A Clinical-Epidemiological and Geospatial Study of Tuberculosis in a Neglected Area in the Amazonian Region Highlights the Urgent Need for Control Measures.

Cristal Ribeiro Mesquita,Rafael Aleixo Coelho De Oliveira,Ricardo José De Paula Souza E Guimarães Guimarães,Karla Valéria Batista Lima,Odinea Maria Da Silva,Luana Nepomuceno Gondim Costa Lima,Emilyn Costa Conceição,Artemir Coelho De Brito,Lúcia Helena Martins Tavares Monteiro

doi:10.3390/ijerph18031335

Abstract

Tuberculosis (TB) is an infectious communicable disease, which despite global efforts, still needs special attention in regions with difficult access. This study aims to describe the spatial and epidemiological trends of TB incidences from 2013 to 2018 in Marajó Island, the Amazonian region, Pará, Brazil. We have obtained secondary data from the Brazilian TB databases and performed geospatial and statistical analyses on the data for new TB cases, relapses, and re-admissions. From 2013 to 2018, 749 new cases were reported, in which the diagnostics (culture) was not performed for 652 (87.2%) patient samples, the drug resistance test (DST) was performed for nine (1.2%) samples, and one (0.13%) was multidrug-resistant TB (MDR-TB). The rapid molecular testing (RMT) was performed on 40 (5.3%) patient samples, with results indicating that eight (20%) were susceptible to rifampicin and two (5%) were rifampicin resistant. Overall, the cure rate was 449 (66.7%), while relapses and re-admissions were 41 and 44, respectively. On the geospatial distribution, the municipality of Soure stands out with a high number of incidences, relapses, and re-admissions. Spatially, the eight MDR cases were randomly distributed. Our data highlight the urgent need for TB control measures in this region, by introducing the Xpert-Ultra® MTB/RIF (Cepheid, Sunnyvale, CA, USA) and Ogawa-Kudoh.

Highlights

This is an epidemiological, descriptive, retrospective study with a quantitative approach on TB data from Marajó Island, Pará, Brazil Marajó Archipelago, where the main island, called Marajó, is formed by 16 municipalities divided into two microregions: Marajó (Afuá, Cachoeira do Arari, Chaves, Muaná, Ponta de Pedra, Salvaterra, Santa Cruz do Arari, São Sebastião da Boa Vista e Soure) and Breves (Anajás, Bagre, Breves, Curralinho, Gurupá, Melgaço e Portel), covering a total area of 68,000 km2, this object is of interest in this study [13]
While relapse is defined as a TB patient who was already declared cured with a completed treatment, but who has reported back with TB symptoms and was confirmed as sputum smear positive within 5 years
Between 2013 and 2018, there were 749 new TB cases registered in Marajó Island (2013103; 2014-120; 2015-120; 2016-127; 2017-141; 2018-138), with an average of 125 cases/year (μ = 124.7) and a standard deviation of 14 cases (σ = 13.7)

Summary

Introduction

Introduction censeeMDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY)license (https://creativecommons.org/Despite the scientific advances in infectious diseases, tuberculosis (TB), an ancient disease caused by Mycobacterium tuberculosis, is still one of the top 10 causes of death worldwide and the leading cause of death from a single infectious agent (ranking above HumanImmunodeficiency Virus/ Acquired Immunodeficiency Syndrome (HIV/AIDS)) [1], relicenses/by/4.0/).Int. J. Environ. Res. Public Health 2021, 18, 1335. https://dx.doi.org/10.3390/ijerph18031335 https://www.mdpi.com/journal/ijerph

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