A tuberculose multirresistente e a rainha vermelha – A rapidez do diagnóstico é decisiva
Multi-drug resistant tuberculosis and the red queen – Diagnosis speed is crucial
João Costeira1,
, Jaime Pina2
Corresponding author
Joao.Costeira@hpv.min-saude.pt
Hospital de Pulido Valente, EPE, Alameda das Linhas de Torres, 117 1769-001 Lisboa
Hospital de Pulido Valente, EPE, Alameda das Linhas de Torres, 117 1769-001 Lisboa
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"referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Jaime" "apellidos" => "Pina" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Assistente Hospitalar Graduado de Pneumologia" "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Chefe de Serviço Hospitalar de Pneumologia e Director do Serviço de Pneumologia 2 do Hospital de Pulido Valente, Lisboa" "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Hospital de Pulido Valente, EPE, Alameda das Linhas de Torres, 117 1769-001 Lisboa" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Multi-drug resistant tuberculosis and the red queen – Diagnosis speed is crucial" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2007-07-02" "fechaAceptado" => "2007-09-12" "PalabrasClave" => array:2 [ "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec159343" "palabras" => array:4 [ 0 => "Tuberculose multirresistente" 1 => "método genotípico" 2 => "sensibilidade" 3 => "especificidade" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec159344" "palabras" => array:4 [ 0 => "Multi-drug resistant tuberculosis" 1 => "genotypic method" 2 => "sensitivity" 3 => "specificity" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A tuberculose multirresistente é uma ameaça importante ao controlo da tuberculose.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Neste sentido, é fundamental o diagnóstico precoce da TBMR para adoptar as medidas mais adequadas. Os métodos de detecção da resistência aos antibacilares baseados na avaliação das determinantes genéticas (métodos genotípicos) têm a vantagem, em relação aos métodos clássicos (fenotípicos), de serem mais céleres, poderem ser aplicados directamente na amostra clínica e de identificarem simultaneamente o <span class="elsevierStyleItalic">Mycobacterium tuberculosis complex</span>.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A análise dos dados dos doentes internados no Serviço de Pneumologia 2 do Hospital de Pulido Valente mostrou uma significativa prevalência de TBMR (10,3%). Revelou, também, que em 34,1% dos doentes com TBMR a multirresistência não foi identificada, tendo sido a mortalidade nesses doentes de 31% <span class="elsevierStyleItalic">versus</span> 18,4% nos doentes com o perfil de resistências previamente conhecido. Estes valores são piores nos doentes com TBMR+SIDA, que têm uma mortalidade de 50% <span class="elsevierStyleItalic">versus</span> 15%, respectivamente.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Para uma rápida identificação das resistências nos doentes internados no Serviço de Pneumologia 2 do HPV, foi avaliado o teste INNO-LIPA Rif.TB para detecção da resistência à RMP como marcador de multirresistência. Os resultados do teste, efectuado em 113 amostras, mostraram elevadas taxas de sensibilidade (91,6%), especificidade (98%), valor preditivo positivo (84,6%) e valor preditivo negativo (99%).</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A demora média para obter os resultados foi de 7,6 dias para o teste genotípico <span class="elsevierStyleItalic">versus</span> 23,4 dias para o teste fenotípico (BACTEC MGIT 960).</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Actualmente, o teste INNO-LIPA Rif. TB é aplicado em todos os doentes internados com tuberculose bacilífera sem perfil de resistências previamente conhecido, com bons resultados.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The multi-drug resistant Tuberculosis (MDRTB) is a huge menace to Tuberculosis control.</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The early detection of MDRTB is essential to best appropriate measures.</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The detection methods for drug resistance based in evaluation of the genetic determinants (genotypic methods), instead of phenotypic methods, allows for faster results, the possibility of direct application in clinical samples and simultaneous identification of <span class="elsevierStyleItalic">Mycobacterium tuberculosis complex</span>.</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The inpatients data analysis in the “Serviço de Pneumologia 2 do Hospital Pulido Valente”, showed a high prevalence of MDRTB (10.3%). In 34.1% of the MDRTB patients the multi-drug resistance was not been identified, with a mortality ratio in this cases of 31% versus 18.4% in the subset of patients with resistance previously identified. Moreover the mortality ratio was worst in MDRTB/AIDS patients with 50% versus 15%, respectively.</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Targeting for rapid drug resistance detection, in hospitalized patients at “Serviço de Pneumologia 2 do Hospital Pulido Valente”, the test INNO-LIPA Rif.TB, to identify the rifampicin resistance as a marker of multi-drug resistance, was evaluated.</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">The test was performed in 113 samples and had a high ratio of sensitivity (91.6%), specificity (98%), positive predictive value (84, 6%) and negative predictive value (99%).</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Time to obtain the results was 7.6 days for the genotypic test versus 23.4 days to the phenotypic test (BACTEC MGIT 960).</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">The INNO-LIPA Rif.TB test is, now, performed in every patient with smear-positive Tuberculosis with no previous knows resistance profile, with good outcome.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografia" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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ISSN: 21735115Original language: Portuguese
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