Utilização estratégica da genotipagem do Mycobacterium tuberculosis no controlo da tuberculose
Strategical use of genotyping of Mycobacterium tuberculosis in tuberculosis control
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"apellidos" => "David" "email" => array:1 [ 0 => "sdavid@ibmc.up.pt" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Investigadora Principal, Centro de Tuberculose e Micobactérias, Instituto Nacional de Saúde Dr. Ricardo Jorge, Rua do Campo Alegre 823, 4150-180 Porto" "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Strategical use of genotyping of <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> in tuberculosis control" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2008-01-30" "fechaAceptado" => "2008-03-26" "PalabrasClave" => array:2 [ "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec159651" "palabras" => array:3 [ 0 => "<span class="elsevierStyleItalic">Mycobacterium tuberculosis</span>" 1 => "Epidemiologia molecular" 2 => "genotipagem" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec159650" "palabras" => array:3 [ 0 => "<span class="elsevierStyleItalic">Mycobacterium tuberculosis</span>" 1 => "molecular epidemiology" 2 => "genotyping" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A situação da tuberculose em Portugal justifica a aplicação de uma estratégia de genotipagem do <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span>, tanto mais que Portugal encontra-se inserido no contexto global de mobilidade das populações humanas e das suas consequências sobre a pandemia.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Vários estudos internacionais posicionam as técnicas do <span class="elsevierStyleItalic">spoligotyping</span> e MIRU-VNTR <span class="elsevierStyleItalic">typing</span> como de primeira linha na epidemiologia molecular do <span class="elsevierStyleItalic">M. tuberculosis</span> por estarem baseadas em tecnologias simples (PCR) e produzirem padrões, podendo ser traduzidos em código numérico de interpretação directa. Assim, tem sido proposta a aplicação do <span class="elsevierStyleItalic">spoligotyping</span> a todos os isolados clínicos, enquanto o MIRU-VNTR <span class="elsevierStyleItalic">typing</span> seria aplicado aos isolados com <span class="elsevierStyleItalic">spoligotype</span> comum. Outras técnicas, incluindo o IS6110-RFLP, seriam reservadas a aplicações segundo critérios seleccionados.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Os trabalhos anteriores em Portugal utilizando o <span class="elsevierStyleItalic">spoligotyping</span> apontaram para a vantagem de uma estraté-gia de genotipagem baseada numa amostragem consecutiva e sem critério de pré-selecção. Esta permite a caracterização da estrutura populacional do <span class="elsevierStyleItalic">M. tuberculosis</span> através do conhecimento da distribuição dos genotipos geograficamente, no tempo e dentro dos vários grupos de risco.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Por outro lado, a associação do <span class="elsevierStyleItalic">spoligotyping</span> com o MIRU-VNTR <span class="elsevierStyleItalic">typing</span> e, eventualmente, outras técnicas, deverá ser avaliada em vários contextos, como na identificação de situações de transmissão recente, na distinção entre episódios de reinfecção e recaída, na caracterização da amplitude e dinâmica de transmissão da doença.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A solução do problema da tuberculose em Portugal passa por uma estruturação na utilização da genotipagem em apoio à luta contra a tuberculose, a ser avaliada através de exemplos e resultados concretos.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The tuberculosis situation in Portugal justifies the use of a strategy for the genotyping of <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span>, particularly as Portugal is part of the global backdrop of human mobility, something which has a knock-on effect on the pandemic.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Several international studies have placed <span class="elsevierStyleItalic">spoligotyping</span> and MIRU-VNTR typing as first line techniques for the molecular epidemiology of <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> as these techniques rely on simple technologies (PCR) and produee patterns which are easily translated into a direct interpretation numerical code. <span class="elsevierStyleItalic">Spoligotyping</span> has been accordingly proposed for all the isolates, while MIRU-VNTR typing should be applied to isolates with a common spoliotype. Other techniques, including IS6110-RFLP, should be reserved for use ill accordance with selected criteria.</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Previous studies in Portugal using spoligotyping have underlined the advantages of a strategy based on sampling consecutive patient isolates with no prior selection criteria. This allows characterisation of the <span class="elsevierStyleItalic">M. tuberculosis</span> population structure through monitoring the distribution of the genotypes geographically over time and within the various risk groups.</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">On the other hand, the association of spoligotyping, MIRU-VNTF (typing and, possibly, other techniques, needs evaluating as part of bigger pictures, including identifying recent transmission situations, distinguishing between reinfection and relapse episodes and ma pping the size and dynamics of disease transmission.</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The solution to the tuberculosis problem in Portugal implies structuring genotyping's role in tuberculosis prevention and control and its evaluation through concrete examples and results.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografia" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:25 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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ISSN: 21735115Original language: Portuguese
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