios, mas apenas 13 tiveram DNA disponível. Foi realizada a genotipagem por spoligotyping e MIRU-VNTR (Mycobacterial Interspersed Repetitive Unit), em todas as amostras de DNA disponíveis. A análise molecular demonstrou que em 4 (30,7%) pacientes, a doença foi atribuída a uma reinfecção e em 9 (69,3%) deles a doença era devido a uma reativação. A recidiva de TB tem implicações na saúde publica, podendo demonstrar uma ineficiência dos programas de controle da TB, tempo do tratamento, pois alguns estudos mostram que o prolongamento do tratamento nos pacientes HIV positivos diminui a taxa de recidiva.A better understanding of the factors associated with recurrence cases of tuberculosis is a challenge to the improvement of the strategies of disease control. The recurrence may result from endogenous reactivation of persistent bacilli in the lesion, or a new infection (exogenous reinfection). The Tuberculosis Control Program considers that disease recurrence is the situation in which the patient develops active disease after completing treatment and be declared cured. The objective of this study was to estimate the prevalence and characterize the endogenous reactivation and exogenous reinfection in patients with recurrence of TB after cure in a region of high prevalence of TB and HIV. This was a retrospective, descriptive study of laboratory surveillance. The study population was composed by patients with TB relapsed from Hospital Sanatorium Parthenon, treated among 2004-2010. Of the 1449 patients who did treatment between 2004 and 2010, there were 1060 new cases (CN) (73.2%), and 462 (26.8%) recurrences. Among the recurrent cases, 203 (14%) had recurrence after cure (RC) and 186 (12.8%) had recurrence after abandon (RA). The percentage of HIV positive in CN, RC and RA groups were, respectively, 22.5, 37.7 and 43.3%. Of the 203 recurrent TB cases, 24 had cultures performed in the first and second episodes, but only 13 had DNA available. Genotyping was performed by spoligotyping and MIRU-VNTR (Mycobacterial Interspersed Repetitive Unit) in all DNA samples available. Molecular analysis showed that 4 (30.7%) patients had reinfection and in 9 (69.3%) the disease was due to reactivation. Recurrence of TB has implications for public health and can demonstrate an inefficiency of TB control programs and treatments, since some studies show that prolonged treatment in HIV-positive patients decreases the rate of recurrence

Detecção de Tuberculose na Penitenciária Estadual do Jacuí,RS

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Tuberculosis recurrence in a high incidence setting for HIV and tuberculosis in Brazil

Background: To compare epidemiological data between recurrent cases after cure (RC), distinguishing relapse from reinfection, after dropout (RD) and new cases (NC) in an ambulatory setting in a TB-endemic country. Methods: Records of patients who started treatment for pulmonary TB between 2004 and 2010 in a TB clinic were reviewed. Epidemiological data were analyzed. Spoligotyping and MIRU patterns were used to determine relapse or reinfection in 13 RC available. Results: Of the eligible group (1449), 1060 were NC (73.2%), among the recurrent cases, 203 (14%) were RC and 186 (12.8%) were RD. Of RC, 171 (84.2%) occurred later than 6 months after a previous episode, 13 had available DNA, in 4 (30.7%) the disease was attributed to reinfection and in 9 (69.3%), to relapse. Comparing RC to NC, HIV (p < 0.0001) was independent risk factor for RC. When RC and RD were compared, alcohol abuse (p = 0.001) and treatment noncompliance (p = 0.006) were more frequent in RD. Conclusions: HIV is the sole more important associated factor for RC. This finding points the need to improve the approach to manage TB in order to decrease the chance for exposure especially in vulnerable people with increased risk of developing disease and to improve DOTS strategy to deal with factors associated to treatment noncompliance

Tuberculosis recurrence in a high incidence setting for HIV and tuberculosis in Brazil

Background: To compare epidemiological data between recurrent cases after cure (RC), distinguishing relapse from reinfection, after dropout (RD) and new cases (NC) in an ambulatory setting in a TB-endemic country. Methods: Records of patients who started treatment for pulmonary TB between 2004 and 2010 in a TB clinic were reviewed. Epidemiological data were analyzed. Spoligotyping and MIRU patterns were used to determine relapse or reinfection in 13 RC available. Results: Of the eligible group (1449), 1060 were NC (73.2%), among the recurrent cases, 203 (14%) were RC and 186 (12.8%) were RD. Of RC, 171 (84.2%) occurred later than 6 months after a previous episode, 13 had available DNA, in 4 (30.7%) the disease was attributed to reinfection and in 9 (69.3%), to relapse. Comparing RC to NC, HIV (p < 0.0001) was independent risk factor for RC. When RC and RD were compared, alcohol abuse (p = 0.001) and treatment noncompliance (p = 0.006) were more frequent in RD. Conclusions: HIV is the sole more important associated factor for RC. This finding points the need to improve the approach to manage TB in order to decrease the chance for exposure especially in vulnerable people with increased risk of developing disease and to improve DOTS strategy to deal with factors associated to treatment noncompliance